THIS IS AN OPEN LETTER FROM. A HARD WORKING EXHAUSTED DOCTOR TO GOVT OF TAMIL NAIDU I CANT COMMENT ON TH THE CONTENTS OF COMMENTS AND WHAT ARE THE PROBLEMS FACED BY DOCTOR IN THE PRESENT ERA OF COVID 19 AT PRESENT HOWEVER I CAN MAKE UP THAT DOCTORS BAND PARAMEDIC STAFF IS WORKING VERY HARD 24 x7 IN DEAKING WITH THE PATIENTS OF COVID 19 PANDEMIC AND YET THEY HAVE TO FACE THE ANGER OF PATIENTS AND THEIR RELATIVES IN THE PRESENT DAY PANDEMIC THIS IS THAT PATIENTS AND THE RELATIVES MAY NOT HAVE BEN SATISFIED WITH ARRANGEMENTS AND DOCTORS BECOME THE TARGET NOF ANGER
I am fully agree with tired resident doctor and his content of open letter but sorry to say no body cares about our working condition and working hours because so many demands are lying unaddressed with our govt for the last many years even more than half of our MP ,MLA find it difficult to read and understand this letter. My best wishes with you dear.
Doctor, you are 100percnet correct. Fully aggree with your feelings and support. But this is professional disadvantage/ advantage. Everyone has to face it. Time and tide do not wait for any one. Bad days will also go away. You will remember these days with pride. Good luck.
Resident doctor’s plea that they are too much tired and pandemic is their and their work is not been recognized
Very sad,that the hard work of residents is not being recognised
Very true representation..
This letter is absolutely true
NICELY DISCUSSED BY. THE. RESPECTED DOCTORS. THANKS
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A girl of age 20yrs physical make up- tall and thin present complaints burning in palm and sole ,whole day < at night when go for sleep > apply of water on palm and sole Backache >lying on back <movement and when turn body EASILY get tired SLEEPY all the day cannot tolerate heat SUNLIGHT cause headache and vertigo Easly get cold after washing head MIND angery easily Irritate easily weep in anger jealousy THIRST- thirsty but cannot drink ,dislike taste of water CRAVING- meat and sweet Aversion - milk PERSPIRATION-excessive on palm and sole without offensiveness SLEEP- Deep sleep MENSES-now regular for 3-4 months ,irregular before 4 months LEUCORRHOEA-profuse ,white , start after last day of menses Please Suggest the medicine@Dr. Vijay Pratap Singh @Dr. Bharat Bhushan @Dr. Venkatesh K. N. @Dr. Debasish Sasmal @Dr. Harish Modi @Dr. Manoj Kumar ShahDr. Ajay Kaushik4 Likes15 Answers
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Friends today I am discussing about a very common problem occurs in change of weather known as tonsillitis. What is tonsillitis? Tonsils are the two lymph nodes located on each side of the back of your throat. They function as a defense mechanism. They help prevent your body from infection. When the tonsils become infected, the condition is called tonsillitis. Tonsillitis can occur at any age and is a common childhood infection. It is most often diagnosed in children from preschool age through their midteens. Symptoms include a sore throat, swollen tonsils, and fever. This condition is contagious and can be caused by a variety of common viruses and bacteria, such as Streptococcal bacteria, which causes strep throat. Tonsillitis caused by strep throat can lead to serious complications if left untreated. Tonsillitis is easily diagnosed. Symptoms usually go away within 7 to 10 days. Find a internist or a pediatrician or an ENT near you. Causes of tonsillitis Tonsils are your first line of defense against illness. They produce white blood cells to help your body fight infection. The tonsils combat bacteria and viruses that enter your body through your mouth. However, tonsils are also vulnerable to infection from these invaders. Tonsillitis can be caused by a virus, such as the common cold, or by a bacterial infection, such as strep throat. According to the American Academy of Family Physicians (AAFP), an estimated 15 to 30 percent of tonsillitis cases are due to bacteria. Most often it's strep bacteria. Viruses are the most common cause of tonsillitis. The Epstein-Barr virus can cause tonsillitis, which can also cause mononucleosis. Children come into close contact with others at school and play, exposing them to a variety of viruses and bacteria. This makes them particularly vulnerable to the germs that cause tonsillitis. Symptoms of tonsillitis There are several types of tonsillitis, and there are many possible symptoms that include: a very sore throat difficulty swallowing or painful swallowing a scratchy-sounding voice bad breath fever chills earaches stomachaches headaches a stiff neck jaw and neck tenderness due to swollen lymph nodes tonsils that appear red and swollen tonsils that have white or