Case #2

Student details , SANTU SAHA , 
IQCMC , Durgapur , India
Class - General Medicine ward ( 3rd semester )

Age              : 74 years
Sex               : Male
Occupation : retired 

State             : West bengal
Year              : 2016

Chief complains
1. Pain in loin region 
2. Radiating pain towards Right lateral thigh from gluteal region
3. Loss of appetite

History of present illness

1. Onset : Two weeks ago, the pain became intense
2. Position : lower loin region 
3. Quality : continuous deep pain
4. Relieving or aggravating factors : pain aggravated when he moved forward or tried to bent
5. Severity : intolerable 
6. Timing : mainly during morning hours
7. Treatment : pain relieving injection received

History of past illness

1. Recent minor trauma in left hip joint
2. Gall bladder calculi also found , but not removed yet
3. Heart related disease

Family history 
His mother had  Spondyloarthropathy.

Confirmatory test : Schober's test also performed (17cm)

Diagnosis

# X- ray report suggests that there are osteophytes in LV1-5 and a typical bamboo shaped vertebral arrangement is also present
# Disc degenerative changes also , found at this level .

# Also , there is reduced size of sacroiliac joint parts .

# Lumbar lordosis reduced too.

All these findings suggests,  Spondyloarthropathy , ankylosing spondylitis.

Case #1

Student details , SANTU SAHA , 
IQCMC , Durgapur , India
Class - General Medicine ward ( 3rd semester )

Age - 56 years
State - West bengal 
Year - 2016

Chief complains
The chief complains of the patient are : 
1. Swollen dorsum of both the foot 
2. Difficulties in breathing
3. Distended abdomen

History of present illness

Since, 2 months , the patient is having difficulties in breathing. 
He also has swollen dorsum of foot of both legs. He noticed this for the first time 15 days back in his feet.
He also has obesity.

Past history

He never had any major or minor surgical operated on him. 
He was apparently normal 2 months ago.

Hypertension           : Present 

Diabetes                    : Present

Edema                       : Present  (dorsum of foot)

TB                               : absent

Respiratory distress    : Present

Increased heart size also found (as per X ray flim) and there is heart failure.
Jugular venous pulsations can also be observed.

Drug history 
No allergy for drugs.

Personal history

Appetite                     : normal
Sleep                          : normal 
Built                            : Obese
Rate of respiration   : 19-22 times per minute  ( abnormal )
Tremors                     : absent

Findings

The problem seems to be due to his obesity. He also has got hypertension and heart failure as the heart is not pumping efficiently.  The edema also developed due this reasons only , as the venous return is not proper and there is accumulation of fluid in the interstitial spaces , again due to increased hydrostatic pressure. 
If any form of yoga or exercise, can be done to reduce the size of his abdominal obese , below 80cm of circumference,  then he can probably live a normal life again.