Eluri vishnu vandana 44

  My patient is a 66year old male, shepherd by occupation referred from dermatology dept. Patient c/o blisters all over the body and a swelling of the distal part of left middle finger. H/O itching all over the body since 5 years. HISTORY OF PRESENT ILLNESS Patient was apparently asymptomatic 5years back,then he developed itching all over the body which was on and off.Five days back, patient developed multiple polysized, painful blisters on both legs&hands,buttock and on the chest,associated with crusting,oozing and bleeding.There is a swelling at the distal phalanx of the left middle finger which is associated with a blister,the swelling is filled with serosanguinous fluid and is resolved after incision and drainage. PAST HISTORY No h/o similar blisters in the past. Patient is a k/c/o diabetes and hypertension since 5 years. No h/o asthma,epilepsy,TB,CAD. DRUG HISTORY Telmisartan for hypertension Metformin 500mg for DM PERSONAL HISTORY Diet- mixed Appetite- normal Sleep- adequate 

 2 nd August 2022. A 49 year old male ,auto driver by occupation came with chief complaints of vomitings and loss of appetite. History of presenting illness: Patient was apparently assymptomatic 10 years back and then he developed weaknesses and fever for which he went to local hospital and diagnosed to be having diabetes  for which he was under medication.And after one year he complained to have head ache and was diagnosed with hypertension, for which he used medication for one year and stopped.6 years back he developed weakness of limbs for which he was found to be having low potassium and was treated accordingly. 25 days ago  patient complained of vomitings ( 5 episodes per day ,non bilious and non projectile). Numbness in the left upper limb and lower limb , deviated jaw to the right side , unable to close the left eye for which he was taken to the hospital and diagnosed to have acute ischemic stroke, he was treated accordingly  and discharged.after one week he had vomitings ( 6 ep

 1 st August,2022. A 65 year old male patient from Gundrampally village, Chityala district who used to be a toddy climber by occupation came to the casuality with C/o Shortness of breath since 3 days Associated symptoms are  Weakness in left upper limb and lower limb since 8 days Difficulty in walking since 8 days Involuntary defecation and micturition since 5 days History of presenting illness As explained by the patients' younger son Patient was apparently asymptomatic 10 years back then one day early in the morning while waking up he noticed weakness in the left upper limb and lower limb and couldn't support himself properly. 2 days later he started using Ayurvedic medicine for the weakness, which progressively improved and he got completely alright within a month and got back to his daily routine Patient had a normal life style until 8 days back.  8 days back at 12 am patient woke up to micturate and noticed that he is having a similar weakness in the left upper and lower l