yellow spots In very young children, you may also notice increased irritability, poor appetite, or excessive drooling. There are two types of tonsillitis: recurrent tonsillitis: multiple episodes of acute tonsillitis a year chronic tonsillitis: episodes last longer than acute tonsillitis in addition to other symptoms that include: chronic sore throat bad breath, or halitosis tender lymph nodes in the neck When to see a doctor In rare cases, tonsillitis can cause the throat to swell so much that it causes trouble breathing. If this happens, seek immediate medical attention. See a doctor if you experience the following symptoms: fever that’s higher than 103˚F (39.5°C) muscle weakness neck stiffness sore throat that doesn’t go away after two days While some tonsillitis episodes go away on their own, some may require other treatments. How tonsillitis is diagnosed Diagnosis is based on a physical examination of your throat. Your doctor may also take a throat culture by gently swabbing the back of your throat. The culture will be sent to a laboratory to identify the cause of your throat infection. Treatment for tonsillitis A mild case of tonsillitis does not necessarily require treatment, especially if a virus, such as a cold, causes it. Treatments for more severe cases of tonsillitis may include antibiotics or a tonsillectomy. Antibiotics will be prescribed to fight a bacterial infection. It’s important you complete the full course of antibiotics. Your doctor may want you to schedule a follow-up visit to ensure that the medication was effective. Surgery to remove the tonsils is called a tonsillectomy. This was once a very common procedure. However, tonsillectomies today are only recommended for people who experience chronic or recurrent tonsillitis. Surgery is also recommend to treat tonsillitis that doesn’t respond to other treatment, or tonsillitis that causes complications. If a person becomes dehydrated due to tonsillitis, they may need intravenous fluids. Pain medicines to relieve the sore throat can also help while the throat is healing. Home care tips to ease a sore throat drink plenty of fluids get lots of rest gargle with warm salt water several times a day use throat lozenges use a humidifier to moisten the air in your home avoid smoke Also, you may want to use over-the-counter (OTC) pain medications, such as acetaminophen and ibuprofen. Always check with your doctor before giving medications to children. Tonsillitis complications People who experience chronic tonsillitis may start to experience obstructive sleep apnea. This happens when the airway swells and prevents a person from sleeping well. It’s also possible the infection will worsen and spread to other areas of the body. This is known as tonsillar cellulitis. The infection can also cause a person to develop a buildup of pus behind the tonsils, which is known as peritonsillar abscess. This can require drainage and more surgery. If a person doesn’t take a full course of antibiotics or the antibiotics don’t kill off the bacteria, it’s possible a person could develop complications. These include rheumatic fever and poststreptococcal glomerulonephritis. Preventing tonsillitis Tonsillitis is highly contagious. To decrease your risk of getting tonsillitis, stay away from people who have active infections. Wash your hands often, especially after coming into contact with someone who has a sore throat, or is coughing or sneezing. If you have tonsillitis, try to stay away from others until you are no longer contagious. Outlook for tonsillitis Swollen tonsils may cause difficulty breathing, which can lead to disturbed sleep. Tonsillitis left untreated can result in the infection spreading to the area behind the tonsils or to the surrounding tissue. Symptoms of tonsillitis caused by a bacterial infection usually improve a few days after you begin taking antibiotics. Strep throat is considered contagious until you have been taking antibiotics for a 24-hour period. Strep Throat Strep throat is a bacterial infection that causes inflammation and pain in the throat. This common condition is caused by group A Streptococcus… Diphtheria Diphtheria is a bacterial infection that affects the throat and nose. Get the facts on causes, symptoms, treatment, and prevention. What’s the Difference Between Tonsillitis and Strep Throat? Tonsillitis can be caused by various viruses or bacteria. Strep throat is only caused by group A Streptococcus bacteria. Tonsillectomy A tonsillectomy is a surgical procedure to remove the tonsils, which are located in the back of your throat. Sometimes they can become infected. Here there are some common homeopathic medicines given for tonsillitis Belladonna – belladonna is