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[{'role': 'user', 'content': 'IP Number: 6\n\nPatient Number: 1239\n\nPatient Name: JERYN MATHEW\n\nGender: M\n\nDate of Birth: 12-07-1984\n\nAddress: UTHINKATTIL HOUSE,CUSAT ROAD,CUSAT P.O\n\nPincode: 682022\n\nPhNo: 0484-2544626\n\nAdmission Date: 29-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: pt alert, vitals stable\r\nscheduled for surgery today at 4 pm\r\nNPO\r\nIV fluids\nPatient recovering satisfactorily. No obvious distress. Urine output and virtals are satisfactory.\ns/b DR. C.J. Varghese/ Dr. Tom. Recovery satisfactory. Dye study done, dye going into the duodenum. NO evidence of any leak.\nNo fever, c/o bloated feeling in the stomach, mild pain in the shoulder.\r\nBarium swallow done - No evidence of leakage\r\nOn I.V fluids D5 NS @ 100 ml/hr\r\nI.V microtaz\n7:30pm Doing well, passed motion , pain at the incision site at deep breathing , Vital Stable, PA-Soft, BS-Prsent RS-Clear\r\nFollow the Advice\nc/o episode of difficulty to catch a breath during the night. Vitals stable .oral fluids 30 ml/ hr, on I.V fluids ( RL @ 100ml/hr)\r\nOutput- 2250\r\nInput- 2225\r\nDressing change to today\r\n9:30AM - Doing well, Vital stable , cath insitu , follow the advice\nDoing well,vital and systemic examination NAD pain reduced, D/c cath, planned to increse the fluid intake to 100ml/hr, Maintaince i.v fluids\r\nMobilze the pt as per Physiotherpaist orders\r\nContinue the same orders\r\nintake -2450/2350\nfeels better, Try to ambulate yesterday. passed motion , No pain, some stiffness at the wound site.\r\nVitals stable. seen By Dr Ramesh yesterday, adviced to use incentive spirometry.\r\nIncreased oral fluids to 60ml/hr. On I.V fluids\r\nSurgery F/U today, will probably remove the catheter after.\r\nI- 2430\r\nO- 2350\r\n6:15 Mobilized , Doing fine, Passed urine, Vital stable\nVitals- stable, foley catheter removed, Pt ambulating. \r\nPlan- discuss with the surgeon for probable D/c today.\r\n\n'}, {'role': 'model', 'content': 'IP Number: 6\n\nPatient Number: 1239\n\nAdmission Date: 29-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis: Obesity Gr2\n\nClinical Exam(With BP): 27 yr old with Obesity Grade2 , with no other significant medical history admitted for Sleeve Gastrectomy.\r\nS/P sleeve gatrectomy on 30-07-2011.\r\nPt tolerated the procedure well and the course during the hospital stay was satisfactory and uneventful\n\nSystolic BP: 110.0\n\nDiastolic BP: 70.0\n\nPhysical examination: lab results and X-ray attatched\n\nXray findings: obese, not in any distress, Vitals- stable\r\nSystemic Exam- Normal\r\nsurgical site- dressing removed, no oozing\n\nDiscussion: nan\n\nDiet: nan\n'}]

[{'role': 'user', 'content': "IP Number: 79\n\nPatient Number: 2939\n\nPatient Name: SANTHOSH M N\n\nGender: M\n\nDate of Birth: 24-05-1970\n\nAddress: ARUNODAYAM, TAGORE NAGAR,\n\nPincode: 682306\n\nPhNo: 0484 - 2782800\n\nAdmission Date: 26-09-2011\n\nDischarge Date: 27-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Human mixtard 12units at night, C-Peptite report awaited\ndiabetic since age 29 yrs.\r\nWas put on insulin\r\nRecently on Insulin ,has flictuating blood sugar, frequent hypo's in mid afternoon\r\nCurrent Meds- human mixtard 25-0-15\r\nTab Atorvasatin 0-1-0\r\nNo increase or decrease in wt\r\nNo polyuria/polyphagia\r\nBluring of Vision- Yes\r\nBurning sensation of the feet- No\r\nDyslipidemia - Yes\r\nHTN- No\r\nCOronary artery Disease- No\r\nPersonal history-\r\nMother- DM since age 75 yrs\r\nalcohol- Occasionaly\r\nSmoking - No\r\n\n"}, {'role': 'model', 'content': "IP Number: 79\n\nPatient Number: 2939\n\nAdmission Date: 26-09-2011\n\nDischarge Date: 27-09-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): admitted with knee pain- severe x 1 week and fluctuating blood sugar\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Young male, not in any distress\r\nSystemic Exam- Normal\n\nDiscussion: 41 yr old with H/o Diabetes Mellitus admitted with Fluctuating blood sugar.\r\nDuring the Stay, he was monitored closely with GRBS ,and Insulin dose was adjusted . He was started on Oral meds as well ( Tab Metformin and Pioglitazone). C- Peptide level was sent. results still pending\r\nHe had a full comprehensive check up for his Diabetes during the admission.\r\nFor knee pain, he had an X-ray of the Knee taken which was negative and treated with NSAID's\n\nDiet: DEPT OF NUTRITION:\r\n\r\nLow calorie low fat Diabetic diet advised.\n"}]

[{'role': 'user', 'content': 'IP Number: 96\n\nPatient Number: 1172\n\nPatient Name: K S MENON\n\nGender: M\n\nDate of Birth: 02-02-1930\n\nAddress: PRAYAG, SRM ROAD , ERNAKULAM NORTH P.O\n\nPincode: 682018\n\nPhNo: 2402194\n\nAdmission Date: 04-10-2011\n\nDischarge Date: 13-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEUROPATHY\nEssential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 7:00pm Delirius, emtional , vital stable\r\nI.VF NS 75ml /hr,DNS + 6units Regular insulin 50ml/hr\r\nCheck\r\nHb,TC,DC,Platelet\r\nUrea , Creatine,NA+, K+\r\nWidal\r\nLeptospiral antibody\r\nDengue Antibody\r\nUS Abdomen\r\n3ml Clot sample for cross Matching\r\n\nGRBS-181mg/dl\r\nStool Occuled Blood,Peripheral smear Have to be taken \r\n\r\nPlanning to do blood investigations (Blood Urea,Blood routine examination,S.Cr,Serum electrolytes)on 6/10/11\r\n\nGRBS-242mg/dl.Patient to be catheterised .Blood transfusion to be given.INJ.Paracetamol I/m stat given.\r\nStill has fever.\r\nUltraosund of the abdomen- Cystitis\nSeen by Dr.A.K.Bhat.\r\nThe left heel eschar is dry&remaining ulcer is clean.No evidence of deep sepsis.Continue daily intrasite+betadine oint dressing.\r\nstill has fever.Pt restless, will transfuse tomorrow\nPatient still have temperature.Inj.neomol I/M stat given at 11.40am.Blood transfusion to be started.\nVitals stable.One unit of PRBC given. Still spiking fever.\r\nantibiotics changed\nHas Fever,blood \r\nSeen by Dr.A.K.Bhat.\r\nThe eschar of left heel is dry.Continue Intrasite +Betadine oint.Dressings.\nOdema over the Lt Hemiface, Hand, Temp-99F\r\nSystemic Examination -NAD\r\nPlanned CT Brain , Blood C/s at temp spike\r\ncontinue the same\nSeen by Dr.A.K.Bhat.\r\nThe eschar left heel is dry.No e/o abscess or infection.\r\nContinue daily intrasite+betadine dressing.\r\n6:30pm No spike from morning, Urine Output 750ml tilll now\r\ncontinue i.v fluids\r\n2pint NS 50ml/hr\r\nContinue the rest\nmoonface,X-ray for leftfoot,chest to be taken.\r\nUrineRE,Culture,Gramstain to be taken\nNo spike in fever since yesterday. Sensorium better, but delerium still present\nTemp 100\r\nVital stable\r\nContinue the Fluids\r\ntab.Welset 500mg igf temp above 100F\r\nCase Seen By DR.KMR\r\nNo Specific Sign of Pnuemonia\r\nXray chest -PA Better\r\nContinue the same\r\nChest Physio\nPatient had mild spike temperature 100*f yesterday night.\r\nInj.pcm given.Enema given yesterday.Today temp 99.2*f.\r\nHas not passed bowel.\r\nI/O-2100/1000ml.\r\nChest physiotheraphy today.\r\nBowel wash today.\r\nBlood urea,creatinine,sodium,bilirubin,TC to be sent.\r\n\nSeen by Dr.A.K.Bhat.\r\nDry eschar left heel.\r\nTemp- 100.8, Output-\r\nDEcision to dicharge for second opinion to another facility\nVITAL STABLE, FEBRILE, CONSIOUS , DELIRIUS,\r\nNO SOURCER FOR FEVER FOUND, PLANNED REF FOR HIGHER CENTER FOR FURTHER EVALUATION \r\nSEND QBC MALARIA, PS FOR MP\n'}, {'role': 'model', 'content': 'IP Number: 96\n\nPatient Number: 1172\n\nAdmission Date: 04-10-2011\n\nDischarge Date: 13-10-2011\n\nDiagnosis: ? sepsis, Fever of unknown origin\r\nToxemic hepatitis\r\n\n\nClinical Exam(With BP): admitted with feverx 5 days and altered sensorium .\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any resp distress\r\nCNS- delerious on and off\r\nRs- Clear\r\nCVS- S1 S2 heard\n\nDiscussion: Admitted with fever and altered sensorium. Initial electrolytes were normal ( Na, Blood urea, K. Creatine ) were normal. URine Re showed numerous pus cells. He was started on broad spectrum antibiotics - INj peperacillin/Tazobactam x 3 doses, changed because of still spike in fever. Ultrasound of the abdomen was done - cystitis. He had an uLcer in the Lt heel which is present x 2-3 months, was getting treated for that. Lt heel ulcer- pus culture was taken which showed E. Coli- sen to amikacin and cefoperazone/sulbactam, started on the medication.\r\nPt still had spikes in fever and the counts were increasing. During the hospital stay, Pt was noted to have Low Hb ( 7.1, repeated 8.5), was transfused 2 units of PRBC. Blood was sent for widal, leptospirosis, DEngue which were negative. Urine culture came back NEgative \r\nCXR was negative. Pt still had spike in fever, on and off altered sensorium.\r\nUrea went upto 60, Na- 125 and creatine -1.0\r\nLFT showed Increase in Bilirubin ( Direct ) and Increase In alkaline phophatase ( 1809), but normal transaminases.and low protein and albumin.\r\nAt present he was given INj Cefoperazone/sulbactam and Prulifloxacin, Held the amikacin.Fever spiked again after 24 hrs. T- 100,\r\nUltrasound of the abdomen- No hepatosplenomegaly, No stone\r\nDuring the stay, he was seen By surgeon who Stated that the focus of infection was not the foot.X- ray of the foot- No sign of osteomyelitis.\r\nSeen by gastro enterologist, and also pulmonary.\r\nBlood culture Taken during a fever spike- No Growth\r\nRpt K+ was 2.7 yesterday, treated with KCl 40 Meq given in the fluids\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 83\n\nPatient Number: 2735\n\nPatient Name: MAMAN P JOSEPH\n\nGender: M\n\nDate of Birth: 20-09-1931\n\nAddress: VELLAPPATTIL HOUSE,ASRAMAM P O\n\nPincode: 689126\n\nPhNo: 0477 2233681\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Chronic obstructive pulmonary disease, unspecified\nB P H\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fmodern\\fprq1\\fcharset0 Courier New;}{\\f1\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f2\\fswiss\\fprq2\\fcharset0 Arial;}{\\f3\\fnil\\fprq2\\fcharset0 Ms Sans Serif;}{\\f4\\fnil\\fprq2\\fcharset0 MS Sans Serif;}{\\f5\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\qc\\b\\f0\\fs24 ECHO REPORT\\b0 \r\n\\par \r\n\\par \\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\pard\\intbl\\f1 Parameter\\cell Actual mm (%)\\cell Normal mm(%)\\fs22\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl AO \\cell\\cell\\f2\\fs18 25-37 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LA\\cell\\cell\\f2\\fs18 19-40 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl Epss\\cell\\cell\\f2\\fs18 < 8 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl IVSD\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDd\\cell\\cell\\f2\\fs18 35-52 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVPW\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDs\\cell\\cell\\f2\\fs18 24-42 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl EF\\cell\\cell\\f2\\fs18 50-70 %\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl FS\\cell\\cell\\f2\\fs18 28-41 %\\f1\\fs24\\cell\\fs20\\row\r\n\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\fs20 Mitral Valve\\b \\b0 : Normal in structure and motion\\b . \\b0 No MVP, no MR\\b \\b0 \r\n\\par \\pard\\fi720\\li1440 E/A is reversed \r\n\\par \\pard\\tx990 \r\n\\par Aortic Valve :\\b \\b0 3 cusps\\b ,\\b0 normal\r\n\\par \r\n\\par Pulmonary Valve : Normal\r\n\\par \r\n\\par Tricuspid Valve : Normal\\b ,\\b0 no significant TR\r\n\\par \r\n\\par \\pard\\fi-2160\\li2160\\tx990 LV : Normal in size and contraction\\b .\r\n\\par \\b0 No RWMA \\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \\pard\\tx2310 Normal LV systolic function\r\n\\par \r\n\\par \\pard\\tx990 Pericardium : Normal \\tab\\tab \\tab\\tab \r\n\\par \r\n\\par \r\n\\par \\pard Remarks : Normal chamber dimension\\b .\\b0 No RWMA \\b ,\\b0 \r\n\\par Normal LV function. No valvar pathology\\f1\\fs24\\tab \r\n\\par \r\n\\par \\f3\\fs20 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par Dr. Sasi Kumar\r\n\\par Consultant Cardiologyst\\f4 \r\n\\par \\f1\\fs24 \r\n\\par \\f5\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 4:00PM -ADMITTED FOR SKIN GRAFT, THURDAY AFTERNOON 3:00PM\r\nPR-80/MIN \r\nB.P 150/90MMOF HG\r\nSPO2-94%\r\nRS-CREPITATION +\r\nCVS-S1S2NORMAL\r\n\nS/B Dr.KMR\r\nVital stable, Spo2 95%, RS-Few crepitation\r\nXray Chest Basal Haziness( status co)\r\nPFT Tomorrow\nSeen by Dr.A.K.Bhat.\r\nFor SSG under SA on 29-9-2011 3pm.\r\nPreop:Daily Oxum dressing.Plain dressing on day of surgery after cleaning with betadine.Consent.Shave the left thigh&genitalia&betadine scrub.IV antibiotics.Blood R/E to be done.Venous doppler.\nVitasl stable. C/o loss of appetite.\r\nVenous doppler done last month- results attached\n8:00pm Better, PR-80, BP 120/76 Consious oriented \r\nStart orally\r\ncontinue the same\r\nNo Insulin at night\r\nMaintaince I.V fliuids\r\nInj.Tramadol 50mg sos\r\n\nVitasl stable. GRBS- 179. Skin Grafting to be done today.\r\nC/o loss of appetite. PFT done today. Pulmonary Evaluation For pre-op before the surgery\nSeen by Dr..A.K.Bhat.\r\nPain.No soakage.Adviced leg elevation.\r\n7:00PM Painless Haematuria, vital stable, Disscussed with Urologist, USG Abd , Urea ,Creatinine\r\nUrology consultation -Tomorrow\nVital stable, I/O 3000ml/900ml, Rs-Better, Spo2 96%\r\nshift to room\nSeen by Dr. Mohammed Saheed-urologist.\r\nComplaints of hemturia-terminal.\r\nO/E:Abdomen-soft.\r\nDRE-Grade I BPH.\r\nUSG- Normal.\r\nimp: ?Prostatic bleed.\r\nAdv:Cap. Contiflo D OD\r\ntry to avoid sulbactum.\r\nAdequate hydration.\r\nurine C/S.\r\nReview later.\r\n10:00pm\r\nBetter\r\nVital stable, \r\nNo Haematuria in the night\r\nIncresed frequency of urine\r\nContinue the same orders\nVital stable, Discharge if fit\r\nRs -Clear except few creoitation\r\nFormonide 400 respicap 1-0-1\r\nLevolin DPI 1-0-1\r\nTab.Doxobid 400mg 1/2-0-1/2\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The SSG has taken up.\r\nContinue leg elevation.\nc/o lack of appetite. Otherwise doing well. Blood sugars are well controlled.\nSeen by DR.A.K.Bhat.\r\nContinue trt.Stop ceftriaxone.\nc/o loss of appetite, dressing change done yesterday by Dr A.K. bhatt, No hematuria\nSeen by Dr.A.K.Bhat.Dressings changed.The SSG of foot is taken up.The donor site of thigh is clean&healing.Continue leg elevation.\r\n6:00pm Fine, Urine C/S -No growth\r\ncontinue the same, D/c Cannula\r\nPlanned discharge on Thursdays\r\ntab.allegra 120 stat\nVitals stable. No fever, c/o mild pain in the Rt thigh where the skin for grafting was taken. No hematuria\nSeen by Dr.A.K.Bhat.\r\nPain decreased.Continue trt.\nVitals stable ,Blood sugar control,GRBS -124mg/dl\r\nI/O -2200/2000 \r\nPlanned to do Pulmonary consultation before discharge\nSeen by Dr.AK.Bhat.\r\nDressings changed.The right foot SSG is settling well.Thigh donor site is clean&healing.\r\nFeels better. No complaints\nVitals stable,No fever.\nGC better.Blood sugar controlled. Wound healing well.\nSeen by Dr.A.K.Bhat.\r\nPain decreased.Continue trt.\r\nFeels better. C/o gas trouble\nGeneral condition good.\r\nSeen by Dr.A.K.Bhat.\r\nDressings changed.SSG Settling.Donor site healing well.\nfine \r\nDischarge tomorrow\nDischarge today.\nSeen by Dr.AK.Bhat.\r\nDressings changed.SSG settling down.Donor site healed.Adviced:Vaseline to right thigh.\n'}, {'role': 'model', 'content': 'IP Number: 83\n\nPatient Number: 2735\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): Admiited for skin grafting, K/C/O Type2 Diabetes Mellitus, Hypertension, BPH, COPD \r\ndid skin grafting on 29/sep/2010 .Doing well , wound clean ,\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Admiited for skin grafting, K/C/O Type2 Diabetes Mellitus, Hypertension, BPH, COPD \r\ndid skin grafting on 29/sep/2010 .Doing well , wound clean ,Discharge in a stable state\n\nDiet: DEPT OF NUTRITION:\r\n\r\nLow calorie Low fat diet prescribed.\n'}]

[{'role': 'user', 'content': 'IP Number: 116\n\nPatient Number: 2149\n\nPatient Name: KAMALAM K.S\n\nGender: F\n\nDate of Birth: 29-06-1933\n\nAddress: MAYURAPRIYA, MATTALIL TEMPLE ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 18-10-2011\n\nDischarge Date: 23-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vitals stable. No fever, had an episode of bleeding per rectum.\nVitals stable. no more diaarhoea\nGC fair.Passed stool today.GRBS-182mg/dl.Continue the same.Plan for discharge tomorrow.\nfine , vital stable, continue the same\r\nStool clear\nfine, no blood and mucosa in stool, no fever\r\nkeep her today for blood sugar monitoring\r\n9 point plasma profile\nNo fever, Abdomen better,continue the antibiotic. Add revera D\r\nDischarge tommorow\r\n\nVital stable, Post Meal suger above the target, continue the same, Insuline as adviced. Continue the i.V Antibiotics\nvital stable , dischagege in stable state, Biopsy report awaited. continue the treatment\n'}, {'role': 'model', 'content': 'IP Number: 116\n\nPatient Number: 2149\n\nAdmission Date: 18-10-2011\n\nDischarge Date: 22-10-2011\n\nDiagnosis: COLITIS ? INFECTIVE( BIOPSY REPORT AWAITED)\r\n\n\nClinical Exam(With BP): Mrs.Kamalam .K.S /78yr/Female ,know case of Diabetes mellitus , Hypertension , Admitted to PVS hospital on 17/10/2011 with 2 days history of lower abdominal pain and blood & mucus in stool. Sigmoidoscopy showed extensive inflammation involving sigmoid colon . Biopsy report awaited. Admitted in our center on 18/10/2011 for the Glycemic control and further managment. Started on I.V. Cefoperosone + sulbactum , I.V Metrogy and supportive measures. For Blood sugar, started on Basal bolus regimen , adjusted the dose of insulin according to SMBG values, Her prelunch values are high, titrated the dose, Added Prokinetic agent for possible Gatroparesis. Biopsy report awaited\n\nSystolic BP: 180.0\n\nDiastolic BP: 100.0\n\nPhysical examination: Biopsy report awaited\n\nXray findings: nan\n\nDiscussion: Mrs.Kamalam .K.S /78yr/Female ,know case of Diabetes mellitus , Hypertension , Admitted to PVS hospital on 17/10/2011 with 2day history of lower Abdomen pain and Blood & mucus in the stool, Sigmoidoscopy showed the extensive inflammation involving sigmoid colon . Biopsy report awaited. admitted in our center on 18/10/2011 for the Glycemic control and further managment.Started on Inj. Cefoperosone + salbatum , I.V Metrogy and supportive measures. For Blood sugar started on Basal bolus regimen , adjusted the dose of insulin according to SMBG values, Her prelunch values are High, titred the dose, Added Prokinetic agent for possible Gatroparesis. Biopsy report awaited . Discharge on oral antibiotic , Insulin on basal bolus regimen in stable state\n\nDiet: nan\n'}]

[{'role': 'user', 'content': "IP Number: 84\n\nPatient Number: 2993\n\nPatient Name: P V KURIAN\n\nGender: M\n\nDate of Birth: 27-09-2026\n\nAddress: NO 37/679D,1ST FLOOR,ROCKS RESIDENCY,\n\nPincode: 682001\n\nPhNo: 0484-2203904\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 8:00PM -ADMITTED WITH HISTORY OF BADLY INFECTED LT FOOT\r\nlONG STANDING DIABETES\r\nPR-92,SPO298%, B.P 160/90, CVS-S1S2 NORMAL\r\nRS-NVBS, NO CREPITATION \r\nPA-NAD\r\nGRBS-496\r\n\nSeen by Dr.A.K.Bhat.\r\nAcute on chronic PVD left foot.Infective gangrene of lateral 4 toes.\r\nFor transmetatarsal/BK amputation after investigations,risk explanation.\r\nIV antibiotics.Betadine dressing.Foleys cath.Betadine scrub of whole lower limb.Arrange packed cell 2 pints for surgery.Inj.TT.\nspiking fever, arterial Doppler to be done today. Evaluate further action based on that\nbetter,PR91,B.P 126/65 RS-Clear,RS-Clear , CVS-S1S2 Normal \r\nTab.Trika 0.25stat\r\n\nstill spiking fever. Pre dinner 333, Insugen R 20 units given.\r\nInsugen N 20 units given at night.\r\nGRBS today- 255\r\nTo start on insulin syringe pump.\r\nNPO after 11'0 clock.\r\nTo start at 2 units /hr.\r\narterial doppler done.Rt side- Biphasic flow till the ankle, with collaterals.\r\n\nwell ,no pain , vital stable, Systemic -NAD,\r\ninsulin infusion on flow\r\nHb,TC\r\nShift to room.\r\nSeen by Dr.A.K.Bhat.\r\nNo soakage.Pain.Continue trt.\r\n6:00 Blood transufusion , No rxn, vital stable, Systemic examination -NAD\r\nInsugen R 20units , Insugen N 28units at bed time\r\nTab.Trika stat\r\n\nVital stable\r\nAppitite better\r\nNo pain \r\nContinue the same\nSeen by Dr.A.K.Bhat.\r\nDressings of left foot changed.The raw area of amputated stump looks viable.There is some slough of sole region.No pockets of pus.The lower leg incision looks clean.\r\nDulcolax suppository 2 SOS.\nSleep was disturbed due to pain. Blood sugars are well controlled.\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Pain decreased.Continue trt.\r\nfine better\nVitals stable. No fever, C/io mild pain. Will remove the foley catheter and check blood\nSeen by Dr.A.K.Bhat.\r\nDressing changed.The stump of amputated foot viability is doubtful&there is slough..No residual pus.The wound of leg is clean.The present condition of the wound has been explained&guarded prognosis given.\nVitals stable. No fever, C/io mild pain. Will clamp the foley catheter today and try to remove the catheter\nPatient complaint of pain.\r\nNo Fever\r\nGRBS- 90mg/dl\r\nI/O 1800/1600\r\nDressing done by Dr .Bhatt.\nSeen by Dr.A.K.Bhat.\r\nPain +.No dressing soakage.\nSeen by Dr.A.K.Bhat.\r\nDressing of left foot changed.There is no evidence of granulation of left foot stump,except of dorsal flap.The ankle wound is clean.Suggested oral antibiotic-Cap.Dalacin-C 300MG tdsx1 week.\r\nC/o pain after the dressing change. will give tramadol\nVitals stable.No pain today.Dressing to be changed today.FBS-117mg/dl.\nHypoglycemia today morning.urine routine culture to be done.\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\nNo complaints. GRBS- 150, afebrile, Urine RE - 8-10 pus cells. will discus with the family the need for VAC therapy\nGRBS-63mg/dl.Discuss abt vac theraphy to DR.BHATT.\r\nSeen by Dr.A.K.Bhat.\r\nDressings changed.Findings same.\nbetter,vital stable continue the same\nSeen by Dr.A.K.Bhat.\r\nDressing changed.The left foot stump is ischemic.The ankle ulcer is clean.Adviced alternate day dressing change.\n"}, {'role': 'model', 'content': 'IP Number: 84\n\nPatient Number: 2993\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis: DIABETIC FOOT\n\nClinical Exam(With BP): admitted with Infected gangrene of left toe upto the midfoot ,Uncontrolled bloodsugar and fever.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, legally blind, not in any resp distress\r\n\n\nDiscussion: Admitted with history of Diabetes. Infected gangrene of left foot upto the base of midtarsal .Uncontrolled bloodsugar and fever.Started on IV antibiotics and Insulin Basal bolus regimen for tight glycemic control.Seen by surgeon recomended mid foot amputation ,Arterior Doppler was done to evaluate the blood flow to affected area. . surgery was performed on 29-09-2011( mid foot amputation). fever and pain subsided. plan is to discharge and do dressings at regular intervals to monitor if the wound is looking healthier.\n\nDiet: DEPT OF NUTRITION:\r\n\r\nLow calorie Low fat Diabetic Diet prescribed.\n'}]

[{'role': 'user', 'content': 'IP Number: 25\n\nPatient Number: 2584\n\nPatient Name: VARGHESE VITHAYATHIL \n\nGender: M\n\nDate of Birth: 27-04-1932\n\nAddress: VITHAYATHIL HOUSE,28/886, CHERUPARAMBATH\n\nPincode: 682020\n\nPhNo: 2313076,\n\nAdmission Date: 17-08-2011\n\nDischarge Date: 27-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: S/b Dr. Bhatt, Ascending Synovial infection ,C&S Pus taken , continue the same treatment, plan may need I&D under SA\npt admitted with severe pain in the plantar aspect of the Lt foot. + erythema + tenderness, Non healing ulcer in the interdigital space .\nSeen by Dr.A.K.Bhat\r\nPus discharging sinus lt foot.Synovial sheath infection+.\r\nNeeds I&D under spinal anesthesia.\r\nPreop.:Consent.C&D before surgery after betadine scrub.IV antibiotics.\r\n6:00pm Febrile, Drowsy, Vital stable . Check Sodium /Potassium, Preanesthetic checkup \r\nContinue the same\r\n7:30pm Wake up from sleep, feeling hungery, Mild dehydration , Systemic examination-NAD\r\nTomorrow ECG, Xray chest-PA\r\nMaintaince I.V Fluids NS 50ml/hr\r\nLantus 8units at bed time, Actrapid 8units before dinner\nVitals stable. sugar better controlled. No pain present now.\r\nZoledronic acid given yesterday.\nGeneral condition staus quo. Getting ready for debridement today. Blood sugars are under reasonable control. Not taking food adequately.\nIn ICU, B.P 153/70, CVS-S1S2 Normal , RS-NVBS\r\nCan start Orally\r\nStop 5% Dextrose\r\nContinue NS 500ml over 4hrs\r\nInsugen 8units before dinner\r\nLantus 12units at bed time \r\nInj. Clexane O.4 mg S/c \r\n\nFine, oriented , Vital stable, Intake-750 out put 450\r\nRS-Clear, CVS-S1S2Normal, PA-NAD\r\nShift to Room\nSeen by DR.A.K.Bhat\r\nNo pain.No soakage.\r\nPlan for change of dressing tomorrow IN OT.\r\nRepeat Blood R/E\r\n8:00pm Better,vital stable, Systemic examination -NAd\nDoing well. Blood sugars are on the low side. Appetite is picking up. Pre dinner- 164 mg/dl,AC- 88 mg/dl. Planned for dressing today.\nSeen by Dr.A.K.Bhat\r\nDressing changed Lt foot Plantar ulcer, relatively clean , some residual slough excised, No Residual pus\r\nAdd Clindamycin 300mg TID\nSeen by DR.A.K.Bhat\r\nAfebrile.No soakage.\r\nVital stable, AC- 163\r\n\nfine,No temp,Vital stable, Wound clean, dressing due, continue the same\r\nBlood routin-22/8/11\nSeen by DR.A.K.Bhat\r\nDressing changed.The raw area sole of left foot looks clean except for some slough on plantar area which was partially excised.\r\n8:15pm Vital stable , continue the orders\nVitals stable, No complaints, sugar controlled\nSeen by Dr.A.K.Bhat\r\nAfebrile.No pain.\r\nVitals stbale. c/o vertigo, will check orthostatic B.P\nVitals stable. Blood sugar controlled, No Pain, No loose motion\r\nDressing change done yesterday by Dr Bhatt\nSeen by DR.A.K.Bhat\r\nDRessing changed.The raw area lt.foot looks clean.\r\nSuggested oral antibiotics.\r\n7:00 pm Better , Vital stable, No giddness Today ,continue the oders\nVitals stable, AC- 104, NO vertigo after sitting up. \r\nwill get physical therapy on the case\nBetter, Vital stable,sleep good,\nDoing well, NO Hypos, Vital stable, No Giddness, Wound healing satisfactory, Planned to continue the same order\nSeen by Dr.A.K.Bhat\r\nDressings changed.The lt sole ulcer is clean and healing well.\r\nAdviced:Dressings on alternate days.Metrogyl gel&Cuticell.\n'}, {'role': 'model', 'content': 'IP Number: 25\n\nPatient Number: 2584\n\nAdmission Date: 17-08-2011\n\nDischarge Date: 27-08-2011\n\nDiagnosis: ?Charcots Foot \r\nAbscess over the Lt foot\r\nNon healing stump (3 rd toe)\n\nClinical Exam(With BP): Non Healing diabetic foot ulcer (amputation stump) Lt 3rd toe (amputation done in June)\r\nSwelling over Lt foot. \r\nCurrent meds-\r\n Tab Glyciphage 500 mg 1-0-1\r\nTab Glimy 2 mg 1-0-1\r\nDyslilidemia - Yes\r\nTab Aztor 5 mg 0-0-1. Acutely swollen Lt foot - ? Charcots foot.\n\nSystolic BP: 120.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: Elderly male. alert , oriented, not in any distress\r\n\n\nDiscussion: 79 yr with H/o DM , peripheral neuropathy, comes in with swelling and pain in the Lt foot. Pt was admitted for I.V antibiotics, Insulin ( Novorapid and Lantus) and I & D and debridement of the Lt foot by Dr Bhatt.\r\n\r\n\r\n\n\nDiet: \r\nNUTRITION Dept:\r\nLow calorie, low fat diabetic diet with small, frequent feeds adviced.\r\nNutrition booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for skin gafting\nVenous doppler -Tomrrow\r\nPR-80\r\nB.P 150/80\r\nCVS-S1S2 Normal \r\nRS-Clear\r\nCNS-Consious / Oriented \r\nPA-NAD\r\nContinue the same\nS/B Dr A.K.Bhat\r\nAdd Inj. Enoxaparin 60mg s/c B.D\r\nBlood Routine\r\nXray chest PA\r\nECG\r\nRFT\r\nLFT\r\nPlan for Skin grafting for tuesday morning\r\n\nVital stable, systemic examionation -NAD\r\nDoppler Venous \r\nContinue the same\nBlood transfusion \r\n1unit PCV\r\nInj.Lasix 20mg i.v stat\r\n\tinj.Avil 1amp i.v stat\r\ntransfusion on flow \r\nvital stable \r\nContinue the same\nital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\n1units over at 2am , No rxn, \r\n2nd unit\r\nBlood tranfusion \r\n1unit\r\nPremedication\r\nInj.Avil 1amp i.v / Inj.Dexona sos\r\ncontinue the same\r\n\r\nVital stable \r\nConinue the same\r\nPBF/Iron profile awaited\r\nContinue the same\nHb/PCV\r\nTransfusion over , No rxn, vital stable\nSeen by Dr.AK.Bhat.\r\nFor SSG left foot&skin biopsy under SA on 1-11-2011.Get consent.C&D left foot.Shave genitalia&left thigh&betadine scrub HS&CM.Medical fitness for the procedure.IV antibiotics Inj.Microtaz 4.5 gm IV HS&CM.\r\n\r\nVITAL STABLE, NPO,FOLLOW THE DR.BHATT ORDRES\r\nHIGH RISK CONSENT\nVITAL STABLE,CONTINUE SAME\nPR-98/min\r\nB.p-124/67mmof Hg\r\nCVS-S1S2 Normal\r\nRS RR-24/min \r\nCNS-Consious /Oriented \r\nPA-Soft , NAD\r\nPain Better\r\nContinue the same\r\nInj.Fortwin 1amp / Phenargan 1/2 amp slow i.v sos\r\nTab.Nitreset sos\nVomitted once , C/o breathlessness\r\nSpo2 94%, PR-90/min, B.P120/80mof Hg\r\nCVS-S1S2 normal\r\nRS-NVBS\r\nCNS-Consious /Oriented\r\nInj.Pantodac 40mg IV\r\nInj.Emeset I.v \r\nCombimist Neb+derinide Neb stat\nGC better.Pt can be shifted from ICU.BP normal.\nSeen by Dr.A.K.Bhat.\r\nSome pain left thigh.Continue trt.\r\nC/o pain in th thigh and headache\r\npulse 0x at 12 am\nVitals stable. No pain at present\r\nPLan- Hold on the warfarin for now and start later.\nSeen by Dr.A.K.Bhat.\r\nFor change of dressing in OT tomorrow.\nVital stable, Continue the same\r\nContinue the same\nBetter\r\ndoing well\r\nRegular with Medication\r\nContinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.SSG left foot has taken up.The donor site left thigh is clean.\r\nSuggested oral antibiotic.\nC/o Breathlessness\r\nC/o Abdomen discomfort\r\nFBS-111\r\nINR-1\r\nVital stable\r\nRS-Clear\r\nCVS-S1S2 Noraml\r\nMild odema over the Foot\r\nStoped tab.Deriphylline\r\nAxipan\r\nAdded tab.ravera D 1-0-1\r\nSyp.Sucrafil 10 ml 1-1-1\r\nContinue the same\nVital stable\r\nno specific complaint\nSeen by DR.A.K.Bhat.\r\nAfebrile.Continue trt.For change of dressing on wednesday.\nvital stable\r\nPT/INR-1.1\r\nContinue the same\r\nIncresed the warf 5mg 1-1-1\r\ncontinue the asame advice\nDoing fine. Not to ambulate as yet. No anitibiotics on board.\r\nPT/ INR tomorrow.\nfine\r\nHB, PCV, PT/INR\nSeen by Dr.AK.Bhat.\r\nDressings changed.The SSG left foot is settling well.The donor area left thigh healing well.\r\nVitals stable. will discharge only on saturday\nSeen by Dr.A.K.Bhat.Status better.No pain.Plan for discharge on saturday.\r\nTab.Deslar 5mg for cold st\nGC better.Slept well.Stool passed.Vitals stable.Continue the same.\r\nSeen by Dr.A.K.Bhat.Continue trt.\nSeen by Dr.A.K.Bhat.Dressings changed.Donor site fully healed.SSG taken up.\r\nAdvice on discharge:Dressing change left foot twice a week-Cuticell/pad/crepe bandage.Vaseline to left thigh thrice a day.Partial weight bearing left leg.Review after 2 weeks.\n'}, {'role': 'model', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis: Essential (primary) hypertension (I10)\r\nTYPE 2 DIABETES MELLITUS (SL13)\r\nDIABETIC FOOT-Necrotising Fascitis\r\n ?FILARIASIS-RT\r\nGlaucoma\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis \r\n\r\n\n\nClinical Exam(With BP): Admitted for grafting of the ulcer on the dorsum of the LT foot\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, obese, not in any resp distress\r\nRS- NVBS\r\nCVS- S1 S2 heard\r\nAbdomen- Normal\n\nDiscussion: Pt admitted for skin grafting of the ulcer on the dorsum of the Lt foot. Venous doppler was done- Thrombosis of both the femoral and popliteal vein. Pt was started on Low molecular Wt heparin. Pt was noted to have low HB, investigation were done and was transfused 2 units of PRBC , SSG was performed on 1/11/2011, with the graft taken from the Lt thigh. skin biopsy was taken from one of the impetiginous lesion.\r\nPt was started on I.V antibiotics, insulin basal bolus regimen, started on Tab Warfarin, while continuing on the inj low molecular wt heparin. INR therapeutic, and heparin stopped.\r\n\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 71\n\nPatient Number: 2927\n\nPatient Name: JOSEPH\n\nGender: M\n\nDate of Birth: 22-09-1959\n\nAddress: B2, DIVINE HOMES, KAKKANAD\n\nPincode: 682001\n\nPhNo: nan\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 24-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: afebrile Blood sugar uncontrolled. Check Versalab, Vibriometer\nC/o dizzness, CNS-NAD\r\nEye check up , USG Abdmen, 24hr urine fore protein during discharge\r\nInsugen R 22units given in the after noon , due for 22units before dinner, Insugen N 28units at bed time\nVitals stable. blood sugar better controlled\r\nWill have versalab, vibriometer and opthal evaluation\nDischarge. vital stable\n'}, {'role': 'model', 'content': 'IP Number: 71\n\nPatient Number: 2927\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 24-09-2011\n\nDiagnosis: ED\n\nClinical Exam(With BP): Uncontrolled blood sugars. Duration of Diabetes - 20-25 years\r\nCurrent meds-\r\nTab Dutrol 2-0-2\r\nHuman Mixtard 40-0-40\r\nPrevious Blood sugar profile-FBS: 259 PPBS: RBS: HBA1C:\r\nPolyuria, Polyphagia, Polydipsia - No\r\nWeight Loss- No\r\nBlurring of vision- Yes\r\nDiabetic eye examination- Yes/ No\r\nBurning Sensation of feet - yes\r\nNumbness of feet- yes\r\nFalling off of foot wear- No\r\nNon healing Diabetic Foot Ulcer- no\r\nSwelling of feet - No\r\nCornary heart Desease- No\r\nHistory of Chest Pain on Exertion/Rest- No\r\nDyslipidemia- No\r\nHypertension- No\r\nRecurrent infections- No\r\nMuskuloskeletal manifestations -No\r\nAutonomic dysfunction (orthostatic hypotension, early satiety, constipation)- Yes/ No\r\nHypoglycemia - No\r\n. mother- DM, sister-DM\r\nAlcohol- No\r\nSmoking- No. systemic Exam- Normal.\n\nSystolic BP: 150.0\n\nDiastolic BP: 90.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: admitted with High Blood sugra, started on Basal bolus regimen, vital stable ,\r\nsugar getting controled, end organ work up, Significant Microalbunuria with S.Creatinine 1.6mg/dl, Due for Eye Examination , Ultrasound Abdomen: Normal Kidneys, Fatty Liver\r\nEvaluation of ED in Next visit , Discharge in stable state\n\nDiet: NUTRITION Dept:\r\n1200 kcal, low fat, diabetic diet adviced\r\nDiet booklet given\n'}]

