A case of Spondylolithesis

-A male patient age about 31 years old - A case of CSM -A C/O severe neck pain left upper limb numbness hamiprasis since last week 4/2/2021 - H/O CAD - H/O lifestyle poor diets hardworking Not know HTN DM COPD IBS TB epilepsy -No C/O fever. Cold. Cough -No Costipetion O/E Patient Counsicsess Dullness PR:90 TM BP:110/70 mmhg Temp: normal Spo2 :99% Motor sensory aphasia 3/4 GCS:E.4 V5. M6

Patient age 75 years male chronic smoker from last 40 years with no h/o diabetes, hypertension, epilepsy and tuberculosis presented with c/c/o sob,sweating, gen body weakness on 24 -4-19(23:40hrs) On arrival his vitals Bp :180/100 mm Hg Temp: 99.5 f Spo2 :80% Pulse by pulse oxymeter: 102 / min O/a his examination: Cns : conscious and oriented Gcs:15/15 Cvs: s1 s2 audible no murmur heard Chest : tachypnoea+ B/l crepts++ P/a: mild tenderness in epigastrium region No significant organomegally felt Constipation +nt Passing urine adequately For the same complaints patient visited a pulmonologist on 19-4-19 and was investigated for routine blood tests which revealed hb: 13.7, tlc: 14720 , dlc: 80,18,01,01,00. Rbs 115 Cxr: pl calcification Bp 160/70 , spo2 84 % And was advised with Tab pulmocef 200 bd Cap esomperazole od es Tab derriphyllin r 300 bd Foracort forte rc bd Tab ribhist am bd Syrup cremaffin 2 tsf Hs Despite all this t/t his condition deteriorated and he landed up with the same problems in our hospital with above mentioned complaints. For the initial relief he was prescribed with o2 inhalation, nebulization with budecort and duolin and for his hypertensive status he was given inj lasix 2ml i/v stat with i/v corticosteroid Cort s 100 mg. He was investigated for cardiac causes for which ecg was done that revealed tachycardia (pic 1) His blood investigations revealed septicaemia , hyperuricemia. (Pic 2) On the behalf of his cbc report he was also added up with i/v Antibiotic augmentin 1.2 gm tds with 50 ml ns. His cxr pa view was done next morning which showed left lower lobe consolidation and left sided pleural effusion (pic 3). Patient was getting relief from above treatment but he was not maintaining spo2 if taken off from o2. On 26-4-19 his sputum for Afb was done which was -ve . His TLC count improved from day. And his family was counselled for the need of hrct to rule out ild or other d/s as ct is not available in town. On 27/4/19 his TLC further decreased to 12000 his hrct chest was done that revealed the findidings as stated in pic 4 Ie: centrilobulor emphysema with bullous lesion in b/l lung field. Consolidation with Swiss cheese appearnce In left upper lobe. B/l plural effusion Left lower lobe passive atelectasis. Few scattered nodules in rt upper lobe and rt middle lobe. Patient was advised to shift their patient to higher centre but due to financial conditions they are unable to shift him and wants to get their patient treated at our centre or to take him home. What can be the line of management in this case..??? And what further investigations we can opt for. Thanks

12 YEARS OLD CHILD CAME WITH HISTORY OF SEIZURE , NOT WELL EXPLAINED BY ATTENDANTS BUT WHAT I CAUGHT, NATURE WAS GENERALISED TONIC NOT CLONIC WITH UPROLLING OF EYEBALLS , SIMILAR EPISODE IN PAST TWO TIMES, EVER TIME NOT EXCEEDING FIVE MINUTES NO HISTORY OF EPILEPSY IN FAMILY NO FEVER NO FOCAL NEUROLOGICAL DEFICIT ON EXAMINATION NO HISTORY OF CONSTIPATION DEVELOPMENT HISTORY NAD PERINATAL HISTORY NAD OPHTHALMOLOGIST OPINION NAD FUNDUS EEG NAD MRI BRAIN ATTACHED PVL ? HIE I HAD TALKED TO RADIOLOGIST I WAS KEEN TO SEARCH METABOLIC CAUSE OF SUCH FINDINGS OR WHITE MATTER DISEASE BECAUSE MOTHER WAS NOT GIVING HISTORY OF PERINATAL ASSAULT BUT RADIOLOGIST SAID BASAL GANGLIA INVOLVEMENT IS MUCH MORE IN KRABEE LIKE DISEASES HOW TO FURTHER APPROACH,SHOULD WE START ANTIEPILEPTIC TSH PTH REPORTS AWAITING ATTACHED MY PRESCRIPTION TOO@Dr. Manish Verma @Dr. Minol Amin @Dr. Sree Harsha @Dr. Brahmananda Merugu @Dr. Saumya Mittal @Dr. Mohd Izhar Jaweed @Dr. Ahemad Karim

A 72-year-old woman has been admitted with shortness of breath. On further questioning, she says she has been unwell for about 8 weeks. She has decreased appetite and nausea when she eats. She has lost weight but her abdomen feels swollen. She has generalized dull abdomen pain and constipation, which is unusual for her. What is the likely diagnosis?

60 yr female, k/c/o hypertension and asthma. Please discuss the ECG lead II attached