the most common and hugely prescribed homeopathic medicines for tonsillitis. Belladonna has the best anti inflammatory action and thus helps a lot to relief the symptoms both in acute and chronic condition. The key symptoms by which belladonna is prescribes are – pain in throat at the time of wallowing, red congested and swelling of tonsils, mild to moderate fever associates with tonsillitis, headache and malaise also present. The tonsils are been affected by taking any cold things like chilled drink or ice cream or cold drink or exposing to cold air etc. The throat pain is slightly relieved after taking any sort of warm drink. If all those symptoms are prominently found in a tonsillitis patient then belladonna is the suitable medicine for that person. Mercurius Solubis- Here is another best hoemopathy medicine for tonsillitis. The key symptoms to prescribe tonsillitis are – pain in throat, congestion of tonsils and unable to drink or eat anything. There is more salivation from mouth. The pain is worse in the night time in compare to day time. There is swelling of tonsils and also swelling of other lymph nodes in neck and sub mandibular regions. There is mild to moderate fever and the person feels thirsty though there is more salivation. If the above symptoms are prominent in any tonsillitis patient this medicine is most suitable medicine for that person Phytolacca- it is also one of the important homeopathic medicine for tonsillitis. The tonsils are dark red or bluish red in colour. There is much pain at the root of tongue, soft palate. The tonsils are swollen. There is a sensation of a lump in throat. While taking any food the throat feels rough, narrow, and hot. The Tonsils are swollen, especially of right side. There is a sharp shooting pain into ears on swallowing anything. There is much pain when swallow anything hot. The pain of phytolacca is burning type of pain. The person cannot swallow anything even water. Hepar Sulphur- Hepar Sulphur is one of the best Homeopathic medicines for tonsillitis. The tendency to suppuration is most marked, and has been a strong guiding symptom in tonsillitis. When swallowing, sensations as if a plug and of a splinter like sensation in throat. There is quinsy with suppuration of tonsils. When swallowing there is stitching type of pain in throat extending to the ear. There is mild to moderate fever and chilliness is feeling during the tonsillitis affection. The person is very chill and cannot tolerate any cold air or cold water. Calcarea Carb –It is a medicine for chronic tonsillitis problem.The person is bulky, obese, gaining weight easily. He is though fatty but very weak in stamina. Exhausted or tired on slightest physical activity. He/she sweats a lot on slightest physical exertion. He is very susceptible to catch cold. the tonsils are large, swelled and get acutely affected on slightest exposure to cold. The throat appearance itself is not always sufficient to prescribe on, but the complaints in the throat are those that come on in persons taking cold so frequently. On every cold he will have cough, tonsil affection, appetite lost. The calcarea carb child is very lazy and lethargic in nature. he takes cold from every, draft, from very exposure, and from damp weather. There are little red patches in the throat, this extends to the roof of the mouth, a sore tongue, and a constant dry, choking feeling in the pharynx, covering the tonsils. The throat is very painful on swallowing. Baryta Carb – it is one of the 1st grade medicine for chronic tonsillitis. The tonsils are inflamed, swelled and very painful in acute condition. After the acute attack passed on the tonsils looks larger than with the last cold. The child is weak, not fatty like calcarea carb. Physically and also mentally he is week. He/she has a tendency to catch cold very easily. But the most important symptom is whenever he catch cold first it attack to the tonsil or throat. So it is written in allens materia medica that every cold settles in the throat. The person sweats more from the feet. Every cold change inflames the tonsils, and in children they very soon enlarge. Children with enlarged tonsils, and with enlarged glands in other places, somewhat weak intellectually, slow to learn.The throat is very painful on swallowing.On every cold change of the weather, and on every exposure to the cold, he gets rattling respiration.Dr. Rajesh Gupta21 Likes36 Answers
