Linci gunaseelan Presenting complaints: Known case of SLE since 2007, Pulmonary hypertension, Interstitial lung disease, Mitral

regurgitation, Polyartralgia,

Past history: H/O Rt CVA recovered 2007, H/O Lupus nephrits, H/O lupus pleurits, Known DM,HTN,Dysdipidemia, Total Hysterectomy, cholecytectomy done Seizure disorder(febrile) Post herpatic neuralgia-2007 B.P: 140/90 mmhg Pulse:97/min Heart:murmur

Investications: Blood reports Random blood sugar:87 mgs Urea:21.22 mgs Creatinine:1.22mgs Cholesterol:219 mgs

Uric acid:5.26 mgs C.R.P:+ve in in 7.84 mgs R.A:Negative c.p.k:40.00 IU/l H.B:11.8 gms ESR:8/22 mmhr Platlet count:2.3 lks TC:6,800 cells/cumm Dc :P 66%L32%E2% Urine routine: Albumin:+ Deposits:5-10 pus cells,3-5 epi cells Sugar : nil Liver funcution test: Bilirubin (total):0.42 mgs Direct:0.18 mgs S.G.O.T: 34 IU/L S.G.P.T:31IU/L Alkaline phosphatase:126.0 u/l Total protein:7.36 mgs Albumin :3.22mgs A/G ratio:0.77 ratio Micro albumin:82.69 mgs C3-1.71 gm/dl C4 :0.24gm /dl Hba1c:6.8%

ABG:165 mgs ANA WESTERN BLOT:strong +ve for PCNA,DsDNA,Nucleosomes,histones Can occurs in SLE in SLE,RA,Drug induced lupus erythematous. Chest x ray PA view Cardiomegaly ECG: sinus tachy cardia, Antero septal myocardial infarction (possibly Recent V1,V2,V3,V4) Excessive overload of lt atrium. CT-Chest: Air space opacities with interstitial thickening fibrosis in basal segments of bilateral lower lobe minimal fibrosis.Loss of volume in rt middle. Pneumonitis with secondary cardiac failure changes in lung with early ILD Mild bilateral pleural effusion Moderate cardio megaly noted. ECHO: Normal lt ventricular systolic funcution LVEF:73% Mild lt ventricular dysfunction Mitral regurgitation moderate Mobile Echogenic mass 3.5*0.76 size attached just below the posterior mitral leaflet with a membranous portion causing on eccentric obsrtution in the lv cavity during systolic resulting in dynamic mild lt ventricular outflow obstruction. Pulmonary HTN_Mild Pulmonary regurgitation mild Tricuspid regurgitation-mild

treatment NAME:Dana sekaran Presenting complaints:

Weakness of both upper limb,lower limb. Sudden onset,not of progressive nature No h/o fever,diarrhoea Had h/o frequent urination before onset. No dysartria No dysphagia, Bladder bowel intact Past history No DM,HTN No APD Smoking,alcohol occ No surgeries On examination Plantar:mute (B/L) Muscle power:0/5( B/L) Upper &lower limb Hand grip:1/5(B/L) DTR:ABSENT(B/L) Diagnosis:GBS Urusthamba ,sarvanga vatam. Investications Blood report RBS:132mgs Urea:50.00 mgs Creatinine:1.00mgs Cholesterol:231 mgs

Uric acid:6.53mgs C.R.P:-ve in 5.63 mgs S.G.P.T:63 IU/L C.P.K:29.00 HB:14 gms ESR:2/6 mmhr TC:8100cells/cumm Dc:p 60%L35%E5% Plt.count:2.4 lakhs Billirubin:total 1.24 mgs Direct:0.46 mgs

T.F.T- normal USG-Abdomen &pelvis taken Mild splenomegaly Rest of the visualized abdominal organs normal

CT-Brain Imp:Normal study MRI Cervical spine Imp:normal study NCS Interpretation:Features suggestive of asymmetrical acquired motor neuropathy of axonal type.motor neuropathy.

Treatment

Internally Ashta varga kashayam- 60 ml 3 times before food Lasuna ksheera kashayam-100ml at night after food Resonadi vati-2-0-2(after food) Bhallataka grutam-10 ml with milk kashayam at night(after food) Ashwagandharistam 25 ml BD( A.F) Kasturi gulika 2-0-2 (A.F) Purna chandrodayam 1-0-1(A.F)

Externally, I phase:Udwartanam(triphala churnam) IIphase:Abhyangam ,jambeera pinda svedam(sahacharadi kuzhambu) IIIphase:Pizhichal,matra vasti (saha vp) IVphase:Kashaya vasti(Dvi pancha muladi vasti) Vphase:Abhyangam kashayadhara

Ganeshan

Age:46yrs Sex:male Presenting complaints: dyspnoea during night,palpitations,fatigue,cough,bilateral pedal odema,elevated JVP.

Past history: Known DM,Dyslipidemia,CVD,Hypothyroidism No H/O surgeries Investications: RBS;140 mgs S.creatinine:1.34 mgs S.G.P.T:31 IU/L HB:12.0gms E.S.R:6/16 mmhr T.WBC:7500cells/cumm Dc:p73%l21%E6% Platlet count:2.3 lakhs cells/cumm Total cholesterol:264 mgs HDL:39 mgs LDL:202 mgs Triglycerides:114mgs VLDL:23mgs TC/HDL:6.76 Ratio LDL/HDL:5.17Ratio Colour Doppler echo cardiography report Imp:probable coronary artery disease Grossly hypokinetic infer posterior walls

Moderate kypokinesia of septal antero septal &anterior walls. Dilated lt ventricle &lt atrium Moderate lt ventricular systolic dysfunction LVEF:27% Mild lt ventricular diastolic dysfunction Rheumatic heart disease Aortic regurgitation severe. Treatment principle Sophaharam,hrydyam,vata anulomanam,moothralam Treatment I phase: Bruhatyadi kashayam- 60 ml 3 times (B.F) Maha dhanwantaram gulika -2-2-2 with kashayam(B.F) Arjuna ksheera kashayam -60 ml at night (A.F) Nerinjil satavari paneeyam-200ml/day Dasamoola haritaki-20 gms at night(A.F) IIPhase: Arjunaristam -25 ml morning & night after food Marutham caps-2-2-2 (A.F) Maha kasturi gulika 3-3-3(A.F) Nayopaya kashayam-60 ml 3 times (B.F) Triphala churnam -2 tsp with hot water at night (A.F) Chandra praba vati-2-0-2(A.F) Svarna bhasmamIIIphase: Srnga bhasmam-25 mg twice a day after food

Ardha vilva paneeyam -200 ml /day Punarnavadi kashayam 60 ml 3 times (B.F) Kushmanda rasayanam-1 tsp 2 times (A.F) Prabakara vati -2-2-2(A.F) Sapta vimsati guggulu -2-0-2(A.F)