[{'role': 'user', 'content': 'IP Number: 113\n\nPatient Number: 3209\n\nPatient Name: MOOSA M A\n\nGender: M\n\nDate of Birth: 15-05-1948\n\nAddress: KEMI,MUDICKAL\n\nPincode: 683542\n\nPhNo: nan\n\nAdmission Date: 17-10-2011\n\nDischarge Date: 21-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for sugar control and iv antibiotics\nPatient admitted for Left index finger paronychia.Start antibiotic and GRBS.\nGC better,Vitals stable.\r\nGRBS-134mg/dl.\r\nSeen by Dr.A.K.Bhat.\r\nLeft index finger:Paronychia with subungual abscess(draining).C/S taken.Adviced:Hand elevation.IV antibiotics.\nNo pain , sugar little high, adjusting insulin according to blood sugar\nGC better.Doing well.FBS-166mg/dl.\r\ndreesing in the morning\nvitals stable. dressing changre done today.\nPt GC better.Vitals stable.Sleep good.Had food.\nS/b Dr.Bhatt.\r\nThe abscess of index finger has resolved.There is superficial slough.Continue daily dressing.\r\nStoped i.v antibiotic\r\nChanged to Curam\r\ncontinue the same\nfine vital stable,wound clean .Discharge\n'}, {'role': 'model', 'content': 'IP Number: 113\n\nPatient Number: 3209\n\nAdmission Date: 17-10-2011\n\nDischarge Date: 21-10-2011\n\nDiagnosis: ACUTE PARONYCHIA\n\nClinical Exam(With BP): admit with infection of the Lt index finger\n\nSystolic BP: 110.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nSystemic Exam- Normal\n\nDiscussion: 63 yr old with H/o DM admitted with infection of the lt index finger after nail cutting. Pt was admitted for I.V antibiotics, Insulin basal bolus regimen, seen by surgeon, regular dressing were done\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 12\n\nPatient Number: 2485\n\nPatient Name: GOPINATH.M.P \n\nGender: M\n\nDate of Birth: 16-04-1940\n\nAddress: LAKSHMI NIVAS,NORTH PARAVOOR\n\nPincode: 683513\n\nPhNo: nan\n\nAdmission Date: 04-08-2011\n\nDischarge Date: 08-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Mixed hyperlipidaemia\nPRIMARY HYPOTHYROIDISM\nEssential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Patient is admitted for a 7 point glucose profile and a end organ evaluation.\r\n7:30pm GRBS -162mg/dl taken 12units of Actrapid , Vital stable , Watch for HYpoglycemic Symptoms\nHad 90mg/dl at midnight , 82mg/dl at 1.am,became symptomatic had few chocolate \r\nPt taking insulin after the food \r\nplanned to watch SMBG till evening\nHad GRBS-78mg/dl at post lunch ,adviced to Give snack\r\nCGMS Done out side shows0% Less than 70mg/dl, Planned to start on Novorapid\nDoing well , No Hypos, Adjusting the dose of insulin, started thyronorm for Hypothyroidism . B.P-130/80, continue the advice\nVitals stable. AC- 184, Changed to NOvorapid 10 units predinner. Given Novorapid 10 unit pre- breakfast.planned to add lantus at bedtime and reduce the dose of novorapid\nDoing well, Prelunch 253mg/dl, Systemic Examination -NAD\nVitals stable, No hypoglycemia, \r\nPre- dinner- 293\r\nAC- 188\nVital stable , No Hypos, Insulin dosage need fine tuning, Planned to discharge\n'}, {'role': 'model', 'content': 'IP Number: 12\n\nPatient Number: 2485\n\nAdmission Date: 04-08-2011\n\nDischarge Date: 08-08-2011\n\nDiagnosis: Type 2 Diabtes Mellitus\r\nPrimary Hypothyroidism\r\nDyslipidemia\r\n? Early Cataract\r\nIrritable Bowel Syndrome\r\nFrequent Hypoglycemia with Fear of hypoglycemia\n\nClinical Exam(With BP): 71 year gentlemen was admitted here for sugar control. He was already on 3 doses of Human Actrapid (+ Metformin and Voglibose) when he came to us. We admitted him for a 7 point glucose profile for insulin titration.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: During the hospital stay a basal insulin was added to the existing regimen and Voglibose was stopped. The blood sugar trend improved with the addition of a basal insulin.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 24\n\nPatient Number: 2622\n\nPatient Name: DAISY JOY\n\nGender: F\n\nDate of Birth: 18-11-1954\n\nAddress: MANGALAPILLY HOUSE, J M ROAD, NAZARATH\n\nPincode: 683101\n\nPhNo: nan\n\nAdmission Date: 17-08-2011\n\nDischarge Date: 24-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nDIABETIC FOOT\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for sugar control and minor debridement of non healing diabetic.\r\n4:00pm S/b Dr.BhattNon Healing SinusRt foot Discharge +, Need slough excsion, consent to be taken\nS/B Dr.Bhatt, Non healing sinusRt Heal, Discharging pus, C/s taken , Sinus probes 3cm , not upto bone. Undermined soft tissue slough present. this will need excision under LA\r\nPeripheral Pulse Present\nSeen by Dr.A.K.Bhat\r\nNo pain.No dressing soakage.\r\nPlan for change of dressing tomorrow.\r\n7:00 pm Better, Vital stable, comfortable , Continue the same\nvitals stable.AC- 123, S/p debridement yesterday, no probing to the bone\nVital stable , Blood sugar fiar control , No hypos\r\nSeen by Dr.A.K.Bhat:\r\nDressing changed.The rt. heel ulcer looks clean.No residual pus or slough.Continue treatment.\nVitals stable, Pre- dinner- 298, AC- 203\r\nDressing change today and evaluate\nSeen by Dr.A.K.Bhat\r\nNo pain.\r\nPlan for change of dressing tomorrow.\nVital stable, GC fair, Little soaking , Hypoglycemia at 1am,\r\n\nDoing fine. GFBS - 196. Predinner- 161 mg/dl, slept well.\nSeen by Dr.A.K.Bhat\r\nDressing changed.Ulcer clean.\nSeen ByDr.A.K.Bhat.\r\nNo pain or soakage.\r\n\r\nT- 100, Tab Welset Given, urine Re to be done\r\n? thrombophlebitis\nWound clean, vital stable, No pain , mild temp yesterday evening, C/S Proteus grown, sensitive to most of the antibiotics, stop Novomox CV , start Oxicip\nSeen by DR.A.K.Bhat\r\nDressing changed.Wound rt heel clean.\r\nAdviced:Change of dressing once in 2 days.No weight bearing on ulcer area.\r\n8:00pm planned discharge , Arrange Dietician , Educator to seen pt in morning session only\nVitals stable, No fever, urine RE taken.AC- 140 mg , pre- dinner- 170\n'}, {'role': 'model', 'content': 'IP Number: 24\n\nPatient Number: 2622\n\nAdmission Date: 17-08-2011\n\nDischarge Date: 24-08-2011\n\nDiagnosis: Non healing Diabetic Foot Ulcer\r\n\r\n\n\nClinical Exam(With BP): Non healing diabetic foot ulcer Rt foot (sole). Human Mixtard 45-0-0\r\nHTN- Tab Losar 50 mg 1-0-1\r\nDyslipidemia - Tab Atorfit 10 mg 0-0-1\r\nPDR-s/p laser both eyes and ? Viterectomy Rt eye\r\nTab Prothiaden 75 mg 1-0-0\r\nTab Ativan 2 mg 0-0-1. Non healing diabetic foot ulcer RT ( Wagner II).\n\nSystolic BP: 140.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 56 yr old comes in with nonhealing ulcer on the RT foot with sinus formation and uncontrollable blood sugar. Started on I.V antibiotics and Insulin, Seen By Dr Bhatt, Debridement along with slough Ecxision done on 18/08/2011. Regular dressings done, along with offloading of the foot.\r\n\n\nDiet: NUTRITION Dept:\r\nLow fat, low calorie, diabetic diet adviced\r\nDiet booklet also given\n'}]

[{'role': 'user', 'content': 'IP Number: 124\n\nPatient Number: 3434\n\nPatient Name: PRASAD.B\n\nGender: M\n\nDate of Birth: 28-05-1955\n\nAddress: QUARTERS NO 201, FACT CD, TOWNSHIP,\n\nPincode: 682303\n\nPhNo: 4842720131\n\nAdmission Date: 28-10-2011\n\nDischarge Date: 01-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nDIABETIC RETINOPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par Intrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Normal in size & echo texture. No calculus or hydronephrosis. \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening. No mucosalirregularity.\r\n\\par \\tab \r\n\\par Prostate\\tab\\tab : Normal in size & echo texture.\r\n\\par \r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par No organomegaly.\r\n\\par No mass lesion or calculus detected.\r\n\\par \r\n\\par Dr.Joe Antony\r\n\\par Consultant Radiologist\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: HOOKED CGMS\r\nSYP.DUPHALAC 10ML HS\nVital stable, CGMS on going , Dowload at 4pm ,further course decide after that\r\ncontinue the same\nvital stable, \r\nPredinner 400mg/dl\r\nActrapid 40units\r\nothers continue\nFasting value good, Vital stable, Bowel and bladder regular\r\nContinue the same \r\nCGMS insitu\nadjusted insulin acc to GRBS\nDoing fine. Blood sugars are controlled. [Plan to download CGMS at 4 pm\r\nEye check up, Veralab, Vibrometer, Dental check up, Alb: Creat ratio, FLP\nFINE,CGMS DOWNLOADED, CONTINUE THE SAME\n'}, {'role': 'model', 'content': 'IP Number: 124\n\nPatient Number: 3434\n\nAdmission Date: 28-10-2011\n\nDischarge Date: 01-11-2011\n\nDiagnosis: Cataract +NPDR +Old submacular hemorrhage post intravitreal AVASTIN\n\nClinical Exam(With BP): Mr.Prasad .B /56yrs/Male.Ref from FACT occuption Health center with complaint of Uncontroled Blood sugars, He is Diabetic since 6yrs on OHA,Recently started on Insulin from the local hospital.Started on Basal Bolus regimen. Connected to CGMS for Monitoring the blood sugars.Adjusted Bolus dose of Insulin according the CGMS analysis.On end organ work out found to have Diabetic Neuropathy,NPDR.Given foot care counselling.Advised blood sugar control.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Temperature :97.6\r\nRespiration :22\r\nBP :124 / 80\r\nWeight :61.7\r\nHeight :171.6\r\n\n\nDiscussion: Mr.Prasad .B /56yrs/Male.Ref from FACT occuption Health center with complaint of Uncontroled Blood sugars, He is Diabetic since 6yrs on OHA,Recently started on Insulin from the local hospital.Started on Basal Bolus regimen connected to CGMS for Monitoring the blood sugars.Adjusted Bolus dose of Insulin according the CGMS analysis.On end organ work out found to have Diabetic Neuropathy,NPDR.Given foot care counselling.Advised blood sugar control.Discharge in a stable state.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 114\n\nPatient Number: 1833\n\nPatient Name: K.A.ALI\n\nGender: M\n\nDate of Birth: 06-10-1951\n\nAddress: KUDIERIKKAL HOUSE,PUTHUPALLIPURAM\n\nPincode: 682033\n\nPhNo: 0484-6416198\n\nAdmission Date: 18-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEUROPATHY\nDIABETIC RETINOPATYH WITH NPDR\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: fine\r\ncontinue the same\r\n9 point plama profile\r\nPredinner, 2hr post dinner, mid night, FBS, 2hr post break fast, prelunch, 2hr post Lunch\r\n\nHoarseness of voice better with NSAIDS. AC- 220 mg/dl. Have decided to put him on a basal bolus regimen.\nVitals stable. GRBS- 250,\nC/O pain.Vitals stable.Gc better.Throat discomfort better. Planned for discharge today.\n'}, {'role': 'model', 'content': "IP Number: 114\n\nPatient Number: 1833\n\nAdmission Date: 18-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis: Iatrogenic Hypothyroidism\r\nPansinusitis\r\nTinea corporis\n\nClinical Exam(With BP): nan\n\nSystolic BP: 130.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 60 yr old with H/o DM, pappilary carcinoma, s/p iodine ablation admitted for sorethroat, hoarsness of voice and 2 episodes of ? hemoptysis and also recurrent hypoglycemic episodes . In hopsital, the pre- mixed regimen was changed to basal bolus regimen, felt better with NSAID's . TSH- < 0.10, on tab thyroxine 200 mcg once a day\r\n\n\nDiet: nan\n"}]

[{'role': 'user', 'content': 'IP Number: 91\n\nPatient Number: 2663\n\nPatient Name: RAVI K.N.\n\nGender: M\n\nDate of Birth: 20-08-1946\n\nAddress: KOIKKAH\n\nPincode: 682036\n\nPhNo: 2321843\n\nAdmission Date: 03-10-2011\n\nDischarge Date: 08-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: S/b Dr.bhat\r\nC/S of pus\r\nStop Platloc AS \r\nContinue\ns/b Dr.\nS/b Dr.A.K.Bhat\r\nXray shows OM of TPX Bone\r\nPlan for Bone nibbling and closure under LA, Tomorrow\r\nConsent\nVitals stable, blood sugar controlled, Culture taken, Dressing done yesterday. continue the antibiotics\nGRBS-101mg/dl\r\nPlanning to discuss with Dr.Bhatt regarding surgery.\r\n\nS/B Dr.A.K Bhat\r\nTPX Nibbled , Dreesing \r\ncontinue the same\nBone nibbling done.Physiotheraphy to be done.\nSeen by Dr.A.K.Bhat.\r\nNo pain.No soakage.Plan for change of dressing tmrw.\nBlood sugar controlled.Culture negative.Oral antibiotics started.\nSeen by Dr.A.K.Bhat.\r\nDressings changed.Suture line left big toe is clean.\r\nC/o pain in the heel\r\nVitals stable\n'}, {'role': 'model', 'content': 'IP Number: 91\n\nPatient Number: 2663\n\nAdmission Date: 03-10-2011\n\nDischarge Date: 08-10-2011\n\nDiagnosis: Non Healing Ulcer over the Gr toe\r\nOM\r\nOLD CVA\n\nClinical Exam(With BP): nan\n\nSystolic BP: 150.0\n\nDiastolic BP: 90.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: nan\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nPatient Name: KOCHU THRESIA MICHAEL\n\nGender: F\n\nDate of Birth: 07-07-1932\n\nAddress: 27/78, V.P MARAIKAR ROAD, EDAPALLY NORTH\n\nPincode: 682024\n\nPhNo: 0484 - 2543217\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat\r\nResolving ?Necrotising fasciitis Lt leg.\r\nAdvice:IV Fortum,Tbact oint. local application tds,Candid cream between toes bd,Inj.Clexane,Rest&leg elevation.\nVitals stable. pre- lunch- 159, still has redness in the Lt leg, an area of ? pus collection near the ankle. will show it to Dr Bhatt\nvitals stable, more alert now, clinically the Lt leg looks better, oedema subsided. redness still present.\r\nBlood sugar well controlled\r\nInput- 850\r\nOutput- 700, Na- 123\nFeeling sleepy. was able to get an I.V access. Will check NA+\r\nOedema subsiding\r\nHb- 8.6, TIBC- 163\nSeen by DR.A.K.Bhat\r\nEdema&redness decreased.Small focal scab lateral ankle needs observation.\r\nAdviced:vaseline application&Tbact\r\n\r\nVitals stable. had good sleep yesterday. more alert sittting up and eating food.\nvitals stable, blood sugar controlled. alert, slept well. oedema subsided. erythema better.\nGeneral condition stable. Cellulitis better. Since the IV line is out we have decided to go with oral cephalosporins.\nSeen by Dr.A.K.Bhat\r\nThe redness is less &ulcers of the left leg are healed.\r\nAdviced:Emollients.\npt feels better, more alert , oedema and redness subsided.\r\nswitched to oral antibiotics.\r\nTab Flunil put on hold.\r\nwill discuss with DR bhatt and family the plan for discharge\nPR 76/min , B.p-140/70mmof hg, CVS-S1S2 Normal , RS-Clear, Restricted Rt Shoulder movement, Cellulitis subsiding\r\n\nfebril, vital stable, Continue the same\r\nTPR Chart, Intake /output\nVitals stable, No fever. ,AC- 150, Blood RE- 12,050.\r\noedema subsiding, redness getting better.\r\n11:00am Disscused with Dr. Bhat, adviced to add Tab. Ciprofloxacin watch for 2days, continue the other medication , Tab.Chymoral forte 1-0-1\nvital stable, no fever, changed the cannula, continue the same orders\nCellulitis better. Onychomycosis+\r\n6:00pm Vital stable , Afebrile, continue the order\nDoing well, vital stable, swelling status co, FBS 169,increse the dose of metformin\r\ncontinue the same orders\nBetter,vital stable, continue the same\nVital stable, Leg sweelling decresed, Systemic examination -NAD\r\nBlood routine , platelet count\nAfebrile, Limb status co, Systemic examination NAD\r\nDiscussed with son , insisted to start on Linzolid, started on Linazolid\nCellulitis/ Necrotizing fascitis - status quo. Over all general condition is good.\nCellulitis better. General condition good. Mobilized her a bit.\r\nSeen by Dr.A.K.Bhat\r\nRedness &swelling decreased.Adviced:Crepe bandage.\r\nStop fortum.\nDoing well, redness subsided , FBS 164, Vital stable , Systemic Examination -NAD\r\nplan to change to Oral medication\nVitals stable. GRBS- 203, No fever\nDoing well, Odema subsided, redness subsided , D/C Cannula, Continue the same order, swith over to Tab.linazolide\nPR-86, B.p 190/100mmof hg , RS-Rhonchi +, \r\nStop Revolol, Change to Tab. Nebivolol, Tab. Amlodipine 2.5mg stat\r\n8:15pm C/o Chest pain transient, PR-70/min, B.p-150/70mm0f hg ECG-RBBB, No ST-TChange\r\nRpt ECG in the morning\nPR-80/min , B.P 140/70mmHg,RS-Rhonchi+, Crepitation +\r\nPA-NAD, Mild pedal odema\r\ncontinue the same\nPR-80/min , B.P 160/70mmof Hg, RS -Crepitation +/Rhonchi\r\nLeg better\r\nDoing well, Plan to add small dose of Diuretics\r\nBLOOD ROUTINE, PLATELET COUNT, UREA , CREATINE, Na+, Ka+ TOMORROW\nPt ambulating. Cough better. Blood work done.\r\nPlan is to discharge to a rehab facility\nseen by Dr.A.K.Bhat.\r\nAdviced emollients.Stop linezolid.\r\n6:30pm Better, RS-Rhonchi +,Stop Cetaphil\nS/b Dr.Ramesh Nair\r\nCellutitis, Acute Bronchitis\r\nIV Deriphylline 2cc i.v slowly bd\r\nCombimist Neb Q6h\r\nBudocort Neb Q8h\r\nTab.Mucinac 600 1-0-1\r\nSteam Inhalition\nc/o feeling Nauseous, B.P better control. \r\nChest - B/l wheeze and Rhonchi\nDoing well. General condition status quo. Chest better- occasional rochi\nfine, B.P 170/80mmof Hg continue the same\nRhonchi, GRBS-223mg/dl, Stop Odyphylline, Started on Abphylline 100mg BD\nVital stable, B.P 130/70mmog hg, CVS-S1S2 Normal, RS-B/l Rhonchi +, Leg Odema Better\r\nStop Tab.Linozolid\nDR.Rmesh Nair visited the Pt\r\n\r\nGC- Better\r\nVital stable. GRBS- 136, plan to discharge on thursday\nPR 76/min , B.P-140/70mmof Hg, RS-Rhonchi+, Mentation stable.Stop Linazolide, stat Levofloxacin , Mucomix Nebulization , continue the same\r\n\r\n\r\nDr .Ramesh Nair visited the pt on 17/09/11\nVitals stable. GRBS- 120, \r\nRS- B/L rhonchi, seen by pulmonary yesterday, continue the same medicines\r\nIntend to D/C tomorrow.\r\nChesyt Physiotherapy\r\nRpt Na tomorrow\nbetter, vital stable, Rs-Rhonchi +\nVitals stble. Intend to D/C today\n'}, {'role': 'model', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis: Cellulitis/? Necrotising fascitis\r\nSIADH\r\nOsteoarthritis\r\nEssential HTN\n\nClinical Exam(With BP): admitted with swelling, redness and pain in the Lt leg x 10-14 days\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, not in any distress.\r\nRS- B/l Rhonchi\r\nLOcal - oedema, redness, INcreased warmth with chronic dermatitis changes\n\nDiscussion: 79 yr old with H/o DM, Osteoarthritis admitted with redness, pain and swelling of the Lt leg, ( cellulitis/? necrotising fasciitis ) started in I.V antibiotics, seen by surgeon. Venous doppler was done which showe No thrombus, but valve incompetanance. Hyponatremia was corrected with hypertonic saline. Glycemic control was achieved with tab Metformin and bed time dose of lantus. Pt was also seen by Cardiology for evaluation of hypertension. Echo was done which was normal. Antihypertensive meds were adjusted. During the hopsital stay, devloped chest congestion, started on Combimist Nebs and Budesonide Nebs and also seen By pulmonary who recommended the same.\r\nPt was initiated on to physical therapy.\r\n\n\nDiet: NUTRITION Dept:\r\n1600 kcal, low fat,less spicy, diabetic diet with small, frequent feeds adviced\r\nExtra salt added\r\nDiet sheet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 92\n\nPatient Number: 3056\n\nPatient Name: MEENAKSHI SUGATHAN\n\nGender: F\n\nDate of Birth: 03-10-1935\n\nAddress: THOOMBAYIL HOUSE, B.O.C ROAD\n\nPincode: 683542\n\nPhNo: 0484 - 2526222\n\nAdmission Date: 03-10-2011\n\nDischarge Date: 14-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Evidence of thinning of renal cortex. \r\n\\par \\tab\\tab\\tab \r\n\\par \r\n\\par Urinary Bladder\\tab : Urinary bladder shows evidence of trabiculation.\r\n\\par \\tab \r\n\\par Uterus \\tab\\tab : Normal in size & echo texture.\r\n\\par \r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par Impression : Possible chronic renal failure with urinary tract obstruction with cystitis.\r\n\\par \r\n\\par DR.JOE ANTONY\r\n\\par RADIOLOGIST.\r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: C/o pain in the Lt Eye\r\nvigamox eye drops 3HRLY intervel of 10min\r\nAcular -LF 3HRLY\r\nB.P -140/80\r\nCVS-S1S2Normal \r\nRs-NVBS\nVitasl stable. Na- low, will slowly correct it. Opthalmology and cardiology consultation today.Blood sugar - not controlled\nvital stable continue the same\r\nNa+,K+ tomorrow\nc/o burning sensation in the epigastric region\r\nC/o Constipation\r\nNa+ 117\r\nAdviced \r\nTab.Dulcolax 2tab stat\r\nI.v 3% saline 200ml over 8hrs\r\nCheck Na+ , K+\r\nSyp.Sucrafil 10ml 1-1-1\nvitals stable.No fever.Correcting sodium with hypertonic saline.GRBS- 250 mg/dl\nGRBS 226mg/dl.Physiotheraphy to be done today.Extra salt diet to be given.I/O-1150/1000ml.\r\nNa- 119, 5 bottle of hypertonic saline given.\r\nFluid restriction -1 l\r\nOPthalmology consultation today. will transfer to Giridhar for eye evaluation\nOpthalmology check up done in Giridhar today. re- evlaute in 5 days. c/o pain in the leg.\r\nWll check Na, K, blood Re\nGC better.I/O-950/850ml.\nPt more alert. had hypoglycemia this afternoon. decreased the dose of Insulin. Hypertonic saline ongoing\nGC better. no hypoglycemia\nSodium tomorrow\r\ncontinue the same\nCheck urea,creatinine.\nconsious,slow mentation ,vital stable\r\nCNS-Rt Residual Hemiparesis, Reflex \r\nDehydration \r\nI.V NS 1pint 50ml/hr\nDo physiotheraphy today.Antibiotic stopped.Review in Giridhar Hospital.\nbetter, opthlmology consultation over, \r\nAdd Alphagan 1-0-1 left Eye\nPatient slightly feel tired.Vitals stable.Repeat sodium,urea,potassium.\nStill feels tired . Given I.V fluids today. physiotherapy done\nVitals stable.GC fair.GRBS-244mg/dl.Ready for discharge.\n'}, {'role': 'model', 'content': 'IP Number: 92\n\nPatient Number: 3056\n\nAdmission Date: 03-10-2011\n\nDischarge Date: 14-10-2011\n\nDiagnosis: Old CVA,\r\n Hyphaema LT eye\r\n Dyslipidemia\r\n BPPV \r\n Complete Heart Block\n\nClinical Exam(With BP): 76 Year old female H/O DM admitted for Uncontrolled blood sugar and decreased vision in the left eye.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 76 year old H/O DM,admitted for Uncontrolled blood sugar and decreased vision in the left eye.She was seen at Giridhar Eye Hospital,was noted to have Hyphaema on the left eye with secondary Glaucoma and Corneal blood staining.Right eye vision normal.she was started on eye drops and medication to decrease Intra occular pressure.Second Review was done in Giridhar hospital and plan to do USG and Surgical intervention,Once the general condition improve .During the hospital stay she was started on Insulin ,basal bolus regimen for tight glycemic control.She was also treated for UTI with anti biotics also treated for Hyponatremia with hypertonic saline and fluid restriction .\n\nDiet: DEPT OF NUTRITION:\r\nLow Calorie Low Fat Diabetic diet (Soft) prescribed.\n'}]

[{'role': 'user', 'content': 'IP Number: 34\n\nPatient Number: 173\n\nPatient Name: T.M.ALEXANDER\n\nGender: M\n\nDate of Birth: 17-07-1935\n\nAddress: THUNDIPARAMBIL HOUSE\n\nPincode: nan\n\nPhNo: 9895405553\n\nAdmission Date: 23-08-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Constipation , vital stable, adviced Enema, continue the orders\nVitals stable , seen By Dr bhatt, X-ray of LT foot- chronic osteomyelitis\r\nGRBS- 187\n3:00am , passed motion , had itching , adviced Inj.Avil slow I.V, stat,stop Tab.chymoral forte\r\nSlept after the Avil injection. Vitals stable. seen by DR BHatt, X-Ray Foot taken- ? osteomyelitis,\r\nWill control the infection and sugar, discussed the plan with the Pt\nSeenb by DR.A.K.Bhat\r\nAfebrile.\r\n?Plan for bone nibbling under LA.\nSeen by DR.A.K.Bhat\r\nDressings reviewed.\r\nThe options given are:\r\n1)conservative.\r\n2)Bone nibbling\r\n3)Debridement&fillet flaps of 2nd&3rd toes.\r\n8:00pm Better,vital stable, sugar under control\nvitals stable. still c/o itching a liitle bit\r\nAC- 114\nBetter, planned case in morning, follow the instruction , Shift the case to OT by 7:15pm\nVital stable, systemic Examination -Status co, Changed the antibiotics according to c/s, stop novomox Cv\r\nDisscussed with Dr.Bhat\nAcute retension of urine, vomiting\r\nAfebrile, PR 80/min , BP 150/90mmof hg, CVS-S1S2Normal , RS-Clear , \r\nCatherized , Inj.emeset 4mg i.v stat, Inj.Rantac I.V \r\n1:00pm Inj.Perinorm stat, IV DNS 500ml + 6units Actrapid 50ml /hr, continue the advice asper the surgery notes\nBetter, No Nause, Vital stable , Insugen R 6units at bed time, continue the same orders\r\nShift to ward tomrrow\nShift to room , vital stable, no vomiting , D/C Cath\r\nSeen by Dr.A.K.Bhat\r\nAfebrile.No soakage of dressing.No pain.\r\nContinue trea6tment.OFFLOADING of operated foot.\r\n\nVitals stable. c/o constipation.\nGC stable,Pruritis better.Taking oral foods.\r\nFBS- 153mg/dl\nVitals stable, Blood sugar control maintained.\r\nDressing change to be done by DR bhatt tomorrow\nVitals stable, prelunch- 71\nVitals steble. blood sugar controlled.\r\nDressing change today.\r\nSeen by Dr.A.K.Bhat\r\nDressing changed.\r\nDrain removed.Suture line is clean.\r\nContinue trt.\nSeen by Dr..AK Bhat\r\nPatient is not offloading the operated foot.Explained the need for offloading.\r\nContinue treatment.\nVitals stable Continue the same\nVitals stable . sugar well controlled, will discuss with Dr bhatt regarding the discharge process\nVitals stable, dressing change to be done tommorrow\nPt c/o different taste in the mouth. vitals stable. Blood sugar controlled\nSeen by DR.A.K.Bhat\r\nC&D done.Suture line of left foot is clean.\r\nSuggested oral antibiotics.\r\n\r\nVitals stable, blood sugar well controlled. Dressing change done. OFF loading of the feet\nDoing fine. General condition good. No hypos.\nSeen by DR.A.K.Bhat\r\nLarge dressing done.Partial suture removal done.The left foot wound is healing well.Adviced:OFFLOADING of operated leg.Dressing review twice a week.\nVitals stable, sugar well controlled.\r\nSutures to be removed today or tomorrow.\n'}, {'role': 'model', 'content': 'IP Number: 34\n\nPatient Number: 173\n\nAdmission Date: 23-08-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis: chronic osteomyelitis\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\n\nClinical Exam(With BP): admitted for chronic ulcer on the plantar aspect of the Lt foot x 2 yrs,s/p amputation of the 5 th digit of the Lt foot few months ago\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nUlcer- Wagner 111 classification, on the planta aspect of the Lt foot in between the 2 and 3rd digit , probing to the bone.\n\nDiscussion: 76 yr old with H/o DM, admitted for non healing ulcer which was infected and probing to the bone. also swelling and pain in the Lt leg. X- Ray of the foot- destruction of the 2 and 3 rd metatarsal head of the LT foot. Seen by a surgeon, Started on I.V antibiotics and Insulin for good glycemic control.\r\nHe had an amputation of the 2 and 3 rd digit along with removal of the osteomyeltic fragments on the metatarsal heads of the 2 and 3 rd digit.\r\ngrafting of the skin .\r\nRegular dressing were done.\r\n\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet with small, frequent feeds adviced\r\nDiet booklet also given\r\n\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for skin gafting\nVenous doppler -Tomrrow\r\nPR-80\r\nB.P 150/80\r\nCVS-S1S2 Normal \r\nRS-Clear\r\nCNS-Consious / Oriented \r\nPA-NAD\r\nContinue the same\nS/B Dr A.K.Bhat\r\nAdd Inj. Enoxaparin 60mg s/c B.D\r\nBlood Routine\r\nXray chest PA\r\nECG\r\nRFT\r\nLFT\r\nPlan for Skin grafting for tuesday morning\r\n\nVital stable, systemic examionation -NAD\r\nDoppler Venous \r\nContinue the same\nBlood transfusion \r\n1unit PCV\r\nInj.Lasix 20mg i.v stat\r\n\tinj.Avil 1amp i.v stat\r\ntransfusion on flow \r\nvital stable \r\nContinue the same\nital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\n1units over at 2am , No rxn, \r\n2nd unit\r\nBlood tranfusion \r\n1unit\r\nPremedication\r\nInj.Avil 1amp i.v / Inj.Dexona sos\r\ncontinue the same\r\n\r\nVital stable \r\nConinue the same\r\nPBF/Iron profile awaited\r\nContinue the same\nHb/PCV\r\nTransfusion over , No rxn, vital stable\nSeen by Dr.AK.Bhat.\r\nFor SSG left foot&skin biopsy under SA on 1-11-2011.Get consent.C&D left foot.Shave genitalia&left thigh&betadine scrub HS&CM.Medical fitness for the procedure.IV antibiotics Inj.Microtaz 4.5 gm IV HS&CM.\r\n\r\nVITAL STABLE, NPO,FOLLOW THE DR.BHATT ORDRES\r\nHIGH RISK CONSENT\nVITAL STABLE,CONTINUE SAME\nPR-98/min\r\nB.p-124/67mmof Hg\r\nCVS-S1S2 Normal\r\nRS RR-24/min \r\nCNS-Consious /Oriented \r\nPA-Soft , NAD\r\nPain Better\r\nContinue the same\r\nInj.Fortwin 1amp / Phenargan 1/2 amp slow i.v sos\r\nTab.Nitreset sos\nVomitted once , C/o breathlessness\r\nSpo2 94%, PR-90/min, B.P120/80mof Hg\r\nCVS-S1S2 normal\r\nRS-NVBS\r\nCNS-Consious /Oriented\r\nInj.Pantodac 40mg IV\r\nInj.Emeset I.v \r\nCombimist Neb+derinide Neb stat\nGC better.Pt can be shifted from ICU.BP normal.\nSeen by Dr.A.K.Bhat.\r\nSome pain left thigh.Continue trt.\r\nC/o pain in th thigh and headache\r\npulse 0x at 12 am\nVitals stable. No pain at present\r\nPLan- Hold on the warfarin for now and start later.\nSeen by Dr.A.K.Bhat.\r\nFor change of dressing in OT tomorrow.\nVital stable, Continue the same\r\nContinue the same\nBetter\r\ndoing well\r\nRegular with Medication\r\nContinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.SSG left foot has taken up.The donor site left thigh is clean.\r\nSuggested oral antibiotic.\nC/o Breathlessness\r\nC/o Abdomen discomfort\r\nFBS-111\r\nINR-1\r\nVital stable\r\nRS-Clear\r\nCVS-S1S2 Noraml\r\nMild odema over the Foot\r\nStoped tab.Deriphylline\r\nAxipan\r\nAdded tab.ravera D 1-0-1\r\nSyp.Sucrafil 10 ml 1-1-1\r\nContinue the same\nVital stable\r\nno specific complaint\nSeen by DR.A.K.Bhat.\r\nAfebrile.Continue trt.For change of dressing on wednesday.\nvital stable\r\nPT/INR-1.1\r\nContinue the same\r\nIncresed the warf 5mg 1-1-1\r\ncontinue the asame advice\nDoing fine. Not to ambulate as yet. No anitibiotics on board.\r\nPT/ INR tomorrow.\nfine\r\nHB, PCV, PT/INR\nSeen by Dr.AK.Bhat.\r\nDressings changed.The SSG left foot is settling well.The donor area left thigh healing well.\r\nVitals stable. will discharge only on saturday\nSeen by Dr.A.K.Bhat.Status better.No pain.Plan for discharge on saturday.\r\nTab.Deslar 5mg for cold st\nGC better.Slept well.Stool passed.Vitals stable.Continue the same.\r\nSeen by Dr.A.K.Bhat.Continue trt.\nSeen by Dr.A.K.Bhat.Dressings changed.Donor site fully healed.SSG taken up.\r\nAdvice on discharge:Dressing change left foot twice a week-Cuticell/pad/crepe bandage.Vaseline to left thigh thrice a day.Partial weight bearing left leg.Review after 2 weeks.\n'}, {'role': 'model', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis: Essential (primary) hypertension (I10)\r\nTYPE 2 DIABETES MELLITUS (SL13)\r\nDIABETIC FOOT-Necrotising Fascitis\r\n ?FILARIASIS-RT\r\nGlaucoma\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis \r\n\r\n\n\nClinical Exam(With BP): Admitted for grafting of the ulcer on the dorsum of the LT foot\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, obese, not in any resp distress\r\nRS- NVBS\r\nCVS- S1 S2 heard\r\nAbdomen- Normal\n\nDiscussion: Pt admitted for skin grafting of the ulcer on the dorsum of the Lt foot. Venous doppler was done- Thrombosis of both the femoral and popliteal vein. Pt was started on Low molecular Wt heparin. Pt was noted to have low HB, investigation were done and was transfused 2 units of PRBC , SSG was performed on 1/11/2011, with the graft taken from the Lt thigh. skin biopsy was taken from one of the impetiginous lesion.\r\nPt was started on I.V antibiotics, insulin basal bolus regimen, started on Tab Warfarin, while continuing on the inj low molecular wt heparin. INR therapeutic, and heparin stopped.\r\n\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 97\n\nPatient Number: 3091\n\nPatient Name: ANNAMMA MATHAI\n\nGender: F\n\nDate of Birth: 30-03-1931\n\nAddress: KIDANGALIL HOUSE,JACOB VALLANATT ROAD,\n\nPincode: 682018\n\nPhNo: 2391837\n\nAdmission Date: 05-10-2011\n\nDischarge Date: 08-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nUrinary tract infection, site not specified\nEssential (primary) hypertension\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Both Kidneys shows mild Renal parenchymal oedema \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening. No mucosalirregularity.\r\n\\par \\tab \r\n\\par Uterus\\tab\\tab : Normal in size and echo texture\r\n\\par \r\n\\par Ovaries : Normal in size and echo texture\r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 Both kidneys shows mild renal parenchymal oedema \r\n\\par S/o Renalinfection /Nephritis\r\n\\par No mass lesion or calculus detected.\r\n\\par \r\n\\par Dr.Joe Antony,MD\r\n\\par Consutant Radiologist\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted with altered mental status.She is Hypertensive.Treated with NTG(stopped after 3 years).\nC/o headache- paracetamol given. No fever, will repeat Labs tomorrow.\r\nWill repeat Blood RE, NA, Urea, creatinine\nRemove catheter.USG tomorrow.Echo done.\nVItals stable. No complaints. Started on oral ,meds.\r\nGRBS- 189\n'}, {'role': 'model', 'content': 'IP Number: 97\n\nPatient Number: 3091\n\nAdmission Date: 05-10-2011\n\nDischarge Date: 08-10-2011\n\nDiagnosis: Accelarated Hypertension \r\nUrinary Tract Infection\r\n\n\nClinical Exam(With BP): 80 YR old lady admitted with DM,HTN.She was found to have Accelerated HTN \r\n\r\n\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, not in any distress\r\nCVS- S1 S2 heard\r\nRS- basal creps\n\nDiscussion: 80 yr old with H/o HTN, old CVA admitted with change in mental status, found to have accelerated HTN, treated with Nitroglycernie for 2-3 hrs.\r\nShe was found to have Cystitis, treated with antibiotics .\r\nUltrasound of tha abdomen was done. ECho - Normal LV Function\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nPatient Name: KOCHU THRESIA MICHAEL\n\nGender: F\n\nDate of Birth: 07-07-1932\n\nAddress: 27/78, V.P MARAIKAR ROAD, EDAPALLY NORTH\n\nPincode: 682024\n\nPhNo: 0484 - 2543217\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat\r\nResolving ?Necrotising fasciitis Lt leg.\r\nAdvice:IV Fortum,Tbact oint. local application tds,Candid cream between toes bd,Inj.Clexane,Rest&leg elevation.\nVitals stable. pre- lunch- 159, still has redness in the Lt leg, an area of ? pus collection near the ankle. will show it to Dr Bhatt\nvitals stable, more alert now, clinically the Lt leg looks better, oedema subsided. redness still present.\r\nBlood sugar well controlled\r\nInput- 850\r\nOutput- 700, Na- 123\nFeeling sleepy. was able to get an I.V access. Will check NA+\r\nOedema subsiding\r\nHb- 8.6, TIBC- 163\nSeen by DR.A.K.Bhat\r\nEdema&redness decreased.Small focal scab lateral ankle needs observation.\r\nAdviced:vaseline application&Tbact\r\n\r\nVitals stable. had good sleep yesterday. more alert sittting up and eating food.\nvitals stable, blood sugar controlled. alert, slept well. oedema subsided. erythema better.\nGeneral condition stable. Cellulitis better. Since the IV line is out we have decided to go with oral cephalosporins.\nSeen by Dr.A.K.Bhat\r\nThe redness is less &ulcers of the left leg are healed.\r\nAdviced:Emollients.\npt feels better, more alert , oedema and redness subsided.\r\nswitched to oral antibiotics.\r\nTab Flunil put on hold.\r\nwill discuss with DR bhatt and family the plan for discharge\nPR 76/min , B.p-140/70mmof hg, CVS-S1S2 Normal , RS-Clear, Restricted Rt Shoulder movement, Cellulitis subsiding\r\n\nfebril, vital stable, Continue the same\r\nTPR Chart, Intake /output\nVitals stable, No fever. ,AC- 150, Blood RE- 12,050.\r\noedema subsiding, redness getting better.\r\n11:00am Disscused with Dr. Bhat, adviced to add Tab. Ciprofloxacin watch for 2days, continue the other medication , Tab.Chymoral forte 1-0-1\nvital stable, no fever, changed the cannula, continue the same orders\nCellulitis better. Onychomycosis+\r\n6:00pm Vital stable , Afebrile, continue the order\nDoing well, vital stable, swelling status co, FBS 169,increse the dose of metformin\r\ncontinue the same orders\nBetter,vital stable, continue the same\nVital stable, Leg sweelling decresed, Systemic examination -NAD\r\nBlood routine , platelet count\nAfebrile, Limb status co, Systemic examination NAD\r\nDiscussed with son , insisted to start on Linzolid, started on Linazolid\nCellulitis/ Necrotizing fascitis - status quo. Over all general condition is good.\nCellulitis better. General condition good. Mobilized her a bit.\r\nSeen by Dr.A.K.Bhat\r\nRedness &swelling decreased.Adviced:Crepe bandage.\r\nStop fortum.\nDoing well, redness subsided , FBS 164, Vital stable , Systemic Examination -NAD\r\nplan to change to Oral medication\nVitals stable. GRBS- 203, No fever\nDoing well, Odema subsided, redness subsided , D/C Cannula, Continue the same order, swith over to Tab.linazolide\nPR-86, B.p 190/100mmof hg , RS-Rhonchi +, \r\nStop Revolol, Change to Tab. Nebivolol, Tab. Amlodipine 2.5mg stat\r\n8:15pm C/o Chest pain transient, PR-70/min, B.p-150/70mm0f hg ECG-RBBB, No ST-TChange\r\nRpt ECG in the morning\nPR-80/min , B.P 140/70mmHg,RS-Rhonchi+, Crepitation +\r\nPA-NAD, Mild pedal odema\r\ncontinue the same\nPR-80/min , B.P 160/70mmof Hg, RS -Crepitation +/Rhonchi\r\nLeg better\r\nDoing well, Plan to add small dose of Diuretics\r\nBLOOD ROUTINE, PLATELET COUNT, UREA , CREATINE, Na+, Ka+ TOMORROW\nPt ambulating. Cough better. Blood work done.\r\nPlan is to discharge to a rehab facility\nseen by Dr.A.K.Bhat.\r\nAdviced emollients.Stop linezolid.\r\n6:30pm Better, RS-Rhonchi +,Stop Cetaphil\nS/b Dr.Ramesh Nair\r\nCellutitis, Acute Bronchitis\r\nIV Deriphylline 2cc i.v slowly bd\r\nCombimist Neb Q6h\r\nBudocort Neb Q8h\r\nTab.Mucinac 600 1-0-1\r\nSteam Inhalition\nc/o feeling Nauseous, B.P better control. \r\nChest - B/l wheeze and Rhonchi\nDoing well. General condition status quo. Chest better- occasional rochi\nfine, B.P 170/80mmof Hg continue the same\nRhonchi, GRBS-223mg/dl, Stop Odyphylline, Started on Abphylline 100mg BD\nVital stable, B.P 130/70mmog hg, CVS-S1S2 Normal, RS-B/l Rhonchi +, Leg Odema Better\r\nStop Tab.Linozolid\nDR.Rmesh Nair visited the Pt\r\n\r\nGC- Better\r\nVital stable. GRBS- 136, plan to discharge on thursday\nPR 76/min , B.P-140/70mmof Hg, RS-Rhonchi+, Mentation stable.Stop Linazolide, stat Levofloxacin , Mucomix Nebulization , continue the same\r\n\r\n\r\nDr .Ramesh Nair visited the pt on 17/09/11\nVitals stable. GRBS- 120, \r\nRS- B/L rhonchi, seen by pulmonary yesterday, continue the same medicines\r\nIntend to D/C tomorrow.\r\nChesyt Physiotherapy\r\nRpt Na tomorrow\nbetter, vital stable, Rs-Rhonchi +\nVitals stble. Intend to D/C today\n'}, {'role': 'model', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis: Cellulitis/? Necrotising fascitis\r\nSIADH\r\nOsteoarthritis\r\nEssential HTN\n\nClinical Exam(With BP): admitted with swelling, redness and pain in the Lt leg x 10-14 days\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, not in any distress.\r\nRS- B/l Rhonchi\r\nLOcal - oedema, redness, INcreased warmth with chronic dermatitis changes\n\nDiscussion: 79 yr old with H/o DM, Osteoarthritis admitted with redness, pain and swelling of the Lt leg, ( cellulitis/? necrotising fasciitis ) started in I.V antibiotics, seen by surgeon. Venous doppler was done which showe No thrombus, but valve incompetanance. Hyponatremia was corrected with hypertonic saline. Glycemic control was achieved with tab Metformin and bed time dose of lantus. Pt was also seen by Cardiology for evaluation of hypertension. Echo was done which was normal. Antihypertensive meds were adjusted. During the hopsital stay, devloped chest congestion, started on Combimist Nebs and Budesonide Nebs and also seen By pulmonary who recommended the same.\r\nPt was initiated on to physical therapy.\r\n\n\nDiet: NUTRITION Dept:\r\n1600 kcal, low fat,less spicy, diabetic diet with small, frequent feeds adviced\r\nExtra salt added\r\nDiet sheet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 99\n\nPatient Number: 3092\n\nPatient Name: K.M NOORJAHAN\n\nGender: F\n\nDate of Birth: 06-10-1956\n\nAddress: THACHAVALLATH HOUSE, MUPPATHADAM P.O\n\nPincode: 683010\n\nPhNo: 0484 - 3222955\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Feels better. GRBS- 198\nPatient was weak.GRBS 395mg/dl.\nDental Consaltation.Opthalmic Consultation.Check TSH,T4.Check Versa lab,Vibrometer.\nFeels better. Sugar still not controlled.Opthalmology and podaitry evaluation done.\nCheck Orsthostatic hypotension.\r\nECG done.\r\nODST to be done.\nC/o Burning sensation in the foot\r\nAdded Tab.Amitone\nVital stable, \r\nMoon face, buffole Hump,Straie\r\n\r\nDexona 1mg at 11:00pm , S.Cortisol at tomorrow 8:00am\r\n(send 1sample outside)\r\nContinue the orders\nPatient was weak.T.welset sos to be given.\nbetter,vital stable, dexomethasone suppresion test\r\n\nPatient feels much better.Low dose supressive test to be done (13/10/2011).\nfine,vital stable, continue the Dexona as adviced\nC/o burning sensation in both the legs,GRBS- 424\nVitals stable.Pelvic traction today.Tomorrow blood withdrawal at 8am.\nGC fine.S.cortisol taken.FBS-193mg/dl.\nComplaints of weakness.AC 231mg/dl.Cortisol reports awaited.\nPut Cannula, heparine 0.5ml dilute in 1ml ,push 0.5ml (Heap block) Draw serum cortisol at mid night(12am)\r\n\nBeter,on MVI\r\nSyp.Duphalac 15ml HS \r\ncontinue other\nMidnight cortisol report awaited.Complaints of generalised weakness.Slept for a few hours.FBS-172mg/dl.\nfine, vital stable\r\nAC-154\r\nDiffculty in walking, \r\nS.cortisol awaited\r\nContinue the same\nAC-138mg/dl.Planning for 24 hrs urine free cortisol level.\r\ncontinue the same\r\n\nC/o pain.GRBS-196mg/dl\nC/o genaralised weakness.Fbs still high.Slept well.Passed stools.24 hr Ufc ongoing.\nfeeling tired,GRBS-301mg/dl\r\nVital stable\r\nWithhold Amitone\r\nContinue the others\nGeneral condition slighlty better. AC- 111 mg/dl. MRI done in 1996 was discussed with radiologist who opined that she had severe spondylosis back then.\nVitals stable, sugar better controlled today.\nC/O GC weakness and head ache.\n'}, {'role': 'model', 'content': "IP Number: 99\n\nPatient Number: 3092\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 55 yr old with H/o DM admitted with weakness and uncontrollable blood sugar.Insulin dosage was titrated up according to the GRBS.She was also evaluated for cushing's during the stay. ODST was performed, cortisolAM level was high, so evaluated for high dose Suppression test. 24 hr urine free cortisol level was done, results awaiting.\r\nH/o lumbar radiculopathy Lt side, phsical therapy was done, with better relief of the pain. Pt also being evalauted ny a neurologist for the worsening radicular pain .\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet in small, frequent feeds adviced\r\nDiet booklet given\r\nGlucerna SR- 2 scoop/ day with skimmed milk- 1 cup (Bed time)\r\n\r\n\n"}]