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How To Use Honey For Eyes - 13 Useful Ways stylecraze.com Oct 23, 2017 12:00 PM Did you know that honey is a boon for your vision? Yes, this sweet and tasty replacement for sugar not only adds flavor to your breakfast, but it also has numerous benefits for your health and skin. You must be aware of many of them, including aiding weight loss and treating diabetes. But, were you aware that the regular use of honey for eyes can be beneficial? Not only for improving vision, this sweet liquid is also a superb tonic for reducing inflammation of the eyes. If you suffer from irritation or redness in the eyes, honey is the perfect solution. This post talks about everything you need to know about whether is honey good for your eyes. Read on! Honey – A Brief ￼ Image: Shutterstock We all love honey, right? And this love is shared by most people around the world. Honey has been a popular and essential part of Ayurveda since ages. Also known as ‘Shahad‘ in Hindi, ‘Tene‘ in Telugu, and ‘Madha‘ in Marathi, it owes its sweetness to the presence of monosaccharides, glucose, and fructose. Its shelf life extends up to thousands of years, making it an essential part of our kitchen. Apart from imparting flavor to food, honey also helps in curing many health ailments. The most important, yet most surprising of them is its effect on our eyes. If you go through the pages of ancient history, you’ll find that honey was used for curing several eye disorders (1). So, it is not surprising that honey was extremely popular amongst the Egyptians and Indians. Modern researchers have only reinforced this fact. For many eye infections, such as eye irritation, conjunctivitis, glaucoma, and trachoma, honey proves to be the absolute medicine. If consumed regularly, honey can prevent eye cataract to a large extent. Impressive, isn’t it? Benefits Of Honey For Eyes Cures Eye AilmentsRefreshes Tired EyesCures Dry EyePrevents Macular DegenerationProtects Your Eyes From GlaucomaKeeps Your Vision IntactCures ConjunctivitisReduces Eye WrinklesTreats Sore EyesHeals Eye InfectionWorks As An Optic Nerve TonicImproves Eye Lens Protein OxidationCan Help In Lightening Eye Color ￼ Image: Shutterstock 1. Cures Eye Ailments Fresh and untreated honey is often the best medicine for a wide range of eye disorders. Honey is the best cure for eye diseases such as blepharoconjunctivitis, corneal ulcers of inflammatory and traumatic origin, and ulcerative blepharitis because of its antibacterial properties (2). For eye troubles, such as dimness of the cornea, fresh comb honey is probably the best option. If the cataract is in the initial stage, fresh comb honey is again an ideal remedy. 2. Refreshes Tired Eyes Do you feel exhausted after sitting for long hours in front of the computer? If yes, honey is the best thing for relieving your strained eyes. Apply honey over closed eyelids. Take rest and relax with some good music playing in the background. After half an hour, wash off the honey with cold water. Your eyes will feel refreshed (3). 3. Cures Dry Eye In today’s electronic age, many of us fall prey to dry eyes. Dry eye is a common condition in which the eye isn’t able to supply required amount of tears needed for its lubrication. Usually, the sufferers face a variety of symptoms, including pain, itchiness, reddening of the eye, and blurring of vision. This condition can easily be treated with the help of honey (4). All you need to do is to make an eyewash with honey and warm water and wash your eyes thoroughly with it. Do it before sleeping every alternate night and see the effects. 4. Prevents Macular Degeneration As we age, we find our vision getting weaker and weaker. This blurred vision is associated with macular degeneration, which can easily be prevented with the help of honey (5). This sweet liquid is full of antioxidants that help in keeping our eye muscles healthy and working in the best way. So, if you are 25 or 50, be assured of good eyesight with the regular usage of honey. 5. Protects Your Eyes From Glaucoma Glaucoma is a condition in which there is fluid build-up in the front part of the eye. This build-up increases the intraocular pressure in the eye, and can even lead to permanent damage to our optic nerves, resulting in vision loss. Many studies have stated that using honey as an eye drop regularly reduces the possibility of occurrence of this disease by 50% (6). 6. Keeps Your Vision Intact It goes without saying that honey is super effective in protecting our vision (7). This is because apart from being rich in antioxidants, it also has various essential vitamins and minerals like zinc. We need an adequate amount of zinc in our body for proper functioning of our optical nerves. Use honey eye drops regularly to protect your vision. 