Thesis

 https://drive.google.com/file/d/1RjNF_-gSFPgeU5oaON2c_EsD3QCONHVL/view?usp=drivesdk

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Case presentation

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  50 yr Male Farmer By Occupation  Came to Casualty With Cheif Complaints of Pain both knees since 6 days HOPI :- Patient Was Apparently Asymptomatic 4 years Back , Then He Developed  Knee joint Pains,bilateral ,which is Insidious In Onset, Gradually Progressive over years,and similar complaints On & off ,went to Rural Community Practitioner And Given Medicine and got relived.  The Patient Had Been Taking pain management Medication whenever he has Joint Pains,Swelling was also present at the knee and Ankle joints during during Pain whenever he gets pain. The patient was able to do his Routine farming Activities for 2 years . Since 2 years the patient stopped  doing  farming works and used to stay at home and was able to take care of his daily activities.  Aggravated during walking and relived with rest and also with medication.  Pain was not completely relieved On taking medication but patient used to feel better. Usually pain is migratory typ...
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 Internal assessment:  Antomocal Diagnosis: glomerulus of kidney Histological: ? Loss of effacement of foot process of podocytes of basement membrane ? Membranous glomerulopathy Etiological: diabetes and hypertension. Diabetic nephropathy    2.azotemia : Increased blood urea nitrogen with BUN to creat ratio 20:1 suggestive of renal or post renal azotemia. https://www.ncbi.nlm.nih.gov/books/NBK538145/   https://www.ncbi.nlm.nih.gov/books/NBK538145 Anemia:https://pubmed.ncbi.nlm.nih.gov/6876938/ https://spectrum.diabetesjournals.org/content/21/1/12 Hypoalbuminemia: Reduced protein intake and inflammation,due to reduced production of albumin by liver leading to decreased synthesis and increased catabolism and vascular permeability. https://pubmed.ncbi.nlm.nih.gov/9848794/ Acidosis: renal failure as there is decreased synthesis of bicarb resulting in high aniono gap metabolic acidosis. https://pubmed.ncbi.nlm.nih.gov/6876938/ 3.according to KDIGO guidelines,oral rep...
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Evidence based medicine

  Octreotide Compared With Placebo in a Treatment Strategy for Early Rebleeding in Cirrhosis. A Double Blind,Randomised Pragmatic Trial  https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.510280507 Objective:  Comparison of Octreotide with placebo in a treatment strategy for Early Rebleeding in Cirrhosis.  P- 262 cirrhotic patients after control of acute upper digestive bleeding. I-131 patients were given a randomized, double blind trial of a 15-day course of subcutaneous octreotide vs placebo after control of upper digestive bleeding from any portal hypertensive source in cirrotic patients. C- Early rebleeding, from any source, within 15 days after randomization, was the primary measure of treatment. Secondary measure was the assessment of a 42-day rebleeding rate. O- Octreotide may safely reduce the risk of early rebleeding after upper digestive portal hypertensive hemorrhage in cirrhotic patients treated by Beta- blockers and/or sclerotherapy for long-...
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