[{'role': 'user', 'content': 'IP Number: 131\n\nPatient Number: 3168\n\nPatient Name: BABU T T\n\nGender: M\n\nDate of Birth: 12-10-1964\n\nAddress: THAREPARAMBIL HOUSE\n\nPincode: 683101\n\nPhNo: nan\n\nAdmission Date: 01-11-2011\n\nDischarge Date: 03-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vitals stable. s/p amputation of the 2nd digit, maceration at the base of the big toe. Pus culture taken.\r\nadmit for I.V antibiotics\nvital stable\r\nSleeping\nGC better.No evidence of sepsis.Blood sugar controlled.Plan to consult Dr.Bhatt.\nSeen by Dr.A.K.Bhat.\r\nLeft foot small ulcer is clean.Right big toe superficial ulcer is clean.Adviced offloading&daily dressing.\nfeels well. seen by DR Bhatt. discharge today\n'}, {'role': 'model', 'content': 'IP Number: 131\n\nPatient Number: 3168\n\nAdmission Date: 01-11-2011\n\nDischarge Date: 03-11-2011\n\nDiagnosis: Osteomyelitis of the Rt 2 nd digit- s/p amputation of the 2nd digit- Rt foot\n\nClinical Exam(With BP): admitted with swelling of the RT foot and small ulceration at the base of the big toe\n\nSystolic BP: 130.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Babu T.T , 47 yrs old with H/O Type 11 DM , old Pulmonary TB, S/p amputation of the 2 nd digit - 3 weeks ago, admitted with swelling of the Rt foot along with maceration at the base of the big toe , next to the amputated stump.\r\nStarted on I.V antibiotics and seen by surgeon Dr Bhatt\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 10\n\nPatient Number: 243\n\nPatient Name: CHANDRIKA\n\nGender: F\n\nDate of Birth: 02-11-1949\n\nAddress: 8 E ASTER SKYLINE APPARTMENTS\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 03-08-2011\n\nDischarge Date: 09-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nDIABETIC NEUROPATHY\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for Disarticulation of Distal Phalengeal joint ,\r\nInj.Microtaz 4.8g i.v stat\r\nInj.TT o.5ml \r\nContinue the Insulin as prescribed\r\nPrepare the part \r\nCT/BT/PT\nCounsious , shifted from post op, unventfull, Vital sable, \r\nNovorapid 26-26-26\r\nLantus 20\r\n7:00Pm Febrile, Tab.Paracetamol stat\r\nUrine Routine, Inj.Amikacin 250mg i.v stat\r\n\nHad one spike of fever yesterday night, pain relived with Inj.Tramadol, urine routine,\r\nPhysiotherapy evalaution for passive range of motion.\r\n7:OOPM s/B Dr.A.K.Bhatt adviced to continue the same medication . During evening round Vital stable , No Pain , Dressing Dry , Output Good \r\n\nSeen by Dr.A.K.Bhat\r\nAfebrile now.No dressing soakage.Continue treatment.Plan for change of dressing tomorrow.\nNo Fever,No Pain , No Hypos,Comfortable, Dreesing Change today\r\nRs-Occtional Rhonchi\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Drain removed.The suture line of rt big toe looks clean.\r\nAdvice:Continue treatment.\r\n6:30pm Feeling Nausea, decresed appititte\r\nPrelunch -279 , Insulin 28units given , Vital stable \r\nFollow thw advice\ns/b Dr.Bhatt wound healing, s/b Dr.Ramesh Nair want to give Duolin Neb, its not available , adviced to continue the Asthalin +Budocort for time being\r\nVital stable , RS-Rhonchi+, GC-Fair.\r\nFollow the same advice\nvitals- stable, AC- 144, NOvorapid 26 units s/c given.\r\nDressing change and drain removed by DR Bhatt yesterday.\r\nc/o pain abdomen yesterday, and Nausea better today.\r\nPlan- Rpt ultrasound abdomen,\r\nprobable urology consultation.\r\nSeen by Dr.A.K.Bhat.\r\nNo pain.\n4:00pm :Afebril,Higer mental function Normal, B.p 130/80, RS-Rhonchi, CVS-S1S2 Normal ,\nVitals stable. c/o difficulty breathing, seen by pulmonary , suggested Duolin nebulisation. No abdominal discomfort present. Dressing change today by Dr bhatt\r\nRS- B/L wheeze.\r\nAC- 213\r\npre- dinner- 127\r\n\r\nSeen by DR.A.K.Bhat\r\n\r\nDressing changed.The suture line of rt big toe looks clean.Suggested oral antibiotic from tomorrow.\n5:00pm -Insulin infusion on , RS-Rhonchi, Vital stable \r\nfollow the Orders\r\nTommrow Urology , Pulmonologist consultation \r\nXray - Haziness over the Lower zone -Both side\nSeen by Dr.A.K.Bhat\r\nNo pain.Continue treatment.\r\nchest- B/l rhonchi and wheeze\r\nUltrasound of the abdomen- post residual urine- 500ml,\r\nRt hydronephrosis\r\nUrology consultation\r\nPulmonary consultation.\r\npre-dinner- 395(8/8)\r\nPre- lunch- 373.\r\nAC- 291\nCase seen by Dr. Ramesh Nair ON 8/8/2011 at 6.00 PM \r\n Foracort MDI BD\r\n LEVOLIN MDI TID & SOS\r\n Tab Deriphylline Retard 150mg BD \r\n OPD Review\r\n\nChronic retention of urine- \r\nuncontrolled Diabetes.\r\nrecurrent persistent UTI.\r\nAltered renal function.\r\n\r\nadvise: catheterisation of bladder for continuous drainage.\r\nControl of UTI with C& S antibiotic.\r\nStart on Prulifloxacin 600 mg OD for 7 days.\r\nRepeat USG to review hydronephrosis.\r\n10:30am Cath bladder , on insulin pump, vital stable , Rs Rhonchi +, stop infusion at 1pm given 30units novorapid just 30min before stoping . planned discharge after Dr.A.k.Bhatt\r\n\r\nSeen by Dr.A.K.Bhat\r\nDressing changed.The suture line of rt big toe looks clean.\r\nAdviced dressing change once in two days with metrogyl gel.\r\nReview for suture removal on 15th monday.\n'}, {'role': 'model', 'content': 'IP Number: 10\n\nPatient Number: 243\n\nAdmission Date: 03-08-2011\n\nDischarge Date: 09-08-2011\n\nDiagnosis: Chronic UTI \r\nMild Hydro urtretro Nephrosis\r\n? VUF\r\nOesteomyleitis of the Rt Big toe\r\n\n\nClinical Exam(With BP): Admittede for the Terminal Phalengeal Excision and bone curretage for Oesteomylitis of Rt Great toe, \r\nSurgery done under local anaesthesia, under antibiotic cover, She developed Excerbation of COPD durning \r\nHospital stay,seen by pulmonologist , adviced Brochodilator . Her Insulin requirment is going high , c/o Pain abd domen \r\nin view of Chronic UTI ,did USG Abd , shows Mild HydroureteroNephrosis, significant PRV, suggestive VUF, sought a Urology\r\nconsultation , adviced Bladder cathterisation , Antibiotic, Rpt culture/USGAbd after 10days, \r\nadjusted the dose of insulin . planned to titre the dose as per SMBG Reading\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: urgery done under local anaesthesia, under antibiotic cover, She developed Excerbation of COPD durning \r\nHospital stay,seen by pulmonologist , adviced Brochodilator . Her Insulin requirment is going high , c/o Pain abd domen \r\nin view of Chronic UTI ,did USG Abd , shows Mild HydroureteroNephrosis, significant PRV, suggestive VUF, sought a Urology\r\nconsultation , adviced Bladder cathterisation , Antibiotic, Rpt culture/USGAbd after 10days, \r\nadjusted the dose of insulin . planned to titre the dose as per SMBG Reading\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for skin gafting\nVenous doppler -Tomrrow\r\nPR-80\r\nB.P 150/80\r\nCVS-S1S2 Normal \r\nRS-Clear\r\nCNS-Consious / Oriented \r\nPA-NAD\r\nContinue the same\nS/B Dr A.K.Bhat\r\nAdd Inj. Enoxaparin 60mg s/c B.D\r\nBlood Routine\r\nXray chest PA\r\nECG\r\nRFT\r\nLFT\r\nPlan for Skin grafting for tuesday morning\r\n\nVital stable, systemic examionation -NAD\r\nDoppler Venous \r\nContinue the same\nBlood transfusion \r\n1unit PCV\r\nInj.Lasix 20mg i.v stat\r\n\tinj.Avil 1amp i.v stat\r\ntransfusion on flow \r\nvital stable \r\nContinue the same\nital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\n1units over at 2am , No rxn, \r\n2nd unit\r\nBlood tranfusion \r\n1unit\r\nPremedication\r\nInj.Avil 1amp i.v / Inj.Dexona sos\r\ncontinue the same\r\n\r\nVital stable \r\nConinue the same\r\nPBF/Iron profile awaited\r\nContinue the same\nHb/PCV\r\nTransfusion over , No rxn, vital stable\nSeen by Dr.AK.Bhat.\r\nFor SSG left foot&skin biopsy under SA on 1-11-2011.Get consent.C&D left foot.Shave genitalia&left thigh&betadine scrub HS&CM.Medical fitness for the procedure.IV antibiotics Inj.Microtaz 4.5 gm IV HS&CM.\r\n\r\nVITAL STABLE, NPO,FOLLOW THE DR.BHATT ORDRES\r\nHIGH RISK CONSENT\nVITAL STABLE,CONTINUE SAME\nPR-98/min\r\nB.p-124/67mmof Hg\r\nCVS-S1S2 Normal\r\nRS RR-24/min \r\nCNS-Consious /Oriented \r\nPA-Soft , NAD\r\nPain Better\r\nContinue the same\r\nInj.Fortwin 1amp / Phenargan 1/2 amp slow i.v sos\r\nTab.Nitreset sos\nVomitted once , C/o breathlessness\r\nSpo2 94%, PR-90/min, B.P120/80mof Hg\r\nCVS-S1S2 normal\r\nRS-NVBS\r\nCNS-Consious /Oriented\r\nInj.Pantodac 40mg IV\r\nInj.Emeset I.v \r\nCombimist Neb+derinide Neb stat\nGC better.Pt can be shifted from ICU.BP normal.\nSeen by Dr.A.K.Bhat.\r\nSome pain left thigh.Continue trt.\r\nC/o pain in th thigh and headache\r\npulse 0x at 12 am\nVitals stable. No pain at present\r\nPLan- Hold on the warfarin for now and start later.\nSeen by Dr.A.K.Bhat.\r\nFor change of dressing in OT tomorrow.\nVital stable, Continue the same\r\nContinue the same\nBetter\r\ndoing well\r\nRegular with Medication\r\nContinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.SSG left foot has taken up.The donor site left thigh is clean.\r\nSuggested oral antibiotic.\nC/o Breathlessness\r\nC/o Abdomen discomfort\r\nFBS-111\r\nINR-1\r\nVital stable\r\nRS-Clear\r\nCVS-S1S2 Noraml\r\nMild odema over the Foot\r\nStoped tab.Deriphylline\r\nAxipan\r\nAdded tab.ravera D 1-0-1\r\nSyp.Sucrafil 10 ml 1-1-1\r\nContinue the same\nVital stable\r\nno specific complaint\nSeen by DR.A.K.Bhat.\r\nAfebrile.Continue trt.For change of dressing on wednesday.\nvital stable\r\nPT/INR-1.1\r\nContinue the same\r\nIncresed the warf 5mg 1-1-1\r\ncontinue the asame advice\nDoing fine. Not to ambulate as yet. No anitibiotics on board.\r\nPT/ INR tomorrow.\nfine\r\nHB, PCV, PT/INR\nSeen by Dr.AK.Bhat.\r\nDressings changed.The SSG left foot is settling well.The donor area left thigh healing well.\r\nVitals stable. will discharge only on saturday\nSeen by Dr.A.K.Bhat.Status better.No pain.Plan for discharge on saturday.\r\nTab.Deslar 5mg for cold st\nGC better.Slept well.Stool passed.Vitals stable.Continue the same.\r\nSeen by Dr.A.K.Bhat.Continue trt.\nSeen by Dr.A.K.Bhat.Dressings changed.Donor site fully healed.SSG taken up.\r\nAdvice on discharge:Dressing change left foot twice a week-Cuticell/pad/crepe bandage.Vaseline to left thigh thrice a day.Partial weight bearing left leg.Review after 2 weeks.\n'}, {'role': 'model', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis: Essential (primary) hypertension (I10)\r\nTYPE 2 DIABETES MELLITUS (SL13)\r\nDIABETIC FOOT-Necrotising Fascitis\r\n ?FILARIASIS-RT\r\nGlaucoma\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis \r\n\r\n\n\nClinical Exam(With BP): Admitted for grafting of the ulcer on the dorsum of the LT foot\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, obese, not in any resp distress\r\nRS- NVBS\r\nCVS- S1 S2 heard\r\nAbdomen- Normal\n\nDiscussion: Pt admitted for skin grafting of the ulcer on the dorsum of the Lt foot. Venous doppler was done- Thrombosis of both the femoral and popliteal vein. Pt was started on Low molecular Wt heparin. Pt was noted to have low HB, investigation were done and was transfused 2 units of PRBC , SSG was performed on 1/11/2011, with the graft taken from the Lt thigh. skin biopsy was taken from one of the impetiginous lesion.\r\nPt was started on I.V antibiotics, insulin basal bolus regimen, started on Tab Warfarin, while continuing on the inj low molecular wt heparin. INR therapeutic, and heparin stopped.\r\n\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nPatient Name: SAJITH KUMAR\n\nGender: M\n\nDate of Birth: 14-04-1968\n\nAddress: CHELAYIL HOUSE, NEAR K.S.E.B\n\nPincode: 682005\n\nPhNo: nan\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC RETINOPATHY\nDIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Blood sugars are 634 mg/dl. Patinet is comfortable. Vitals are fine.\nConsious , oriented , febril , HR-82, BP- 150/90 RS-B/l Basal crepitation , Cvs -JVP Elevated , S1,S2 Normal \r\nAdviced Tab.Welset sos, Planned Cardiology consultation tommrow, statrt Inj.Metrogyl 100 i.v 1-1-1, Tab.Levofloxacin 500mg . Surgical Debridement on friday\nFebrile,Vital stable, Continue the same medication , prepare for the wound debridement under local \r\n\nTemp-99.2, PR-82, BP-130/80, Systemic Examination -NAD \r\nAdviced ECG/XrayChest -PA Veiw, \r\nadjusted the insulin dose, inform Prelunch, predinner, continue othe medication as Advice \r\nInform OT Staff,\nGeneral condition better. Slept well. Passed stools. Scheduled for debridement today. AC- 140 mg /dl. To be shifted to the recovery/ ICU at 9AM\r\n\r\n29/07/2011\r\nOperation done....\r\nSlough Excision of Right Heel Ulcer done under L/A.\r\nAfter adequate preparation and draping, the Ulcer slough was Excised For about 2X2 inches.\r\nThe slough did not seem to extend to the bone.\r\nThe Residual Ulcer after Excision, Bleeding was satisfactory.\r\nUlcer Haemostasis achieved.\r\nABGEL and Compression Dressing given.(DR. A.K. Bhat).\r\n\r\nPOST OPERATIVE ORDERS/INSTRUCTIONS:\r\n\r\nStrict Right Leg Elevation and Bed Rest.\r\nTPR/BP Monitoring.\r\nWatch For Bleeding.\r\nContinue IV Antibiotics.\r\nInject. Tramadol IM S.O.S\r\nPlanned for change of dressing in Recovery Room 31/07/2011.\r\n\nSeen by Dr.A.K.B\r\nPt afebrile.\r\nAdvice no wt.bearing on rt.leg .\r\nFor C/D tomorrow in OT Recovery.\npt alert, had an episode of hypoglycemia yesterday, ( sweating) GRBS- 86 .\r\nNo fever, chills\r\nPost debridement yesterday, No pain\r\ndressing tomorrow.\r\n\nSeen by Dr. A.K.Bhat and Dr. Tom Babu.\r\nDressings have been changed.\r\nThe Ulcer of the Right Heel looks CLEAN.\r\nNo Residual Pus or Slough.\r\nNo Evidence of Cellulitis.\r\n\nNo fever, No pain, Vitals stable, Dressing done yesterday, switched to oral antibiotics\nNo complaints, vitals stable,dressing to be done today by DR Bhatt, Intend to discharge tomorrow.\r\nAC- 93, Insugen R 24 units given. Midnight GRBS- 130\r\n10:00am Doing well, No Hypos, awating for surgeon for dreesing , adjusted the insulin dose according to the GRBS, planned discharge\r\n2:00pm s/b Dr.A.K.Bhatt , dressing changed , ulcer of the Rt heel looks clean except for some slough of the floor , part of which excised , Abgel compression dressing given , surronding skin and soft tissue inflamation subsided, continue the same Treatment .\r\n\nVital stable,GC-Better,Systemic Examination-NAD\r\nPredinner -165, adviced InsugenR 22units , Insugen N 26units at bed time \r\nPlanned discharge on 4/08/2011\nAfebrile, No pain, AC- 160, Insugen R 24 units given\r\nSeen and dressing change done by Dr A.K. Bhatt yesterday,\r\nDressing to be changed tomorrow again and Intend to D/c tomorrow.\nSeen by Dr.A.K.Bhat\r\nDressing changed.The ulcer right heel looks clean.\r\nAdvice:Dressing change as OP once in two days.No weight bearing on ulcer area.Oral antibiotics for one week.\nVital stable ,one episode of hypoglycemia , Dressing change today, continue the same\n'}, {'role': 'model', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis: Infected Non Healing Ulcer\n\nClinical Exam(With BP): 43 yr old with H/O DM admitted for Infected non healing Ulcer. S/P debridement of the the ulcer by DR A.K.Bhatt on 29-07-2011.\r\nTreated with Broad spectrum I.V Antibiotics , and tight control of sugar by basal insulin( INsugenN ) and three time regular insulin ( InsugenR).\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: lab results attatched\n\nXray findings: nan\n\nDiscussion: Controlled blood sugar with Basal bolus regimen, under antibiotic cover, wound debridement done , adviced to continue the insulin , off loading , regular dressing\n\nDiet: \r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 80\n\nPatient Number: 2962\n\nPatient Name: T N PARAMESWARAN\n\nGender: M\n\nDate of Birth: 26-09-2018\n\nAddress: NO.14 ,PALMGREEN VILLAS,KUNJANBAWA ROAD\n\nPincode: 682019\n\nPhNo: 3259391\n\nAdmission Date: 26-09-2011\n\nDischarge Date: 03-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 6:30PM Better,vital stable, Spo2 98% with 2l o2\r\nWithhold Solumedrol \r\nContinue others\r\nMucomix Nebulization ,\nK/C/O Type 2 Diabetes Mellitus / Hypertension , Had Hypoglycemia This morning, Had vomited once, \r\nPR-60%, B.P -160/80mmof Hg , RS-Diffuse Rhonchi, SPo2 60%, Consious Oriented , Plantar Down going, \r\nInj .Hydrocortisone 100mg i.V stat, Combist Nebulization stat, Rpt after 5min , Inj.Levoflox 100ml i.V stat, Budocort Nebulization , Inj.Deriphylline I.V stat,\r\n9:00AM C/O B.P 190/80 Started on NTG 3microdrops, taper of acc B.P \r\n12:00PM\r\nBetter, Vital stable, Changed to Nasal prongs, O2 2l/min \r\nContinue the NS\r\nWithhold the Salumedrol in the afternoon\r\nLiquid Diet\r\nInsugen R 4units at 3pm (confoirm the dose)\nBetter, vital stable, Spo2 93% with O2\r\nRs-Rhonchi+, Better compare to yesterday\r\nFBS-70mg/dl\r\nfollow the orders\r\nShift to room after Rounds\r\nXray Chest \r\nPulmonology consultation\r\nCBC, Na, K,\nS/B DR.KMR\r\nVital stable, Spo2-95 with 1L/min O2\r\nContinue the Antibiotic, Good chest physio\r\nAnd O2 to maintain Spo2 >/- 95%\r\nTab.Bidenzen forte 1-1-1\r\nReview after 2days after 2day with Fresh Xrays\nVitals stable., No fever. had an hypoglycemic episode\r\nduring the night GRBS- 40, was given D5NS during the night.\r\nRS- B/L creps\nlow grade fever in the afternoon. started on eurepa.\r\nRS- b/l rhonchi and creps\nHypoglycemia in the evening 6:30pm, Better with carbohydrate\nVitals stable, slept well, still c/o cough- not able to bring the phlegm out.\r\nChest- B/L rhonchi and creps\r\nRpt CXR today, Pulmonary Evaluation today\nFine, continue the same\r\nXray chest -PA\nS/B Dr.KMR\r\nVital stable\r\nRs-Few crepitation on Both infrasapular region\r\nSpo2 96%\r\nXray Chest -Shows good Clearence\r\nMay be discharge\r\nAdvice to continue\r\nTab.Microcef CV250 1-0-1 for 7days\r\nTab.Deriphylline retard 150mg 1-0-1 x 7dats\r\nBidenzen forte 10mg 1-1-1 x7days\r\nSALBAIR I R/C 1-0-1\r\nFORAIR 250mcg R/C 1-0-1\r\nR/a 7days\r\n\nSlept well. Vomited once early in the morning. Blood sugars are well controlled. Scheduled for discharged tomorrow.\r\nbetter, Vo0mitted in the morning\r\nTab.Ravera D 1-0-1 1/2 before food\r\nBilurubin\r\nSGOT/SGPT\r\nHB\r\nPCV\nVitals stable. C/0vomtting x 2 times\r\nECG - taken\n'}, {'role': 'model', 'content': 'IP Number: 80\n\nPatient Number: 2962\n\nAdmission Date: 26-09-2011\n\nDischarge Date: 03-10-2011\n\nDiagnosis: Aspiration Pneumonia\n\nClinical Exam(With BP): Admitted with Breathlesness, fever.\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, was in resp distress\r\nRS- B/L rhonchi\r\nCVS- S1 S2 heard\n\nDiscussion: 93 yr old with shortness of breath , fever, Was admiited to the ICU because of hypoxic, later recovered. Pt was treated for Aspiration Pneumonia with I.V antibiotics, Combimist Nebs, steroid nebulisation, chest physiotherapy. His insulin regimine was adjusted because of repeated Hypoglycemia\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, diabetic diet with small, frequent feeds adviced\r\nDiet booklet given\n'}]

[{'role': 'user', 'content': 'IP Number: 48\n\nPatient Number: 1082\n\nPatient Name: LILLY MARIAM\n\nGender: F\n\nDate of Birth: 12-01-1939\n\nAddress: PANAMPURAM HOUSE, FATHIMA CHURCH LANE\n\nPincode: 682020\n\nPhNo: 0484 - 2205197\n\nAdmission Date: 05-09-2011\n\nDischarge Date: 07-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY\nDIABETIC RETINOPATHY\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Patient was brought in an unconcious state. 25 %D given IV. \r\nGRBS at arrival was 35 mg/dl. With dextrose pushed blood sugar rose to 90 mg/dl.\nBetter, Vital stable, Consious oriented , Systemic examination -NAD\ncomfortable, afternoon GRBS 300 plus, Vital stable, \r\nC/o Burning sensation , adviced tab.Ravera D 1-0-0 1/2 hr before food\n'}, {'role': 'model', 'content': 'IP Number: 48\n\nPatient Number: 1082\n\nAdmission Date: 05-09-2011\n\nDischarge Date: 07-09-2011\n\nDiagnosis: Severe Hypoglycemia\r\nHyperuresimia\r\nCOPD\n\nClinical Exam(With BP): k\\c\\o DM, Glaucoma ,Mild NPDR. Hypothyroid on replacement .Admitted with sever hypoglycemia , treated with I. V Dextrose\r\nfully recoved , stoped NPH, adjusted on Regular insulin .\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: k\\c\\o DMtype2 on Basal bolus, Glaucoma ,Mild NPDR .Admitted with sever hypoglycemia , treated with I. V Dextrose\r\nfully recoved , stoped NPH, adjusted on Regular insulin . Discharge in a stable state\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for skin gafting\nVenous doppler -Tomrrow\r\nPR-80\r\nB.P 150/80\r\nCVS-S1S2 Normal \r\nRS-Clear\r\nCNS-Consious / Oriented \r\nPA-NAD\r\nContinue the same\nS/B Dr A.K.Bhat\r\nAdd Inj. Enoxaparin 60mg s/c B.D\r\nBlood Routine\r\nXray chest PA\r\nECG\r\nRFT\r\nLFT\r\nPlan for Skin grafting for tuesday morning\r\n\nVital stable, systemic examionation -NAD\r\nDoppler Venous \r\nContinue the same\nBlood transfusion \r\n1unit PCV\r\nInj.Lasix 20mg i.v stat\r\n\tinj.Avil 1amp i.v stat\r\ntransfusion on flow \r\nvital stable \r\nContinue the same\nital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\n1units over at 2am , No rxn, \r\n2nd unit\r\nBlood tranfusion \r\n1unit\r\nPremedication\r\nInj.Avil 1amp i.v / Inj.Dexona sos\r\ncontinue the same\r\n\r\nVital stable \r\nConinue the same\r\nPBF/Iron profile awaited\r\nContinue the same\nHb/PCV\r\nTransfusion over , No rxn, vital stable\nSeen by Dr.AK.Bhat.\r\nFor SSG left foot&skin biopsy under SA on 1-11-2011.Get consent.C&D left foot.Shave genitalia&left thigh&betadine scrub HS&CM.Medical fitness for the procedure.IV antibiotics Inj.Microtaz 4.5 gm IV HS&CM.\r\n\r\nVITAL STABLE, NPO,FOLLOW THE DR.BHATT ORDRES\r\nHIGH RISK CONSENT\nVITAL STABLE,CONTINUE SAME\nPR-98/min\r\nB.p-124/67mmof Hg\r\nCVS-S1S2 Normal\r\nRS RR-24/min \r\nCNS-Consious /Oriented \r\nPA-Soft , NAD\r\nPain Better\r\nContinue the same\r\nInj.Fortwin 1amp / Phenargan 1/2 amp slow i.v sos\r\nTab.Nitreset sos\nVomitted once , C/o breathlessness\r\nSpo2 94%, PR-90/min, B.P120/80mof Hg\r\nCVS-S1S2 normal\r\nRS-NVBS\r\nCNS-Consious /Oriented\r\nInj.Pantodac 40mg IV\r\nInj.Emeset I.v \r\nCombimist Neb+derinide Neb stat\nGC better.Pt can be shifted from ICU.BP normal.\nSeen by Dr.A.K.Bhat.\r\nSome pain left thigh.Continue trt.\r\nC/o pain in th thigh and headache\r\npulse 0x at 12 am\nVitals stable. No pain at present\r\nPLan- Hold on the warfarin for now and start later.\nSeen by Dr.A.K.Bhat.\r\nFor change of dressing in OT tomorrow.\nVital stable, Continue the same\r\nContinue the same\nBetter\r\ndoing well\r\nRegular with Medication\r\nContinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.SSG left foot has taken up.The donor site left thigh is clean.\r\nSuggested oral antibiotic.\nC/o Breathlessness\r\nC/o Abdomen discomfort\r\nFBS-111\r\nINR-1\r\nVital stable\r\nRS-Clear\r\nCVS-S1S2 Noraml\r\nMild odema over the Foot\r\nStoped tab.Deriphylline\r\nAxipan\r\nAdded tab.ravera D 1-0-1\r\nSyp.Sucrafil 10 ml 1-1-1\r\nContinue the same\nVital stable\r\nno specific complaint\nSeen by DR.A.K.Bhat.\r\nAfebrile.Continue trt.For change of dressing on wednesday.\nvital stable\r\nPT/INR-1.1\r\nContinue the same\r\nIncresed the warf 5mg 1-1-1\r\ncontinue the asame advice\nDoing fine. Not to ambulate as yet. No anitibiotics on board.\r\nPT/ INR tomorrow.\nfine\r\nHB, PCV, PT/INR\nSeen by Dr.AK.Bhat.\r\nDressings changed.The SSG left foot is settling well.The donor area left thigh healing well.\r\nVitals stable. will discharge only on saturday\nSeen by Dr.A.K.Bhat.Status better.No pain.Plan for discharge on saturday.\r\nTab.Deslar 5mg for cold st\nGC better.Slept well.Stool passed.Vitals stable.Continue the same.\r\nSeen by Dr.A.K.Bhat.Continue trt.\nSeen by Dr.A.K.Bhat.Dressings changed.Donor site fully healed.SSG taken up.\r\nAdvice on discharge:Dressing change left foot twice a week-Cuticell/pad/crepe bandage.Vaseline to left thigh thrice a day.Partial weight bearing left leg.Review after 2 weeks.\n'}, {'role': 'model', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis: Essential (primary) hypertension (I10)\r\nTYPE 2 DIABETES MELLITUS (SL13)\r\nDIABETIC FOOT-Necrotising Fascitis\r\n ?FILARIASIS-RT\r\nGlaucoma\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis \r\n\r\n\n\nClinical Exam(With BP): Admitted for grafting of the ulcer on the dorsum of the LT foot\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, obese, not in any resp distress\r\nRS- NVBS\r\nCVS- S1 S2 heard\r\nAbdomen- Normal\n\nDiscussion: Pt admitted for skin grafting of the ulcer on the dorsum of the Lt foot. Venous doppler was done- Thrombosis of both the femoral and popliteal vein. Pt was started on Low molecular Wt heparin. Pt was noted to have low HB, investigation were done and was transfused 2 units of PRBC , SSG was performed on 1/11/2011, with the graft taken from the Lt thigh. skin biopsy was taken from one of the impetiginous lesion.\r\nPt was started on I.V antibiotics, insulin basal bolus regimen, started on Tab Warfarin, while continuing on the inj low molecular wt heparin. INR therapeutic, and heparin stopped.\r\n\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': "IP Number: 79\n\nPatient Number: 2939\n\nPatient Name: SANTHOSH M N\n\nGender: M\n\nDate of Birth: 24-05-1970\n\nAddress: ARUNODAYAM, TAGORE NAGAR,\n\nPincode: 682306\n\nPhNo: 0484 - 2782800\n\nAdmission Date: 26-09-2011\n\nDischarge Date: 27-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Human mixtard 12units at night, C-Peptite report awaited\ndiabetic since age 29 yrs.\r\nWas put on insulin\r\nRecently on Insulin ,has flictuating blood sugar, frequent hypo's in mid afternoon\r\nCurrent Meds- human mixtard 25-0-15\r\nTab Atorvasatin 0-1-0\r\nNo increase or decrease in wt\r\nNo polyuria/polyphagia\r\nBluring of Vision- Yes\r\nBurning sensation of the feet- No\r\nDyslipidemia - Yes\r\nHTN- No\r\nCOronary artery Disease- No\r\nPersonal history-\r\nMother- DM since age 75 yrs\r\nalcohol- Occasionaly\r\nSmoking - No\r\n\n"}, {'role': 'model', 'content': "IP Number: 79\n\nPatient Number: 2939\n\nAdmission Date: 26-09-2011\n\nDischarge Date: 27-09-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): admitted with knee pain- severe x 1 week and fluctuating blood sugar\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Young male, not in any distress\r\nSystemic Exam- Normal\n\nDiscussion: 41 yr old with H/o Diabetes Mellitus admitted with Fluctuating blood sugar.\r\nDuring the Stay, he was monitored closely with GRBS ,and Insulin dose was adjusted . He was started on Oral meds as well ( Tab Metformin and Pioglitazone). C- Peptide level was sent. results still pending\r\nHe had a full comprehensive check up for his Diabetes during the admission.\r\nFor knee pain, he had an X-ray of the Knee taken which was negative and treated with NSAID's\n\nDiet: DEPT OF NUTRITION:\r\n\r\nLow calorie low fat Diabetic diet advised.\n"}]

[{'role': 'user', 'content': 'IP Number: 45\n\nPatient Number: 1275\n\nPatient Name: SULEKHA K.K\n\nGender: F\n\nDate of Birth: 19-02-1949\n\nAddress: ARACKAPARAMBIL HOUSE, NETTOOR P.O\n\nPincode: 682304\n\nPhNo: nan\n\nAdmission Date: 03-09-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for iv anitbiotics and strict glycemic control.\r\nSeen BY DR A.K bhatt, ? abscess, due to infected hair follicle\r\nADviced GM dressing\r\nI.v antibiotics\r\nantifungal for in between the toes.\r\n\nSeen by Dr.A.K.Bhat\r\nThe pustule was deroofed&pus drained.Sent fr C/S.The deeper dermis looks viable.Adviced daily tbact dressings.\nVitals stable.AC slightly high,GM dressing done, ? abscess still not ruptured. \r\nwill speak with the surgeon the need for possible incision.\r\nNo fever\n'}, {'role': 'model', 'content': 'IP Number: 45\n\nPatient Number: 1275\n\nAdmission Date: 03-09-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis: Cellulitis Lt lower limb\n\nClinical Exam(With BP): admitted for swelling in the dorsum of the Lt foot, along with ? redness along with a small pustule on the ant aspect of the Lt leg\n\nSystolic BP: 100.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, not in any distress\r\nLt leg- anterior aspect, small pustule surrounding redness, swelling on the dorsum of the lt leg\n\nDiscussion: 62 yr old with H/o Dm, admitted for swelling in the dorsum of the Lt foot and small pustule in the Lt leg. Pt was started on I.V antibiotics, seen by surgeon Dressing done, a small incision and drainage was done. Pus culture taken\r\n\n\nDiet: NUTRITION Dept:\r\n1700 kcal, low fat, diabetic diet adviced\r\nNutrition booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 135\n\nPatient Number: 200\n\nPatient Name: PADMANABHAN .P.M\n\nGender: M\n\nDate of Birth: 05-06-1950\n\nAddress: H NO 81, POORNIMA, EROOR SOUTH P.O\n\nPincode: 682306\n\nPhNo: 9048781538\n\nAdmission Date: 07-11-2011\n\nDischarge Date: 16-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nDIABETIC RETINOPATYH WITH NPDR\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: fine\r\ncontinue the same\nscany discharge from the wound,swelling prsent\r\ncontinue the same\nCellulitis better but pus is seen on putting pressure. X- ray Rt foot.\r\nsurgery consultation today.\nSeen by Dr.AK.Bhat.\r\nH/O injury right foot 10 days ago.C/O pain&swelling. Numbness 2nd toe.O/e:Cellulitis right foot.Sinus discharging pus(C/S Taken) base of 2nd toe.?subcut.necrosis.Xray no e/o bone/joint problem.Adviced continue IV antibiotics.C&D done.May need I&D/slough excision under LA.Will decide tomorrow.\nCheck CRP, TC -Today\r\nFollow up C/S-Pus\r\nProced as per dr.A.K.Bhat\r\n\r\n\nSeen by Dr.A.K.Bhat.\r\nC&D done.The sinus rt.foot pus discharge is less.Cellulitis less.Metrogyl gel instilled.Continue trt.\r\nTab.Afenac Plus stat\nGC better.Slept well.Continue the same.\r\nSeen by Dr.A.K.Bhat.\r\nPus discharge decreased.Continue trt.\npain better\r\nfair glycemic control\r\ncontinue the same\r\nC/S-No growth \r\nstop Antibiotic.\r\nSeen by Dr.A.K.Bhat.\r\nNo soakage. continue trt.\nSeen by DrA.K.Bhat.\r\nC&D done.Ulcer base of rt.2nd toe clean except for some slough which was excised.Plan for discharge on wednesday.\nfair glycemic contol\r\nVital stable\r\nAntibiotic to be decided \r\ncontinue the same\r\nProbabaly for Discharge\r\n\nVitals atable. will do dressing tomorrow, and Intend To D/c tomorrow\nfine\r\nvital stable \r\ncontinue the same\r\n\nDoing fine. Scheduled for discharge today.\ngg\n'}, {'role': 'model', 'content': 'IP Number: 135\n\nPatient Number: 200\n\nAdmission Date: 07-11-2011\n\nDischarge Date: 16-11-2011\n\nDiagnosis: Cellulitis Rt Foot\n\nClinical Exam(With BP): nan\n\nSystolic BP: 120.0\n\nDiastolic BP: 90.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nSystemic Exam- Normal\n\nDiscussion: Mr.Padmanabhan 61yrs old was admitted with swelling and tenderness of the RT foot along with disharging sinus present at the base of the 2 nd toe. Pt was started on Insulin Basal bolus regimen and I.V antibiotics. ulcer/ sinus foot plantar base of 2nd toe was explored on 12/11/11.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 67\n\nPatient Number: 2893\n\nPatient Name: GEORGE M.X\n\nGender: M\n\nDate of Birth: 12-02-1962\n\nAddress: MANAKKIL HOUSE,PANAMPILLY NAGAR P.O\n\nPincode: 682036\n\nPhNo: 0484-3019988\n\nAdmission Date: 19-09-2011\n\nDischarge Date: 21-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Alcoholic cirrhosis of liver\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Patinet was admitted with polyuria and polydipsia for sugar control.\nViatal stable, compensatory liver failure, Novorapid 16units, Insugen N 18units\r\nContinue the same\nVital stable, passed motion , adjused the dose of insulin\nVitals stable. GRBS-282\n'}, {'role': 'model', 'content': 'IP Number: 67\n\nPatient Number: 2893\n\nAdmission Date: 19-09-2011\n\nDischarge Date: 21-09-2011\n\nDiagnosis: Chronic liver Disease\n\nClinical Exam(With BP): admitted with fatigue. noted to have high blood sugar. admitted for sugar control\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Young male, not in any distress\n\nDiscussion: 49 yr old H/o chronic liver disease, recently diagnosed DM admitted with high blood sugar, admitted for glycemic control. Pt was put on Basal bolus regimen because of the liver disease.\r\nHe was started on NPH and NOvorapid\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat diabetic diet given\r\nDiet booklet given\n'}]

[{'role': 'user', 'content': 'IP Number: 83\n\nPatient Number: 2735\n\nPatient Name: MAMAN P JOSEPH\n\nGender: M\n\nDate of Birth: 20-09-1931\n\nAddress: VELLAPPATTIL HOUSE,ASRAMAM P O\n\nPincode: 689126\n\nPhNo: 0477 2233681\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Chronic obstructive pulmonary disease, unspecified\nB P H\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fmodern\\fprq1\\fcharset0 Courier New;}{\\f1\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f2\\fswiss\\fprq2\\fcharset0 Arial;}{\\f3\\fnil\\fprq2\\fcharset0 Ms Sans Serif;}{\\f4\\fnil\\fprq2\\fcharset0 MS Sans Serif;}{\\f5\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\qc\\b\\f0\\fs24 ECHO REPORT\\b0 \r\n\\par \r\n\\par \\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\pard\\intbl\\f1 Parameter\\cell Actual mm (%)\\cell Normal mm(%)\\fs22\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl AO \\cell\\cell\\f2\\fs18 25-37 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LA\\cell\\cell\\f2\\fs18 19-40 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl Epss\\cell\\cell\\f2\\fs18 < 8 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl IVSD\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDd\\cell\\cell\\f2\\fs18 35-52 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVPW\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDs\\cell\\cell\\f2\\fs18 24-42 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl EF\\cell\\cell\\f2\\fs18 50-70 %\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl FS\\cell\\cell\\f2\\fs18 28-41 %\\f1\\fs24\\cell\\fs20\\row\r\n\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\fs20 Mitral Valve\\b \\b0 : Normal in structure and motion\\b . \\b0 No MVP, no MR\\b \\b0 \r\n\\par \\pard\\fi720\\li1440 E/A is reversed \r\n\\par \\pard\\tx990 \r\n\\par Aortic Valve :\\b \\b0 3 cusps\\b ,\\b0 normal\r\n\\par \r\n\\par Pulmonary Valve : Normal\r\n\\par \r\n\\par Tricuspid Valve : Normal\\b ,\\b0 no significant TR\r\n\\par \r\n\\par \\pard\\fi-2160\\li2160\\tx990 LV : Normal in size and contraction\\b .\r\n\\par \\b0 No RWMA \\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \\pard\\tx2310 Normal LV systolic function\r\n\\par \r\n\\par \\pard\\tx990 Pericardium : Normal \\tab\\tab \\tab\\tab \r\n\\par \r\n\\par \r\n\\par \\pard Remarks : Normal chamber dimension\\b .\\b0 No RWMA \\b ,\\b0 \r\n\\par Normal LV function. No valvar pathology\\f1\\fs24\\tab \r\n\\par \r\n\\par \\f3\\fs20 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par Dr. Sasi Kumar\r\n\\par Consultant Cardiologyst\\f4 \r\n\\par \\f1\\fs24 \r\n\\par \\f5\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 4:00PM -ADMITTED FOR SKIN GRAFT, THURDAY AFTERNOON 3:00PM\r\nPR-80/MIN \r\nB.P 150/90MMOF HG\r\nSPO2-94%\r\nRS-CREPITATION +\r\nCVS-S1S2NORMAL\r\n\nS/B Dr.KMR\r\nVital stable, Spo2 95%, RS-Few crepitation\r\nXray Chest Basal Haziness( status co)\r\nPFT Tomorrow\nSeen by Dr.A.K.Bhat.\r\nFor SSG under SA on 29-9-2011 3pm.\r\nPreop:Daily Oxum dressing.Plain dressing on day of surgery after cleaning with betadine.Consent.Shave the left thigh&genitalia&betadine scrub.IV antibiotics.Blood R/E to be done.Venous doppler.\nVitasl stable. C/o loss of appetite.\r\nVenous doppler done last month- results attached\n8:00pm Better, PR-80, BP 120/76 Consious oriented \r\nStart orally\r\ncontinue the same\r\nNo Insulin at night\r\nMaintaince I.V fliuids\r\nInj.Tramadol 50mg sos\r\n\nVitasl stable. GRBS- 179. Skin Grafting to be done today.\r\nC/o loss of appetite. PFT done today. Pulmonary Evaluation For pre-op before the surgery\nSeen by Dr..A.K.Bhat.\r\nPain.No soakage.Adviced leg elevation.\r\n7:00PM Painless Haematuria, vital stable, Disscussed with Urologist, USG Abd , Urea ,Creatinine\r\nUrology consultation -Tomorrow\nVital stable, I/O 3000ml/900ml, Rs-Better, Spo2 96%\r\nshift to room\nSeen by Dr. Mohammed Saheed-urologist.\r\nComplaints of hemturia-terminal.\r\nO/E:Abdomen-soft.\r\nDRE-Grade I BPH.\r\nUSG- Normal.\r\nimp: ?Prostatic bleed.\r\nAdv:Cap. Contiflo D OD\r\ntry to avoid sulbactum.\r\nAdequate hydration.\r\nurine C/S.\r\nReview later.\r\n10:00pm\r\nBetter\r\nVital stable, \r\nNo Haematuria in the night\r\nIncresed frequency of urine\r\nContinue the same orders\nVital stable, Discharge if fit\r\nRs -Clear except few creoitation\r\nFormonide 400 respicap 1-0-1\r\nLevolin DPI 1-0-1\r\nTab.Doxobid 400mg 1/2-0-1/2\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The SSG has taken up.\r\nContinue leg elevation.\nc/o lack of appetite. Otherwise doing well. Blood sugars are well controlled.\nSeen by DR.A.K.Bhat.\r\nContinue trt.Stop ceftriaxone.\nc/o loss of appetite, dressing change done yesterday by Dr A.K. bhatt, No hematuria\nSeen by Dr.A.K.Bhat.Dressings changed.The SSG of foot is taken up.The donor site of thigh is clean&healing.Continue leg elevation.\r\n6:00pm Fine, Urine C/S -No growth\r\ncontinue the same, D/c Cannula\r\nPlanned discharge on Thursdays\r\ntab.allegra 120 stat\nVitals stable. No fever, c/o mild pain in the Rt thigh where the skin for grafting was taken. No hematuria\nSeen by Dr.A.K.Bhat.\r\nPain decreased.Continue trt.\nVitals stable ,Blood sugar control,GRBS -124mg/dl\r\nI/O -2200/2000 \r\nPlanned to do Pulmonary consultation before discharge\nSeen by Dr.AK.Bhat.\r\nDressings changed.The right foot SSG is settling well.Thigh donor site is clean&healing.\r\nFeels better. No complaints\nVitals stable,No fever.\nGC better.Blood sugar controlled. Wound healing well.\nSeen by Dr.A.K.Bhat.\r\nPain decreased.Continue trt.\r\nFeels better. C/o gas trouble\nGeneral condition good.\r\nSeen by Dr.A.K.Bhat.\r\nDressings changed.SSG Settling.Donor site healing well.\nfine \r\nDischarge tomorrow\nDischarge today.\nSeen by Dr.AK.Bhat.\r\nDressings changed.SSG settling down.Donor site healed.Adviced:Vaseline to right thigh.\n'}, {'role': 'model', 'content': 'IP Number: 83\n\nPatient Number: 2735\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): Admiited for skin grafting, K/C/O Type2 Diabetes Mellitus, Hypertension, BPH, COPD \r\ndid skin grafting on 29/sep/2010 .Doing well , wound clean ,\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Admiited for skin grafting, K/C/O Type2 Diabetes Mellitus, Hypertension, BPH, COPD \r\ndid skin grafting on 29/sep/2010 .Doing well , wound clean ,Discharge in a stable state\n\nDiet: DEPT OF NUTRITION:\r\n\r\nLow calorie Low fat diet prescribed.\n'}]