7. Cures Conjunctivitis We all, at some point in time or the other, fall victim to the pink eye and are forced to wear sunglasses to prevent it from spreading. This condition is even more prevalent in small children, making them all agitated and irritated from watery eyes and itching. Well, several studies have pointed out that honey eye drops work effectively cure conjunctivitis (8). 8. Reduces Eye Wrinkles We all afraid of signs of aging that throw us off the hook even before we start feeling old. Thankfully, apart from treating eye disorders, honey is also amazing in reducing wrinkles and fine lines around our eyes (9). You just need to apply some honey on your closed eyes and let it rest for 15 minutes. Then, wash it off with warm water. 9. Treats Sore Eyes From staying up the entire night to being a victim of an eye infection, there are many reasons that lead to sore eyes. However, you can get rid of this puffiness by using honey (10). Consume honey regularly, and you will be okay in no time. 10. Heals Eye Infection Have you ever used honey for eye infection? Honey is coined to be the best remedy for curing all sorts of eye infections, whether they are caused due to bacteria, virus, or any other microorganisms. As we already know, honey has antibacterial properties, which make it essential in the cure of eye infections (11). All you need to do is mix equal quantities of honey and boiling water and apply this solution on your eye with the help of a cotton ball. Do it daily for best results. 11. Works As An Optic Nerve Tonic Honey can also act as an optic nerve tonic (12). It helps in increasing the production of nitric oxide that is required for efficient blood flow to the optic nerves. So, start using honey now to ensure better vision in the future. 12. Improves Eye Lens Protein Oxidation Whether you add it to food or use it as an eyewash, utilizing honey on a regular basis can improve eye lens oxidation, which provides you with long-lasting good vision (13). 13. Can Help In Lightening Eye Color It might come as a surprise, but it has been proved time and again that you can use honey to lighten your eye color, that too naturally. To lighten eyes with honey, you will need to have some patience and the correct ingredients in proper proportions. Use pure honey and water for eyes to obtain the best results. What You Need 1 drop of raw honey5 drops of warm bottled water What You Need To Do Add a drop of honey in five drops of water and mix well. You can also take a higher amount of both the ingredients in the ratio of 1:5 for storage purposes.Store the solution in a clean bottle. Put three drops of this solution every morning and evening in your eyes to light them. Make sure you store the solution in a cool and dark place. Caution: Putting anything in your eyes without proper consultation can lead to loss of vision. So, consult your doctor before taking this big step. How To Use Honey For Eyes ￼ Image: Shutterstock The uses of honey are varied. It is popular as an external application as well as used for internal consumption. We are acquainted with many foods where honey is an essential ingredient. However, it is important to know how one may apply this liquid gold externally as well. 1. Eyewash You need a teaspoon each of honey and warm bottled water. Dissolve honey in the warm water and let it cool down for some time. You may also refrigerate it for faster cooling. Use the solution as an eyewash when it is cool. 2. Eye Drops For making honey eye drops, you should always go for fresh comb honey. Dissolve this honey well in the proportionate amount of distilled boiled water. Use the solution twice or thrice a day, depending on its density. Tip: While you make the honey eye drops at home, you should always remember not to store the solution for more than a week. You can make the solution on a regular basis. Do not worry if you experience an itching sensation immediately after applying the drops. This burning sensation is normal, and it will cool down gradually. 3. Topical Application For making a soothing and relaxing eye mask, you can use egg white and vitamin E gel along with honey. For the first mask, mix a teaspoon of honey with 2-3 drops of lemon juice and egg white and apply it under your eyes. Wash it after 10-15 minutes. Put a tablespoon of vitamin E gel and a teaspoon honey in a small container and whisk well. Use this as an eye mask thrice a week for best results. A Word Of Caution Our eyes are really precious. Hence, we need to look out for all the possible risks associated with any product we put in our eyes, and the same goes for honey. Let’s take a look at what you need to consider before using honey for eyes: If you have any previous allergy to pollens and other bee-related sensitivity, avoid using honey in your eyes. It can aggravate the infection and cause temporary loss of vision.Many types of honey can be fairly acidic (pH 3.4-6.1), so it can cause serious discomfort in your eyes. Hence, make sure that the honey you are using is not acidic. Hope you like our post on the various benefits of honey for eyes health. Honey can work amazingly well for your eyes, provided you take the necessary precautions and follow the instructions mentioned above. So, did you ever use honey for eyes before? How was your experience? Do share with us by commenting below. Recommended ArticlesDr. Tapan Kumar Sau6 Likes10 Answers
