34/M Patient who was apparently well 10 days back with no problems, has come with: Abdominal distension, nausea, burping, hiccups off & on, difficulty breathing, occasional mild coughing x 10 days Chronic tobacco chewer, occassional alchol consumption H/o passing frequent scanty stools. H/o dark / blackish stool x 1 day H/o yellowish to dark yellow urine x 10 days with occasional reddish urine No h/o fever, burning micturition, bleeding from any site Patient had been prescribed AKT-4 yesterday and has taken 1 dose today morning. H/o severe headache 10 days back. Similar episode 5 years back. No details about investigations available at present. ---- GCS = 15. Vitals stable. Pallor present. No apparent icterus, edema, cyanosis, lymphadenopathy. However, GC seems poor. Chest: A/E reduced bilaterally (rt > lt). B/L crepts. Abd: Distended, mild generalized tenderness more pronounced in RUQ and epigastrium No significant findings on genital or per-rectal exam. CVS and neurological exam - no significant findings. ---- Patient has some reports from his consultation elsewhere. (Attached). Somehow I feel that the provided reports do not match the patient's condition. ---- Diagnosis, work-up and management?

A 35 Yrs Old Male Patient With No H/o Past illness. Comes With complain Of Dyspnea & Having Problem In Breathing. No Fever, No Body Ache, No Cough & Cold, No Taste Change & No Smell Changes So No Suspect of Covid But Advised RTPCR for Confirmation. Please Help To Conclude Dx & Management? Thank You *Chief Complaints* Dyspnea on Exertion, Tiredness

A 58 years old male with history of fever and cough 3 days,duration. RT - PCR for COVID-19 disease done 1 week was negative. Other investigations revealed multi, organ involvement. Including- Fever profile , USG and cardiac evaluation HRCT was suggestive of COVID-19 disease A new clinical entity seems to be emerging Nln - RT - PCR positive- COVID-19 disease

Chronic kidney failure, also known as chronic renal failure, chronic renal disease, or chronic kidney disease, is a slow progressive loss of kidney function over a period of several years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. CKD is initially without specific symptoms and is generally only detected as an increase in serum creatinine or protein in the urine. Later on there is- increased urination, especially at night decreased urination blood in the urine (not a common symptom of chronic renal failure) urine that is cloudy or tea-coloured puffy eyes, hands, and feet (called edema) high blood pressure fatigue shortness of breath loss of appetite nausea and vomiting (this is a common symptom) thirst bad taste in the mouth or bad breath weight loss generalized, persistent itchy skin muscle twitching or cramping a yellowish-brown tint to the skin Pathology- A normal kidney contains approximately 1 million nephrons, each of which contributes to the total glomerular filtration rate (GFR). In the face of renal injury (regardless of the etiology), the kidney has an innate ability to maintain GFR, despite progressive destruction of nephrons, as the remaining healthy nephrons manifest hyperfiltration and compensatory hypertrophy. This nephron adaptability allows for continued normal clearance of plasma solutes. The hyperfiltration and hypertrophy of residual nephrons, although beneficial for the reasons noted, has been hypothesized to represent a major cause of progressive renal dysfunction. Causes- Type 1 or type 2 diabetes High blood pressure Glomerulonephritis Interstitial nephritis, an inflammation of the kidney’s tubules and surrounding structures Polycystic kidney disease Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers Recurrent kidney infection, also called pyelonephritis Types- Each patient is classified into one of the following 5 stages of CKD according to the progression of damage. Stage 1: Kidney damage with normal or increased GFR(>90 mL/min/1.73 m2) Stage 2: Mild reductionin GFR (60-89 mL/min/1.73 m2) Stage 3: Moderate reductionin GFR (30-59 mL/min/1.73 m2) Stage 4: Severe reductionin GFR (15-29 mL/min/1.73 m2) Stage 5: Kidney failure(GFR <15 mL/min/1.73 m2 or dialysis) Complications- Anemia – hemoglobin levels drop and not enough oxygen reaches many parts of the body. Central nervous system damage. Dry skin, skin color changes. Fluid retention – this can lead to swollen tissue, heart failure, and fluid build-up in the lungs. Hyperkalemia– blood potassium levels rise; this can result in heart damage. Insomnia – this is a common consequence of kidney failure Lower libido (sex drive) Male erectile dysfunction. Osteomalacia– bones become weak and break easily. Pericarditis – the sac-like membrane that envelops the heart (pericardium) becomes inflamed. Stomach ulcers. Weak immune system– the patient becomes much more susceptible to infection. Complications in children: Erythropoietinproduction drops, resulting in a much lower red blood cell count. Vitamin D – the kidneys will no longer be able to activate vitamin D, resulting in poor calcium absorption and muscle function. Consequently, children with kidney failure may fail to grow properly. Complications during pregnancy: When a woman is pregnant the kidneys have to work especially hard because the amount of fluid in the body increases. Pregnant women with chronic kidney failure may experience worsening hypertension and an increase in waste products in their blood. This can affect both the mother and her baby. Women with chronic kidney failure who are pregnant have a significantly higher risk of developing preeclampsia, compared to other women – blood pressure rises dangerously high. If left untreated the result could be a brain hemorrhage, or hemorrhaging in the liver or kidneys – both potentially fatal for both mother and baby.

Case electric Burns, entry point scalp, post debridement status, plz comment on management