[{'role': 'user', 'content': 'IP Number: 7\n\nPatient Number: 2460\n\nPatient Name: ROY K ALIAS\n\nGender: M\n\nDate of Birth: 22-05-1968\n\nAddress: KURUPPAMCHERYIL HOUSE,KUZHIMATTAM.P.O\n\nPincode: 686533\n\nPhNo: 481-2330259\n\nAdmission Date: 03-08-2011\n\nDischarge Date: 05-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 6:00 pm : GRBS -90mg/dl, reduced frequence of monitoring to 3hrly once, if less than 60 , adviced 30min monitoring , and other advice as follow\nPatient is admitted for a 48 hour fast for ruling out hyperinsulinemia (insulinoma) induced hypoglycemia.\nFasting continued ,No Symtomatic Or documented Hypoglycemia , planned continue the 48hr fast\r\ncollect serum for insulin ,C-peptide, Sugar, Growth hormone, cortisol once GRBS less than or equal to 50\r\nBreak the fast only lab confirm the value, or Sever Neurohypoglycemic Symptoms\nvitals stable. will continue NPO till this evening, GRBS- 106, Checked 2-3 hrly\nNo Hypoglycemic episode after 48hr Fast, break the fast, adviced draw a blood for Insulin , c-peptide, Growth Hormone, cortisol , blood sugars \r\nPlaned Opthalmology consultation for Long sight\r\nAdviced diet counselling. Discharge by evening\n'}, {'role': 'model', 'content': 'IP Number: 7\n\nPatient Number: 2460\n\nAdmission Date: 03-08-2011\n\nDischarge Date: 05-08-2011\n\nDiagnosis: Reactive Hypoglycemia \r\n\r\n\n\nClinical Exam(With BP): Pt admitted with history of seizure attack, at that time documented low sugar on the glucometer\r\nH/o Episode of low Sugar after GTT\r\nAdmitted for to rule out Insulinoma v/s Non insulinoma pancreatogenic Hypoglycemia\r\nSubjected for 48hr fasting, No Symptomatic or Documented Hypoglycemia during 48Hr fasting \r\nSerum insulin ,Proinsulin ,Growth hormone report awaited \r\nAdviced to have Complex carbohydrates, avoid simple sugars\r\nPlanned to start 0n Voglibose in view more than 200mg/dl ofter the 2hrs of meal, followed by \r\nsudden drop in sugar just after 1hr. \r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Systemic Examination- NAD\n\nDiscussion: Pt admitted with history of seizure attack, at that time documented low sugar on the glucometer\r\nH/o Episode of low Sugar after GTT\r\nAdmitted for to rule out Insulinoma v/s Non insulinoma pancreatogenic Hypoglycemia\r\nSubjected for 48hr fasting, No Symptomatic or Documented Hypoglycemia during 48Hr fasting \r\nSerum insulin ,Proinsulin ,Growth hormone report awaited \r\nAdviced to have Complex carbohydrates, avoid simple sugars\r\nPlanned to start 0n Voglibose in view more than 200mg/dl ofter the 2hrs of meal, followed by \r\nsudden drop in sugar just after 1hr. \r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 6\n\nPatient Number: 1239\n\nPatient Name: JERYN MATHEW\n\nGender: M\n\nDate of Birth: 12-07-1984\n\nAddress: UTHINKATTIL HOUSE,CUSAT ROAD,CUSAT P.O\n\nPincode: 682022\n\nPhNo: 0484-2544626\n\nAdmission Date: 29-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: pt alert, vitals stable\r\nscheduled for surgery today at 4 pm\r\nNPO\r\nIV fluids\nPatient recovering satisfactorily. No obvious distress. Urine output and virtals are satisfactory.\ns/b DR. C.J. Varghese/ Dr. Tom. Recovery satisfactory. Dye study done, dye going into the duodenum. NO evidence of any leak.\nNo fever, c/o bloated feeling in the stomach, mild pain in the shoulder.\r\nBarium swallow done - No evidence of leakage\r\nOn I.V fluids D5 NS @ 100 ml/hr\r\nI.V microtaz\n7:30pm Doing well, passed motion , pain at the incision site at deep breathing , Vital Stable, PA-Soft, BS-Prsent RS-Clear\r\nFollow the Advice\nc/o episode of difficulty to catch a breath during the night. Vitals stable .oral fluids 30 ml/ hr, on I.V fluids ( RL @ 100ml/hr)\r\nOutput- 2250\r\nInput- 2225\r\nDressing change to today\r\n9:30AM - Doing well, Vital stable , cath insitu , follow the advice\nDoing well,vital and systemic examination NAD pain reduced, D/c cath, planned to increse the fluid intake to 100ml/hr, Maintaince i.v fluids\r\nMobilze the pt as per Physiotherpaist orders\r\nContinue the same orders\r\nintake -2450/2350\nfeels better, Try to ambulate yesterday. passed motion , No pain, some stiffness at the wound site.\r\nVitals stable. seen By Dr Ramesh yesterday, adviced to use incentive spirometry.\r\nIncreased oral fluids to 60ml/hr. On I.V fluids\r\nSurgery F/U today, will probably remove the catheter after.\r\nI- 2430\r\nO- 2350\r\n6:15 Mobilized , Doing fine, Passed urine, Vital stable\nVitals- stable, foley catheter removed, Pt ambulating. \r\nPlan- discuss with the surgeon for probable D/c today.\r\n\n'}, {'role': 'model', 'content': 'IP Number: 6\n\nPatient Number: 1239\n\nAdmission Date: 29-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis: Obesity Gr2\n\nClinical Exam(With BP): 27 yr old with Obesity Grade2 , with no other significant medical history admitted for Sleeve Gastrectomy.\r\nS/P sleeve gatrectomy on 30-07-2011.\r\nPt tolerated the procedure well and the course during the hospital stay was satisfactory and uneventful\n\nSystolic BP: 110.0\n\nDiastolic BP: 70.0\n\nPhysical examination: lab results and X-ray attatched\n\nXray findings: obese, not in any distress, Vitals- stable\r\nSystemic Exam- Normal\r\nsurgical site- dressing removed, no oozing\n\nDiscussion: nan\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 33\n\nPatient Number: 1097\n\nPatient Name: DEVAKI ANDARJANAM (IN)\n\nGender: F\n\nDate of Birth: 15-01-1931\n\nAddress: SREE NILAYAM , MANAKKAPARAMBU LANE\n\nPincode: 682017\n\nPhNo: 0484 2346155\n\nAdmission Date: 22-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC RETINOPATHY\nCORONARY ARTERY DISEASE\nDIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Patient is admitted with h/o vomiting (3 episodes) for evaluation.\nVitals stable, No vomitting, probable discharge tomorrow,\nComfortable , changed insulin regimen, Vital stable, planned to discharge today by afternoon\n'}, {'role': 'model', 'content': 'IP Number: 33\n\nPatient Number: 1097\n\nAdmission Date: 22-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis: Vomiting for evaluation\n\nClinical Exam(With BP): 80 YR old with H/O DM, CAD , Essential HTN comes in with Vomitting 3-4 times, In hospital she was started on I.V fluids and I.V antibiotics for Urinary tract infection.\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: ECG\n\nXray findings: alert and oriented\r\nSystemic Exam - NOrmal\n\nDiscussion: 80 yr old admitted with Vomitting, started on I.V fluids and treated fot Urimary tract infection with I.V Antibiotics, noted to have uncontrolled sugar\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 128\n\nPatient Number: 3449\n\nPatient Name: BEENA CHRISTOPHER\n\nGender: F\n\nDate of Birth: 23-05-1964\n\nAddress: VALAVANTHURUTHIL HOUSE, PALLURUTHY P.O\n\nPincode: 682006\n\nPhNo: nan\n\nAdmission Date: 31-10-2011\n\nDischarge Date: 02-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for sugar control and work up of Cushings Disease.\r\nPlan\r\n24 hour Urine free cortisol (inform lab)\r\nMidnight sleeping Cortisol (inform lab)\r\nEye check up, FLP, Urine alb: Creat ratio, Dental check up, Versalab, Vibrometer, Liver function test and Renal function test\nCOLLECTING URINE FOR CORTISOL\r\nMID NIGHT CORTISOL\r\nCANNULA INSITU\r\nHEP BLOCK GIVEN\nsleeping\n'}, {'role': 'model', 'content': "IP Number: 128\n\nPatient Number: 3449\n\nAdmission Date: 31-10-2011\n\nDischarge Date: 02-11-2011\n\nDiagnosis: To r/o Cushings Disease\r\n\r\n\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Temperature :97.6\r\nRespiration :22\r\nBP :120 / 90\r\nWeight :68.45\r\nHeight :139.6\r\nGeneral Examination :No goiter\r\nBroad striae (> 1 cm) seen over the abdomen\r\nOther systems- wnl\r\n\n\nDiscussion: Beena christopher,47yr old is a known case of Type 2 DM was admitted with uncontrolled blood sugars and to R/o cushings disease. Insulin dosage was adjusted. 24 hr Urine free cortisol and mid night sleeping cortisol test was done to r/o Cushing's disease . Results awaited . comprehensive work up for Diabetes was also done, including opthalmology check up\r\n\n\nDiet: nan\n"}]

[{'role': 'user', 'content': 'IP Number: 28\n\nPatient Number: 2639\n\nPatient Name: BAIJU.T.B\n\nGender: M\n\nDate of Birth: 19-08-1975\n\nAddress: THURUTHIL HOUSE,THIRUVANIYOOR\n\nPincode: nan\n\nPhNo: 3220409\n\nAdmission Date: 19-08-2011\n\nDischarge Date: 22-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable, continue the insulin acc GRBS\nfine, present in the room during rounds, vital stable, continue the same orders\nvitals stable, AC- 162, opthalmology check up done\nSlet well. Blood sugars are well controlled. AC- 103 mg/dl, Pre dinner - 135 mg/dl.\n'}, {'role': 'model', 'content': 'IP Number: 28\n\nPatient Number: 2639\n\nAdmission Date: 19-08-2011\n\nDischarge Date: 22-08-2011\n\nDiagnosis: ? LADA\r\nMOOD DISORDER\r\nDiabetic Peripheral Neuropathy\r\nMicroalbuminuria\n\nClinical Exam(With BP): 36 yr old with H/O DM, admitted for uncontrollable blood sugar.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Lean, not in any Resp Distress.\r\nSystemic Exam - Normal\n\nDiscussion: nan\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 42\n\nPatient Number: 322\n\nPatient Name: SAJAN VARGHEESE\n\nGender: M\n\nDate of Birth: 11-06-1955\n\nAddress: THURUTHIYIL, ALLAPRA P.O\n\nPincode: 683542\n\nPhNo: 0484- 2520077\n\nAdmission Date: 02-09-2011\n\nDischarge Date: 03-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Dental caries\nMixed hyperlipidaemia\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for sugar control brefore tooth extraction.\nTOOTH EXTRACTION TOMORROW. blood sugar controlled, started on oral antibiotic\nVitals stable. AC- 169, given Novorapid 20 units s/c.\r\nScheduled for tooth extraction today\n'}, {'role': 'model', 'content': 'IP Number: 42\n\nPatient Number: 322\n\nAdmission Date: 02-09-2011\n\nDischarge Date: 03-09-2011\n\nDiagnosis: Type 2 Diabetes Mellitus\n\nClinical Exam(With BP): H/o DM admitted for tooth extraction.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Young, obese, not in any distress\r\napthous ulcer\r\nRS- Clear\r\nCVS- S1 S2 herad\r\nSystemic Exam- Normal\n\nDiscussion: %6 yr old with H/o DM admitted for tooth extraxction. Pt was started on Insulin Basal bolus regime, started on oral antibiotic. Tooth extraction was not able to be performed, becuase Of not able to achieve adequate local anaesthesia\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nPatient Name: SAJITH KUMAR\n\nGender: M\n\nDate of Birth: 14-04-1968\n\nAddress: CHELAYIL HOUSE, NEAR K.S.E.B\n\nPincode: 682005\n\nPhNo: nan\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC RETINOPATHY\nDIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Blood sugars are 634 mg/dl. Patinet is comfortable. Vitals are fine.\nConsious , oriented , febril , HR-82, BP- 150/90 RS-B/l Basal crepitation , Cvs -JVP Elevated , S1,S2 Normal \r\nAdviced Tab.Welset sos, Planned Cardiology consultation tommrow, statrt Inj.Metrogyl 100 i.v 1-1-1, Tab.Levofloxacin 500mg . Surgical Debridement on friday\nFebrile,Vital stable, Continue the same medication , prepare for the wound debridement under local \r\n\nTemp-99.2, PR-82, BP-130/80, Systemic Examination -NAD \r\nAdviced ECG/XrayChest -PA Veiw, \r\nadjusted the insulin dose, inform Prelunch, predinner, continue othe medication as Advice \r\nInform OT Staff,\nGeneral condition better. Slept well. Passed stools. Scheduled for debridement today. AC- 140 mg /dl. To be shifted to the recovery/ ICU at 9AM\r\n\r\n29/07/2011\r\nOperation done....\r\nSlough Excision of Right Heel Ulcer done under L/A.\r\nAfter adequate preparation and draping, the Ulcer slough was Excised For about 2X2 inches.\r\nThe slough did not seem to extend to the bone.\r\nThe Residual Ulcer after Excision, Bleeding was satisfactory.\r\nUlcer Haemostasis achieved.\r\nABGEL and Compression Dressing given.(DR. A.K. Bhat).\r\n\r\nPOST OPERATIVE ORDERS/INSTRUCTIONS:\r\n\r\nStrict Right Leg Elevation and Bed Rest.\r\nTPR/BP Monitoring.\r\nWatch For Bleeding.\r\nContinue IV Antibiotics.\r\nInject. Tramadol IM S.O.S\r\nPlanned for change of dressing in Recovery Room 31/07/2011.\r\n\nSeen by Dr.A.K.B\r\nPt afebrile.\r\nAdvice no wt.bearing on rt.leg .\r\nFor C/D tomorrow in OT Recovery.\npt alert, had an episode of hypoglycemia yesterday, ( sweating) GRBS- 86 .\r\nNo fever, chills\r\nPost debridement yesterday, No pain\r\ndressing tomorrow.\r\n\nSeen by Dr. A.K.Bhat and Dr. Tom Babu.\r\nDressings have been changed.\r\nThe Ulcer of the Right Heel looks CLEAN.\r\nNo Residual Pus or Slough.\r\nNo Evidence of Cellulitis.\r\n\nNo fever, No pain, Vitals stable, Dressing done yesterday, switched to oral antibiotics\nNo complaints, vitals stable,dressing to be done today by DR Bhatt, Intend to discharge tomorrow.\r\nAC- 93, Insugen R 24 units given. Midnight GRBS- 130\r\n10:00am Doing well, No Hypos, awating for surgeon for dreesing , adjusted the insulin dose according to the GRBS, planned discharge\r\n2:00pm s/b Dr.A.K.Bhatt , dressing changed , ulcer of the Rt heel looks clean except for some slough of the floor , part of which excised , Abgel compression dressing given , surronding skin and soft tissue inflamation subsided, continue the same Treatment .\r\n\nVital stable,GC-Better,Systemic Examination-NAD\r\nPredinner -165, adviced InsugenR 22units , Insugen N 26units at bed time \r\nPlanned discharge on 4/08/2011\nAfebrile, No pain, AC- 160, Insugen R 24 units given\r\nSeen and dressing change done by Dr A.K. Bhatt yesterday,\r\nDressing to be changed tomorrow again and Intend to D/c tomorrow.\nSeen by Dr.A.K.Bhat\r\nDressing changed.The ulcer right heel looks clean.\r\nAdvice:Dressing change as OP once in two days.No weight bearing on ulcer area.Oral antibiotics for one week.\nVital stable ,one episode of hypoglycemia , Dressing change today, continue the same\n'}, {'role': 'model', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis: Infected Non Healing Ulcer\n\nClinical Exam(With BP): 43 yr old with H/O DM admitted for Infected non healing Ulcer. S/P debridement of the the ulcer by DR A.K.Bhatt on 29-07-2011.\r\nTreated with Broad spectrum I.V Antibiotics , and tight control of sugar by basal insulin( INsugenN ) and three time regular insulin ( InsugenR).\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: lab results attatched\n\nXray findings: nan\n\nDiscussion: Controlled blood sugar with Basal bolus regimen, under antibiotic cover, wound debridement done , adviced to continue the insulin , off loading , regular dressing\n\nDiet: \r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 29\n\nPatient Number: 2647\n\nPatient Name: MANUEL P.M\n\nGender: M\n\nDate of Birth: 20-08-1949\n\nAddress: PUTHANPURARIRAPPEL\n\nPincode: 682037\n\nPhNo: 0484 - 2423723\n\nAdmission Date: 20-08-2011\n\nDischarge Date: 25-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Iand D done, C/o Pain , Vital stable , CVS-S1S2Normal, RS Clear, PA-NAD, No fever\nVitals stable, admitted for uncontrollable blood sugar, multiple carbuncles.\r\nSeen by Dr.A.K.Bhat.\r\nMultiple carbuncles,rt.thigh,leg,buttock&back.The one on the rt thigh is large &will need I&D under LA.\r\nGet consent.\nDoing well, I&D of the thigh abscess done yesterday. Patient is doing well. c/o gaseous distension of abdomen. AC-113 mg/dl.\nSeen by DR.A.K.Bhat\r\nAfebrile.No dressing soakage.Pain decreased.\r\nContinue treatment.\nSeen by Dr.A.K.Bhat\r\nDressing changed.Ulcer lt thigh clean.\r\nContinue treatment.\r\nvitals stable, GRBS- 152\r\nNo fever, c/o pain\r\nECG- normal\nVitals stable, c/o mild pain in the thigh, ? chest discmofort too.\r\nECG - Normal\nAfebril, Vital stable, Systemoic examination -NAD, Wound looking better, continue the orders.\r\nSeen by DR.A.K.Bhat\r\nNo pain.\nBetter, abdomen distension better, pain subsided\nSeen by DR.A.K.Bhat\r\nDressing changed.Ulcer clean.\r\nC/o pain after dressing change, Vitals stable\nVitals stable,C/o some difficulty breathing yesterday night.\r\nchest - clear, No rhonchi, Chest discomfort better\r\nRpt Pus culture taken\n'}, {'role': 'model', 'content': 'IP Number: 29\n\nPatient Number: 2647\n\nAdmission Date: 20-08-2011\n\nDischarge Date: 25-08-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): 62 yr old with H/o DM comes in with Multiple carbuncles , one on the Lt thigh, RT buttock and the back X 20 days. Was admitted for Excision of the carbuncle along with Control of Blood sugar and infection control.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male not in any distress\r\nSystemic Exam - Normal\r\n\n\nDiscussion: admitted for excision of the carbunle, and sugar control, and for I.V antibiotics.\r\nI & D of the abscess was done on 21/08/2011 by Dr Bhatt. Pt was Started on I.V antibiotics and Insulin for blood sugar control.\r\nAntibiotics was switched according to the pus culture report\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet adviced\r\nDiet booklet given\r\n\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 75\n\nPatient Number: 2929\n\nPatient Name: FRANCIS K.A\n\nGender: M\n\nDate of Birth: 25-01-2020\n\nAddress: KATTUPARAMBIL HOUSE, MUNDENVELI\n\nPincode: 682507\n\nPhNo: 2318240\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 24-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable. seen by surgeon yesterday. T- bact dressing\r\nchange\nbetter, Afternoon Blood sugar 298 Insugen N 22units given , Adviced 24units 30min before dinner, Insugen N 28units at bed time\nvital stable, pedal odema, Basal crepitation , sleep disturbed at night\r\nECG,HB, TC, Xray Chest -PA\r\nplan to add tab.lasix 20mg stat, continue others ,adjusted the dose of insulin\n'}, {'role': 'model', 'content': 'IP Number: 75\n\nPatient Number: 2929\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 24-09-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): C/o swelling and pain annd rednenss in both the Rt leg. It started with small blister after itching in the RT 2 nd digit of the Rt leg x 2-3 weeks ago, was started on oral antibiotics and notee to have high blood sugar, started on Insulin. Then 2-3 days, started itching on the dorsum of the Rt foot, with discharge.\r\nc/o pain and swelling\r\nDuration of Diabetes - 10-15 years\r\nCurrent Medication\r\nTab jalra 50 mg 1-0-1\r\nTab Lipiking 10 mg 0-0-1\r\nWosulin 30/70 20-0-20\r\nPrevious Blood sugar profile-FBS: PPBS: RBS: 290 HBA1C:\r\nWeight Loss- No\r\nPolyuria, Polyphagia, Polydipsia - No\r\nFrequency of blood sugar estimation- only when symptomatic\r\nBlurring of vision- Yes\r\nDiabetic eye examination- No\r\nBurning Sensation of feet - No\r\nNumbness of feet- No\r\nFalling off of foot wear- No\r\nNon healing Diabetic Foot Ulcer- No\r\nSwelling of feet - Yes\r\nCornary heart Desease- No\r\nHistory of Chest Pain on Exertion/Rest- No -Years\r\nDyslipidemia-yes\r\ntab Lipikind 0-0-1\r\nRecurrent infections- No\r\nHypertension- No\r\nMuskuloskeletal manifestations - No\r\nAutonomic dysfunction (orthostatic hypotension, early satiety, constipation)- Yes/ No\r\nHypoglycemia - No\r\n. Alcohol- 1 peg/day\r\nSmoking - No. systemic exam - normal\r\nRt leg- exzema on the rt leg with discharge.\r\nredness, Increased warmth, swelling.\n\nSystolic BP: 120.0\n\nDiastolic BP: 60.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Elderly Gentelman K/C/O Type 2 Diabetes Mellitus , Dyslipidemia . admitted with cellulitis, Uncontrolled diabetes, started on Basal Bolus Regimen , I.V antibiotic , restless at night , Discharge on request\n\nDiet: NUTRITION Dept:\r\n1700 kcal, low fat, diabetic diet in small, frequent feeds adviced\r\nDiet booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 109\n\nPatient Number: 2313\n\nPatient Name: MARY NOBLE\n\nGender: F\n\nDate of Birth: 04-01-1964\n\nAddress: 37/628A, THARAPPEL BUILDING , S.A.ROAD\n\nPincode: 682020\n\nPhNo: 0484-2203829\n\nAdmission Date: 13-10-2011\n\nDischarge Date: 15-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Mixed hyperlipidaemia\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: admitted for sugar control, need evalution for Acromegaloid feature,\nPatients doing well.AC-95mg.Getting ready for glucose supressed Gh level.\nGC fine.Vitals stable.\n'}, {'role': 'model', 'content': 'IP Number: 109\n\nPatient Number: 2313\n\nAdmission Date: 13-10-2011\n\nDischarge Date: 15-10-2011\n\nDiagnosis: RENAL CALCULI(staghorn)\n\nClinical Exam(With BP): 47 Year old female admitted with Uncontrol Blood Sugar, Prior to Lithotripsy of Renal Calculi.Insulin dose was adjusted for tight glycemic control.\n\nSystolic BP: 130.0\n\nDiastolic BP: 90.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 47year old Female admitted with Uncontrolled Blood Sugar and Glycemic control,Prior to Lithotripsy of Renal Calculi.During admission patient was evaluated for Acromegaly.Insulin dose was adjusted for tight Glycemic control and Growth Hormone Supressive Test was also done.Awaiting result.\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nPatient Name: KOCHU THRESIA MICHAEL\n\nGender: F\n\nDate of Birth: 07-07-1932\n\nAddress: 27/78, V.P MARAIKAR ROAD, EDAPALLY NORTH\n\nPincode: 682024\n\nPhNo: 0484 - 2543217\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat\r\nResolving ?Necrotising fasciitis Lt leg.\r\nAdvice:IV Fortum,Tbact oint. local application tds,Candid cream between toes bd,Inj.Clexane,Rest&leg elevation.\nVitals stable. pre- lunch- 159, still has redness in the Lt leg, an area of ? pus collection near the ankle. will show it to Dr Bhatt\nvitals stable, more alert now, clinically the Lt leg looks better, oedema subsided. redness still present.\r\nBlood sugar well controlled\r\nInput- 850\r\nOutput- 700, Na- 123\nFeeling sleepy. was able to get an I.V access. Will check NA+\r\nOedema subsiding\r\nHb- 8.6, TIBC- 163\nSeen by DR.A.K.Bhat\r\nEdema&redness decreased.Small focal scab lateral ankle needs observation.\r\nAdviced:vaseline application&Tbact\r\n\r\nVitals stable. had good sleep yesterday. more alert sittting up and eating food.\nvitals stable, blood sugar controlled. alert, slept well. oedema subsided. erythema better.\nGeneral condition stable. Cellulitis better. Since the IV line is out we have decided to go with oral cephalosporins.\nSeen by Dr.A.K.Bhat\r\nThe redness is less &ulcers of the left leg are healed.\r\nAdviced:Emollients.\npt feels better, more alert , oedema and redness subsided.\r\nswitched to oral antibiotics.\r\nTab Flunil put on hold.\r\nwill discuss with DR bhatt and family the plan for discharge\nPR 76/min , B.p-140/70mmof hg, CVS-S1S2 Normal , RS-Clear, Restricted Rt Shoulder movement, Cellulitis subsiding\r\n\nfebril, vital stable, Continue the same\r\nTPR Chart, Intake /output\nVitals stable, No fever. ,AC- 150, Blood RE- 12,050.\r\noedema subsiding, redness getting better.\r\n11:00am Disscused with Dr. Bhat, adviced to add Tab. Ciprofloxacin watch for 2days, continue the other medication , Tab.Chymoral forte 1-0-1\nvital stable, no fever, changed the cannula, continue the same orders\nCellulitis better. Onychomycosis+\r\n6:00pm Vital stable , Afebrile, continue the order\nDoing well, vital stable, swelling status co, FBS 169,increse the dose of metformin\r\ncontinue the same orders\nBetter,vital stable, continue the same\nVital stable, Leg sweelling decresed, Systemic examination -NAD\r\nBlood routine , platelet count\nAfebrile, Limb status co, Systemic examination NAD\r\nDiscussed with son , insisted to start on Linzolid, started on Linazolid\nCellulitis/ Necrotizing fascitis - status quo. Over all general condition is good.\nCellulitis better. General condition good. Mobilized her a bit.\r\nSeen by Dr.A.K.Bhat\r\nRedness &swelling decreased.Adviced:Crepe bandage.\r\nStop fortum.\nDoing well, redness subsided , FBS 164, Vital stable , Systemic Examination -NAD\r\nplan to change to Oral medication\nVitals stable. GRBS- 203, No fever\nDoing well, Odema subsided, redness subsided , D/C Cannula, Continue the same order, swith over to Tab.linazolide\nPR-86, B.p 190/100mmof hg , RS-Rhonchi +, \r\nStop Revolol, Change to Tab. Nebivolol, Tab. Amlodipine 2.5mg stat\r\n8:15pm C/o Chest pain transient, PR-70/min, B.p-150/70mm0f hg ECG-RBBB, No ST-TChange\r\nRpt ECG in the morning\nPR-80/min , B.P 140/70mmHg,RS-Rhonchi+, Crepitation +\r\nPA-NAD, Mild pedal odema\r\ncontinue the same\nPR-80/min , B.P 160/70mmof Hg, RS -Crepitation +/Rhonchi\r\nLeg better\r\nDoing well, Plan to add small dose of Diuretics\r\nBLOOD ROUTINE, PLATELET COUNT, UREA , CREATINE, Na+, Ka+ TOMORROW\nPt ambulating. Cough better. Blood work done.\r\nPlan is to discharge to a rehab facility\nseen by Dr.A.K.Bhat.\r\nAdviced emollients.Stop linezolid.\r\n6:30pm Better, RS-Rhonchi +,Stop Cetaphil\nS/b Dr.Ramesh Nair\r\nCellutitis, Acute Bronchitis\r\nIV Deriphylline 2cc i.v slowly bd\r\nCombimist Neb Q6h\r\nBudocort Neb Q8h\r\nTab.Mucinac 600 1-0-1\r\nSteam Inhalition\nc/o feeling Nauseous, B.P better control. \r\nChest - B/l wheeze and Rhonchi\nDoing well. General condition status quo. Chest better- occasional rochi\nfine, B.P 170/80mmof Hg continue the same\nRhonchi, GRBS-223mg/dl, Stop Odyphylline, Started on Abphylline 100mg BD\nVital stable, B.P 130/70mmog hg, CVS-S1S2 Normal, RS-B/l Rhonchi +, Leg Odema Better\r\nStop Tab.Linozolid\nDR.Rmesh Nair visited the Pt\r\n\r\nGC- Better\r\nVital stable. GRBS- 136, plan to discharge on thursday\nPR 76/min , B.P-140/70mmof Hg, RS-Rhonchi+, Mentation stable.Stop Linazolide, stat Levofloxacin , Mucomix Nebulization , continue the same\r\n\r\n\r\nDr .Ramesh Nair visited the pt on 17/09/11\nVitals stable. GRBS- 120, \r\nRS- B/L rhonchi, seen by pulmonary yesterday, continue the same medicines\r\nIntend to D/C tomorrow.\r\nChesyt Physiotherapy\r\nRpt Na tomorrow\nbetter, vital stable, Rs-Rhonchi +\nVitals stble. Intend to D/C today\n'}, {'role': 'model', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis: Cellulitis/? Necrotising fascitis\r\nSIADH\r\nOsteoarthritis\r\nEssential HTN\n\nClinical Exam(With BP): admitted with swelling, redness and pain in the Lt leg x 10-14 days\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, not in any distress.\r\nRS- B/l Rhonchi\r\nLOcal - oedema, redness, INcreased warmth with chronic dermatitis changes\n\nDiscussion: 79 yr old with H/o DM, Osteoarthritis admitted with redness, pain and swelling of the Lt leg, ( cellulitis/? necrotising fasciitis ) started in I.V antibiotics, seen by surgeon. Venous doppler was done which showe No thrombus, but valve incompetanance. Hyponatremia was corrected with hypertonic saline. Glycemic control was achieved with tab Metformin and bed time dose of lantus. Pt was also seen by Cardiology for evaluation of hypertension. Echo was done which was normal. Antihypertensive meds were adjusted. During the hopsital stay, devloped chest congestion, started on Combimist Nebs and Budesonide Nebs and also seen By pulmonary who recommended the same.\r\nPt was initiated on to physical therapy.\r\n\n\nDiet: NUTRITION Dept:\r\n1600 kcal, low fat,less spicy, diabetic diet with small, frequent feeds adviced\r\nExtra salt added\r\nDiet sheet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 18\n\nPatient Number: 2048\n\nPatient Name: ANEESH BABU\n\nGender: M\n\nDate of Birth: 09-02-1984\n\nAddress: THEVARIL HOUSE,KATTIKULAM.P.O,VAYNAD\n\nPincode: 670646\n\nPhNo: 4935278129\n\nAdmission Date: 15-08-2011\n\nDischarge Date: 16-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 1 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: No vomiting, No Seizure, Headach once he move the Neck\r\nVital stable, follow the orders\r\nCalcium / Magnesium / serum albumin -\nNo Headach , No vomiting , Vital stable, one episode of Asymtomatic Hypoglycemia. Discharge\n'}, {'role': 'model', 'content': 'IP Number: 18\n\nPatient Number: 2048\n\nAdmission Date: 15-08-2011\n\nDischarge Date: 16-08-2011\n\nDiagnosis: Post Ictal Headach\r\n? Hypoglycemia \r\n\n\nClinical Exam(With BP): Type 1 diabetes on Premixed insulin , Had seizure like episode, followed by \r\nHeadach, Vomiting , Documented GRBS of 86mg/dl, during this episode \r\nsought a Neurology consultation , Observed him for 24hr, Symptoms better\r\nHad one episode of Hypoglycemic Unawarness durning hospital stay , Lab \r\nAll report are with in Normal limit,except Calcium , Send sample outside for confirmation \r\ncalcium/Magnesium with in Normal limits\r\nShifted him on Basal Bolus Regimen\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: eadach, Vomiting , Documented GRBS of 86mg/dl, during this episode \r\nsought a Neurology consultation , Observed him for 24hr, Symptoms better\r\nHad one episode of Hypoglycemic Unawarness durning hospital stay , Lab \r\nAll report are with in Normal limit,except Calcium , Send sample outside for confirmation \r\nShifted him on Basal Bolus Regimen\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 59\n\nPatient Number: 129\n\nPatient Name: AMBIKA SASIDHARAN\n\nGender: F\n\nDate of Birth: 18-05-1960\n\nAddress: SOUPARNIKA,THALACODE P O\n\nPincode: nan\n\nPhNo: 0484-2711467\n\nAdmission Date: 15-09-2011\n\nDischarge Date: 17-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nDIABETIC NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted with pain and swelling over the back x 3days\r\nO/E\r\nCarbuncle with a stye and sorrounding cellulitis\r\n\r\nInvestigation\r\nCBC, Se Creat, Na, K, ECG, CXR - PA\r\n\r\nTo show Dr. Bhatt for debridement\nSeen by DR.A.K.Bhat.\r\nCarbuncle interscapular region.For I&D under LA.Get consent.\nHad l-stool in the night, 1episode, vital stable, post op uneventfull,continue the sameFBS-143\nSeen by Dr.BHAT.\r\ncontinue trt.Fr. change of dressing tmrw.\r\nC/o pain , No fever, vital stable,\nSeen by Dr.A.K.Bhat.\r\nDressings changed.Wound interscapular region is clean.\nVitals stable. Dressing today and probable discharge\n'}, {'role': 'model', 'content': 'IP Number: 59\n\nPatient Number: 129\n\nAdmission Date: 15-09-2011\n\nDischarge Date: 16-09-2011\n\nDiagnosis: Diabetic Carbuncle\n\nClinical Exam(With BP): K/C/O Diabetes Mellitus Type2, Essential Hypertension , Carbuncle with surronding cellulits, admitted for surgical incision and drainage\r\ncontrolled blood sugar with insulin, i.v antibiotic for infection\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: K/C/O Diabetes Mellitus Type2, Essential Hypertension , Carbuncle with surronding cellulits, admitted for surgical incision and drainage\r\ncontrolled blood sugar with insulin, i.v antibiotic for infection. Discharge in stable state\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 13\n\nPatient Number: 1185\n\nPatient Name: SUJITH K S\n\nGender: M\n\nDate of Birth: 12-01-1972\n\nAddress: KATTUNGAL KARTHIKA,BINNY ROAD,PALLURUTHY\n\nPincode: 682006\n\nPhNo: 0484-2232086\n\nAdmission Date: 05-08-2011\n\nDischarge Date: 09-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for Methyl Prednisolone injection\nVital stable , comfortable , follow the advice\nDoing well. Eye congestion better.\nVital stable , symtomaticaly better, GRBS awaited , continue the same\r\n\n4:00pm Better, Symptoms better, Viatal stable, Insulin acc GRBS\nvitals stable, symptoms better.\r\nAC- 285\r\nPre- dinner - 364\nVital stable, insulin according to the GRBS,Stop Steriods inj\nVitals stable.\r\nPre- dinner- 257\r\nAC- 253, given I.V methylprednisolone 500mg yesterday.\r\nwill continue Insulin today and discharge tomorrow\nDoing well. Blood sugars are well controlled on Insulin. No difficulties reported after taking 3 doses of methylpred.\n'}, {'role': 'model', 'content': "IP Number: 13\n\nPatient Number: 1185\n\nAdmission Date: 05-08-2011\n\nDischarge Date: 09-08-2011\n\nDiagnosis: Graves Disease\r\nGrade IV Orbitopathy with CAS 4\n\nClinical Exam(With BP): 39 yr old with H/O Grave's disease admiited for I.V methylprednisolone x 3 doses (in 500 ml of normal saline) for Grade 1V orbitopathy. His blood sugars rose during the hopsital stay and was put on basal bolus regimen. ( Novorapid+ NPH). Blood sugars came down once the methyl pred was stopped. His eye signs improved.\n\nSystolic BP: 140.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: nan\n\nDiet: nan\n"}]