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RT.OPTIC NERVE ATROPHY" cured by Homoeo medicines"-- pt. was young came from Indore, he was suffering from Amblyopia, pain , tired, exhausted in the rt. eye's.he was having anorexia, burning chest after little bit of eating, desires cold food & drinks, Throat infection & dry coughing , fear of darkness, desire company especially parent's.stool always loose , P/H childhood Tb in chest treatments allopathic for 1 years.( sort case history) I gave him Phosphorus 0/5 for 1 month, next followed by placebos..The miracle result you see...Dr. Supriyo Sarkar6 Likes9 Answers
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A male patient of age 19yrs presented to the emergency department with a complain of fever and pain in the lower abdomen for last 4 days.The patient was alright 4 days before admission, when patient started having complain of fatigue, fever, and chills .The next day, he started having headache, vomiting which was non bilious and not blood stained, diarrhea 1 to 2 episodes watery in nature, decreased appetite, low back pain, and pain and burning sensation while passing urine.He also complained of pain in groin and scrotum.He was brought to the emergency department, where he reported dry mouth, eye pain when he was febrile, and light-headedness. He had a history of exercise-induced asthma and had been hospitalized during early childhood for diarrhea.There is no history of any drug intake or drug allergies. Patient took all immunizations according to the schedule. He lived with his mother, stepfather, and brother in an urban area and had no history of travel outside the country. The patient had a negative interferon-gamma release assay for tuberculosis two months before this evaluation. He was sexually active with one female partner and reported consistent condom use. Two months earlier, tests for human immunodeficiency virus, syphilis, gonorrhea, and chlamydia had been negative. He smoked one cigarette each day, used marijuana three times per week, and drank alcohol intermittently. He had a pet rabbit but no contact with other animals, no history of recent tick or mosquito bites, and no contact with sick persons. There was no family history of renal stones or autoimmune disorders. On examination, the patient appeared to be tired. The temperature was 39.4°C, the blood pressure 120/70 mm Hg, the pulse 121 beats per minute, the respiratory rate 36 breaths per minute, and the oxygen saturation 100% while he was breathing ambient air. The paraspinal muscles of the low back were tender. The remainder of the examination was normal. Laboratory Data, results of renal-function tests were normal, also the erythrocyte sedimentation rate, red-cell indexes, and blood levels of amylase, lipase, albumin, globulin, alkaline phosphatase, total bilirubin, and direct bilirubin were normal.Test results are shown in TABLE1. Urinalysis revealed 2+ albumin and 1+ ketones by dipstick; there were few squamous cells and very few transitional cells per high-power field, amorphous crystals, and mucin. Blood and urine culture were negative. Also tests for influenza virus, respiratory syncytial virus, adenovirus, and parainfluenza virus types 1, 2, and 3 and urinary nucleic-acid tests for Neisseria gonorrhoeae and Chlamydia trachomatis. Intravenous fluids, paracetamol, ondansetron, and ibuprofen were administered. During the next 4 hours, the fever, tachycardia, and the pain resolved, and the patient was able to drink water without vomiting. He was discharged home and advised to continue taking paracetamol, ibuprofen, and ondansetron, as well as to take rest and plenty of oral fluids. The next morning, the patient awoke with severe pain in the abdomen, groin, and scrotum on the left side. Head heaviness, dysuria, diarrhea, and nausea persisted, and he vomited after each attempt to eat or drink. He returned to the emergency department, where he reported his pain to be modrate to severe. He reported that 3 weeks earlier, he had a testicular trauma while attempting a stunt jump on his bicycle. On examination, he appeared to be uncomfortable, lying still on the stretcher. The temperature was 37.5°C, the blood pressure 122/70 mm Hg, the pulse 110 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 98% while he was breathing ambient air. There was tenderness of the left costovertebral angle, the left lower quadrant of the abdomen, the left inguinal crease, and the superior aspect of the left testicle. There was no scrotal mass, edema, or discoloration. The remaining physical examination was normal. The erythrocyte sedimentation rate was normal, and the level of C-reactive protein was 162.7 mg per liter (reference value, <8.0). Examination of the urine before and after prostatic massage revealed trace occult blood by dipstick in both samples, with otherwise normal results. Ultrasonography of the scrotum, kidneys, and bladder revealed an 8-mm cyst in the left epididymal head and no acute abnormalities. Ketorolac was administered. The patient’s pain persisted, and the temperature rose to 38.9°C. Patient was admitted to the hospital. On admission, the patient reported left scrotal pain and headache. His diarrhea had resolved. The temperature was 39.2°C, the blood pressure 110/60 mm Hg, the pulse 104 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 98% while he was breathing room air. There was mild tenderness of the anterior and posterior left thigh; results of the physical examination was same as in the emergency department. Intravenous fluids, ketorolac, paracetamol and ondansetron were administered. The patient’s urine was strained after each void; no stones were found. On the second hospital day, vomiting resolved but fever persisted and pain of the abdomen and groin worsened; morphine was administered for pain relief. Laboratory test results are shown in Table1.CT of the abdomen and pelvis, performed after the administration of contrast material which revealed an ill-defined low-density material that tracked along the left retroperitoneum anterior to the left psoas muscle and aorta and into the pelvis, displacing the bladder to the right. Low-density material was also seen in the left paracolic gutter.The radiologic differential diagnosis included infectious and inflammatory causes with a possible pelvic, leg, or genitourinary source or traumatic injury to the bladder or ureter. There was no hepatomegaly or splenomegaly, and other visualized structures in the abdomen, pelvis, and lower thorax were normal. On the third hospital day, the patient continued to receive morphine for pain and paracetamol for fever. Abdominal ultrasonography revealed two enlarged left external iliac lymph nodes (0.8 cm and 0.7 cm in diameter) and a heterogeneous, ill-defined, mixed echogenic collection located to the left of the bladder, a finding suggestive of loculated fluid or phlegmon. A chest radiograph was normal. Examination of a peripheral-blood smear revealed normochromic normocytic red cells, occasional symmetrical spindle-shaped red cells with smooth contours, very few burr cells, very few teardrop-shaped red cells, normal lymphocytes and monocytes, and normal platelets with occasional large forms. Results of renal-function tests and of hemoglobin electrophoresis were normal, also red-cell indexes and blood levels of amylase, lipase, albumin, globulin, alkaline phosphatase, total bilirubin, and direct bilirubin. Tests for heterophile antibodies and IgM and IgG antibodies to Ehrlichia chaffeensis, and Rickettsia rickettsii were negative, as was a polymerase-chain-reaction assay for A. phagocytophilum DNA; results of tests for antibodies to Epstein–Barr virus (EBV) and cytomegalovirus (CMV) were suggestive of past infection. Ampicillin–sulbactam and gentamicin were administered. On the fourth hospital day, the patient’s pain decreased and his fever resolved. Laboratory test results are shown in Table1. A diagnostic procedure was performed. What is the procedure? What is the diagnosis? TABLE 1 1 day before admission Day 2 after admission Day 3 Day 4 Haemoglobin 14% 13.2% 13.3% 13.0% Haematocrit 41.2 38.9 38.2 37.6 Reticulocyte count 0.4 0.3 0.3 Total WBC count (cmm) 6100 2300 2203 2200 Differtial count Neutrophils 78 62.2 54.8 36.6 Band forms 0 8.0 0 0 Lymphocytes 13.9 22.2 35.1 53.0 Atypical lymphocytes 0 3.0 0 0 Monocytes 7.2 4.0 9.5 9.1 Eosinophil 0 0 0 0 Basophil 0.1 1.0 0 0.5 Platelets 120,000 70,000 75,000 82,000 Prothrombin time 14.2 14.6 PT-INR 1.1 1.2 APTT 27.5 28.4 Fibrinogen 401 Sodium 131 134 134 132 Potassium 3.6 3.6 3.8 4.0 Chloride 94 104 102 99 CO2 24.4 22.7 23.6 24.6 Calcium 9.2 8.0 8.2 Phosphorus 3.1 Magnesium 2.1 Glucose 112 114 90 101 Total protein 7.4 5.9 5.2 ALT 28 156 154 AST 32 116 `114 LDH 467 469 CRP 120.9 178.6 156.5 Ferritin 8340 7008 Triglyceride 341 282 Iron 24 TIBC 165Shyam Prashad0 Like3 Answers