[{'role': 'user', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nPatient Name: M.J.JOSEPH\n\nGender: M\n\nDate of Birth: 11-08-1933\n\nAddress: MEKKATTUPARAMBIL HOUSE,PADAMUGAL\n\nPincode: 682021\n\nPhNo: 2422226\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEUROPATHY\nEssential (primary) hypertension\nCORONARY ARTERY DISEASE\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 5:00pm GRBS-502mg/dl, Vital stable , Shift to OT for Iand D , \r\nGiven Insugen 20units I.V Bolus, continue Insulin drip at 10u/hr, stop lasix, I/o Chart, continue the I.V NS 50ml/hr, Inform GRBS Hrly\r\n5:00pm Shift the \r\n8:00 pm - Shifted to i.c.u, PR80/min , B.P-130/80, CVS-S1S2, Rs-Clear , Catheterized under aseptic precaution, monitor intake , out put\nC/o pain , GRBS Hi, Started on insulin infusion , Maintain NS ml/hr , follow the other orders\n4:00pm Vital stable , Intake-550, output-200. \r\nI.v Ns 75ml/hr 2pints \r\n5:30pm Doing well, pain subsided, Vital stable , Dreesing clean , Follow the Advice\nSeen by Dr.A.K.Bhat\r\nDressing changed.There is no evidence of residual pus.However the floor of the ulcer looks ?ischemic.Needs further observation&guarded prognosis.\r\n9:00am GC fair, Vital stable, GRBS 107, on Insulin infusion 1u/hr, Dreezing done by Dr.Bhatt, shift to room\r\n9:30pm S/b Dr.Tom , Adviced to continue the same,\r\n12:30pm 10units Insugen s/c\r\nAdd Inj .Tramadol 50mg in I.V fluid\n8:00am Doing well, slept well, No Pain , \r\nPR70/min , BP-110/70, RS-Basal crepitation +, I/0 1925/800\r\nplus positive balance of 1100\r\n\nChest clear , vital stable, D/c Cath \r\nfollow the order, inform Predinner\nGC fine, Vital stable, Rs Few crepitation + , Wound Clean , No Discharge, explained the Bystandard about the prognosis\nVital stable, Given analgeic for pain , pain subsided after this. adjusted the insulin according to the GRBS\r\n6:00pm seen by dr.tom sir , fine, doing well, RS-B/l crepitation . folloe the same orders\r\nHb,Tc,Dc, Urea , Creatine, FLP, Sodium , potassium , FBS\nHad Hypoglycemia at 7pm , better with carbohydrate. Adviced Actrapid 24-24-24, Lantus 24 ,planned dreesing today by Dr.Bhatt.\r\nDressing change done by DR Bhatt, Awaiting Pus culture\nS/b Cardilogist, adviced ECHO/Xray Chest-PA\r\nFine , Vital stable,\nDoing well, sugar under control, No hypos , adviced Xray chest-PA, Xray foot -AP/Lat\nS/b Dr.bhatt And Dr.Tom Ulcer of the lt foot is unhealthy,exposing unhealthy deep tendon of sole of foot\r\nRpt Cand S taken, sugested Arterial doppler to confirm diagnosis of chronic PVD\nSeen by Dr.A.K.Bhat\r\nDressing changed.Same findings of ischemic ulcer lt sole with exposed tendons and fascia.Metrogyl gel dressing given.Guarded prognosis regarding healing need to be explained.\r\n7:oopm Better, No hypoglycemia, Vital stable , follow the order\nVitals stable AC- 48 and then 90. Dressing change done by\r\nDR bhatt. discussed in details with the family\nMild pain , GC Fair , Vital stable , RS Clear\r\nSeen by Dr.A.K.Bhat\r\nOcc.Pain.Dressing overpadded.\nVitals Stable, C/o pain in the leg.\r\nPre- dinner- 145\r\nFBS- 56\nFine, Mild pain , Tingling sensation in the foot.\r\nC AND S Sensitive to klebsilla ,started on Inj. Amikacin\nSeen by DR.A.K.Bhat.\r\nC&D done.Same findings.\r\n8:00pm -Better,vital stable,CVS-S1S2 Normal , RS: NVBS\nSlept well. pain over Lt foot in the morinig, relieved with NSAIDS. Passed stools. AC- 161 mg/dl, Pre dinner - 95 mg/dl\nSeen by DR.A.K.Bhat\r\nDressing reviewed.Same findings.\r\nRepeat C/S taken.\r\nDoppler done. GRBS- 264, Pus culture taken\nVitals stable, doppler of the legs today, intend to D/c probably tomorrow\nSeen by DR.A.K.Bhat\r\nSame findings.Adviced Dressing change daily.\nvitals stable. Doppler done yesrterday. will discuss with Dr Bhatt regarding the discharge.\r\nAC- 247\r\nPre-dinner- 264.\n'}, {'role': 'model', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis: Ulcer over the Lt Plantar aspect of the foot\r\nPeripheral Vascular Disease\r\nModerate LV Dysfunction \r\n\r\n\n\nClinical Exam(With BP): H/o Noticed Abscess over the Foot-Lt -1week. Duration of Diabetes - 30 years\r\nCurrent Medication\r\nHuman mixtard 28-0-23\r\nTab.Lasix40mg 1/2-0-0\r\nTab.Enam 10 0-0-1\r\nTab.Nicardia retard 20 1-0-0\r\nTab.Cadloc 3.125 1-0-1\r\nTab.Glyciphage 500 1/2-0-1/2\r\nTab.lanoxin 1-0-0 5/7\r\nPrevious Blood sugar profile-FBS: PPBS: RBS: HBA1C:\r\nWeight Loss- stable \r\nFrequency of blood sugar estimation Twice daily/once weekly/once monthly\r\nBlurring of vision-Left Eye\r\nDiabetic eye examination- Yes\r\nBurning Sensation of feet -No\r\nNumbness of feet-No\r\nFalling off of foot wear-No\r\nSwelling of feet -Yes\r\nCornary heart Desease-Yes-Years [1994 ]\r\nDyslipidemia-No\r\nHypertension-20yrs\r\nRecurrent infections-No\r\nHypoglycemia - Yes\r\n. Father -Diabetic. GC fair ,No Pallor\r\nCVS-S1S2\r\nRS-Clear\r\nFoot impaired Sensation\r\nClawing of toes\r\nDry skin\r\nAbscess over the 2/3 of the Ventral aspect of foot\r\n.\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Toxic , Dehyration \r\nConsious and Oriented \r\nLt Postrior tibial pulse absent\r\nRS: NVBS, Base Clear\r\nCVS S1S2 Normal \r\nCNS: Consious and oriented\n\nDiscussion: K/c/o Type 2 Diabetes Mellitus, Coronary Heart Disease with Moderate L.V Dysfunction , Hypertension , Diabetic Neuropathy, Admitted with Lt plantar absecess, HU, Septisemia. started on Insulin infusion and \r\nHydration with normal saline, started on empirical antibiotic, changed antibiotic asper C/s . Disscused to option with Bystandred . because of the emergency situation taken for Absess exsion and debridement of the necrotic tissuereport Excised the abscess under aseptic precaution,Count starts commimg done. fair glycemic control,genaral condition improved Wound healing not satisfactory, Started on LMWH, Arterial doppler compramised distal circulation . planned to continue the oral antibiotic , glycemic control with Basal bolus regimen , Ulcer wait and watch, wound care\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 40\n\nPatient Number: 2735\n\nPatient Name: MAMAN P JOSEPH\n\nGender: M\n\nDate of Birth: 20-09-1931\n\nAddress: VELLAPPATTIL HOUSE,ASRAMAM P O\n\nPincode: 689126\n\nPhNo: 0477 2233681\n\nAdmission Date: 29-08-2011\n\nDischarge Date: 03-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Chronic obstructive pulmonary disease, unspecified\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fmodern\\fprq1\\fcharset0 Courier New;}{\\f1\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f2\\fswiss\\fprq2\\fcharset0 Arial;}{\\f3\\fnil\\fprq2\\fcharset0 Ms Sans Serif;}{\\f4\\fnil\\fprq2\\fcharset0 MS Sans Serif;}{\\f5\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\qc\\b\\f0\\fs24 ECHO REPORT\\b0 \r\n\\par \r\n\\par \\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 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mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LA\\cell\\cell\\f2\\fs18 19-40 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl Epss\\cell\\cell\\f2\\fs18 < 8 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl IVSD\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDd\\cell\\cell\\f2\\fs18 35-52 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVPW\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDs\\cell\\cell\\f2\\fs18 24-42 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl EF\\cell\\cell\\f2\\fs18 50-70 %\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl FS\\cell\\cell\\f2\\fs18 28-41 %\\f1\\fs24\\cell\\fs20\\row\r\n\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\fs20 Mitral Valve\\b \\b0 : Normal in structure and motion\\b . \\b0 No MVP, no MR\\b \\b0 \r\n\\par \\pard\\fi720\\li1440 E/A is reversed \r\n\\par \\pard\\tx990 \r\n\\par Aortic Valve :\\b \\b0 3 cusps\\b ,\\b0 normal\r\n\\par \r\n\\par Pulmonary Valve : Normal\r\n\\par \r\n\\par Tricuspid Valve : Normal\\b ,\\b0 no significant TR\r\n\\par \r\n\\par \\pard\\fi-2160\\li2160\\tx990 LV : Normal in size and contraction\\b .\r\n\\par \\b0 No RWMA \\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \\pard\\tx2310 Normal LV systolic function\r\n\\par \r\n\\par \\pard\\tx990 Pericardium : Normal \\tab\\tab \\tab\\tab \r\n\\par \r\n\\par \r\n\\par \\pard Remarks : Normal chamber dimension\\b .\\b0 No RWMA \\b ,\\b0 \r\n\\par Normal LV function. No valvar pathology\\f1\\fs24\\tab \r\n\\par \r\n\\par \\f3\\fs20 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par Dr. Sasi Kumar\r\n\\par Consultant Cardiologyst\\f4 \r\n\\par \\f1\\fs24 \r\n\\par \\f5\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vitals stable, GRBS- 147, echo done- Normal LV Function,\r\nDyspnoea probably due to COPD. \r\nPlan- Ultrasound of the abdomen\r\n Pulmonary consultation\r\n\nVitals stable. AC - 123. Seen by urologist. ultrasound of the\r\nabdomen - enlarged prostate. Echo- Normal LV function.\r\nPlan- surgical consultation.\r\n pulmonary consultation \r\n opthalmology consultation\r\n Versalab/ vibriometer\r\n\r\nSeen by Dr.A.K.Bhat\r\nNonhealing,recurrent ulcer rt foot for 2-3 years.Pain mild.Numbness both legs.\r\nTaking trt in local hospital and dressing with neosporin powder&steroid cream.\r\nOn local examination:Ulcer dorsum of rt foot 6x6 cm. with minimal granulation& patchy slough of floor&edges.Surrounding skin is thick&fibrous.Distal pulsations are felt.Ankle movt restricted.?Varicose veins.\r\nAdvice:Rest and leg elevation.Daily dressing with metrogyl gel&ceptigras.(May benefit with intrasite gel dressing to debride slough).Arterial&venous doppler.Future Plan will be to get the granulation till the ulcer is fit for a skin graft.\r\n\nVitals stable. Versalab- Normal study\r\nVibriometer- severe neuropathy\r\nSeen by pulmonary- Severe COPD\r\nPFT done\r\n\r\n\nDr.Ramesh Nair seen the pt on 30/8/11\r\n \r\nPFT - shows obstruction with decreased PVC\r\nVitals stable AC -159, insugen R 8 units given\r\nDressing with intrasite gel daily as per surgery.\r\nOpthalmology- mild NPDR\r\npodiatry- Severe neuropathy\r\nABI normal\r\n\nSeen by Dr.A.K.Bhat\r\nDressing done with Intrasite gel.Ulcer clean and granulation +.\nVitasl stable, feels better, put on Mixtard twice a day.\r\nDressing done with intrasite gel\nvitals stable, pre - dinner- 183, FBS- 131, given insulin yeaterday.\r\nDressing done with intrasite gel yesterday, wound looking better.\r\nStill has some breathing difficulty, better with steroids\nSeen by Dr.A.K.Bhat\r\nUlcer C&D done.Granulation coming up.Slough minimal&should debride with debridace&intrasite gel.\r\n\r\nVitals stable, blood sugar conrolled , still c/o of shortness of breath.\r\nWill get Venous doppler of the Leg .Dressing change tomorrw and will evaluate to intend to Discharge tomorrow.\nVitals stable, Steam inhalation. DRessing change done. Venous doppler tomorrow. Intend to D/C after that\nVitals stable. Venous doppler done, Intend to discharge today\n'}, {'role': 'model', 'content': "IP Number: 40\n\nPatient Number: 2735\n\nAdmission Date: 29-08-2011\n\nDischarge Date: 03-09-2011\n\nDiagnosis: Peripheral Neuropathy\n\nClinical Exam(With BP): 79 yr old with H/o DM, COPD admitted for ulcer on the dorsum of the LT foot x 2-3 yrs\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nRS- b/l rhonchi\r\nLT foot - punched out ulcer on the dorsum with slough\n\nDiscussion: admitted for ulcer on the dorsum of the Lt foot, X 2-3 yrs.\r\nPt was started in I.V antibiotics, metformin for sugar control. was put on Human Mixtard for better control.\r\nFor Dyspnoea, was seen by a cardiologist , 2D echo performed- NOrmal LVF\r\nSeen BY a Pulmonologist, PFT - Obstruction with reduced FVC, suggested combinist and Budesonide Nebs.\r\nDressing was done with Intrasite gel and debridase.\r\nPt was also seen by a urologist, ultrasound of the abdomen- en;larged prostate, put on Veltam.\r\nDuring the hospital stay, Pt had a complete Diabetic Work up.\r\n'OPthalmology- Mild NPDR\r\nSevere peripheral neuropathy.\n\nDiet: NUTRITION Dept:\r\n1200 kcal, low fat diabetic diet with small, frequent feeds adviced.\r\nNutrition booklet given\r\n\r\n\n"}]

[{'role': 'user', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nPatient Name: M.J.JOSEPH\n\nGender: M\n\nDate of Birth: 11-08-1933\n\nAddress: MEKKATTUPARAMBIL HOUSE,PADAMUGAL\n\nPincode: 682021\n\nPhNo: 2422226\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEUROPATHY\nEssential (primary) hypertension\nCORONARY ARTERY DISEASE\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 5:00pm GRBS-502mg/dl, Vital stable , Shift to OT for Iand D , \r\nGiven Insugen 20units I.V Bolus, continue Insulin drip at 10u/hr, stop lasix, I/o Chart, continue the I.V NS 50ml/hr, Inform GRBS Hrly\r\n5:00pm Shift the \r\n8:00 pm - Shifted to i.c.u, PR80/min , B.P-130/80, CVS-S1S2, Rs-Clear , Catheterized under aseptic precaution, monitor intake , out put\nC/o pain , GRBS Hi, Started on insulin infusion , Maintain NS ml/hr , follow the other orders\n4:00pm Vital stable , Intake-550, output-200. \r\nI.v Ns 75ml/hr 2pints \r\n5:30pm Doing well, pain subsided, Vital stable , Dreesing clean , Follow the Advice\nSeen by Dr.A.K.Bhat\r\nDressing changed.There is no evidence of residual pus.However the floor of the ulcer looks ?ischemic.Needs further observation&guarded prognosis.\r\n9:00am GC fair, Vital stable, GRBS 107, on Insulin infusion 1u/hr, Dreezing done by Dr.Bhatt, shift to room\r\n9:30pm S/b Dr.Tom , Adviced to continue the same,\r\n12:30pm 10units Insugen s/c\r\nAdd Inj .Tramadol 50mg in I.V fluid\n8:00am Doing well, slept well, No Pain , \r\nPR70/min , BP-110/70, RS-Basal crepitation +, I/0 1925/800\r\nplus positive balance of 1100\r\n\nChest clear , vital stable, D/c Cath \r\nfollow the order, inform Predinner\nGC fine, Vital stable, Rs Few crepitation + , Wound Clean , No Discharge, explained the Bystandard about the prognosis\nVital stable, Given analgeic for pain , pain subsided after this. adjusted the insulin according to the GRBS\r\n6:00pm seen by dr.tom sir , fine, doing well, RS-B/l crepitation . folloe the same orders\r\nHb,Tc,Dc, Urea , Creatine, FLP, Sodium , potassium , FBS\nHad Hypoglycemia at 7pm , better with carbohydrate. Adviced Actrapid 24-24-24, Lantus 24 ,planned dreesing today by Dr.Bhatt.\r\nDressing change done by DR Bhatt, Awaiting Pus culture\nS/b Cardilogist, adviced ECHO/Xray Chest-PA\r\nFine , Vital stable,\nDoing well, sugar under control, No hypos , adviced Xray chest-PA, Xray foot -AP/Lat\nS/b Dr.bhatt And Dr.Tom Ulcer of the lt foot is unhealthy,exposing unhealthy deep tendon of sole of foot\r\nRpt Cand S taken, sugested Arterial doppler to confirm diagnosis of chronic PVD\nSeen by Dr.A.K.Bhat\r\nDressing changed.Same findings of ischemic ulcer lt sole with exposed tendons and fascia.Metrogyl gel dressing given.Guarded prognosis regarding healing need to be explained.\r\n7:oopm Better, No hypoglycemia, Vital stable , follow the order\nVitals stable AC- 48 and then 90. Dressing change done by\r\nDR bhatt. discussed in details with the family\nMild pain , GC Fair , Vital stable , RS Clear\r\nSeen by Dr.A.K.Bhat\r\nOcc.Pain.Dressing overpadded.\nVitals Stable, C/o pain in the leg.\r\nPre- dinner- 145\r\nFBS- 56\nFine, Mild pain , Tingling sensation in the foot.\r\nC AND S Sensitive to klebsilla ,started on Inj. Amikacin\nSeen by DR.A.K.Bhat.\r\nC&D done.Same findings.\r\n8:00pm -Better,vital stable,CVS-S1S2 Normal , RS: NVBS\nSlept well. pain over Lt foot in the morinig, relieved with NSAIDS. Passed stools. AC- 161 mg/dl, Pre dinner - 95 mg/dl\nSeen by DR.A.K.Bhat\r\nDressing reviewed.Same findings.\r\nRepeat C/S taken.\r\nDoppler done. GRBS- 264, Pus culture taken\nVitals stable, doppler of the legs today, intend to D/c probably tomorrow\nSeen by DR.A.K.Bhat\r\nSame findings.Adviced Dressing change daily.\nvitals stable. Doppler done yesrterday. will discuss with Dr Bhatt regarding the discharge.\r\nAC- 247\r\nPre-dinner- 264.\n'}, {'role': 'model', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis: Ulcer over the Lt Plantar aspect of the foot\r\nPeripheral Vascular Disease\r\nModerate LV Dysfunction \r\n\r\n\n\nClinical Exam(With BP): H/o Noticed Abscess over the Foot-Lt -1week. Duration of Diabetes - 30 years\r\nCurrent Medication\r\nHuman mixtard 28-0-23\r\nTab.Lasix40mg 1/2-0-0\r\nTab.Enam 10 0-0-1\r\nTab.Nicardia retard 20 1-0-0\r\nTab.Cadloc 3.125 1-0-1\r\nTab.Glyciphage 500 1/2-0-1/2\r\nTab.lanoxin 1-0-0 5/7\r\nPrevious Blood sugar profile-FBS: PPBS: RBS: HBA1C:\r\nWeight Loss- stable \r\nFrequency of blood sugar estimation Twice daily/once weekly/once monthly\r\nBlurring of vision-Left Eye\r\nDiabetic eye examination- Yes\r\nBurning Sensation of feet -No\r\nNumbness of feet-No\r\nFalling off of foot wear-No\r\nSwelling of feet -Yes\r\nCornary heart Desease-Yes-Years [1994 ]\r\nDyslipidemia-No\r\nHypertension-20yrs\r\nRecurrent infections-No\r\nHypoglycemia - Yes\r\n. Father -Diabetic. GC fair ,No Pallor\r\nCVS-S1S2\r\nRS-Clear\r\nFoot impaired Sensation\r\nClawing of toes\r\nDry skin\r\nAbscess over the 2/3 of the Ventral aspect of foot\r\n.\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Toxic , Dehyration \r\nConsious and Oriented \r\nLt Postrior tibial pulse absent\r\nRS: NVBS, Base Clear\r\nCVS S1S2 Normal \r\nCNS: Consious and oriented\n\nDiscussion: K/c/o Type 2 Diabetes Mellitus, Coronary Heart Disease with Moderate L.V Dysfunction , Hypertension , Diabetic Neuropathy, Admitted with Lt plantar absecess, HU, Septisemia. started on Insulin infusion and \r\nHydration with normal saline, started on empirical antibiotic, changed antibiotic asper C/s . Disscused to option with Bystandred . because of the emergency situation taken for Absess exsion and debridement of the necrotic tissuereport Excised the abscess under aseptic precaution,Count starts commimg done. fair glycemic control,genaral condition improved Wound healing not satisfactory, Started on LMWH, Arterial doppler compramised distal circulation . planned to continue the oral antibiotic , glycemic control with Basal bolus regimen , Ulcer wait and watch, wound care\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 133\n\nPatient Number: 3493\n\nPatient Name: SASIDHARAN.M\n\nGender: M\n\nDate of Birth: nan\n\nAddress: ETHIRPPAN PARAMBIL, AROOR P O,\n\nPincode: 688534\n\nPhNo: nan\n\nAdmission Date: 04-11-2011\n\nDischarge Date: 09-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat.\r\nFor slough excision ulcer rt.thigh under LA tomorrow.Preop.:Shave&betadine scrub&C&D tomorrow.Consent.IV antibiotics.\nBetter\r\nVital stable \r\nPlanned debridement under local Anae\r\nContinue the same\r\nVac therpay after discussing with Dr.A.K.Bhat\nVital stable \r\nSystemic examination -NAD\r\nC/o Burning sensation over the chest\r\nContinue the same\r\nadded PPI\nfine\r\nvital stable\nDoing well. C& S not sensitive to the present medication. Have moved him on Clindamycin. c/o gaseous distension of abdomen.\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Raw area rt.thigh clean.Plan fr discharge on wednesday.\ndoing well ,slept well, fair glycemic control, continuer the same\nfine \r\ndischarge after dr .AK Bhat\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The raw area right thigh is clean.Adviced dressings once in 2 days.Tab.Cetrizine 10mg HSx5days.Plan for SSG after 10 days.\n'}, {'role': 'model', 'content': 'IP Number: 133\n\nPatient Number: 3493\n\nAdmission Date: 04-11-2011\n\nDischarge Date: 09-11-2011\n\nDiagnosis: NON HEALING ULCER OVER THE RT THIGH\n\nClinical Exam(With BP): Mr.SaSidharn.M /60yr/male , admitted with non Healing Ulcer over the Rt Thigh of 1month duration \r\ndebride the wound, c/s report suggestive of Staphylococus aureus, started on Antibiotic according to sensitivity report\r\nintiated on basal bolus regimen for fair glycemic control, wound Healing satisfactory.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: T\n\nXray findings: Temperature :97\r\nRespiration :22\r\nBP :130 / 80\r\nWeight :62.65\r\nRS-NVBS\r\nCVS-S1S2 Normal\r\nUlcer over the lateral aspect of Rt Thigh , Measuring 5x3\r\nBase Partial Granulated, Slough +\n\nDiscussion: Mr.SaSidharn.M /60yr/male , admitted with non Healing Ulcer over the Rt Thigh of 1month duration \r\ndebride the wound, c/s report suggestive of Staphylococus aureus, started on Antibiotic according to sensitivity report\r\nintiated on basal bolus regimen for fair glycemic control, wound Healing satisfactory.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 108\n\nPatient Number: 3091\n\nPatient Name: ANNAMMA MATHAI\n\nGender: F\n\nDate of Birth: 30-03-1931\n\nAddress: KIDANGALIL HOUSE,JACOB VALLANATT ROAD,\n\nPincode: 682018\n\nPhNo: 2391837\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 18-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\nCORONARY ARTERY DISEASE\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Both Kidneys shows mild Renal parenchymal oedema \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening. No mucosalirregularity.\r\n\\par \\tab \r\n\\par Uterus\\tab\\tab : Normal in size and echo texture\r\n\\par \r\n\\par Ovaries : Normal in size and echo texture\r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 Both kidneys shows mild renal parenchymal oedema \r\n\\par S/o Renalinfection /Nephritis\r\n\\par No mass lesion or calculus detected.\r\n\\par \r\n\\par Dr.Joe Antony,MD\r\n\\par Consutant Radiologist\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Pulse Ox- low without oxygen.\r\nWith oxygen 2L- 98%\r\nCXR- mottling seen (? acute pulmonary edema)\r\nInj Lasix 240 mg IV stat and Inj Derphylline 80 mg iv stat given and shifted to the ICU\r\nMaintained on 6 lits of O2, SPO2 80-90 %\r\n\r\nICU notes 9.00 pm\r\nNTG given at 2 mics and Dobutamine given at 5 mics (on flow)\r\nSaturation improved with treatment \r\nTab Carvedilol 6.125 mg and Tab Telmisartan 40 mg given\r\nInj Clexane 0.6 mg given\r\nBP 165/ 75 mm of hg\r\nCathetrized \r\n\nBetter, Vital stable, Spo2 96 with out O2\r\nContinue the same\nSeen By Dr.Tom \r\nSymptomaticaly better\r\nVital stable, NTG/Dobutamine on flow\r\nCardiology consultation Awaited\r\nS/B Dr .SasiKumar. Cardiologist\r\nPR-80, B.P 120/80mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Rt Crepitation \r\nPrerenal azotenimia\r\nECHo Gr 3 MR, No RWMA, Normal LV Function\r\nIshemia Precipted Pulmonary odema\r\nFolow the advice\r\nConsider Tab.Amlodipin 5mg instead of Telmisartan in view of Elevated Urea /Creatinine\nPR-70/min ., B.P 128/67, CVS-S1S2Normal , RS-Rt Basal crepitation +\r\nI/O 1250/2000\r\nChanged Telmisartan to Calcheck in view of Elevated Creatinine \r\nInj .Lasix 40mg \r\nIntake restricted to 1.2l\r\nLow salt diet\nVital stable, PR-90/min , B.P 130/80 mmof Hg\r\nCVS-S1S2 Normal \r\nRs few crepitation\r\nBlood transfusion over 4hr\r\n1units today\r\nInj.Lasix 20mg i.v st\r\nInj.Avil 1/2 amp i.v stat\nBlood transfusion 1units , Inj.Avil 1 amp i.v stat\r\nWith hold Inj.Dynalix\r\nPR-89/min \r\nB.P -140/80\r\nCVS-S1S2 Normal\r\nRS-Rt Basal crepitation\r\nCNS-Consious, Disoriented\r\nMotor/sensory/Reflex -Normal\r\nContinue the same medication.\r\nI/o 1650/2850\nPR-80\r\nB.P 120/80 mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Clear\r\nPA-Soft\r\nCNS-Consious /Oriented\r\nReflex Normal\nC/O tiredness,headache\r\nBP-140/80\r\nSPO2-94 RA\r\nVitals stable.\r\n\nDoing well. Had walked in the corridor without distress. Chest is clear.\r\nInformed dr.Sasikumar\r\nPR 86/min\r\nB.P 170/80mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Few crepitation\r\nCNS-Counsious/oriented\r\nadviced \r\nTab.Natrilex SR 1.5mg 1-0-0\r\nTab.Dytor 10mg insted of Lasix\r\nWithhold the Telmisartan 40mg\r\nContinue other as adviced\nS/B Dr.Sasikumar\r\nBetter, \r\nPR-80/min\r\nB.P -140/80 mmof Hg\r\nCVs-S1S2 Normal\r\nRs-Few crepitation \r\nContinue the same\r\nTab Epitus 25 1-0-1 for 1week, after 1week reduced to once aday\r\nMobilise\r\nDischarge tomorrow by evening\r\nS/b Dr Saeed\r\nUrine C/S\r\nLocal oestrogen cream\r\n\r\n\n'}, {'role': 'model', 'content': 'IP Number: 108\n\nPatient Number: 3091\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 18-10-2011\n\nDiagnosis: ACUTE PULMONARY ODEMA\r\nUTI\r\nANEMIA ? GI BLEEDING\r\nMOOD SWINGS NEED EVALUATION\n\nClinical Exam(With BP): Mrs Annamma Mathai K/C/O Type2 Diabetes mellitus, Hypertension , Dyslipedimia on treatment\r\nrecently discharge from the hospital , came with Breathlessness Acute onset, No H/o PND,Admitted for evaluation\r\nPt developed Flash Pulmonary odema, treated with Antifailure measures and put her on CPAP, sought cardiology consultation\r\nECG-LBBB(Old Change), ECHO-Dilated LA, Gr3/4 MR, Normal L.V function, CKMB-Normal limit, Pulomonary odema may\r\nbe because of Ischemia, defferted Coronary angiogram in view of genaral condition and age.changed ARB to Calcium Channel Blocker in view of\r\nelevated Urea/Creatinine, Electrolytes are normal During ICU stay HB droped to 7.2mg/dl\r\nStool for occult Blood Positive,Normal stoped LMWH,Asprine, tranfused 2units of Packed cells, Shifted from the ICU,Vital stable, Adjusted the Antihypertensive .started mild Physical activity without Symptoms\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Mrs Annamma Mathai K/C/O Type2 Diabetes mellitus, Hypertension , Dyslipedimia on treatment\r\nrecently discharge from the hospital , came with Breathlessness Acute onset, No H/o PND,Admitted for evaluation\r\nPt developed Flash Pulmonary odema, treated with Antifailure measures and put her on CPAP, sought cardiology consultation\r\nECG-LBBB(Old Change), ECHO-Dilated LA, Gr3/4 MR, Normal L.V function, CKMB-Normal limit, Pulomonary odema may\r\nbe because of Ischemia, defferted Coronary angiogram in view of genaral condition and age.changed ARB to Calcium Channel Blocker in view of\r\nelevated Urea/Creatinine, Electrolytes are normal During ICU stay HB droped to 7.2mg/dl\r\nStool for occult Blood Positive, stoped LMWH,Asprine, tranfused 2units of Packed cells, Shifted from the ICU,Vital stable, Adjusted the Antihypertensive .started mild Physical activity without Symptoms. Durning hospital stay She had mood fluction . Planned CT Brain, Upper GI Endoscopy/Colonoscopy on later date.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': "IP Number: 121\n\nPatient Number: 3091\n\nPatient Name: ANNAMMA MATHAI\n\nGender: F\n\nDate of Birth: 30-03-1931\n\nAddress: KIDANGALIL HOUSE,JACOB VALLANATT ROAD,\n\nPincode: 682018\n\nPhNo: 2391837\n\nAdmission Date: 26-10-2011\n\nDischarge Date: 08-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nCORONARY ARTERY DISEASE\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Both Kidneys shows mild Renal parenchymal oedema \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening. No mucosalirregularity.\r\n\\par \\tab \r\n\\par Uterus\\tab\\tab : Normal in size and echo texture\r\n\\par \r\n\\par Ovaries : Normal in size and echo texture\r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 Both kidneys shows mild renal parenchymal oedema \r\n\\par S/o Renalinfection /Nephritis\r\n\\par No mass lesion or calculus detected.\r\n\\par \r\n\\par Dr.Joe Antony,MD\r\n\\par Consutant Radiologist\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: H/o Vomiting , Feverish\r\nH/o Altered sensorium\r\nPR-80, Temp-99.4F\r\nB.P 170/70mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Basal Crepitation on Rt\r\nCNS-Consious\r\nDisoriented\r\nPlantar Down going\r\nAdmitted in ICU\nPR-80/min \r\nB.P-110/80mmof HG\r\nCVS-S1S2 Normal \r\nRS-Few crepitation \r\nCNS- Consious level better, Orientation better\r\nNo Motor/sensory deficit\r\nInsulin infusion on flow\r\nAdviced to stop 3% saline after this\r\nAdviced NS 50ml/hr Maintaince \r\nLook for Overload\r\nInform If Tachycardia, Breathlessness, Desaturation , \r\n\nAfebril \r\nPR-82/min \r\nB.P-112/80mmof Hg \r\nCVS-S1S2 Normal\r\nRS-few crepitation \r\nRR-20/min \r\nSpo2 -965\r\nPA-NAD\r\nCNS-Consious /Oriented \r\nBlack stool 1episode\r\n, scanty\r\ncontinue the same \r\nKeep the intake B/w 1500-2000l/24hr\r\nNapy Rash -\r\nApply Cetaphil Moisturising lotion \r\ninfusion on flow \r\nUSG ABD tomorrow 9am\r\nHB,PCV,TC, Creatinine, Urea, sodium, Potassium \r\n\nGeneral condition better. Na 122, TC- 20,600 cell/m3. Urine in the catheter is clearing up. Temp in 99 degrees F.\ns/b DR.ABDUL RASEED Nephrologist\r\nDrowsy\r\nDehydrated\r\nVital stable\r\nB.P 130/80\r\nNo odema\r\nLung-Clear\r\nImpression \r\nA/C Pylonephritis\r\nA/C on chronic Renal failure\r\nPlan continue Antibiotic C/S report available\r\nChange if Neccesary\r\nI.V.F NS 500ml Q6h\r\nOral fluid as per Need \r\nRFT Tomorrow\r\nCalcium and Uric acid \r\nRRT SOS\r\n\r\nbetter,vital stable\r\nTab.Nitreset 5mg sos\nVital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\nvital stable\r\nStool -Tarry Black\r\nCBC -Tomorrow\r\nPlanned Transfusion if low HB\r\n\r\n8.30 pm\r\nPatint developed shortness of breath after straining a bit. Saturation dropped to 89 %. IV 80 mg lasix given.shifted to the ICU. Saturation picked up with O2. NTG satrted @ 3 mics.\nPR-80/min\r\nB.P-120/80 mmof Hg\r\nspo2-95 %RA\r\nRS-Basa clear\r\nContinue the same\r\nNS 20ml /hr On flow\r\nContinue the same\r\nTab.Nitrest 5mg sos\nStop NTG\r\noff the o2 \r\nPR-80/min \r\nB.P 120/80mmof Hg \r\nCVS-S1S2 Normal\r\nRS-few crepitation in base\r\nPA-NAD\r\nCNS-Consious /Oriented\r\nI/o-1850/2750\r\nlab report awaiting \r\n\nPR-83/MIN\r\nB.P-137/59\r\nCVS-S1S2\r\nRS-CLEAR\r\nI.V NS 20ML/HR\r\nCONTINUE THA SAME\nVital stable, Spo2 95%RA\r\nRS-Clear except few crepitation , JVP Normal\r\nCNS Consious /Oriented \r\nI/O 1950/2270\r\nTab.Dytor 10mg Tuesday, Friday, sunday\nPR-84/min\r\nB.P 130/80mmof Hg\r\nCVS-S1S2\r\nRS-Few crepitation Rt , NVBS\r\nAdviced tab.Nitreset 5mg st\r\nHb,Urea,Creat\nGC better.Haemoglobin are up.Remove catheter.Stop IV antibiotic.Start on Nitrofurantoin.\r\nIntermittent cath-Nel cath\nVitals stable. Foley's catheter was removed in the morning, \r\nNo fever\r\nEvening catheterisation- 100ml\r\n9:12pm\r\nC/o Breathlessness-Acute onset\r\nPR-80/min \r\nB.P 160/80mmof Hg\r\nRS-Basal crepitation / Rhonchi +\r\nPA-Soft, NAD\r\nInj.Lasix 40mg i.v stat and sos \r\nCombimist Neb\r\nInj.Deriphylline 1amp sosi.v\r\nCardilogist opinion -tomrrow\r\n\nPR-76/min\r\nB.P -110/60mmof Hg\r\nCVS-S1s2 normal\r\nRS-Clear\r\nContinue the same\r\nCardilogy consultation\nbetter\r\nvital stable\r\nRS-Basal crepitation +\r\n Continue the same\r\nHB,TC,Sodium,Potassium, S.Creat, UREA,\nC/o breathlessness\r\nB.P140/80mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Basal Crepitation +\r\nPA-Soft\r\nTab.Dytor 10mg st\r\nTab. Coversyl 4mg 0-0-1/2 \r\nTab.Trika 0.5HS\r\nContinue the rest\r\nUrea/S.Creat/sodium/ potassium -CMS\r\n\nvital stable \r\nRs-basal crepitation\r\nAdviced \r\nRestrict the fliud intake to 1.2l\r\nLow sodium \r\nTab.Trika 0.5mg Hs\r\n\r\n\nPR-80/min\r\nB.P-120/50mmof HG\r\nCVS-S1S2 Normal\r\nRS-Clear\r\nHydration Better\r\nContinue the same\nDoing well, allow to walk for 2min, No symptoms\r\nfair glycemic control\r\nAdviced to continue same\r\nChanged to pantoprazole tab\r\nHB, Urine Routine, S.Creatine, UREA , NA+,K+\nVital stable\r\nSymptoms better\r\n\nC/o Nausea\r\nVital stable\r\nRS-Crepitation +\r\nCNS-Depresed\r\nContinue the same\r\nGive Tab.Coversyl AM in morning instead of Tab.Coversyl 4mg \r\nRest continue the same\r\nTab.Isordil 10mg 1-1-1-1\nSlept well. Catheterization being given twice daily. Blood sugar is 109mg/dl.\r\ns/b Dr.sasikumar\r\nadviced \r\nAdd Calcium channel blocker\r\nTab.Isordil 10mg 1-1-1-1\r\nreduced Tab.Dytor 1-0-0\nPatient is ready for Discharge. Vitals stable. Cardiac consultation awaited.\n"}, {'role': 'model', 'content': 'IP Number: 121\n\nPatient Number: 3091\n\nAdmission Date: 26-10-2011\n\nDischarge Date: 08-11-2011\n\nDiagnosis: HYPONATRIMIA\r\nUROSEPSIS\r\nANEMIA UNDER EVALUATION ? G.I BLEED \r\nACUTE ON CHRONIC RENAL FAILURE\r\nCONGESTIVE CARDIAC FAILURE\n\nClinical Exam(With BP): Mrs.Annamma Mathai/80yrs/ Female . was discharged few days ago with diagnosis of Type 2 Diabetes Mellitus , Hypertension , Dyslipidemia\r\nCoronary Artery disease,Acute Pulmonary Odema , Acute on Chronic renal failure, Anemia.Admiitted Back with History of Altered sensorium, Fever, Vomiting, found to have Urosepsis, SIADH, Acute on Chronic renal failure, Droping Heamoglobulin . Treateted with i.V antibiotics,corrected the sodium, adjusted the dose of Anti cardiac failure medication. Stoped Clopidiogreal in view of Droping Haemoglobulin. anemia work out suggestive of Occult blood in stool, PBS-Normocytic HypoChromic Anaemia,treated with Iron supplement. I.V Pantoprazole, Sucralfate suspension .planned Upper GI Scopy once stable\r\nContinue the medication adviced .Discharge in a stable state\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: PR-80, Temp-99.4F\r\nB.P 170/70mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Basal Crepitation more on Rt\r\nCNS-Consious\r\nDisoriented\r\nPlantar Down going\r\n\r\n\n\nDiscussion: Mrs.Annamma Mathai/80yrs/ Female . was discharged few days ago with diagnosis of Type 2 Diabetes Mellitus , Hypertension , Dyslipidemia\r\nCoronary Artery disease,Acute Pulmonary Odema , Acute on Chronic renal failure, Anemia.Admiitted Back with History of Altered sensorium, Fever, Vomiting, found to have Urosepsis, SIADH, Acute on Chronic renal failure, Droping Heamoglobulin . Treateted with i.V antibiotics,corrected the sodium, adjusted the dose of Anti cardiac failure medication. Stoped Clopidiogreal in view of Droping Haemoglobulin. anemia work out suggestive of Occult blood i stool, PBS-Normocytic HypoChromic Anaemia,treated with Iron supplement. I.V Pantoprazole, Sucralfate suspension .planned Upper GI Scopy once stable\r\nContinue the medication adviced .Discharge in a stable state\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 53\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: PRIMARY HYPOTHYROIDISM\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable, mild Hypoglycemic episode at 6:30pm , adviced to give dinner\r\nC/o Pain in the Leg\r\nInj.Emeset 4mg I.V stat\r\nAdviced Inj .Tramadol 50mg I.V st ATD\r\nNovorapid 10units just after dinner\r\nLantus 16units at bed time\r\nTab.Lasix 40mg st\r\n10:40pm C/o Brethlessness, B.P 130/80\r\nRS-Basal Crepitation +\r\nInj. Lasix 40 mg i.V stat\r\nECG Left axis deviation, No ST strain\r\nSPO2-95%\r\n\nSleep disturbed , pain prsentPR 76/min , B.p110/70mmof hg, RS-Clear\r\nIntake/output-300/350\r\nSerum Creat levels are going up (2.4 mg/dl)\r\nReduced the Microtaz 4.5g BD\r\nStop Tab. Telmisartan, Tab. Platloc A\r\nS/b Dr.A.K.B \r\nB/l Lower limb lymphangitis/Cellulitis\r\nNo Evidence of focal abcess.Blisters dorsum of left foot-deroofed.\r\nPlanned to add Linozolid.\r\nXray left foot including toes AP&Oblique\r\nCBC, Urea, creatinine,sodium, potassium\nPR-76/min , B.p 110/70mmof Hg, RR-26, RS-Air entry equal \r\nAfebrile, Pain subside,\r\nTachypenic , Rs-Clear, CVS-S1S2 Normal , PA-Fluid shift +\r\nPlanned Shift to ICU\r\nS/B Dr.Sasikumar\r\nTachycardic , Tachypenic, Cardiac status with in normal limit\r\nBreathlessnesss because of Volume overload, ? Acute on Chronic Renal failure\r\n\r\n11:15am S/B Dr.Elizabath, Dermatologist\r\nImpresion Bacterial Skin infection , Cetaphin lotion , Rt axilla mild Fungal infection , apply candid cream, \r\nApply T-bact Ointment for Local infection. Antibiotic according to blood c/s\r\n12:00 am Shift to ICU\r\nUrinary Cath\r\nI/O Chart\r\n\nPulse- 107, B.P-110/70, output- 800ml\r\nNo fever, \r\nChest - clear\r\nHb, TC, Na+, K+, Urea, Creatinine- Morning\nBetter, Afebril,vital stable, continue the same\r\n7:30pm Febrile, cannula out , adviced Tab.Welset, Inj.Clindamycin i.m , incrase oral intake\nSeen by Dr.A.K.Bhat:Pain&redness right leg has decreased.\r\nThere are multiple blisters over dorsum of left foot.The blisters were deroofed&serous fluid drained.Dressing done.Adviced:Inj.Clindamycin.\r\n9:00am S/b Dr.Tom , Clinicaly better, Vital stable , continue the Hydration , Spo2 99% , PR-108/min , B.p 110/80mmof Hg, CVS-S1S2 Normal ,RS-NVBS,No added sound\r\nStop Linazolide, continue the other, Blood transfusion (Whole Blood)\nSeen by Dr.A.K.Bhat.\r\nThe blisters of left foot dorsum were deroofed to reveal a sinus exposing deeper subcut.fat /slough, suggestive of localised necrotising fasciitis.Repeat wound swab fr C/S taken.A part of the subcut.fat was excised and sent fr tissue C/S.\r\nC&D DONE.\r\nCounts coming down, S.creatinine coming down, \r\nDiuretic phase\r\nH/o L-stools\r\nadd Cap.Yogut 1-0-1\r\n8:30PM B.P 190/80MMOF HG\r\ntAB.REVOLOL50MG 1-0-1\r\nTAB.OLVANCE 40MG STAT\nNo loose stools since last night. Sleep disturbed. c/o dry cough. Secured a good line for IV access.\r\no/e: chest clear, skin lesion with cellulitis better.\r\nTransferred from the ICU, Renal function getting better.\r\nCreatinine-1.4, blood urea- 54, will stop I.V fluids\r\nSpoke with surgeon, might need debridement of the underlying tissue, discussed with the family\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The blisters of left foot dorsum completely deroofed.However the edema&redness of foot&leg has decreased.There is e/o subcut.necrosis fr about 7x7 cm over dorsum.This may need skin&soft tissue slough excision under LA.\nC/o Breathlessness at night, sleep disturbed, vital stable\r\nBlood sugar good, Xray Chest -PA, ECG\nSitting, PR-108/min , B.P-140/80mmof Hg , CVS-s1s2 N0rmal, RS diffuse crepitation ,spo2 90%, adviced\r\nBudocort Nebulization 1-1-1\r\nInj.Tramadol 50mg sos\r\nwithhold platloc As\r\nHb,DC,S.Cr, Na+,K+-morning\nBetter, Vital stable, Spo2-94%, PR-80/min , RS-few rhonchi\r\nContinue the Nebulization\nVitals stable. dyspnoea slightly better..pulse oximetry- 94% RA. Planned to do debridement today under local.\r\nafebrile, renal function improving. WBC slightly decreased.\r\nChest- b/l rhonchi and wheeze\nHas not slept last night. Swelling over both feet much better.\r\n\r\nTo send CBC, Na, K, Se Creat tomorrow\nfine, Tab.Trika 0.5mg stat\nFine vital stable, Rs-Clear, CVS-S1S2 Normal, Vasolin Body lotion for local application , Cetaphil lotion -stop.\r\nSeen by Dr.AK.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.\r\nS/b Dr.KMR\r\n? Allergic Bronchitis\r\nAdviced add Tab.Claribid 250 mg BD x 5days\r\nOdphylline 400mg 1/2 -0-1\r\nTab.Allegra 180mg OD\r\nSyp. Alex (sugar free) 2tsp 1-1-1\r\n\nVital stable , comfortable, Inj. MicrotaZ 4.5g, Tab.Dalacin 600mg, Tab.Linazolide 600mg\\\r\nContinue the same\nVital stable, RS-Clear, stop Microtaz , reduced the nebulization, Clindamycin changed to tab, added Linazolide\r\nClaripid for atypical coverage\nVitals stable. GRBS- 99, \r\nRS- B/l creps\nSeen by DR.A.K.Bhat.\r\nDressings changed.The raw area over left foot dorsum is clean.No residual pus or slough.Right heel superficial ulcer is healing well.Adviced:Cap.Clindamycin 300 mg tds.\r\nfine, continue tha same\nsitting up, not in any distress. blood sugar controlled. \r\nc/o itching in the armpits and in between the buttocks.\nVitals stable. No fever. Dressing change done yesterday by DR bhatt. Lt foot- healing, granulation tissue present.\r\nChest - B/L creps\nseen by dr.a.k.bhat.\r\nafebrile.\r\nGetting chest physiotherapy. No fever, stopped linezolid\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.Rt. leg blisters healing well.\r\nContinue trt.\r\n6:00pm Cough, vomited once \r\nRS-Crepitation +, Rhonchi +\r\nIncrese the nebulization Combimist Q6h, Derinide 1-1-1\r\nRestarted Tab. Mucinak 600mg -1-0-1\nVitals stable. sittting up. GRBS morning controlled, afternoon sugar slightly high.\r\n\n142mg/dl -8units Novorapid ,\n6:00pm PR-90/min , B.P 140/60mmof Hg, CVS-S1S2 Normal, RS Few crepitation , Rhonchi\r\nBlood tranfusion \r\nPremedication\r\nVital stable\r\n\nDoing well. Blood sugars are well controlled.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Left foot raw area clean.\r\nRt. heel healing well.\n'}, {'role': 'model', 'content': 'IP Number: 53\n\nPatient Number: 2822\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis: DIABETIC FOOT-Necrotising Facitis\r\nFILARIASIS-RT\r\nGLUCOMA\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis\r\nAcute Renal failure\n\nClinical Exam(With BP): H/o Sweling over the Both foot-1week\r\nUncontrolled Diabetes\r\nH/o multiple Furcuncle over the leg. Duration of Diabetes - 10 years\r\nCurrent Medication\r\nNovorapid 18-20-0\r\nNovomix 25 at bed time\r\nDecresed urine out put\r\nH/o fever\r\nPolyuria, Polyphagia, Polydipsia - No\r\nWeight Loss- No\r\nBlurring of vision-No\r\nDiabetic eye examination- Yes\r\nGlucoma, No DPR\r\nBurning Sensation of feet -Yes\r\nNumbness of feet-Yes\r\nNon healing Diabetic Foot Ulcer-Recurren\r\nSwelling of feet -Yes, increses during Fever\r\nRt Filariasis\r\nCornary heart Desease-No\r\nDyslipidemia-No\r\nHypertension-yes\r\nRecurrent infections- Yes\r\nAutonomic dysfunction (orthostatic hypotension, early satiety, constipation)- Yes \r\nHypoglycemia - No\r\nDry skin. Had Abscess-Rt foot, Iand D done 11/2yrs back\r\nH/o Blood transfusion in past for anemia\r\n. Dyspenic\r\nRS-B/l Airentery Equal\r\nCVS-S1S2 normal\r\nPA- Soft, No Tenderness, No Organomegaley\r\nShifting dullness prsent\r\nCNS-Consious /Oriented\r\nMotor/sensory -Normal\r\nReflex -+\r\nPeripheral circulation -+\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Elderly Lady K/C/O Type 2 Diabetes Mellitus , Hypertension , Diabetic Neuropathy .Admitted with the history of Swelling and pain over the both leg more on the Lt ,Lab investigation Leucocytosis, Elevated Urea , Creatinine, Urine routine -Bacteruria, Multiple Pus cell. Treated with Broad specturm antibiotic covering Gram Positive,Negative,Anaerobic, Pus/Blood Culture were negative . On 3rd day of admission Renal parameter are settling down,\r\nInfection localized to Rt foot, Incsion and Excised the Necrotic tissue, Blood count are improving, Had Broncho constriction , sought pulmonoilogist consultation , started on Bronchodilators, inhaled steriods and Mucolytic and Chest Physio, Chest is better, on Prophylactic DVT regimen. Slowly ambulated. Her HB was low tranfused 1units of Whole Blood\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, low salt, low potassium, diabetic diet with small, frequent feeds adviced\r\nDiet sheet and diet booklet given\n'}]

[{'role': 'user', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nPatient Name: KOCHU THRESIA MICHAEL\n\nGender: F\n\nDate of Birth: 07-07-1932\n\nAddress: 27/78, V.P MARAIKAR ROAD, EDAPALLY NORTH\n\nPincode: 682024\n\nPhNo: 0484 - 2543217\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat\r\nResolving ?Necrotising fasciitis Lt leg.\r\nAdvice:IV Fortum,Tbact oint. local application tds,Candid cream between toes bd,Inj.Clexane,Rest&leg elevation.\nVitals stable. pre- lunch- 159, still has redness in the Lt leg, an area of ? pus collection near the ankle. will show it to Dr Bhatt\nvitals stable, more alert now, clinically the Lt leg looks better, oedema subsided. redness still present.\r\nBlood sugar well controlled\r\nInput- 850\r\nOutput- 700, Na- 123\nFeeling sleepy. was able to get an I.V access. Will check NA+\r\nOedema subsiding\r\nHb- 8.6, TIBC- 163\nSeen by DR.A.K.Bhat\r\nEdema&redness decreased.Small focal scab lateral ankle needs observation.\r\nAdviced:vaseline application&Tbact\r\n\r\nVitals stable. had good sleep yesterday. more alert sittting up and eating food.\nvitals stable, blood sugar controlled. alert, slept well. oedema subsided. erythema better.\nGeneral condition stable. Cellulitis better. Since the IV line is out we have decided to go with oral cephalosporins.\nSeen by Dr.A.K.Bhat\r\nThe redness is less &ulcers of the left leg are healed.\r\nAdviced:Emollients.\npt feels better, more alert , oedema and redness subsided.\r\nswitched to oral antibiotics.\r\nTab Flunil put on hold.\r\nwill discuss with DR bhatt and family the plan for discharge\nPR 76/min , B.p-140/70mmof hg, CVS-S1S2 Normal , RS-Clear, Restricted Rt Shoulder movement, Cellulitis subsiding\r\n\nfebril, vital stable, Continue the same\r\nTPR Chart, Intake /output\nVitals stable, No fever. ,AC- 150, Blood RE- 12,050.\r\noedema subsiding, redness getting better.\r\n11:00am Disscused with Dr. Bhat, adviced to add Tab. Ciprofloxacin watch for 2days, continue the other medication , Tab.Chymoral forte 1-0-1\nvital stable, no fever, changed the cannula, continue the same orders\nCellulitis better. Onychomycosis+\r\n6:00pm Vital stable , Afebrile, continue the order\nDoing well, vital stable, swelling status co, FBS 169,increse the dose of metformin\r\ncontinue the same orders\nBetter,vital stable, continue the same\nVital stable, Leg sweelling decresed, Systemic examination -NAD\r\nBlood routine , platelet count\nAfebrile, Limb status co, Systemic examination NAD\r\nDiscussed with son , insisted to start on Linzolid, started on Linazolid\nCellulitis/ Necrotizing fascitis - status quo. Over all general condition is good.\nCellulitis better. General condition good. Mobilized her a bit.\r\nSeen by Dr.A.K.Bhat\r\nRedness &swelling decreased.Adviced:Crepe bandage.\r\nStop fortum.\nDoing well, redness subsided , FBS 164, Vital stable , Systemic Examination -NAD\r\nplan to change to Oral medication\nVitals stable. GRBS- 203, No fever\nDoing well, Odema subsided, redness subsided , D/C Cannula, Continue the same order, swith over to Tab.linazolide\nPR-86, B.p 190/100mmof hg , RS-Rhonchi +, \r\nStop Revolol, Change to Tab. Nebivolol, Tab. Amlodipine 2.5mg stat\r\n8:15pm C/o Chest pain transient, PR-70/min, B.p-150/70mm0f hg ECG-RBBB, No ST-TChange\r\nRpt ECG in the morning\nPR-80/min , B.P 140/70mmHg,RS-Rhonchi+, Crepitation +\r\nPA-NAD, Mild pedal odema\r\ncontinue the same\nPR-80/min , B.P 160/70mmof Hg, RS -Crepitation +/Rhonchi\r\nLeg better\r\nDoing well, Plan to add small dose of Diuretics\r\nBLOOD ROUTINE, PLATELET COUNT, UREA , CREATINE, Na+, Ka+ TOMORROW\nPt ambulating. Cough better. Blood work done.\r\nPlan is to discharge to a rehab facility\nseen by Dr.A.K.Bhat.\r\nAdviced emollients.Stop linezolid.\r\n6:30pm Better, RS-Rhonchi +,Stop Cetaphil\nS/b Dr.Ramesh Nair\r\nCellutitis, Acute Bronchitis\r\nIV Deriphylline 2cc i.v slowly bd\r\nCombimist Neb Q6h\r\nBudocort Neb Q8h\r\nTab.Mucinac 600 1-0-1\r\nSteam Inhalition\nc/o feeling Nauseous, B.P better control. \r\nChest - B/l wheeze and Rhonchi\nDoing well. General condition status quo. Chest better- occasional rochi\nfine, B.P 170/80mmof Hg continue the same\nRhonchi, GRBS-223mg/dl, Stop Odyphylline, Started on Abphylline 100mg BD\nVital stable, B.P 130/70mmog hg, CVS-S1S2 Normal, RS-B/l Rhonchi +, Leg Odema Better\r\nStop Tab.Linozolid\nDR.Rmesh Nair visited the Pt\r\n\r\nGC- Better\r\nVital stable. GRBS- 136, plan to discharge on thursday\nPR 76/min , B.P-140/70mmof Hg, RS-Rhonchi+, Mentation stable.Stop Linazolide, stat Levofloxacin , Mucomix Nebulization , continue the same\r\n\r\n\r\nDr .Ramesh Nair visited the pt on 17/09/11\nVitals stable. GRBS- 120, \r\nRS- B/L rhonchi, seen by pulmonary yesterday, continue the same medicines\r\nIntend to D/C tomorrow.\r\nChesyt Physiotherapy\r\nRpt Na tomorrow\nbetter, vital stable, Rs-Rhonchi +\nVitals stble. Intend to D/C today\n'}, {'role': 'model', 'content': 'IP Number: 41\n\nPatient Number: 2756\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis: Cellulitis/? Necrotising fascitis\r\nSIADH\r\nOsteoarthritis\r\nEssential HTN\n\nClinical Exam(With BP): admitted with swelling, redness and pain in the Lt leg x 10-14 days\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, not in any distress.\r\nRS- B/l Rhonchi\r\nLOcal - oedema, redness, INcreased warmth with chronic dermatitis changes\n\nDiscussion: 79 yr old with H/o DM, Osteoarthritis admitted with redness, pain and swelling of the Lt leg, ( cellulitis/? necrotising fasciitis ) started in I.V antibiotics, seen by surgeon. Venous doppler was done which showe No thrombus, but valve incompetanance. Hyponatremia was corrected with hypertonic saline. Glycemic control was achieved with tab Metformin and bed time dose of lantus. Pt was also seen by Cardiology for evaluation of hypertension. Echo was done which was normal. Antihypertensive meds were adjusted. During the hopsital stay, devloped chest congestion, started on Combimist Nebs and Budesonide Nebs and also seen By pulmonary who recommended the same.\r\nPt was initiated on to physical therapy.\r\n\n\nDiet: NUTRITION Dept:\r\n1600 kcal, low fat,less spicy, diabetic diet with small, frequent feeds adviced\r\nExtra salt added\r\nDiet sheet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 76\n\nPatient Number: 2755\n\nPatient Name: V.T. JOHN\n\nGender: M\n\nDate of Birth: 31-08-1938\n\nAddress: VAYARANPUNNAKAL HOUSE, EDAYAR P.O\n\nPincode: 686662\n\nPhNo: 0485-2253483\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: seen by pulmonary\r\nDM with bronchitis\r\nTab unicintin 1/2 -0 -1/2\nBetter, continue the same, No Local rxn with Levoflox\nc/o loss of appettite.\r\nChest - b/l Rhonchi\r\n\nVITAL STABLE, GRBS-336MG/DL -INSUGEN R16 BEFORE DINNER, INSUGEN N 10UNITS AT BED TIME\nGeneral condition much better.\r\nRS- Crepitation persisting but better.\n'}, {'role': 'model', 'content': 'IP Number: 76\n\nPatient Number: 2755\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis: ? Monogenic Form of Diabetes (? Lipoatrophic Variety)\r\nLRTI\n\nClinical Exam(With BP): K/C/O Monogenic Diabetes , on Insulin, Steriods, admitted with the history of Cough, fever\r\ntreated as LRTI, responded to the I.V Antibiotic, Inhaled Bronchodilators given to relive the congestion\r\nAppitite better,genaral condition improved .Discharge in stable state\n\nSystolic BP: 120.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Elderly Gentelman K/C/O Monogenic Diabetes , on Insulin, Steriods, admitted with the history of Cough, fever\r\ntreated as LRTI, responded to the I.V Antibiotic, Inhaled Bronchodilators given to relive the congestion\r\nAppitite better,genaral condition improved .Discharge in stable state\n\nDiet: NUTRITION Dept:\r\n1600 kcal, low fat dieabetic diet given\r\nDiet booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for skin gafting\nVenous doppler -Tomrrow\r\nPR-80\r\nB.P 150/80\r\nCVS-S1S2 Normal \r\nRS-Clear\r\nCNS-Consious / Oriented \r\nPA-NAD\r\nContinue the same\nS/B Dr A.K.Bhat\r\nAdd Inj. Enoxaparin 60mg s/c B.D\r\nBlood Routine\r\nXray chest PA\r\nECG\r\nRFT\r\nLFT\r\nPlan for Skin grafting for tuesday morning\r\n\nVital stable, systemic examionation -NAD\r\nDoppler Venous \r\nContinue the same\nBlood transfusion \r\n1unit PCV\r\nInj.Lasix 20mg i.v stat\r\n\tinj.Avil 1amp i.v stat\r\ntransfusion on flow \r\nvital stable \r\nContinue the same\nital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\n1units over at 2am , No rxn, \r\n2nd unit\r\nBlood tranfusion \r\n1unit\r\nPremedication\r\nInj.Avil 1amp i.v / Inj.Dexona sos\r\ncontinue the same\r\n\r\nVital stable \r\nConinue the same\r\nPBF/Iron profile awaited\r\nContinue the same\nHb/PCV\r\nTransfusion over , No rxn, vital stable\nSeen by Dr.AK.Bhat.\r\nFor SSG left foot&skin biopsy under SA on 1-11-2011.Get consent.C&D left foot.Shave genitalia&left thigh&betadine scrub HS&CM.Medical fitness for the procedure.IV antibiotics Inj.Microtaz 4.5 gm IV HS&CM.\r\n\r\nVITAL STABLE, NPO,FOLLOW THE DR.BHATT ORDRES\r\nHIGH RISK CONSENT\nVITAL STABLE,CONTINUE SAME\nPR-98/min\r\nB.p-124/67mmof Hg\r\nCVS-S1S2 Normal\r\nRS RR-24/min \r\nCNS-Consious /Oriented \r\nPA-Soft , NAD\r\nPain Better\r\nContinue the same\r\nInj.Fortwin 1amp / Phenargan 1/2 amp slow i.v sos\r\nTab.Nitreset sos\nVomitted once , C/o breathlessness\r\nSpo2 94%, PR-90/min, B.P120/80mof Hg\r\nCVS-S1S2 normal\r\nRS-NVBS\r\nCNS-Consious /Oriented\r\nInj.Pantodac 40mg IV\r\nInj.Emeset I.v \r\nCombimist Neb+derinide Neb stat\nGC better.Pt can be shifted from ICU.BP normal.\nSeen by Dr.A.K.Bhat.\r\nSome pain left thigh.Continue trt.\r\nC/o pain in th thigh and headache\r\npulse 0x at 12 am\nVitals stable. No pain at present\r\nPLan- Hold on the warfarin for now and start later.\nSeen by Dr.A.K.Bhat.\r\nFor change of dressing in OT tomorrow.\nVital stable, Continue the same\r\nContinue the same\nBetter\r\ndoing well\r\nRegular with Medication\r\nContinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.SSG left foot has taken up.The donor site left thigh is clean.\r\nSuggested oral antibiotic.\nC/o Breathlessness\r\nC/o Abdomen discomfort\r\nFBS-111\r\nINR-1\r\nVital stable\r\nRS-Clear\r\nCVS-S1S2 Noraml\r\nMild odema over the Foot\r\nStoped tab.Deriphylline\r\nAxipan\r\nAdded tab.ravera D 1-0-1\r\nSyp.Sucrafil 10 ml 1-1-1\r\nContinue the same\nVital stable\r\nno specific complaint\nSeen by DR.A.K.Bhat.\r\nAfebrile.Continue trt.For change of dressing on wednesday.\nvital stable\r\nPT/INR-1.1\r\nContinue the same\r\nIncresed the warf 5mg 1-1-1\r\ncontinue the asame advice\nDoing fine. Not to ambulate as yet. No anitibiotics on board.\r\nPT/ INR tomorrow.\nfine\r\nHB, PCV, PT/INR\nSeen by Dr.AK.Bhat.\r\nDressings changed.The SSG left foot is settling well.The donor area left thigh healing well.\r\nVitals stable. will discharge only on saturday\nSeen by Dr.A.K.Bhat.Status better.No pain.Plan for discharge on saturday.\r\nTab.Deslar 5mg for cold st\nGC better.Slept well.Stool passed.Vitals stable.Continue the same.\r\nSeen by Dr.A.K.Bhat.Continue trt.\nSeen by Dr.A.K.Bhat.Dressings changed.Donor site fully healed.SSG taken up.\r\nAdvice on discharge:Dressing change left foot twice a week-Cuticell/pad/crepe bandage.Vaseline to left thigh thrice a day.Partial weight bearing left leg.Review after 2 weeks.\n'}, {'role': 'model', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis: Essential (primary) hypertension (I10)\r\nTYPE 2 DIABETES MELLITUS (SL13)\r\nDIABETIC FOOT-Necrotising Fascitis\r\n ?FILARIASIS-RT\r\nGlaucoma\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis \r\n\r\n\n\nClinical Exam(With BP): Admitted for grafting of the ulcer on the dorsum of the LT foot\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, obese, not in any resp distress\r\nRS- NVBS\r\nCVS- S1 S2 heard\r\nAbdomen- Normal\n\nDiscussion: Pt admitted for skin grafting of the ulcer on the dorsum of the Lt foot. Venous doppler was done- Thrombosis of both the femoral and popliteal vein. Pt was started on Low molecular Wt heparin. Pt was noted to have low HB, investigation were done and was transfused 2 units of PRBC , SSG was performed on 1/11/2011, with the graft taken from the Lt thigh. skin biopsy was taken from one of the impetiginous lesion.\r\nPt was started on I.V antibiotics, insulin basal bolus regimen, started on Tab Warfarin, while continuing on the inj low molecular wt heparin. INR therapeutic, and heparin stopped.\r\n\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for skin gafting\nVenous doppler -Tomrrow\r\nPR-80\r\nB.P 150/80\r\nCVS-S1S2 Normal \r\nRS-Clear\r\nCNS-Consious / Oriented \r\nPA-NAD\r\nContinue the same\nS/B Dr A.K.Bhat\r\nAdd Inj. Enoxaparin 60mg s/c B.D\r\nBlood Routine\r\nXray chest PA\r\nECG\r\nRFT\r\nLFT\r\nPlan for Skin grafting for tuesday morning\r\n\nVital stable, systemic examionation -NAD\r\nDoppler Venous \r\nContinue the same\nBlood transfusion \r\n1unit PCV\r\nInj.Lasix 20mg i.v stat\r\n\tinj.Avil 1amp i.v stat\r\ntransfusion on flow \r\nvital stable \r\nContinue the same\nital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\n1units over at 2am , No rxn, \r\n2nd unit\r\nBlood tranfusion \r\n1unit\r\nPremedication\r\nInj.Avil 1amp i.v / Inj.Dexona sos\r\ncontinue the same\r\n\r\nVital stable \r\nConinue the same\r\nPBF/Iron profile awaited\r\nContinue the same\nHb/PCV\r\nTransfusion over , No rxn, vital stable\nSeen by Dr.AK.Bhat.\r\nFor SSG left foot&skin biopsy under SA on 1-11-2011.Get consent.C&D left foot.Shave genitalia&left thigh&betadine scrub HS&CM.Medical fitness for the procedure.IV antibiotics Inj.Microtaz 4.5 gm IV HS&CM.\r\n\r\nVITAL STABLE, NPO,FOLLOW THE DR.BHATT ORDRES\r\nHIGH RISK CONSENT\nVITAL STABLE,CONTINUE SAME\nPR-98/min\r\nB.p-124/67mmof Hg\r\nCVS-S1S2 Normal\r\nRS RR-24/min \r\nCNS-Consious /Oriented \r\nPA-Soft , NAD\r\nPain Better\r\nContinue the same\r\nInj.Fortwin 1amp / Phenargan 1/2 amp slow i.v sos\r\nTab.Nitreset sos\nVomitted once , C/o breathlessness\r\nSpo2 94%, PR-90/min, B.P120/80mof Hg\r\nCVS-S1S2 normal\r\nRS-NVBS\r\nCNS-Consious /Oriented\r\nInj.Pantodac 40mg IV\r\nInj.Emeset I.v \r\nCombimist Neb+derinide Neb stat\nGC better.Pt can be shifted from ICU.BP normal.\nSeen by Dr.A.K.Bhat.\r\nSome pain left thigh.Continue trt.\r\nC/o pain in th thigh and headache\r\npulse 0x at 12 am\nVitals stable. No pain at present\r\nPLan- Hold on the warfarin for now and start later.\nSeen by Dr.A.K.Bhat.\r\nFor change of dressing in OT tomorrow.\nVital stable, Continue the same\r\nContinue the same\nBetter\r\ndoing well\r\nRegular with Medication\r\nContinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.SSG left foot has taken up.The donor site left thigh is clean.\r\nSuggested oral antibiotic.\nC/o Breathlessness\r\nC/o Abdomen discomfort\r\nFBS-111\r\nINR-1\r\nVital stable\r\nRS-Clear\r\nCVS-S1S2 Noraml\r\nMild odema over the Foot\r\nStoped tab.Deriphylline\r\nAxipan\r\nAdded tab.ravera D 1-0-1\r\nSyp.Sucrafil 10 ml 1-1-1\r\nContinue the same\nVital stable\r\nno specific complaint\nSeen by DR.A.K.Bhat.\r\nAfebrile.Continue trt.For change of dressing on wednesday.\nvital stable\r\nPT/INR-1.1\r\nContinue the same\r\nIncresed the warf 5mg 1-1-1\r\ncontinue the asame advice\nDoing fine. Not to ambulate as yet. No anitibiotics on board.\r\nPT/ INR tomorrow.\nfine\r\nHB, PCV, PT/INR\nSeen by Dr.AK.Bhat.\r\nDressings changed.The SSG left foot is settling well.The donor area left thigh healing well.\r\nVitals stable. will discharge only on saturday\nSeen by Dr.A.K.Bhat.Status better.No pain.Plan for discharge on saturday.\r\nTab.Deslar 5mg for cold st\nGC better.Slept well.Stool passed.Vitals stable.Continue the same.\r\nSeen by Dr.A.K.Bhat.Continue trt.\nSeen by Dr.A.K.Bhat.Dressings changed.Donor site fully healed.SSG taken up.\r\nAdvice on discharge:Dressing change left foot twice a week-Cuticell/pad/crepe bandage.Vaseline to left thigh thrice a day.Partial weight bearing left leg.Review after 2 weeks.\n'}, {'role': 'model', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis: Essential (primary) hypertension (I10)\r\nTYPE 2 DIABETES MELLITUS (SL13)\r\nDIABETIC FOOT-Necrotising Fascitis\r\n ?FILARIASIS-RT\r\nGlaucoma\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis \r\n\r\n\n\nClinical Exam(With BP): Admitted for grafting of the ulcer on the dorsum of the LT foot\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, obese, not in any resp distress\r\nRS- NVBS\r\nCVS- S1 S2 heard\r\nAbdomen- Normal\n\nDiscussion: Pt admitted for skin grafting of the ulcer on the dorsum of the Lt foot. Venous doppler was done- Thrombosis of both the femoral and popliteal vein. Pt was started on Low molecular Wt heparin. Pt was noted to have low HB, investigation were done and was transfused 2 units of PRBC , SSG was performed on 1/11/2011, with the graft taken from the Lt thigh. skin biopsy was taken from one of the impetiginous lesion.\r\nPt was started on I.V antibiotics, insulin basal bolus regimen, started on Tab Warfarin, while continuing on the inj low molecular wt heparin. INR therapeutic, and heparin stopped.\r\n\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nPatient Name: SAJITH KUMAR\n\nGender: M\n\nDate of Birth: 14-04-1968\n\nAddress: CHELAYIL HOUSE, NEAR K.S.E.B\n\nPincode: 682005\n\nPhNo: nan\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC RETINOPATHY\nDIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Blood sugars are 634 mg/dl. Patinet is comfortable. Vitals are fine.\nConsious , oriented , febril , HR-82, BP- 150/90 RS-B/l Basal crepitation , Cvs -JVP Elevated , S1,S2 Normal \r\nAdviced Tab.Welset sos, Planned Cardiology consultation tommrow, statrt Inj.Metrogyl 100 i.v 1-1-1, Tab.Levofloxacin 500mg . Surgical Debridement on friday\nFebrile,Vital stable, Continue the same medication , prepare for the wound debridement under local \r\n\nTemp-99.2, PR-82, BP-130/80, Systemic Examination -NAD \r\nAdviced ECG/XrayChest -PA Veiw, \r\nadjusted the insulin dose, inform Prelunch, predinner, continue othe medication as Advice \r\nInform OT Staff,\nGeneral condition better. Slept well. Passed stools. Scheduled for debridement today. AC- 140 mg /dl. To be shifted to the recovery/ ICU at 9AM\r\n\r\n29/07/2011\r\nOperation done....\r\nSlough Excision of Right Heel Ulcer done under L/A.\r\nAfter adequate preparation and draping, the Ulcer slough was Excised For about 2X2 inches.\r\nThe slough did not seem to extend to the bone.\r\nThe Residual Ulcer after Excision, Bleeding was satisfactory.\r\nUlcer Haemostasis achieved.\r\nABGEL and Compression Dressing given.(DR. A.K. Bhat).\r\n\r\nPOST OPERATIVE ORDERS/INSTRUCTIONS:\r\n\r\nStrict Right Leg Elevation and Bed Rest.\r\nTPR/BP Monitoring.\r\nWatch For Bleeding.\r\nContinue IV Antibiotics.\r\nInject. Tramadol IM S.O.S\r\nPlanned for change of dressing in Recovery Room 31/07/2011.\r\n\nSeen by Dr.A.K.B\r\nPt afebrile.\r\nAdvice no wt.bearing on rt.leg .\r\nFor C/D tomorrow in OT Recovery.\npt alert, had an episode of hypoglycemia yesterday, ( sweating) GRBS- 86 .\r\nNo fever, chills\r\nPost debridement yesterday, No pain\r\ndressing tomorrow.\r\n\nSeen by Dr. A.K.Bhat and Dr. Tom Babu.\r\nDressings have been changed.\r\nThe Ulcer of the Right Heel looks CLEAN.\r\nNo Residual Pus or Slough.\r\nNo Evidence of Cellulitis.\r\n\nNo fever, No pain, Vitals stable, Dressing done yesterday, switched to oral antibiotics\nNo complaints, vitals stable,dressing to be done today by DR Bhatt, Intend to discharge tomorrow.\r\nAC- 93, Insugen R 24 units given. Midnight GRBS- 130\r\n10:00am Doing well, No Hypos, awating for surgeon for dreesing , adjusted the insulin dose according to the GRBS, planned discharge\r\n2:00pm s/b Dr.A.K.Bhatt , dressing changed , ulcer of the Rt heel looks clean except for some slough of the floor , part of which excised , Abgel compression dressing given , surronding skin and soft tissue inflamation subsided, continue the same Treatment .\r\n\nVital stable,GC-Better,Systemic Examination-NAD\r\nPredinner -165, adviced InsugenR 22units , Insugen N 26units at bed time \r\nPlanned discharge on 4/08/2011\nAfebrile, No pain, AC- 160, Insugen R 24 units given\r\nSeen and dressing change done by Dr A.K. Bhatt yesterday,\r\nDressing to be changed tomorrow again and Intend to D/c tomorrow.\nSeen by Dr.A.K.Bhat\r\nDressing changed.The ulcer right heel looks clean.\r\nAdvice:Dressing change as OP once in two days.No weight bearing on ulcer area.Oral antibiotics for one week.\nVital stable ,one episode of hypoglycemia , Dressing change today, continue the same\n'}, {'role': 'model', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis: Infected Non Healing Ulcer\n\nClinical Exam(With BP): 43 yr old with H/O DM admitted for Infected non healing Ulcer. S/P debridement of the the ulcer by DR A.K.Bhatt on 29-07-2011.\r\nTreated with Broad spectrum I.V Antibiotics , and tight control of sugar by basal insulin( INsugenN ) and three time regular insulin ( InsugenR).\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: lab results attatched\n\nXray findings: nan\n\nDiscussion: Controlled blood sugar with Basal bolus regimen, under antibiotic cover, wound debridement done , adviced to continue the insulin , off loading , regular dressing\n\nDiet: \r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 99\n\nPatient Number: 3092\n\nPatient Name: K.M NOORJAHAN\n\nGender: F\n\nDate of Birth: 06-10-1956\n\nAddress: THACHAVALLATH HOUSE, MUPPATHADAM P.O\n\nPincode: 683010\n\nPhNo: 0484 - 3222955\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Feels better. GRBS- 198\nPatient was weak.GRBS 395mg/dl.\nDental Consaltation.Opthalmic Consultation.Check TSH,T4.Check Versa lab,Vibrometer.\nFeels better. Sugar still not controlled.Opthalmology and podaitry evaluation done.\nCheck Orsthostatic hypotension.\r\nECG done.\r\nODST to be done.\nC/o Burning sensation in the foot\r\nAdded Tab.Amitone\nVital stable, \r\nMoon face, buffole Hump,Straie\r\n\r\nDexona 1mg at 11:00pm , S.Cortisol at tomorrow 8:00am\r\n(send 1sample outside)\r\nContinue the orders\nPatient was weak.T.welset sos to be given.\nbetter,vital stable, dexomethasone suppresion test\r\n\nPatient feels much better.Low dose supressive test to be done (13/10/2011).\nfine,vital stable, continue the Dexona as adviced\nC/o burning sensation in both the legs,GRBS- 424\nVitals stable.Pelvic traction today.Tomorrow blood withdrawal at 8am.\nGC fine.S.cortisol taken.FBS-193mg/dl.\nComplaints of weakness.AC 231mg/dl.Cortisol reports awaited.\nPut Cannula, heparine 0.5ml dilute in 1ml ,push 0.5ml (Heap block) Draw serum cortisol at mid night(12am)\r\n\nBeter,on MVI\r\nSyp.Duphalac 15ml HS \r\ncontinue other\nMidnight cortisol report awaited.Complaints of generalised weakness.Slept for a few hours.FBS-172mg/dl.\nfine, vital stable\r\nAC-154\r\nDiffculty in walking, \r\nS.cortisol awaited\r\nContinue the same\nAC-138mg/dl.Planning for 24 hrs urine free cortisol level.\r\ncontinue the same\r\n\nC/o pain.GRBS-196mg/dl\nC/o genaralised weakness.Fbs still high.Slept well.Passed stools.24 hr Ufc ongoing.\nfeeling tired,GRBS-301mg/dl\r\nVital stable\r\nWithhold Amitone\r\nContinue the others\nGeneral condition slighlty better. AC- 111 mg/dl. MRI done in 1996 was discussed with radiologist who opined that she had severe spondylosis back then.\nVitals stable, sugar better controlled today.\nC/O GC weakness and head ache.\n'}, {'role': 'model', 'content': "IP Number: 99\n\nPatient Number: 3092\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 55 yr old with H/o DM admitted with weakness and uncontrollable blood sugar.Insulin dosage was titrated up according to the GRBS.She was also evaluated for cushing's during the stay. ODST was performed, cortisolAM level was high, so evaluated for high dose Suppression test. 24 hr urine free cortisol level was done, results awaiting.\r\nH/o lumbar radiculopathy Lt side, phsical therapy was done, with better relief of the pain. Pt also being evalauted ny a neurologist for the worsening radicular pain .\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet in small, frequent feeds adviced\r\nDiet booklet given\r\nGlucerna SR- 2 scoop/ day with skimmed milk- 1 cup (Bed time)\r\n\r\n\n"}]

[{'role': 'user', 'content': 'IP Number: 64\n\nPatient Number: 1997\n\nPatient Name: PADMAKUMARY B (IN)\n\nGender: F\n\nDate of Birth: 22-05-1950\n\nAddress: PARIJATHAM,VALUMMEL ROAD,\n\nPincode: 682005\n\nPhNo: 2232550\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 20-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Pain subsided, better, vital stable , continue the same\r\nUSG Abd -Tommorow\nadmitted with pain in the Rt iliac fossa pain, No vomiting, No Fever\nNo Pain , NO vomiting\r\nVital stable, Tab.Blisto 2MF 1/2\r\nplan to start insulin\r\nSemisolide/Liquid diet\nPain abdomen better. USG planned soon.\nBetter, Vital stable, continue the same medication , Blist dose changed , CBC\nfine continue same, CBC tommorow morning , USG ABD\n'}, {'role': 'model', 'content': 'IP Number: 64\n\nPatient Number: 1997\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 20-09-2011\n\nDiagnosis: Sub Acute Appendicitis\n\nClinical Exam(With BP): admitted with abdominal pain\n\nSystolic BP: 110.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: Elderly female , not in any distress\r\nAbdomen- Tenderness over the RT iliac fossa, NO rebound or guarding\n\nDiscussion: 61 yr old with H/o HTN, DM admitted for abdominal pain. On Examination - had tenderness over the RT iliac foosa, admiited to R/o acute appendicitis.\r\nPt was started on I.V antibiotics. Ultrasound of the abdomen was done- \r\nClouding of the ileal loops. No fluid. Pain resolved. Rpt Ultrasound of the abdomen- NOrmal (20-0-11)\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, diabetic diet with small, frequent feeds adviced\r\nDiet booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nPatient Name: M.J.JOSEPH\n\nGender: M\n\nDate of Birth: 11-08-1933\n\nAddress: MEKKATTUPARAMBIL HOUSE,PADAMUGAL\n\nPincode: 682021\n\nPhNo: 2422226\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEUROPATHY\nEssential (primary) hypertension\nCORONARY ARTERY DISEASE\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 5:00pm GRBS-502mg/dl, Vital stable , Shift to OT for Iand D , \r\nGiven Insugen 20units I.V Bolus, continue Insulin drip at 10u/hr, stop lasix, I/o Chart, continue the I.V NS 50ml/hr, Inform GRBS Hrly\r\n5:00pm Shift the \r\n8:00 pm - Shifted to i.c.u, PR80/min , B.P-130/80, CVS-S1S2, Rs-Clear , Catheterized under aseptic precaution, monitor intake , out put\nC/o pain , GRBS Hi, Started on insulin infusion , Maintain NS ml/hr , follow the other orders\n4:00pm Vital stable , Intake-550, output-200. \r\nI.v Ns 75ml/hr 2pints \r\n5:30pm Doing well, pain subsided, Vital stable , Dreesing clean , Follow the Advice\nSeen by Dr.A.K.Bhat\r\nDressing changed.There is no evidence of residual pus.However the floor of the ulcer looks ?ischemic.Needs further observation&guarded prognosis.\r\n9:00am GC fair, Vital stable, GRBS 107, on Insulin infusion 1u/hr, Dreezing done by Dr.Bhatt, shift to room\r\n9:30pm S/b Dr.Tom , Adviced to continue the same,\r\n12:30pm 10units Insugen s/c\r\nAdd Inj .Tramadol 50mg in I.V fluid\n8:00am Doing well, slept well, No Pain , \r\nPR70/min , BP-110/70, RS-Basal crepitation +, I/0 1925/800\r\nplus positive balance of 1100\r\n\nChest clear , vital stable, D/c Cath \r\nfollow the order, inform Predinner\nGC fine, Vital stable, Rs Few crepitation + , Wound Clean , No Discharge, explained the Bystandard about the prognosis\nVital stable, Given analgeic for pain , pain subsided after this. adjusted the insulin according to the GRBS\r\n6:00pm seen by dr.tom sir , fine, doing well, RS-B/l crepitation . folloe the same orders\r\nHb,Tc,Dc, Urea , Creatine, FLP, Sodium , potassium , FBS\nHad Hypoglycemia at 7pm , better with carbohydrate. Adviced Actrapid 24-24-24, Lantus 24 ,planned dreesing today by Dr.Bhatt.\r\nDressing change done by DR Bhatt, Awaiting Pus culture\nS/b Cardilogist, adviced ECHO/Xray Chest-PA\r\nFine , Vital stable,\nDoing well, sugar under control, No hypos , adviced Xray chest-PA, Xray foot -AP/Lat\nS/b Dr.bhatt And Dr.Tom Ulcer of the lt foot is unhealthy,exposing unhealthy deep tendon of sole of foot\r\nRpt Cand S taken, sugested Arterial doppler to confirm diagnosis of chronic PVD\nSeen by Dr.A.K.Bhat\r\nDressing changed.Same findings of ischemic ulcer lt sole with exposed tendons and fascia.Metrogyl gel dressing given.Guarded prognosis regarding healing need to be explained.\r\n7:oopm Better, No hypoglycemia, Vital stable , follow the order\nVitals stable AC- 48 and then 90. Dressing change done by\r\nDR bhatt. discussed in details with the family\nMild pain , GC Fair , Vital stable , RS Clear\r\nSeen by Dr.A.K.Bhat\r\nOcc.Pain.Dressing overpadded.\nVitals Stable, C/o pain in the leg.\r\nPre- dinner- 145\r\nFBS- 56\nFine, Mild pain , Tingling sensation in the foot.\r\nC AND S Sensitive to klebsilla ,started on Inj. Amikacin\nSeen by DR.A.K.Bhat.\r\nC&D done.Same findings.\r\n8:00pm -Better,vital stable,CVS-S1S2 Normal , RS: NVBS\nSlept well. pain over Lt foot in the morinig, relieved with NSAIDS. Passed stools. AC- 161 mg/dl, Pre dinner - 95 mg/dl\nSeen by DR.A.K.Bhat\r\nDressing reviewed.Same findings.\r\nRepeat C/S taken.\r\nDoppler done. GRBS- 264, Pus culture taken\nVitals stable, doppler of the legs today, intend to D/c probably tomorrow\nSeen by DR.A.K.Bhat\r\nSame findings.Adviced Dressing change daily.\nvitals stable. Doppler done yesrterday. will discuss with Dr Bhatt regarding the discharge.\r\nAC- 247\r\nPre-dinner- 264.\n'}, {'role': 'model', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis: Ulcer over the Lt Plantar aspect of the foot\r\nPeripheral Vascular Disease\r\nModerate LV Dysfunction \r\n\r\n\n\nClinical Exam(With BP): H/o Noticed Abscess over the Foot-Lt -1week. Duration of Diabetes - 30 years\r\nCurrent Medication\r\nHuman mixtard 28-0-23\r\nTab.Lasix40mg 1/2-0-0\r\nTab.Enam 10 0-0-1\r\nTab.Nicardia retard 20 1-0-0\r\nTab.Cadloc 3.125 1-0-1\r\nTab.Glyciphage 500 1/2-0-1/2\r\nTab.lanoxin 1-0-0 5/7\r\nPrevious Blood sugar profile-FBS: PPBS: RBS: HBA1C:\r\nWeight Loss- stable \r\nFrequency of blood sugar estimation Twice daily/once weekly/once monthly\r\nBlurring of vision-Left Eye\r\nDiabetic eye examination- Yes\r\nBurning Sensation of feet -No\r\nNumbness of feet-No\r\nFalling off of foot wear-No\r\nSwelling of feet -Yes\r\nCornary heart Desease-Yes-Years [1994 ]\r\nDyslipidemia-No\r\nHypertension-20yrs\r\nRecurrent infections-No\r\nHypoglycemia - Yes\r\n. Father -Diabetic. GC fair ,No Pallor\r\nCVS-S1S2\r\nRS-Clear\r\nFoot impaired Sensation\r\nClawing of toes\r\nDry skin\r\nAbscess over the 2/3 of the Ventral aspect of foot\r\n.\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Toxic , Dehyration \r\nConsious and Oriented \r\nLt Postrior tibial pulse absent\r\nRS: NVBS, Base Clear\r\nCVS S1S2 Normal \r\nCNS: Consious and oriented\n\nDiscussion: K/c/o Type 2 Diabetes Mellitus, Coronary Heart Disease with Moderate L.V Dysfunction , Hypertension , Diabetic Neuropathy, Admitted with Lt plantar absecess, HU, Septisemia. started on Insulin infusion and \r\nHydration with normal saline, started on empirical antibiotic, changed antibiotic asper C/s . Disscused to option with Bystandred . because of the emergency situation taken for Absess exsion and debridement of the necrotic tissuereport Excised the abscess under aseptic precaution,Count starts commimg done. fair glycemic control,genaral condition improved Wound healing not satisfactory, Started on LMWH, Arterial doppler compramised distal circulation . planned to continue the oral antibiotic , glycemic control with Basal bolus regimen , Ulcer wait and watch, wound care\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 36\n\nPatient Number: 2689\n\nPatient Name: SKARIAH K A\n\nGender: M\n\nDate of Birth: 25-02-1943\n\nAddress: T1D, YASORAM PANCHARATNA APPARTMENT\n\nPincode: 682019\n\nPhNo: nan\n\nAdmission Date: 25-08-2011\n\nDischarge Date: 31-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable, Urinary in contience , ? NPH, Planned MRI after discussing with relative, sugar under control\nplanned MRI Brain in morning\r\nVital stable, condom cath\nvitals stable. Spoke with the daughter , wants to have MRI Of the brain, will get the scan as an outpt\r\nGRBS- 270- 12 p/m\r\n\r\n\nvital stable, MRI done, continue the same\nvitals stable.AC- 157\r\nPre- dinner- 215 mg/dl\r\nGC stable\r\nMRI Of the brain without contrast to be done today.\r\nUltrasound of the abdomen- Prostatomegaly\r\nfatty liver\nVitals stable. MRI of the brain without contrast done.\r\nNo fever\nfine, MRI suggestive of NPH, vital stable, fair glycemic control,\nVitals stable. blood sugar well controlled.\r\nPosted for cataract surgery tomorrow.\nvitals stable, AC- 119\r\nSeen by neurologist\r\nReviewd the MRI of the brain with previuos scan- Not much change from the prior scans.\r\nOn Exam - LT visual field cut,\r\nNeeds to discuss with the opthalmologist regarding the exam findings\nCase of NPH on medical management. Recently complains of worsening storage LUTS.\r\nO/E:Large median scar of laparotomy.\r\ngrade I prostatomegaly.\r\n\r\nVitals stable , seen by urologist, sent for cataract surgery.\r\nBlood tinged sputum today. Pulmonary evaluation\nVitals stable. post cataract surgery today.\r\nSeen By pulmonary- continue the current treatment\r\nPrelunch- 165\nDr.Ramesh Nair seen the pt on 30/8/11 at 6pm \r\n\r\nCateract operated with C/o cough \r\n RS- Air entry satisfactory\n'}, {'role': 'model', 'content': 'IP Number: 36\n\nPatient Number: 2689\n\nAdmission Date: 25-08-2011\n\nDischarge Date: 31-08-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): referred from Giridhar Hopsital for Uncontrolled blood sugar, before cataract surgery. Duration of Diabetes - 2 years\r\nCurrent Medication\r\nTab Daonil 1-0-0\r\n\r\n\r\n.\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, alert, not in any resp distress\r\nRS- B/L rhonchi\r\nCVS- S1 S2 heard\r\nAbdomen- Median laparotmy scar\r\nUrinary incontinence\r\n\n\nDiscussion: Admitted for uncontrolled blood sugar prior to surgery. During the hopsital stay pt was started on Insulin ( Insugen R 3 times before meals and Insugen N before bed time). Pt waxs also stared on Antibiotic for Bronchitis. In hopsital as per familty request pt had an MRI of the brain without contrast for evaluation of hydrocephalus.Pt was also seen by a neurologist who compared the MRI scan with old scan, suggested that there is no significant change compared to the prior scan. As per neurology that becuse the hydrocephalus is long standing it is unlikely that he woul benefit from a VP shunt, but if ther is detioration in hi status, an L.P could be doneas a diagnostic test to see if it improves his status. discussed the family in detail.\r\nSince the urinary incontinence had worsened in few months, pt was also seen by a urologist. ultrasound- enlarged prostate, He is put on two medicines\r\nHe was also seen by a pulmonologist for Bronchitis, suggested to switched to oral antibiotics\r\n\n\nDiet: NUTRITION Dept:\r\n1700 kcal, low fat diabetic diet with small, frequent feeds adviced.\r\nNutrition booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 51\n\nPatient Number: 1410\n\nPatient Name: ZAINABA ISMAIL\n\nGender: F\n\nDate of Birth: 23-03-1941\n\nAddress: ZAINABAI HOUSE,ST.FRANCIS CHURCH ROAD\n\nPincode: 682017\n\nPhNo: 0484-3928021\n\nAdmission Date: 09-09-2011\n\nDischarge Date: 12-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: CORONARY ARTERY DISEASE\nMixed hyperlipidaemia\nPRIMARY HYPOTHYROIDISM\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: A\nAdmitted , Vital stable, Systemic Examination -NAD, \r\nTo Rule out Hyponatrimia\nNausea present, B.p 130/70mm of hg, Systemic examination -NAD\r\nInj.Novorapid 16units just before food\r\nInj. Lantus 22units at bed time\r\nContinue the same\r\nS.CReatine, sodium , potassium\r\nNovomox 1.2g BD\nc/o persistent cough, more at night. O/E- throat looks congested. BRE shows elevation of total count. Fasting blood sugars are high.\r\n11:47am Vital stable, Vomited once,Inj.Pantodac 40mg I.V OD\r\n2:00pm Vomited , adviced Inj.Emeset 4mg I.V stat\nGeneral condition fine. Blood sugars are high.\r\nNa+, K+, Creat, TC, Hb\r\n 12:30pm Vomitied Once\r\nBilious, Inj.Emeset sos\n'}, {'role': 'model', 'content': 'IP Number: 51\n\nPatient Number: 1410\n\nAdmission Date: 09-09-2011\n\nDischarge Date: 12-09-2011\n\nDiagnosis: ? Dementia\n\nClinical Exam(With BP): Mrs.Zainaba Ismail /70yr/ female, K/c/o Type 2 Diabetes mellitus, Hypertension, Dyslipidemia, CAD,Diabetic retinopathy, Diabetic Nephropathy with CRF\r\nAdmitted with Vomiting , Nausea, Decresed intake, cough, Sore throat of 2day duration , O/E Vital stable, Systemic examination with in Normal limit\r\nMild Throat congestion , RS-Clear.Lab Mild Leucocytosis, Na+, K+ with in the Normal Limit\r\nTreated with Amoxcillin +Cloxacillin , Antiemetic, Adjusted the dose of Insulin according to Blood sugar.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: K/c/o Type 2 Diabetes mellitus, Hypertension, Dyslipidemia, Diabetic retinopathy, Diabetic Nephropathy with CRF\r\nAdmitted with Vomiting , Nausea, Decresed intake, cough, Sore throat of 2day duration , O/E Vital stable, Systemic examination with in Normal limit\r\nMild Throat congestion , RS-Clear.Lab Mild Leucocytosis, Na+, K+ with in the Normal Limit\r\nTreated with Amoxcillin +Cloxacillin , Antiemetic, Adjusted the dose of Insulin according to Blood sugar.Discharge in stable\n\nDiet: Low calorie, low fat, low potassium diabetic diet adviced\n'}]

[{'role': 'user', 'content': 'IP Number: 119\n\nPatient Number: 3110\n\nPatient Name: KOCHU THRESIA SEBASTIAN\n\nGender: F\n\nDate of Birth: 07-10-1931\n\nAddress: DAIRY COTTAGE ORANGE VIEW , COONOOR\n\nPincode: 643102\n\nPhNo: 0484 - 2231058\n\nAdmission Date: 22-10-2011\n\nDischarge Date: 04-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Better, vital stable,C/S Pseudomonas Heavy growth\r\nContinue the same\nPR88/Min, B.P-160/80mmof Hg, CVS-S!S@ Normal\r\nRs-NVBS, Sever Neuropathy. \r\nSurgical consultation\r\nTab.Afenac plus sos for pain,Antibiotic after C/S.\r\n\r\nSeen by Dr.A.K.Bhat.\r\nDressings left foot changed.\r\nDressings right foot changed.\r\nRt.2nd toe stump OM.Lt.Big toe gangrene.Infected.\r\nPlan:IV antibiotics as per C/S.Versalab.Stop Clopidrel.Plan for revision surgery next week.\nseen by Dr.Bhatt.afebrile.Vitals stable.redness and oedema reduced.Continue Ab.Dressing changed.\r\nPlan for right 2nd toe revision amputation.\r\nLeft big toe proximal amputation under local anaesthesia on 25/10/11 at 1pm.\r\nGet informed consentplain C& D plain dressing.\r\nInj.Clexane 0.4ml s/c\r\n XRAY CHEST-NAD\r\nECG-NORMAL LIMIT\r\nMEDICALLY FIT\nvital stable, continue the same\nDoing well. Slept well. An absecess over Rt shoulder (? hematoma secondary to Clexane injection). BP- 170/90.\r\nstoped calcheck,add nifedipine capsule, check B.P every 2nd hrly\r\nPlanned for amputation at around 1pm\nVital stable, Systemic examination -NADNo pain shifted to room\r\nCap.Nicardia 10mg Q6H\r\ncontinue the same \r\nHB,PCV\nfine,vital stable, not passed motion today\r\ncontinue the same\nmcg Did not sleep becuase of pain. Appetite normal. AC- 179 mg/dl.\nB.P- stable now. No complaints. seen by DR Bhatt, Dressing change tomorrow.\nPR100/min \r\nB.P 120/70mm0f \r\nConstipation\r\nstop Nicardia \r\nfollow the orders\nPR-120/min, B.P 180/90mmof Hg \r\nCVS-s1s2 Normal, RS-Clear\r\nCNS-Consious /Oriented\nSeen by Dr.Bhat.\r\nDressing changed.Suture line clean.\r\nChange to oral antibiotic\r\nStop I.V Antibiotic\r\nTab.Oxicip 500mg 1-0-1\r\n\r\nSTAEM INHALATION\nBetter,continue the same\nDoing well , PR-80/min, B.P 150/90mmof Hg \r\nCVS-S1S2 normal \r\nRS-Clear\r\nBowel and bladder Regular\r\n\r\nS/b Dr .Sasikumar\r\nAdviced \r\nContinue the same\r\nChange over to Coversyl AM instead of Telmisartan + calcium Channel blocker\r\nIn view of Economical constraint , Not change\r\nAdd Tab. Natrilex SR 1.5mg 1-0-0\nBetter, vtal stable, continue the same\nSeen by Dr.AK.Bhat.\r\nC&D done.Suture line both feet clean.Continue trt.\nVITAL STABLE, CONTINUE THE SAME\nSeen by Dr.A.K.Bhat.\r\nNo pain.Continue trt.\nC&D done.Both feet suture line clean.\r\nVitals stable. feels better. probable discharge on friday\nVital stable. Slept well. B.P and Pulse rate controlled\r\nIntend to D/C tomorrow.Steam inhalation to be done.Chest physiotheraphy\nSeen by Dr.A.K.Bhat.\r\nSutures removed.Wounds clean.\r\nAdviced:Review on wednesday 9-11-2011 4pm.\r\nDressings once in two days betadine oint.+cuticell.\nVital stable , Systemic examiantion -NAD\r\nDischarge\n'}, {'role': 'model', 'content': 'IP Number: 119\n\nPatient Number: 3110\n\nAdmission Date: 22-10-2011\n\nDischarge Date: 04-11-2011\n\nDiagnosis: PVD\r\nOM OF RT 2ND TOE\n\nClinical Exam(With BP): Mrs.Kochu Thresia sebastatin/80yrs /Female, was admitted recently in local hospital for the 2nd toe amputation\r\nadmitted here with history of stump infection , found to have frost bite.\r\nRight 2nd toe revision amputation done,Left big toe proximal amputation under local anaesthesia\r\nwound healing satisfactory, Sutures removed.Discharge is in stable state\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Mrs.Kochu Thresia sebastatin/80yrs /Female, was admitted recently in local hospital for the 2nd toe amputation\r\nadmitted here with history of stump infection , found to have frost bite.\r\nRight 2nd toe revision amputation done,Left big toe proximal amputation under local anaesthesia\r\nwound healing satisfactory, Sutures removedDischarge is in stable state\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 109\n\nPatient Number: 2313\n\nPatient Name: MARY NOBLE\n\nGender: F\n\nDate of Birth: 04-01-1964\n\nAddress: 37/628A, THARAPPEL BUILDING , S.A.ROAD\n\nPincode: 682020\n\nPhNo: 0484-2203829\n\nAdmission Date: 13-10-2011\n\nDischarge Date: 15-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Mixed hyperlipidaemia\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: admitted for sugar control, need evalution for Acromegaloid feature,\nPatients doing well.AC-95mg.Getting ready for glucose supressed Gh level.\nGC fine.Vitals stable.\n'}, {'role': 'model', 'content': 'IP Number: 109\n\nPatient Number: 2313\n\nAdmission Date: 13-10-2011\n\nDischarge Date: 15-10-2011\n\nDiagnosis: RENAL CALCULI(staghorn)\n\nClinical Exam(With BP): 47 Year old female admitted with Uncontrol Blood Sugar, Prior to Lithotripsy of Renal Calculi.Insulin dose was adjusted for tight glycemic control.\n\nSystolic BP: 130.0\n\nDiastolic BP: 90.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 47year old Female admitted with Uncontrolled Blood Sugar and Glycemic control,Prior to Lithotripsy of Renal Calculi.During admission patient was evaluated for Acromegaly.Insulin dose was adjusted for tight Glycemic control and Growth Hormone Supressive Test was also done.Awaiting result.\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 53\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: PRIMARY HYPOTHYROIDISM\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable, mild Hypoglycemic episode at 6:30pm , adviced to give dinner\r\nC/o Pain in the Leg\r\nInj.Emeset 4mg I.V stat\r\nAdviced Inj .Tramadol 50mg I.V st ATD\r\nNovorapid 10units just after dinner\r\nLantus 16units at bed time\r\nTab.Lasix 40mg st\r\n10:40pm C/o Brethlessness, B.P 130/80\r\nRS-Basal Crepitation +\r\nInj. Lasix 40 mg i.V stat\r\nECG Left axis deviation, No ST strain\r\nSPO2-95%\r\n\nSleep disturbed , pain prsentPR 76/min , B.p110/70mmof hg, RS-Clear\r\nIntake/output-300/350\r\nSerum Creat levels are going up (2.4 mg/dl)\r\nReduced the Microtaz 4.5g BD\r\nStop Tab. Telmisartan, Tab. Platloc A\r\nS/b Dr.A.K.B \r\nB/l Lower limb lymphangitis/Cellulitis\r\nNo Evidence of focal abcess.Blisters dorsum of left foot-deroofed.\r\nPlanned to add Linozolid.\r\nXray left foot including toes AP&Oblique\r\nCBC, Urea, creatinine,sodium, potassium\nPR-76/min , B.p 110/70mmof Hg, RR-26, RS-Air entry equal \r\nAfebrile, Pain subside,\r\nTachypenic , Rs-Clear, CVS-S1S2 Normal , PA-Fluid shift +\r\nPlanned Shift to ICU\r\nS/B Dr.Sasikumar\r\nTachycardic , Tachypenic, Cardiac status with in normal limit\r\nBreathlessnesss because of Volume overload, ? Acute on Chronic Renal failure\r\n\r\n11:15am S/B Dr.Elizabath, Dermatologist\r\nImpresion Bacterial Skin infection , Cetaphin lotion , Rt axilla mild Fungal infection , apply candid cream, \r\nApply T-bact Ointment for Local infection. Antibiotic according to blood c/s\r\n12:00 am Shift to ICU\r\nUrinary Cath\r\nI/O Chart\r\n\nPulse- 107, B.P-110/70, output- 800ml\r\nNo fever, \r\nChest - clear\r\nHb, TC, Na+, K+, Urea, Creatinine- Morning\nBetter, Afebril,vital stable, continue the same\r\n7:30pm Febrile, cannula out , adviced Tab.Welset, Inj.Clindamycin i.m , incrase oral intake\nSeen by Dr.A.K.Bhat:Pain&redness right leg has decreased.\r\nThere are multiple blisters over dorsum of left foot.The blisters were deroofed&serous fluid drained.Dressing done.Adviced:Inj.Clindamycin.\r\n9:00am S/b Dr.Tom , Clinicaly better, Vital stable , continue the Hydration , Spo2 99% , PR-108/min , B.p 110/80mmof Hg, CVS-S1S2 Normal ,RS-NVBS,No added sound\r\nStop Linazolide, continue the other, Blood transfusion (Whole Blood)\nSeen by Dr.A.K.Bhat.\r\nThe blisters of left foot dorsum were deroofed to reveal a sinus exposing deeper subcut.fat /slough, suggestive of localised necrotising fasciitis.Repeat wound swab fr C/S taken.A part of the subcut.fat was excised and sent fr tissue C/S.\r\nC&D DONE.\r\nCounts coming down, S.creatinine coming down, \r\nDiuretic phase\r\nH/o L-stools\r\nadd Cap.Yogut 1-0-1\r\n8:30PM B.P 190/80MMOF HG\r\ntAB.REVOLOL50MG 1-0-1\r\nTAB.OLVANCE 40MG STAT\nNo loose stools since last night. Sleep disturbed. c/o dry cough. Secured a good line for IV access.\r\no/e: chest clear, skin lesion with cellulitis better.\r\nTransferred from the ICU, Renal function getting better.\r\nCreatinine-1.4, blood urea- 54, will stop I.V fluids\r\nSpoke with surgeon, might need debridement of the underlying tissue, discussed with the family\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The blisters of left foot dorsum completely deroofed.However the edema&redness of foot&leg has decreased.There is e/o subcut.necrosis fr about 7x7 cm over dorsum.This may need skin&soft tissue slough excision under LA.\nC/o Breathlessness at night, sleep disturbed, vital stable\r\nBlood sugar good, Xray Chest -PA, ECG\nSitting, PR-108/min , B.P-140/80mmof Hg , CVS-s1s2 N0rmal, RS diffuse crepitation ,spo2 90%, adviced\r\nBudocort Nebulization 1-1-1\r\nInj.Tramadol 50mg sos\r\nwithhold platloc As\r\nHb,DC,S.Cr, Na+,K+-morning\nBetter, Vital stable, Spo2-94%, PR-80/min , RS-few rhonchi\r\nContinue the Nebulization\nVitals stable. dyspnoea slightly better..pulse oximetry- 94% RA. Planned to do debridement today under local.\r\nafebrile, renal function improving. WBC slightly decreased.\r\nChest- b/l rhonchi and wheeze\nHas not slept last night. Swelling over both feet much better.\r\n\r\nTo send CBC, Na, K, Se Creat tomorrow\nfine, Tab.Trika 0.5mg stat\nFine vital stable, Rs-Clear, CVS-S1S2 Normal, Vasolin Body lotion for local application , Cetaphil lotion -stop.\r\nSeen by Dr.AK.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.\r\nS/b Dr.KMR\r\n? Allergic Bronchitis\r\nAdviced add Tab.Claribid 250 mg BD x 5days\r\nOdphylline 400mg 1/2 -0-1\r\nTab.Allegra 180mg OD\r\nSyp. Alex (sugar free) 2tsp 1-1-1\r\n\nVital stable , comfortable, Inj. MicrotaZ 4.5g, Tab.Dalacin 600mg, Tab.Linazolide 600mg\\\r\nContinue the same\nVital stable, RS-Clear, stop Microtaz , reduced the nebulization, Clindamycin changed to tab, added Linazolide\r\nClaripid for atypical coverage\nVitals stable. GRBS- 99, \r\nRS- B/l creps\nSeen by DR.A.K.Bhat.\r\nDressings changed.The raw area over left foot dorsum is clean.No residual pus or slough.Right heel superficial ulcer is healing well.Adviced:Cap.Clindamycin 300 mg tds.\r\nfine, continue tha same\nsitting up, not in any distress. blood sugar controlled. \r\nc/o itching in the armpits and in between the buttocks.\nVitals stable. No fever. Dressing change done yesterday by DR bhatt. Lt foot- healing, granulation tissue present.\r\nChest - B/L creps\nseen by dr.a.k.bhat.\r\nafebrile.\r\nGetting chest physiotherapy. No fever, stopped linezolid\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.Rt. leg blisters healing well.\r\nContinue trt.\r\n6:00pm Cough, vomited once \r\nRS-Crepitation +, Rhonchi +\r\nIncrese the nebulization Combimist Q6h, Derinide 1-1-1\r\nRestarted Tab. Mucinak 600mg -1-0-1\nVitals stable. sittting up. GRBS morning controlled, afternoon sugar slightly high.\r\n\n142mg/dl -8units Novorapid ,\n6:00pm PR-90/min , B.P 140/60mmof Hg, CVS-S1S2 Normal, RS Few crepitation , Rhonchi\r\nBlood tranfusion \r\nPremedication\r\nVital stable\r\n\nDoing well. Blood sugars are well controlled.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Left foot raw area clean.\r\nRt. heel healing well.\n'}, {'role': 'model', 'content': 'IP Number: 53\n\nPatient Number: 2822\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis: DIABETIC FOOT-Necrotising Facitis\r\nFILARIASIS-RT\r\nGLUCOMA\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis\r\nAcute Renal failure\n\nClinical Exam(With BP): H/o Sweling over the Both foot-1week\r\nUncontrolled Diabetes\r\nH/o multiple Furcuncle over the leg. Duration of Diabetes - 10 years\r\nCurrent Medication\r\nNovorapid 18-20-0\r\nNovomix 25 at bed time\r\nDecresed urine out put\r\nH/o fever\r\nPolyuria, Polyphagia, Polydipsia - No\r\nWeight Loss- No\r\nBlurring of vision-No\r\nDiabetic eye examination- Yes\r\nGlucoma, No DPR\r\nBurning Sensation of feet -Yes\r\nNumbness of feet-Yes\r\nNon healing Diabetic Foot Ulcer-Recurren\r\nSwelling of feet -Yes, increses during Fever\r\nRt Filariasis\r\nCornary heart Desease-No\r\nDyslipidemia-No\r\nHypertension-yes\r\nRecurrent infections- Yes\r\nAutonomic dysfunction (orthostatic hypotension, early satiety, constipation)- Yes \r\nHypoglycemia - No\r\nDry skin. Had Abscess-Rt foot, Iand D done 11/2yrs back\r\nH/o Blood transfusion in past for anemia\r\n. Dyspenic\r\nRS-B/l Airentery Equal\r\nCVS-S1S2 normal\r\nPA- Soft, No Tenderness, No Organomegaley\r\nShifting dullness prsent\r\nCNS-Consious /Oriented\r\nMotor/sensory -Normal\r\nReflex -+\r\nPeripheral circulation -+\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Elderly Lady K/C/O Type 2 Diabetes Mellitus , Hypertension , Diabetic Neuropathy .Admitted with the history of Swelling and pain over the both leg more on the Lt ,Lab investigation Leucocytosis, Elevated Urea , Creatinine, Urine routine -Bacteruria, Multiple Pus cell. Treated with Broad specturm antibiotic covering Gram Positive,Negative,Anaerobic, Pus/Blood Culture were negative . On 3rd day of admission Renal parameter are settling down,\r\nInfection localized to Rt foot, Incsion and Excised the Necrotic tissue, Blood count are improving, Had Broncho constriction , sought pulmonoilogist consultation , started on Bronchodilators, inhaled steriods and Mucolytic and Chest Physio, Chest is better, on Prophylactic DVT regimen. Slowly ambulated. Her HB was low tranfused 1units of Whole Blood\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, low salt, low potassium, diabetic diet with small, frequent feeds adviced\r\nDiet sheet and diet booklet given\n'}]

[{'role': 'user', 'content': "IP Number: 88\n\nPatient Number: 2820\n\nPatient Name: SASIKUMAR K P \n\nGender: M\n\nDate of Birth: 20-05-1953\n\nAddress: CMC 12/284, DWARAKA , CHERTHALA P.O\n\nPincode: 688524\n\nPhNo: 0478-2813722\n\nAdmission Date: 29-09-2011\n\nDischarge Date: 12-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\nB P H\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: S/b Dr.Bhat\r\nDreesing Done ,Planned Vascular Flap on tuesday\r\nStop Platloc A 75mg from tomorrow\nSeen by Dr.A.K.Bhat.\r\nContinue daily dressings.\r\n8:00pm Continue the same\nWound slough+, Vital stable, Systemic Examination-NAD\nDreesing done, Vital stable\r\nwound clean \r\ncontinue the same\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Dressing reviewed.The raw area left leg is exposing bone fr about 5x3cm.Infection under control.Daily oxum dressing.\nSlept well. Fasting Blood sugar on the lower side.\nSeennby Dr.A.K.Bhat.\r\nFor local flap cover and SSG lt. leg under SA on 4-10-2011 11 AM.Preop.:Consent.Shave both thighs and genitalia and betadine scrub.IV Antibiotics.Nil oral from 6.30 am.Medical fitness fr the proposed procedure.\r\n6:00PM \r\nFollow the Dr.Bhat\r\nvital stable, NPO , Recent culture report MS Microtaz\r\ntomorrow change to Cefoper/salbactum (Magnexor Kefbactum 1.5mg)\nVitals stable, No fever, Fasting sugar controlled, Skin grafting tomorrow\nPR-88/MIN, B.P-130/85mmof Hg\r\nCVS/RS-Clear \r\nContinue the Orders\r\n8:45pm\r\nB.p-150/100\r\nurinary retension \r\nCatherised under aseptic precaustion\nVitals stable. Kept NPO for local flap cover with SSG to the LT leg Ulcer.Blood sugar controlled. Pus Culture- Pseudomonas - Sen - to CEfoperazone/Sulbactam\r\nAntibiotic changed\nAble to pass urine.Foleys catheter insitu.Slept well yesterday.Patient is ready to be shifted to room.\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Dressings of left leg changed.The flap looks viable.Oedema+.Advice:Leg elevation.Start Inj.Clexane 0.4 ml SC od.Continue Inj.Low molecular weight dextran&IV antibiotics.\nGRBS 93mg/dl.Complaints of pain in leg.Foley's catheter to be removed.\nSeen by Dr.A.K.Bhat.\r\nDressing left leg changed.The drain was removed.The flap looks viable.\r\nfeels well, INJ tramadol for pain SOS. blood sugar controlled\nGC better.\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Pain is lesss.For Change of dressing in OT tmrw.\r\nInj.Nirtran last day today.\r\nGRBS- 174, No pain\nPatient was hypoglycemic yesterday.Now feels good.\r\nSeen by Dr.A.K.Bhat.\r\n4th POD.Dressings changed in OT.\r\nFindings:The flap is viable.The SSG has taken up.Suggested Inj.Microtaz.Continue Inj.Dynalix.\nSeen by Dr.A.K.Bhat.\r\nDressings changed.Left leg flap&graft OK.\r\nContinue IV Antibiotics.\nDr.Bhatt saw the patient.Patient is fine.Dressing tomorrow.\nbetter, vital stable\r\nAfter noon suger was little high\r\nAdjusted the dose\nPatient was feeling better.Intend to discharge after seen by DR.Bhatt.\n"}, {'role': 'model', 'content': 'IP Number: 88\n\nPatient Number: 2820\n\nAdmission Date: 29-09-2011\n\nDischarge Date: 12-10-2011\n\nDiagnosis: NoN Healing Ulcer over the Lt leg -\r\nP/S Skin flap\r\n\n\nClinical Exam(With BP): Admitted for skin flap operation , Left leg raw area granulated well except an area of tibia which is exposed for about 2x1 inch.\r\nC/S Pseudomonas, Treateted with Cefaperasone +Salbactum according to sensitivity report. skin flop done on 4/10/2011.\r\nintial dreesing had rednees and little collection, Changed to piperacillin +Tazobactum. Today dreesing shows healthy graft \r\n\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Systemic examination -NAD\n\nDiscussion: Mr.Sasikumar discharge few week back with Non healing Ulcer, Excision and curretage done.Admitted for skin flap operation , Left leg raw area granulated well except an area of tibia which is exposed for about 2x1 inch.\r\nC/S Pseudomonas, Treateted with Cefaperasone +Salbactum according to sensitivity report. skin flop done on 4/10/2011.\r\nintial dreesing had rednees and little collection, Changed to piperacillin +Tazobactum.Fair Glycemic control with Basa Bolus regimen Today dreesing shows healthy graft .Discharge in a stable state\r\n\r\n\n\nDiet: DEPT OF NUTRITION:\r\nLow Calorie Low Fat Diabetic diet prescribed.\n'}]

[{'role': 'user', 'content': 'IP Number: 53\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: PRIMARY HYPOTHYROIDISM\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable, mild Hypoglycemic episode at 6:30pm , adviced to give dinner\r\nC/o Pain in the Leg\r\nInj.Emeset 4mg I.V stat\r\nAdviced Inj .Tramadol 50mg I.V st ATD\r\nNovorapid 10units just after dinner\r\nLantus 16units at bed time\r\nTab.Lasix 40mg st\r\n10:40pm C/o Brethlessness, B.P 130/80\r\nRS-Basal Crepitation +\r\nInj. Lasix 40 mg i.V stat\r\nECG Left axis deviation, No ST strain\r\nSPO2-95%\r\n\nSleep disturbed , pain prsentPR 76/min , B.p110/70mmof hg, RS-Clear\r\nIntake/output-300/350\r\nSerum Creat levels are going up (2.4 mg/dl)\r\nReduced the Microtaz 4.5g BD\r\nStop Tab. Telmisartan, Tab. Platloc A\r\nS/b Dr.A.K.B \r\nB/l Lower limb lymphangitis/Cellulitis\r\nNo Evidence of focal abcess.Blisters dorsum of left foot-deroofed.\r\nPlanned to add Linozolid.\r\nXray left foot including toes AP&Oblique\r\nCBC, Urea, creatinine,sodium, potassium\nPR-76/min , B.p 110/70mmof Hg, RR-26, RS-Air entry equal \r\nAfebrile, Pain subside,\r\nTachypenic , Rs-Clear, CVS-S1S2 Normal , PA-Fluid shift +\r\nPlanned Shift to ICU\r\nS/B Dr.Sasikumar\r\nTachycardic , Tachypenic, Cardiac status with in normal limit\r\nBreathlessnesss because of Volume overload, ? Acute on Chronic Renal failure\r\n\r\n11:15am S/B Dr.Elizabath, Dermatologist\r\nImpresion Bacterial Skin infection , Cetaphin lotion , Rt axilla mild Fungal infection , apply candid cream, \r\nApply T-bact Ointment for Local infection. Antibiotic according to blood c/s\r\n12:00 am Shift to ICU\r\nUrinary Cath\r\nI/O Chart\r\n\nPulse- 107, B.P-110/70, output- 800ml\r\nNo fever, \r\nChest - clear\r\nHb, TC, Na+, K+, Urea, Creatinine- Morning\nBetter, Afebril,vital stable, continue the same\r\n7:30pm Febrile, cannula out , adviced Tab.Welset, Inj.Clindamycin i.m , incrase oral intake\nSeen by Dr.A.K.Bhat:Pain&redness right leg has decreased.\r\nThere are multiple blisters over dorsum of left foot.The blisters were deroofed&serous fluid drained.Dressing done.Adviced:Inj.Clindamycin.\r\n9:00am S/b Dr.Tom , Clinicaly better, Vital stable , continue the Hydration , Spo2 99% , PR-108/min , B.p 110/80mmof Hg, CVS-S1S2 Normal ,RS-NVBS,No added sound\r\nStop Linazolide, continue the other, Blood transfusion (Whole Blood)\nSeen by Dr.A.K.Bhat.\r\nThe blisters of left foot dorsum were deroofed to reveal a sinus exposing deeper subcut.fat /slough, suggestive of localised necrotising fasciitis.Repeat wound swab fr C/S taken.A part of the subcut.fat was excised and sent fr tissue C/S.\r\nC&D DONE.\r\nCounts coming down, S.creatinine coming down, \r\nDiuretic phase\r\nH/o L-stools\r\nadd Cap.Yogut 1-0-1\r\n8:30PM B.P 190/80MMOF HG\r\ntAB.REVOLOL50MG 1-0-1\r\nTAB.OLVANCE 40MG STAT\nNo loose stools since last night. Sleep disturbed. c/o dry cough. Secured a good line for IV access.\r\no/e: chest clear, skin lesion with cellulitis better.\r\nTransferred from the ICU, Renal function getting better.\r\nCreatinine-1.4, blood urea- 54, will stop I.V fluids\r\nSpoke with surgeon, might need debridement of the underlying tissue, discussed with the family\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The blisters of left foot dorsum completely deroofed.However the edema&redness of foot&leg has decreased.There is e/o subcut.necrosis fr about 7x7 cm over dorsum.This may need skin&soft tissue slough excision under LA.\nC/o Breathlessness at night, sleep disturbed, vital stable\r\nBlood sugar good, Xray Chest -PA, ECG\nSitting, PR-108/min , B.P-140/80mmof Hg , CVS-s1s2 N0rmal, RS diffuse crepitation ,spo2 90%, adviced\r\nBudocort Nebulization 1-1-1\r\nInj.Tramadol 50mg sos\r\nwithhold platloc As\r\nHb,DC,S.Cr, Na+,K+-morning\nBetter, Vital stable, Spo2-94%, PR-80/min , RS-few rhonchi\r\nContinue the Nebulization\nVitals stable. dyspnoea slightly better..pulse oximetry- 94% RA. Planned to do debridement today under local.\r\nafebrile, renal function improving. WBC slightly decreased.\r\nChest- b/l rhonchi and wheeze\nHas not slept last night. Swelling over both feet much better.\r\n\r\nTo send CBC, Na, K, Se Creat tomorrow\nfine, Tab.Trika 0.5mg stat\nFine vital stable, Rs-Clear, CVS-S1S2 Normal, Vasolin Body lotion for local application , Cetaphil lotion -stop.\r\nSeen by Dr.AK.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.\r\nS/b Dr.KMR\r\n? Allergic Bronchitis\r\nAdviced add Tab.Claribid 250 mg BD x 5days\r\nOdphylline 400mg 1/2 -0-1\r\nTab.Allegra 180mg OD\r\nSyp. Alex (sugar free) 2tsp 1-1-1\r\n\nVital stable , comfortable, Inj. MicrotaZ 4.5g, Tab.Dalacin 600mg, Tab.Linazolide 600mg\\\r\nContinue the same\nVital stable, RS-Clear, stop Microtaz , reduced the nebulization, Clindamycin changed to tab, added Linazolide\r\nClaripid for atypical coverage\nVitals stable. GRBS- 99, \r\nRS- B/l creps\nSeen by DR.A.K.Bhat.\r\nDressings changed.The raw area over left foot dorsum is clean.No residual pus or slough.Right heel superficial ulcer is healing well.Adviced:Cap.Clindamycin 300 mg tds.\r\nfine, continue tha same\nsitting up, not in any distress. blood sugar controlled. \r\nc/o itching in the armpits and in between the buttocks.\nVitals stable. No fever. Dressing change done yesterday by DR bhatt. Lt foot- healing, granulation tissue present.\r\nChest - B/L creps\nseen by dr.a.k.bhat.\r\nafebrile.\r\nGetting chest physiotherapy. No fever, stopped linezolid\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.Rt. leg blisters healing well.\r\nContinue trt.\r\n6:00pm Cough, vomited once \r\nRS-Crepitation +, Rhonchi +\r\nIncrese the nebulization Combimist Q6h, Derinide 1-1-1\r\nRestarted Tab. Mucinak 600mg -1-0-1\nVitals stable. sittting up. GRBS morning controlled, afternoon sugar slightly high.\r\n\n142mg/dl -8units Novorapid ,\n6:00pm PR-90/min , B.P 140/60mmof Hg, CVS-S1S2 Normal, RS Few crepitation , Rhonchi\r\nBlood tranfusion \r\nPremedication\r\nVital stable\r\n\nDoing well. Blood sugars are well controlled.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Left foot raw area clean.\r\nRt. heel healing well.\n'}, {'role': 'model', 'content': 'IP Number: 53\n\nPatient Number: 2822\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis: DIABETIC FOOT-Necrotising Facitis\r\nFILARIASIS-RT\r\nGLUCOMA\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis\r\nAcute Renal failure\n\nClinical Exam(With BP): H/o Sweling over the Both foot-1week\r\nUncontrolled Diabetes\r\nH/o multiple Furcuncle over the leg. Duration of Diabetes - 10 years\r\nCurrent Medication\r\nNovorapid 18-20-0\r\nNovomix 25 at bed time\r\nDecresed urine out put\r\nH/o fever\r\nPolyuria, Polyphagia, Polydipsia - No\r\nWeight Loss- No\r\nBlurring of vision-No\r\nDiabetic eye examination- Yes\r\nGlucoma, No DPR\r\nBurning Sensation of feet -Yes\r\nNumbness of feet-Yes\r\nNon healing Diabetic Foot Ulcer-Recurren\r\nSwelling of feet -Yes, increses during Fever\r\nRt Filariasis\r\nCornary heart Desease-No\r\nDyslipidemia-No\r\nHypertension-yes\r\nRecurrent infections- Yes\r\nAutonomic dysfunction (orthostatic hypotension, early satiety, constipation)- Yes \r\nHypoglycemia - No\r\nDry skin. Had Abscess-Rt foot, Iand D done 11/2yrs back\r\nH/o Blood transfusion in past for anemia\r\n. Dyspenic\r\nRS-B/l Airentery Equal\r\nCVS-S1S2 normal\r\nPA- Soft, No Tenderness, No Organomegaley\r\nShifting dullness prsent\r\nCNS-Consious /Oriented\r\nMotor/sensory -Normal\r\nReflex -+\r\nPeripheral circulation -+\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Elderly Lady K/C/O Type 2 Diabetes Mellitus , Hypertension , Diabetic Neuropathy .Admitted with the history of Swelling and pain over the both leg more on the Lt ,Lab investigation Leucocytosis, Elevated Urea , Creatinine, Urine routine -Bacteruria, Multiple Pus cell. Treated with Broad specturm antibiotic covering Gram Positive,Negative,Anaerobic, Pus/Blood Culture were negative . On 3rd day of admission Renal parameter are settling down,\r\nInfection localized to Rt foot, Incsion and Excised the Necrotic tissue, Blood count are improving, Had Broncho constriction , sought pulmonoilogist consultation , started on Bronchodilators, inhaled steriods and Mucolytic and Chest Physio, Chest is better, on Prophylactic DVT regimen. Slowly ambulated. Her HB was low tranfused 1units of Whole Blood\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, low salt, low potassium, diabetic diet with small, frequent feeds adviced\r\nDiet sheet and diet booklet given\n'}]

[{'role': 'user', 'content': 'IP Number: 70\n\nPatient Number: 2572\n\nPatient Name: BHANUMATHI O.R\n\nGender: F\n\nDate of Birth: 02-01-1951\n\nAddress: SREYAS, UDAYA NAGAR, 3RD LANE\n\nPincode: 682017\n\nPhNo: 2331800\n\nAdmission Date: 21-09-2011\n\nDischarge Date: 24-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted with Cough with expectaration-4days, intialy fever present\r\nTemp-Normal, PR-84/min, B.P 150/90, Spo2 - 96% CVS-S1S2 Normal, Rs-few crepitation , \r\nAdviced continue the same\nPatient was admitted with h/o cough with expectoration. o/e bilateral creptiations with wheeze.\r\n\r\nInvestigations\r\nCBC, CXR- PA, Se Creat, NA+, K+, Urine Routine Exam, SGOT, SGPT\nFeels better. No fever.\r\nChest- No rhonchi\r\nwill continue the same\nseen by pulmonary Dr Ramesh Nair.\r\nDiag- LRTI\r\n\r\nContinue the same\nVitals stable . no fver, slightly better\r\nChest - B/L rhonchi\r\n6:20pm Better, vital stable ,Insugen R 24units given , Before dinner 26units, Insugen N 30units at bed time\nfeels slightly better. c/o pain in the Rt hypochondrium after coughing\r\nChest - b/l rhonchi\n296mg/dl -26units given\n'}, {'role': 'model', 'content': 'IP Number: 70\n\nPatient Number: 2572\n\nAdmission Date: 21-09-2011\n\nDischarge Date: 24-09-2011\n\nDiagnosis: LRTI\n\nClinical Exam(With BP): Admitted with uncontroled Blood sugars , Lower respiratory tract infection , adjsting the \r\ninsulin dose accroding to SMBG values, Responde to Cefipime, Bronchodilator nebulization \r\ndisscused about the Bariatric surgery in view Obesity, Incresed insulin demand\r\n\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: K/C/O Type 2 Diabetes , Hypertension , Dyslipedimia, Obesity\r\n Admitted with uncontroled Blood sugars , Lower respiratory tract infection , adjsting the \r\ninsulin dose accroding to SMBG values, Responde to Cefipime, Bronchodilator nebulization \r\ndisscused about the Bariatric surgery in view Obesity, Incresed insulin demand. Clincaly Better. Discharge in a stable state , Planned to put on insulin analoge in view better control of Diabetes\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 21\n\nPatient Number: 2565\n\nPatient Name: MATHEWS PANAKKAL\n\nGender: M\n\nDate of Birth: 10-06-1935\n\nAddress: PANAKKAL HOUSE,MANATTUPARAMBIL\n\nPincode: 682505\n\nPhNo: 9142676719\n\nAdmission Date: 16-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \\b\\fs20 \r\n\\par \r\n\\par \\fs24 Left Limb\\b0 \\b\\fs32 : \\fs24 Left deep vein no thrombosis\r\n\\par \r\n\\par Multiple varicose veins below knee.\r\n\\par \r\n\\par Left great Saphenous shows\r\n\\par incompetence from thigh to lower leg.\r\n\\par \r\n\\par Few perfurators show incompetence in lower leg.\r\n\\par \r\n\\par \r\n\\par Dr.Joe Antony\r\n\\par Radiologist\r\n\\par \r\n\\par \r\n\\par \\f2\\fs32 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: S/b Dr.Bhatt Chronic varicose Ulcer Lt Dorsum of ankel measures about 10x 7cm, with pale granulation,surronding skin unhealthy,hypopigmented and fibrotic and ankel is fixed. VARICOSE VEIN +Adviced Rest , Limb elevation, Oxum dreesing .Tab.Trental 400mg 1-1-1 for 3week\nVitals stable, No fever, Dressing change done yesterday.\r\nBiopsy taken. will await the biopsy results\r\n Better vital stable continue the medication , plan to change to cipro or levoflox, make arrngment for Dr.Bhatt consultation\nVitals stable. AC- 68, dressing change done and seen by DR bhatt. AWaiting biopsy results.\nDisscussed with Dr.Bhatt, Kertoacanthosis need a Wide Excision + skin Graft + Varicose vein repair , \r\nVital stable .\nVital stable. Biopsy results- Keratoacanthoma.\r\nPre- dinner- 184\r\nFBS-110\nVitals stable. Biopsy- keratoacanthoma, will discuss withDR bhatt regarding the need for punch biopsy.\nfine,TPR-Normal , Systemic examination -NAD\nDoing fine, Pre dinner 187 mg/dl, FBS- 89 mg/dl\nSeen by DR.A.K.Bhat\r\nSuggested: Wide excision&SSG With varicose vein perforator ligation\r\nVitals stable, will discuss with family regarding the need for surgery.\nvitals stable. Blood sugar better controlled.\n'}, {'role': 'model', 'content': 'IP Number: 21\n\nPatient Number: 2565\n\nAdmission Date: 16-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): 76 yr old with h/o Type 2 Diabetes mellitus, CAD presents with ulcer on the dorsum of the Lt Foot which has been present for more than 2 yrs.\npresented with uncontrolled blood sugar and infected non healing ulcer. started on I.V antibiotics,\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: nan\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020\n\nPhNo: nan\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for skin gafting\nVenous doppler -Tomrrow\r\nPR-80\r\nB.P 150/80\r\nCVS-S1S2 Normal \r\nRS-Clear\r\nCNS-Consious / Oriented \r\nPA-NAD\r\nContinue the same\nS/B Dr A.K.Bhat\r\nAdd Inj. Enoxaparin 60mg s/c B.D\r\nBlood Routine\r\nXray chest PA\r\nECG\r\nRFT\r\nLFT\r\nPlan for Skin grafting for tuesday morning\r\n\nVital stable, systemic examionation -NAD\r\nDoppler Venous \r\nContinue the same\nBlood transfusion \r\n1unit PCV\r\nInj.Lasix 20mg i.v stat\r\n\tinj.Avil 1amp i.v stat\r\ntransfusion on flow \r\nvital stable \r\nContinue the same\nital stable , fair glycemic control, \r\nLow Hb, Planned Blood tranfusion \r\nAdviced \r\nSerum .Iron\r\nTIBC\r\nS.ferrtin \r\nContinue the same\r\nAdded Antibiotic\r\nS/b Dr.Sasikumar \r\nDVT\r\nStart on LMWH, stop on day of surgery\r\nStart on Oral anticogulation therpy after surgery , monitoir the PT/INR on therpy\r\nCan be taken for surger under moderate risk\n1units over at 2am , No rxn, \r\n2nd unit\r\nBlood tranfusion \r\n1unit\r\nPremedication\r\nInj.Avil 1amp i.v / Inj.Dexona sos\r\ncontinue the same\r\n\r\nVital stable \r\nConinue the same\r\nPBF/Iron profile awaited\r\nContinue the same\nHb/PCV\r\nTransfusion over , No rxn, vital stable\nSeen by Dr.AK.Bhat.\r\nFor SSG left foot&skin biopsy under SA on 1-11-2011.Get consent.C&D left foot.Shave genitalia&left thigh&betadine scrub HS&CM.Medical fitness for the procedure.IV antibiotics Inj.Microtaz 4.5 gm IV HS&CM.\r\n\r\nVITAL STABLE, NPO,FOLLOW THE DR.BHATT ORDRES\r\nHIGH RISK CONSENT\nVITAL STABLE,CONTINUE SAME\nPR-98/min\r\nB.p-124/67mmof Hg\r\nCVS-S1S2 Normal\r\nRS RR-24/min \r\nCNS-Consious /Oriented \r\nPA-Soft , NAD\r\nPain Better\r\nContinue the same\r\nInj.Fortwin 1amp / Phenargan 1/2 amp slow i.v sos\r\nTab.Nitreset sos\nVomitted once , C/o breathlessness\r\nSpo2 94%, PR-90/min, B.P120/80mof Hg\r\nCVS-S1S2 normal\r\nRS-NVBS\r\nCNS-Consious /Oriented\r\nInj.Pantodac 40mg IV\r\nInj.Emeset I.v \r\nCombimist Neb+derinide Neb stat\nGC better.Pt can be shifted from ICU.BP normal.\nSeen by Dr.A.K.Bhat.\r\nSome pain left thigh.Continue trt.\r\nC/o pain in th thigh and headache\r\npulse 0x at 12 am\nVitals stable. No pain at present\r\nPLan- Hold on the warfarin for now and start later.\nSeen by Dr.A.K.Bhat.\r\nFor change of dressing in OT tomorrow.\nVital stable, Continue the same\r\nContinue the same\nBetter\r\ndoing well\r\nRegular with Medication\r\nContinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.SSG left foot has taken up.The donor site left thigh is clean.\r\nSuggested oral antibiotic.\nC/o Breathlessness\r\nC/o Abdomen discomfort\r\nFBS-111\r\nINR-1\r\nVital stable\r\nRS-Clear\r\nCVS-S1S2 Noraml\r\nMild odema over the Foot\r\nStoped tab.Deriphylline\r\nAxipan\r\nAdded tab.ravera D 1-0-1\r\nSyp.Sucrafil 10 ml 1-1-1\r\nContinue the same\nVital stable\r\nno specific complaint\nSeen by DR.A.K.Bhat.\r\nAfebrile.Continue trt.For change of dressing on wednesday.\nvital stable\r\nPT/INR-1.1\r\nContinue the same\r\nIncresed the warf 5mg 1-1-1\r\ncontinue the asame advice\nDoing fine. Not to ambulate as yet. No anitibiotics on board.\r\nPT/ INR tomorrow.\nfine\r\nHB, PCV, PT/INR\nSeen by Dr.AK.Bhat.\r\nDressings changed.The SSG left foot is settling well.The donor area left thigh healing well.\r\nVitals stable. will discharge only on saturday\nSeen by Dr.A.K.Bhat.Status better.No pain.Plan for discharge on saturday.\r\nTab.Deslar 5mg for cold st\nGC better.Slept well.Stool passed.Vitals stable.Continue the same.\r\nSeen by Dr.A.K.Bhat.Continue trt.\nSeen by Dr.A.K.Bhat.Dressings changed.Donor site fully healed.SSG taken up.\r\nAdvice on discharge:Dressing change left foot twice a week-Cuticell/pad/crepe bandage.Vaseline to left thigh thrice a day.Partial weight bearing left leg.Review after 2 weeks.\n'}, {'role': 'model', 'content': 'IP Number: 123\n\nPatient Number: 2822\n\nAdmission Date: 27-10-2011\n\nDischarge Date: 12-11-2011\n\nDiagnosis: Essential (primary) hypertension (I10)\r\nTYPE 2 DIABETES MELLITUS (SL13)\r\nDIABETIC FOOT-Necrotising Fascitis\r\n ?FILARIASIS-RT\r\nGlaucoma\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis \r\n\r\n\n\nClinical Exam(With BP): Admitted for grafting of the ulcer on the dorsum of the LT foot\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, obese, not in any resp distress\r\nRS- NVBS\r\nCVS- S1 S2 heard\r\nAbdomen- Normal\n\nDiscussion: Pt admitted for skin grafting of the ulcer on the dorsum of the Lt foot. Venous doppler was done- Thrombosis of both the femoral and popliteal vein. Pt was started on Low molecular Wt heparin. Pt was noted to have low HB, investigation were done and was transfused 2 units of PRBC , SSG was performed on 1/11/2011, with the graft taken from the Lt thigh. skin biopsy was taken from one of the impetiginous lesion.\r\nPt was started on I.V antibiotics, insulin basal bolus regimen, started on Tab Warfarin, while continuing on the inj low molecular wt heparin. INR therapeutic, and heparin stopped.\r\n\r\n\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 34\n\nPatient Number: 173\n\nPatient Name: T.M.ALEXANDER\n\nGender: M\n\nDate of Birth: 17-07-1935\n\nAddress: THUNDIPARAMBIL HOUSE\n\nPincode: nan\n\nPhNo: 9895405553\n\nAdmission Date: 23-08-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Constipation , vital stable, adviced Enema, continue the orders\nVitals stable , seen By Dr bhatt, X-ray of LT foot- chronic osteomyelitis\r\nGRBS- 187\n3:00am , passed motion , had itching , adviced Inj.Avil slow I.V, stat,stop Tab.chymoral forte\r\nSlept after the Avil injection. Vitals stable. seen by DR BHatt, X-Ray Foot taken- ? osteomyelitis,\r\nWill control the infection and sugar, discussed the plan with the Pt\nSeenb by DR.A.K.Bhat\r\nAfebrile.\r\n?Plan for bone nibbling under LA.\nSeen by DR.A.K.Bhat\r\nDressings reviewed.\r\nThe options given are:\r\n1)conservative.\r\n2)Bone nibbling\r\n3)Debridement&fillet flaps of 2nd&3rd toes.\r\n8:00pm Better,vital stable, sugar under control\nvitals stable. still c/o itching a liitle bit\r\nAC- 114\nBetter, planned case in morning, follow the instruction , Shift the case to OT by 7:15pm\nVital stable, systemic Examination -Status co, Changed the antibiotics according to c/s, stop novomox Cv\r\nDisscussed with Dr.Bhat\nAcute retension of urine, vomiting\r\nAfebrile, PR 80/min , BP 150/90mmof hg, CVS-S1S2Normal , RS-Clear , \r\nCatherized , Inj.emeset 4mg i.v stat, Inj.Rantac I.V \r\n1:00pm Inj.Perinorm stat, IV DNS 500ml + 6units Actrapid 50ml /hr, continue the advice asper the surgery notes\nBetter, No Nause, Vital stable , Insugen R 6units at bed time, continue the same orders\r\nShift to ward tomrrow\nShift to room , vital stable, no vomiting , D/C Cath\r\nSeen by Dr.A.K.Bhat\r\nAfebrile.No soakage of dressing.No pain.\r\nContinue trea6tment.OFFLOADING of operated foot.\r\n\nVitals stable. c/o constipation.\nGC stable,Pruritis better.Taking oral foods.\r\nFBS- 153mg/dl\nVitals stable, Blood sugar control maintained.\r\nDressing change to be done by DR bhatt tomorrow\nVitals stable, prelunch- 71\nVitals steble. blood sugar controlled.\r\nDressing change today.\r\nSeen by Dr.A.K.Bhat\r\nDressing changed.\r\nDrain removed.Suture line is clean.\r\nContinue trt.\nSeen by Dr..AK Bhat\r\nPatient is not offloading the operated foot.Explained the need for offloading.\r\nContinue treatment.\nVitals stable Continue the same\nVitals stable . sugar well controlled, will discuss with Dr bhatt regarding the discharge process\nVitals stable, dressing change to be done tommorrow\nPt c/o different taste in the mouth. vitals stable. Blood sugar controlled\nSeen by DR.A.K.Bhat\r\nC&D done.Suture line of left foot is clean.\r\nSuggested oral antibiotics.\r\n\r\nVitals stable, blood sugar well controlled. Dressing change done. OFF loading of the feet\nDoing fine. General condition good. No hypos.\nSeen by DR.A.K.Bhat\r\nLarge dressing done.Partial suture removal done.The left foot wound is healing well.Adviced:OFFLOADING of operated leg.Dressing review twice a week.\nVitals stable, sugar well controlled.\r\nSutures to be removed today or tomorrow.\n'}, {'role': 'model', 'content': 'IP Number: 34\n\nPatient Number: 173\n\nAdmission Date: 23-08-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis: chronic osteomyelitis\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\n\nClinical Exam(With BP): admitted for chronic ulcer on the plantar aspect of the Lt foot x 2 yrs,s/p amputation of the 5 th digit of the Lt foot few months ago\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nUlcer- Wagner 111 classification, on the planta aspect of the Lt foot in between the 2 and 3rd digit , probing to the bone.\n\nDiscussion: 76 yr old with H/o DM, admitted for non healing ulcer which was infected and probing to the bone. also swelling and pain in the Lt leg. X- Ray of the foot- destruction of the 2 and 3 rd metatarsal head of the LT foot. Seen by a surgeon, Started on I.V antibiotics and Insulin for good glycemic control.\r\nHe had an amputation of the 2 and 3 rd digit along with removal of the osteomyeltic fragments on the metatarsal heads of the 2 and 3 rd digit.\r\ngrafting of the skin .\r\nRegular dressing were done.\r\n\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet with small, frequent feeds adviced\r\nDiet booklet also given\r\n\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 77\n\nPatient Number: 1762\n\nPatient Name: KHADEEJA\n\nGender: F\n\nDate of Birth: 17-05-1961\n\nAddress: SAINA MANZIL,AROOKKUTTY P.O,CHERTHALA\n\nPincode: 688535\n\nPhNo: nan\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 29-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: \r\n\nAdmitted with history of cough for 2week, became worse\r\nNo fever,Hypothyroid on replacement, vital stable, Rs-Rhonchi+\r\ninformed Pulmonologist\r\nAdviced to change it to Nebulization , continue the rest of think \r\n\nNo fever, still has resp distress \r\nChest- B/L rhonchi \r\nsaturation- Normal\nS/bDr.Ramesh Nair \r\nVital stable, Rs-Rhonchi, CNS-S1S2 Normal, \r\nPlanned \r\nCall after 2days to decide on the dose of Hydrocortisone.\r\nfollow the advice\r\n6:10pm Better, chest better, continue the same\ncough out sputum, Vital stable, comfortable\nCough persisting. FBS a little high (? steroid induced)\nSputum C/S , Gram Stain. B/L rhonchi. NO fever, cough slightly improved\nVitals stable. looks a lot better. \r\nGRBS- 174, will check post meal sugars\r\nPulmonary evaluation today. Intend to D/C tomorrow on oral steroids\r\n\r\n\ns/b Dr.KMR\r\nAdviced Reduced I.V Solumedral 40mg BD\r\nCombist Neb q8h\r\nDerinide Neb q12h\r\nStop Mucomix\r\nTab.Amitone 10mg hs\r\nTab.allegra 120 hs\r\nContinue Tab.Unicontine, antibiotic\r\n\r\n\nC/o cough, not able to sleep. seen By pulmonary , Decreased the dose of solumedrol\r\nChest- Mild rhonchi\r\nBut better\r\nFBS- 144\r\nwill speak with the family, about doing the CT scan of the chest and Neck as an outpt\nVitals stable. feels better. probable CT scan of the chest and neck tomorrow\nVitals stable. Slept well yesterday. GRBS- 125.\r\nCT Scan Of the Neck and chest to be done today and pulmonary evaluation after that\n'}, {'role': 'model', 'content': 'IP Number: 77\n\nPatient Number: 1762\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 29-09-2011\n\nDiagnosis: Acute Allergic Bronchitis\n\nClinical Exam(With BP): Mrs .Khadeeja /50yrs/female admit with cough of more than 2week duration , \r\non bronchodilators , cough suppresent, on Lt4 for Hypothyroidism. Started on I.V \r\nAntibiotic , Steriods, Bronchodilator , steriod nebulisation,Chest physio therpy\r\nDid CT Chest/Neck to R/o cause , Nothing detected . Symptomaticaly better\n\nSystolic BP: 110.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: RS-B/L Rhonchi+\n\nDiscussion: Mrs .Khadeeja /50yrs/female admit with cough of more than 2week duration , \r\non bronchodilators , cough suppresent, on Lt4 for Hypothyroidism. Started on I.V \r\nAntibiotic , Steriods, Bronchodilator , steriod nebulisation,Chest physio therpy\r\nDid CT Chest/Neck to R/o cause , Nothing detected . Symptomaticaly better\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nPatient Name: SAJITH KUMAR\n\nGender: M\n\nDate of Birth: 14-04-1968\n\nAddress: CHELAYIL HOUSE, NEAR K.S.E.B\n\nPincode: 682005\n\nPhNo: nan\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC RETINOPATHY\nDIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Blood sugars are 634 mg/dl. Patinet is comfortable. Vitals are fine.\nConsious , oriented , febril , HR-82, BP- 150/90 RS-B/l Basal crepitation , Cvs -JVP Elevated , S1,S2 Normal \r\nAdviced Tab.Welset sos, Planned Cardiology consultation tommrow, statrt Inj.Metrogyl 100 i.v 1-1-1, Tab.Levofloxacin 500mg . Surgical Debridement on friday\nFebrile,Vital stable, Continue the same medication , prepare for the wound debridement under local \r\n\nTemp-99.2, PR-82, BP-130/80, Systemic Examination -NAD \r\nAdviced ECG/XrayChest -PA Veiw, \r\nadjusted the insulin dose, inform Prelunch, predinner, continue othe medication as Advice \r\nInform OT Staff,\nGeneral condition better. Slept well. Passed stools. Scheduled for debridement today. AC- 140 mg /dl. To be shifted to the recovery/ ICU at 9AM\r\n\r\n29/07/2011\r\nOperation done....\r\nSlough Excision of Right Heel Ulcer done under L/A.\r\nAfter adequate preparation and draping, the Ulcer slough was Excised For about 2X2 inches.\r\nThe slough did not seem to extend to the bone.\r\nThe Residual Ulcer after Excision, Bleeding was satisfactory.\r\nUlcer Haemostasis achieved.\r\nABGEL and Compression Dressing given.(DR. A.K. Bhat).\r\n\r\nPOST OPERATIVE ORDERS/INSTRUCTIONS:\r\n\r\nStrict Right Leg Elevation and Bed Rest.\r\nTPR/BP Monitoring.\r\nWatch For Bleeding.\r\nContinue IV Antibiotics.\r\nInject. Tramadol IM S.O.S\r\nPlanned for change of dressing in Recovery Room 31/07/2011.\r\n\nSeen by Dr.A.K.B\r\nPt afebrile.\r\nAdvice no wt.bearing on rt.leg .\r\nFor C/D tomorrow in OT Recovery.\npt alert, had an episode of hypoglycemia yesterday, ( sweating) GRBS- 86 .\r\nNo fever, chills\r\nPost debridement yesterday, No pain\r\ndressing tomorrow.\r\n\nSeen by Dr. A.K.Bhat and Dr. Tom Babu.\r\nDressings have been changed.\r\nThe Ulcer of the Right Heel looks CLEAN.\r\nNo Residual Pus or Slough.\r\nNo Evidence of Cellulitis.\r\n\nNo fever, No pain, Vitals stable, Dressing done yesterday, switched to oral antibiotics\nNo complaints, vitals stable,dressing to be done today by DR Bhatt, Intend to discharge tomorrow.\r\nAC- 93, Insugen R 24 units given. Midnight GRBS- 130\r\n10:00am Doing well, No Hypos, awating for surgeon for dreesing , adjusted the insulin dose according to the GRBS, planned discharge\r\n2:00pm s/b Dr.A.K.Bhatt , dressing changed , ulcer of the Rt heel looks clean except for some slough of the floor , part of which excised , Abgel compression dressing given , surronding skin and soft tissue inflamation subsided, continue the same Treatment .\r\n\nVital stable,GC-Better,Systemic Examination-NAD\r\nPredinner -165, adviced InsugenR 22units , Insugen N 26units at bed time \r\nPlanned discharge on 4/08/2011\nAfebrile, No pain, AC- 160, Insugen R 24 units given\r\nSeen and dressing change done by Dr A.K. Bhatt yesterday,\r\nDressing to be changed tomorrow again and Intend to D/c tomorrow.\nSeen by Dr.A.K.Bhat\r\nDressing changed.The ulcer right heel looks clean.\r\nAdvice:Dressing change as OP once in two days.No weight bearing on ulcer area.Oral antibiotics for one week.\nVital stable ,one episode of hypoglycemia , Dressing change today, continue the same\n'}, {'role': 'model', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis: Infected Non Healing Ulcer\n\nClinical Exam(With BP): 43 yr old with H/O DM admitted for Infected non healing Ulcer. S/P debridement of the the ulcer by DR A.K.Bhatt on 29-07-2011.\r\nTreated with Broad spectrum I.V Antibiotics , and tight control of sugar by basal insulin( INsugenN ) and three time regular insulin ( InsugenR).\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: lab results attatched\n\nXray findings: nan\n\nDiscussion: Controlled blood sugar with Basal bolus regimen, under antibiotic cover, wound debridement done , adviced to continue the insulin , off loading , regular dressing\n\nDiet: \r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 29\n\nPatient Number: 2647\n\nPatient Name: MANUEL P.M\n\nGender: M\n\nDate of Birth: 20-08-1949\n\nAddress: PUTHANPURARIRAPPEL\n\nPincode: 682037\n\nPhNo: 0484 - 2423723\n\nAdmission Date: 20-08-2011\n\nDischarge Date: 25-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Iand D done, C/o Pain , Vital stable , CVS-S1S2Normal, RS Clear, PA-NAD, No fever\nVitals stable, admitted for uncontrollable blood sugar, multiple carbuncles.\r\nSeen by Dr.A.K.Bhat.\r\nMultiple carbuncles,rt.thigh,leg,buttock&back.The one on the rt thigh is large &will need I&D under LA.\r\nGet consent.\nDoing well, I&D of the thigh abscess done yesterday. Patient is doing well. c/o gaseous distension of abdomen. AC-113 mg/dl.\nSeen by DR.A.K.Bhat\r\nAfebrile.No dressing soakage.Pain decreased.\r\nContinue treatment.\nSeen by Dr.A.K.Bhat\r\nDressing changed.Ulcer lt thigh clean.\r\nContinue treatment.\r\nvitals stable, GRBS- 152\r\nNo fever, c/o pain\r\nECG- normal\nVitals stable, c/o mild pain in the thigh, ? chest discmofort too.\r\nECG - Normal\nAfebril, Vital stable, Systemoic examination -NAD, Wound looking better, continue the orders.\r\nSeen by DR.A.K.Bhat\r\nNo pain.\nBetter, abdomen distension better, pain subsided\nSeen by DR.A.K.Bhat\r\nDressing changed.Ulcer clean.\r\nC/o pain after dressing change, Vitals stable\nVitals stable,C/o some difficulty breathing yesterday night.\r\nchest - clear, No rhonchi, Chest discomfort better\r\nRpt Pus culture taken\n'}, {'role': 'model', 'content': 'IP Number: 29\n\nPatient Number: 2647\n\nAdmission Date: 20-08-2011\n\nDischarge Date: 25-08-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): 62 yr old with H/o DM comes in with Multiple carbuncles , one on the Lt thigh, RT buttock and the back X 20 days. Was admitted for Excision of the carbuncle along with Control of Blood sugar and infection control.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male not in any distress\r\nSystemic Exam - Normal\r\n\n\nDiscussion: admitted for excision of the carbunle, and sugar control, and for I.V antibiotics.\r\nI & D of the abscess was done on 21/08/2011 by Dr Bhatt. Pt was Started on I.V antibiotics and Insulin for blood sugar control.\r\nAntibiotics was switched according to the pus culture report\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet adviced\r\nDiet booklet given\r\n\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 85\n\nPatient Number: 1497\n\nPatient Name: JOYCE SEBASTIAN\n\nGender: F\n\nDate of Birth: 08-02-1957\n\nAddress: JR VILLA, MATTAM HOUSE, CHALAKUDY\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 28-09-2011\n\nDischarge Date: 01-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: GRBS- 198, No fever, admitted with discharge from the wound,\nVitals stable. GRBS- 198, No fever, No pain\nS/b Dr.Bhat\r\nLocal fungal infection , Vital stable, Candid Dusting Powder over the wound\r\nCandid Ointment Local application to the \r\nCan send Home\r\nStop I.v antibiotic\nVitals stable. No itching today. Dermatology and surgical consultation\nSeen by Dr.A.K.Bhat.\r\nBetter.Continue treatment.\r\n8:00pm better,fine,continue same\nbetter, vital stable\n'}, {'role': 'model', 'content': 'IP Number: 85\n\nPatient Number: 1497\n\nAdmission Date: 28-09-2011\n\nDischarge Date: 01-10-2011\n\nDiagnosis: Acute Paronychia-Nail removal done\r\nOnycomycosis\n\nClinical Exam(With BP): Mrs .Joyce sebastian /54yrs/female Type 2 diabetes Mellitus, admiited with history of\r\nDischarge from the previously operated toe, sought Dermatologist opnion, \r\nsugested superadded fungal infection , keep the wound open, Antifungal for the wound \r\nand surronding skin \r\nAdjusted the dose of insulin \r\nDischarge in stable state\n\nSystolic BP: 170.0\n\nDiastolic BP: 100.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Discharge from the previously operated toe, sought Dermatologist opnion, \r\nsugested superadded fungal infection , keep the wound open, Antifungal for the wound \r\nand surronding skin \r\nAdjusted the dose of insulin \r\nDischarge in stable state\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nPatient Name: M.J.JOSEPH\n\nGender: M\n\nDate of Birth: 11-08-1933\n\nAddress: MEKKATTUPARAMBIL HOUSE,PADAMUGAL\n\nPincode: 682021\n\nPhNo: 2422226\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEUROPATHY\nEssential (primary) hypertension\nCORONARY ARTERY DISEASE\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 5:00pm GRBS-502mg/dl, Vital stable , Shift to OT for Iand D , \r\nGiven Insugen 20units I.V Bolus, continue Insulin drip at 10u/hr, stop lasix, I/o Chart, continue the I.V NS 50ml/hr, Inform GRBS Hrly\r\n5:00pm Shift the \r\n8:00 pm - Shifted to i.c.u, PR80/min , B.P-130/80, CVS-S1S2, Rs-Clear , Catheterized under aseptic precaution, monitor intake , out put\nC/o pain , GRBS Hi, Started on insulin infusion , Maintain NS ml/hr , follow the other orders\n4:00pm Vital stable , Intake-550, output-200. \r\nI.v Ns 75ml/hr 2pints \r\n5:30pm Doing well, pain subsided, Vital stable , Dreesing clean , Follow the Advice\nSeen by Dr.A.K.Bhat\r\nDressing changed.There is no evidence of residual pus.However the floor of the ulcer looks ?ischemic.Needs further observation&guarded prognosis.\r\n9:00am GC fair, Vital stable, GRBS 107, on Insulin infusion 1u/hr, Dreezing done by Dr.Bhatt, shift to room\r\n9:30pm S/b Dr.Tom , Adviced to continue the same,\r\n12:30pm 10units Insugen s/c\r\nAdd Inj .Tramadol 50mg in I.V fluid\n8:00am Doing well, slept well, No Pain , \r\nPR70/min , BP-110/70, RS-Basal crepitation +, I/0 1925/800\r\nplus positive balance of 1100\r\n\nChest clear , vital stable, D/c Cath \r\nfollow the order, inform Predinner\nGC fine, Vital stable, Rs Few crepitation + , Wound Clean , No Discharge, explained the Bystandard about the prognosis\nVital stable, Given analgeic for pain , pain subsided after this. adjusted the insulin according to the GRBS\r\n6:00pm seen by dr.tom sir , fine, doing well, RS-B/l crepitation . folloe the same orders\r\nHb,Tc,Dc, Urea , Creatine, FLP, Sodium , potassium , FBS\nHad Hypoglycemia at 7pm , better with carbohydrate. Adviced Actrapid 24-24-24, Lantus 24 ,planned dreesing today by Dr.Bhatt.\r\nDressing change done by DR Bhatt, Awaiting Pus culture\nS/b Cardilogist, adviced ECHO/Xray Chest-PA\r\nFine , Vital stable,\nDoing well, sugar under control, No hypos , adviced Xray chest-PA, Xray foot -AP/Lat\nS/b Dr.bhatt And Dr.Tom Ulcer of the lt foot is unhealthy,exposing unhealthy deep tendon of sole of foot\r\nRpt Cand S taken, sugested Arterial doppler to confirm diagnosis of chronic PVD\nSeen by Dr.A.K.Bhat\r\nDressing changed.Same findings of ischemic ulcer lt sole with exposed tendons and fascia.Metrogyl gel dressing given.Guarded prognosis regarding healing need to be explained.\r\n7:oopm Better, No hypoglycemia, Vital stable , follow the order\nVitals stable AC- 48 and then 90. Dressing change done by\r\nDR bhatt. discussed in details with the family\nMild pain , GC Fair , Vital stable , RS Clear\r\nSeen by Dr.A.K.Bhat\r\nOcc.Pain.Dressing overpadded.\nVitals Stable, C/o pain in the leg.\r\nPre- dinner- 145\r\nFBS- 56\nFine, Mild pain , Tingling sensation in the foot.\r\nC AND S Sensitive to klebsilla ,started on Inj. Amikacin\nSeen by DR.A.K.Bhat.\r\nC&D done.Same findings.\r\n8:00pm -Better,vital stable,CVS-S1S2 Normal , RS: NVBS\nSlept well. pain over Lt foot in the morinig, relieved with NSAIDS. Passed stools. AC- 161 mg/dl, Pre dinner - 95 mg/dl\nSeen by DR.A.K.Bhat\r\nDressing reviewed.Same findings.\r\nRepeat C/S taken.\r\nDoppler done. GRBS- 264, Pus culture taken\nVitals stable, doppler of the legs today, intend to D/c probably tomorrow\nSeen by DR.A.K.Bhat\r\nSame findings.Adviced Dressing change daily.\nvitals stable. Doppler done yesrterday. will discuss with Dr Bhatt regarding the discharge.\r\nAC- 247\r\nPre-dinner- 264.\n'}, {'role': 'model', 'content': 'IP Number: 15\n\nPatient Number: 2563\n\nAdmission Date: 11-08-2011\n\nDischarge Date: 23-08-2011\n\nDiagnosis: Ulcer over the Lt Plantar aspect of the foot\r\nPeripheral Vascular Disease\r\nModerate LV Dysfunction \r\n\r\n\n\nClinical Exam(With BP): H/o Noticed Abscess over the Foot-Lt -1week. Duration of Diabetes - 30 years\r\nCurrent Medication\r\nHuman mixtard 28-0-23\r\nTab.Lasix40mg 1/2-0-0\r\nTab.Enam 10 0-0-1\r\nTab.Nicardia retard 20 1-0-0\r\nTab.Cadloc 3.125 1-0-1\r\nTab.Glyciphage 500 1/2-0-1/2\r\nTab.lanoxin 1-0-0 5/7\r\nPrevious Blood sugar profile-FBS: PPBS: RBS: HBA1C:\r\nWeight Loss- stable \r\nFrequency of blood sugar estimation Twice daily/once weekly/once monthly\r\nBlurring of vision-Left Eye\r\nDiabetic eye examination- Yes\r\nBurning Sensation of feet -No\r\nNumbness of feet-No\r\nFalling off of foot wear-No\r\nSwelling of feet -Yes\r\nCornary heart Desease-Yes-Years [1994 ]\r\nDyslipidemia-No\r\nHypertension-20yrs\r\nRecurrent infections-No\r\nHypoglycemia - Yes\r\n. Father -Diabetic. GC fair ,No Pallor\r\nCVS-S1S2\r\nRS-Clear\r\nFoot impaired Sensation\r\nClawing of toes\r\nDry skin\r\nAbscess over the 2/3 of the Ventral aspect of foot\r\n.\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Toxic , Dehyration \r\nConsious and Oriented \r\nLt Postrior tibial pulse absent\r\nRS: NVBS, Base Clear\r\nCVS S1S2 Normal \r\nCNS: Consious and oriented\n\nDiscussion: K/c/o Type 2 Diabetes Mellitus, Coronary Heart Disease with Moderate L.V Dysfunction , Hypertension , Diabetic Neuropathy, Admitted with Lt plantar absecess, HU, Septisemia. started on Insulin infusion and \r\nHydration with normal saline, started on empirical antibiotic, changed antibiotic asper C/s . Disscused to option with Bystandred . because of the emergency situation taken for Absess exsion and debridement of the necrotic tissuereport Excised the abscess under aseptic precaution,Count starts commimg done. fair glycemic control,genaral condition improved Wound healing not satisfactory, Started on LMWH, Arterial doppler compramised distal circulation . planned to continue the oral antibiotic , glycemic control with Basal bolus regimen , Ulcer wait and watch, wound care\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 107\n\nPatient Number: 3168\n\nPatient Name: BABU T T\n\nGender: M\n\nDate of Birth: 12-10-1964\n\nAddress: THAREPARAMBIL HOUSE\n\nPincode: 683101\n\nPhNo: nan\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat.\r\nLeft foot infective osteomyelitis of 2nd and residual 3rd(earlier amputated)toes with large pus draining sinus base of 1st toe near web.There is e/o necrosis of subcutaneous tissues around the toe bases.Cellulitis of foot present.Xray confirms clinical findings.?involvement of Ist MT head.\r\nAdvice:IV antibiotics.Dressings with betadine oint.\r\nWill need wound debridement/curettage&amputation of 2nd toe under SA,Provided he is medically fit for the procedure.\nSeen by Dr.AK.Bhat.\r\nDressing changed.There is active OM of 2nd and residual 3rd ray of left foot.Cellulitis decreased.Plan for 2nd toe ray amputation,nibbling 3rd ray, and slough excision under ankle block anesthesia on Saturday(15-10-2011).Get informed consent.\nVital stable, Aferile, Sugar under control, \r\nXray Foot Lt OM 2and 3rd toes, P/s disarticulation of 3rd toe\nSeen by Dr.AK.Bhat.\r\nFor Amputation of left 2nd toe under local/Ankle block on 15-10-2011.Get informed consent for amputation(explaining about present condition of infection,osteomyelitis,?involvement of big toe,diabetes,neuropathy,wound healing problem etc.). Clean&dress left foot.\r\nNPO after 10:00pm\nvital stable, ac 98mg/dl, planned ray dissection\r\nLFT/PT-INR, Blood Routine, Platelet count, Urea, Creatinine\r\nECG\nBetter,shifted from ICU\r\nPased motion , Doing well\r\nVital stable\r\nContinue the same\nVital stable\r\nGc-Fair\r\ncontinue the same.\r\nSeen by Dr.A.K.Bhat.\r\nAfebrile.No pain.\nGC ggood.Doing well.Blood sugar ctrl.Continue the same.\nGc better.Vitals stable.Dressing tomorrow.GRBS-203mg/dl\nVital stable, \r\nStop I.V antibiotic\r\nContinue the other Orders\nfine, vital stable, Sugar fine\r\nContinue the same.\r\n\r\nSeen by Dr.A.K.Bhat.\r\nDressings left foot changed.\r\nSuture line clean.\r\nDrain removed.\r\nSuggested oral antibiotics.\nDoing well. AC- 139 mg/dl. Slept well.\nVitals stable. Intend to D/C in a.m\nDoing fine. AC- 170 mg/dl. Being discharged today.\n'}, {'role': 'model', 'content': 'IP Number: 107\n\nPatient Number: 3168\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis: Osteomyelitis 2 nd digit RT foot\r\n Chronic liver Disease\r\n OLd pulmonary TB Rt lung\n\nClinical Exam(With BP): nan\n\nSystolic BP: 136.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Young male, not in any resp distress\r\nSystemic Exam- Normal\n\nDiscussion: 47 yr old with H/o DM, old TB admitted with infected sinus in between the 1 st and 2 nd digit. X-ray showed osteomyelitis of the 2 nd digit upto the metatarsal head . Pt was admitted, started on I.V antibiotics, insulin regimen, seen by surgeon, amputation of the 2 nd digit was done. pOst perative stay was uneeventful. switched to oral antibiotics and regular dressings done\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet in small, frequent feeds adviced\r\nDiet booklet given\r\n\r\n\n'}]

[{'role': 'user', 'content': "IP Number: 84\n\nPatient Number: 2993\n\nPatient Name: P V KURIAN\n\nGender: M\n\nDate of Birth: 27-09-2026\n\nAddress: NO 37/679D,1ST FLOOR,ROCKS RESIDENCY,\n\nPincode: 682001\n\nPhNo: 0484-2203904\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 8:00PM -ADMITTED WITH HISTORY OF BADLY INFECTED LT FOOT\r\nlONG STANDING DIABETES\r\nPR-92,SPO298%, B.P 160/90, CVS-S1S2 NORMAL\r\nRS-NVBS, NO CREPITATION \r\nPA-NAD\r\nGRBS-496\r\n\nSeen by Dr.A.K.Bhat.\r\nAcute on chronic PVD left foot.Infective gangrene of lateral 4 toes.\r\nFor transmetatarsal/BK amputation after investigations,risk explanation.\r\nIV antibiotics.Betadine dressing.Foleys cath.Betadine scrub of whole lower limb.Arrange packed cell 2 pints for surgery.Inj.TT.\nspiking fever, arterial Doppler to be done today. Evaluate further action based on that\nbetter,PR91,B.P 126/65 RS-Clear,RS-Clear , CVS-S1S2 Normal \r\nTab.Trika 0.25stat\r\n\nstill spiking fever. Pre dinner 333, Insugen R 20 units given.\r\nInsugen N 20 units given at night.\r\nGRBS today- 255\r\nTo start on insulin syringe pump.\r\nNPO after 11'0 clock.\r\nTo start at 2 units /hr.\r\narterial doppler done.Rt side- Biphasic flow till the ankle, with collaterals.\r\n\nwell ,no pain , vital stable, Systemic -NAD,\r\ninsulin infusion on flow\r\nHb,TC\r\nShift to room.\r\nSeen by Dr.A.K.Bhat.\r\nNo soakage.Pain.Continue trt.\r\n6:00 Blood transufusion , No rxn, vital stable, Systemic examination -NAD\r\nInsugen R 20units , Insugen N 28units at bed time\r\nTab.Trika stat\r\n\nVital stable\r\nAppitite better\r\nNo pain \r\nContinue the same\nSeen by Dr.A.K.Bhat.\r\nDressings of left foot changed.The raw area of amputated stump looks viable.There is some slough of sole region.No pockets of pus.The lower leg incision looks clean.\r\nDulcolax suppository 2 SOS.\nSleep was disturbed due to pain. Blood sugars are well controlled.\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Pain decreased.Continue trt.\r\nfine better\nVitals stable. No fever, C/io mild pain. Will remove the foley catheter and check blood\nSeen by Dr.A.K.Bhat.\r\nDressing changed.The stump of amputated foot viability is doubtful&there is slough..No residual pus.The wound of leg is clean.The present condition of the wound has been explained&guarded prognosis given.\nVitals stable. No fever, C/io mild pain. Will clamp the foley catheter today and try to remove the catheter\nPatient complaint of pain.\r\nNo Fever\r\nGRBS- 90mg/dl\r\nI/O 1800/1600\r\nDressing done by Dr .Bhatt.\nSeen by Dr.A.K.Bhat.\r\nPain +.No dressing soakage.\nSeen by Dr.A.K.Bhat.\r\nDressing of left foot changed.There is no evidence of granulation of left foot stump,except of dorsal flap.The ankle wound is clean.Suggested oral antibiotic-Cap.Dalacin-C 300MG tdsx1 week.\r\nC/o pain after the dressing change. will give tramadol\nVitals stable.No pain today.Dressing to be changed today.FBS-117mg/dl.\nHypoglycemia today morning.urine routine culture to be done.\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\nNo complaints. GRBS- 150, afebrile, Urine RE - 8-10 pus cells. will discus with the family the need for VAC therapy\nGRBS-63mg/dl.Discuss abt vac theraphy to DR.BHATT.\r\nSeen by Dr.A.K.Bhat.\r\nDressings changed.Findings same.\nbetter,vital stable continue the same\nSeen by Dr.A.K.Bhat.\r\nDressing changed.The left foot stump is ischemic.The ankle ulcer is clean.Adviced alternate day dressing change.\n"}, {'role': 'model', 'content': 'IP Number: 84\n\nPatient Number: 2993\n\nAdmission Date: 27-09-2011\n\nDischarge Date: 10-10-2011\n\nDiagnosis: DIABETIC FOOT\n\nClinical Exam(With BP): admitted with Infected gangrene of left toe upto the midfoot ,Uncontrolled bloodsugar and fever.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, legally blind, not in any resp distress\r\n\n\nDiscussion: Admitted with history of Diabetes. Infected gangrene of left foot upto the base of midtarsal .Uncontrolled bloodsugar and fever.Started on IV antibiotics and Insulin Basal bolus regimen for tight glycemic control.Seen by surgeon recomended mid foot amputation ,Arterior Doppler was done to evaluate the blood flow to affected area. . surgery was performed on 29-09-2011( mid foot amputation). fever and pain subsided. plan is to discharge and do dressings at regular intervals to monitor if the wound is looking healthier.\n\nDiet: DEPT OF NUTRITION:\r\n\r\nLow calorie Low fat Diabetic Diet prescribed.\n'}]

[{'role': 'user', 'content': 'IP Number: 108\n\nPatient Number: 3091\n\nPatient Name: ANNAMMA MATHAI\n\nGender: F\n\nDate of Birth: 30-03-1931\n\nAddress: KIDANGALIL HOUSE,JACOB VALLANATT ROAD,\n\nPincode: 682018\n\nPhNo: 2391837\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 18-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\nCORONARY ARTERY DISEASE\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Both Kidneys shows mild Renal parenchymal oedema \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening. No mucosalirregularity.\r\n\\par \\tab \r\n\\par Uterus\\tab\\tab : Normal in size and echo texture\r\n\\par \r\n\\par Ovaries : Normal in size and echo texture\r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 Both kidneys shows mild renal parenchymal oedema \r\n\\par S/o Renalinfection /Nephritis\r\n\\par No mass lesion or calculus detected.\r\n\\par \r\n\\par Dr.Joe Antony,MD\r\n\\par Consutant Radiologist\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Pulse Ox- low without oxygen.\r\nWith oxygen 2L- 98%\r\nCXR- mottling seen (? acute pulmonary edema)\r\nInj Lasix 240 mg IV stat and Inj Derphylline 80 mg iv stat given and shifted to the ICU\r\nMaintained on 6 lits of O2, SPO2 80-90 %\r\n\r\nICU notes 9.00 pm\r\nNTG given at 2 mics and Dobutamine given at 5 mics (on flow)\r\nSaturation improved with treatment \r\nTab Carvedilol 6.125 mg and Tab Telmisartan 40 mg given\r\nInj Clexane 0.6 mg given\r\nBP 165/ 75 mm of hg\r\nCathetrized \r\n\nBetter, Vital stable, Spo2 96 with out O2\r\nContinue the same\nSeen By Dr.Tom \r\nSymptomaticaly better\r\nVital stable, NTG/Dobutamine on flow\r\nCardiology consultation Awaited\r\nS/B Dr .SasiKumar. Cardiologist\r\nPR-80, B.P 120/80mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Rt Crepitation \r\nPrerenal azotenimia\r\nECHo Gr 3 MR, No RWMA, Normal LV Function\r\nIshemia Precipted Pulmonary odema\r\nFolow the advice\r\nConsider Tab.Amlodipin 5mg instead of Telmisartan in view of Elevated Urea /Creatinine\nPR-70/min ., B.P 128/67, CVS-S1S2Normal , RS-Rt Basal crepitation +\r\nI/O 1250/2000\r\nChanged Telmisartan to Calcheck in view of Elevated Creatinine \r\nInj .Lasix 40mg \r\nIntake restricted to 1.2l\r\nLow salt diet\nVital stable, PR-90/min , B.P 130/80 mmof Hg\r\nCVS-S1S2 Normal \r\nRs few crepitation\r\nBlood transfusion over 4hr\r\n1units today\r\nInj.Lasix 20mg i.v st\r\nInj.Avil 1/2 amp i.v stat\nBlood transfusion 1units , Inj.Avil 1 amp i.v stat\r\nWith hold Inj.Dynalix\r\nPR-89/min \r\nB.P -140/80\r\nCVS-S1S2 Normal\r\nRS-Rt Basal crepitation\r\nCNS-Consious, Disoriented\r\nMotor/sensory/Reflex -Normal\r\nContinue the same medication.\r\nI/o 1650/2850\nPR-80\r\nB.P 120/80 mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Clear\r\nPA-Soft\r\nCNS-Consious /Oriented\r\nReflex Normal\nC/O tiredness,headache\r\nBP-140/80\r\nSPO2-94 RA\r\nVitals stable.\r\n\nDoing well. Had walked in the corridor without distress. Chest is clear.\r\nInformed dr.Sasikumar\r\nPR 86/min\r\nB.P 170/80mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Few crepitation\r\nCNS-Counsious/oriented\r\nadviced \r\nTab.Natrilex SR 1.5mg 1-0-0\r\nTab.Dytor 10mg insted of Lasix\r\nWithhold the Telmisartan 40mg\r\nContinue other as adviced\nS/B Dr.Sasikumar\r\nBetter, \r\nPR-80/min\r\nB.P -140/80 mmof Hg\r\nCVs-S1S2 Normal\r\nRs-Few crepitation \r\nContinue the same\r\nTab Epitus 25 1-0-1 for 1week, after 1week reduced to once aday\r\nMobilise\r\nDischarge tomorrow by evening\r\nS/b Dr Saeed\r\nUrine C/S\r\nLocal oestrogen cream\r\n\r\n\n'}, {'role': 'model', 'content': 'IP Number: 108\n\nPatient Number: 3091\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 18-10-2011\n\nDiagnosis: ACUTE PULMONARY ODEMA\r\nUTI\r\nANEMIA ? GI BLEEDING\r\nMOOD SWINGS NEED EVALUATION\n\nClinical Exam(With BP): Mrs Annamma Mathai K/C/O Type2 Diabetes mellitus, Hypertension , Dyslipedimia on treatment\r\nrecently discharge from the hospital , came with Breathlessness Acute onset, No H/o PND,Admitted for evaluation\r\nPt developed Flash Pulmonary odema, treated with Antifailure measures and put her on CPAP, sought cardiology consultation\r\nECG-LBBB(Old Change), ECHO-Dilated LA, Gr3/4 MR, Normal L.V function, CKMB-Normal limit, Pulomonary odema may\r\nbe because of Ischemia, defferted Coronary angiogram in view of genaral condition and age.changed ARB to Calcium Channel Blocker in view of\r\nelevated Urea/Creatinine, Electrolytes are normal During ICU stay HB droped to 7.2mg/dl\r\nStool for occult Blood Positive,Normal stoped LMWH,Asprine, tranfused 2units of Packed cells, Shifted from the ICU,Vital stable, Adjusted the Antihypertensive .started mild Physical activity without Symptoms\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Mrs Annamma Mathai K/C/O Type2 Diabetes mellitus, Hypertension , Dyslipedimia on treatment\r\nrecently discharge from the hospital , came with Breathlessness Acute onset, No H/o PND,Admitted for evaluation\r\nPt developed Flash Pulmonary odema, treated with Antifailure measures and put her on CPAP, sought cardiology consultation\r\nECG-LBBB(Old Change), ECHO-Dilated LA, Gr3/4 MR, Normal L.V function, CKMB-Normal limit, Pulomonary odema may\r\nbe because of Ischemia, defferted Coronary angiogram in view of genaral condition and age.changed ARB to Calcium Channel Blocker in view of\r\nelevated Urea/Creatinine, Electrolytes are normal During ICU stay HB droped to 7.2mg/dl\r\nStool for occult Blood Positive, stoped LMWH,Asprine, tranfused 2units of Packed cells, Shifted from the ICU,Vital stable, Adjusted the Antihypertensive .started mild Physical activity without Symptoms. Durning hospital stay She had mood fluction . Planned CT Brain, Upper GI Endoscopy/Colonoscopy on later date.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 34\n\nPatient Number: 173\n\nPatient Name: T.M.ALEXANDER\n\nGender: M\n\nDate of Birth: 17-07-1935\n\nAddress: THUNDIPARAMBIL HOUSE\n\nPincode: nan\n\nPhNo: 9895405553\n\nAdmission Date: 23-08-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Constipation , vital stable, adviced Enema, continue the orders\nVitals stable , seen By Dr bhatt, X-ray of LT foot- chronic osteomyelitis\r\nGRBS- 187\n3:00am , passed motion , had itching , adviced Inj.Avil slow I.V, stat,stop Tab.chymoral forte\r\nSlept after the Avil injection. Vitals stable. seen by DR BHatt, X-Ray Foot taken- ? osteomyelitis,\r\nWill control the infection and sugar, discussed the plan with the Pt\nSeenb by DR.A.K.Bhat\r\nAfebrile.\r\n?Plan for bone nibbling under LA.\nSeen by DR.A.K.Bhat\r\nDressings reviewed.\r\nThe options given are:\r\n1)conservative.\r\n2)Bone nibbling\r\n3)Debridement&fillet flaps of 2nd&3rd toes.\r\n8:00pm Better,vital stable, sugar under control\nvitals stable. still c/o itching a liitle bit\r\nAC- 114\nBetter, planned case in morning, follow the instruction , Shift the case to OT by 7:15pm\nVital stable, systemic Examination -Status co, Changed the antibiotics according to c/s, stop novomox Cv\r\nDisscussed with Dr.Bhat\nAcute retension of urine, vomiting\r\nAfebrile, PR 80/min , BP 150/90mmof hg, CVS-S1S2Normal , RS-Clear , \r\nCatherized , Inj.emeset 4mg i.v stat, Inj.Rantac I.V \r\n1:00pm Inj.Perinorm stat, IV DNS 500ml + 6units Actrapid 50ml /hr, continue the advice asper the surgery notes\nBetter, No Nause, Vital stable , Insugen R 6units at bed time, continue the same orders\r\nShift to ward tomrrow\nShift to room , vital stable, no vomiting , D/C Cath\r\nSeen by Dr.A.K.Bhat\r\nAfebrile.No soakage of dressing.No pain.\r\nContinue trea6tment.OFFLOADING of operated foot.\r\n\nVitals stable. c/o constipation.\nGC stable,Pruritis better.Taking oral foods.\r\nFBS- 153mg/dl\nVitals stable, Blood sugar control maintained.\r\nDressing change to be done by DR bhatt tomorrow\nVitals stable, prelunch- 71\nVitals steble. blood sugar controlled.\r\nDressing change today.\r\nSeen by Dr.A.K.Bhat\r\nDressing changed.\r\nDrain removed.Suture line is clean.\r\nContinue trt.\nSeen by Dr..AK Bhat\r\nPatient is not offloading the operated foot.Explained the need for offloading.\r\nContinue treatment.\nVitals stable Continue the same\nVitals stable . sugar well controlled, will discuss with Dr bhatt regarding the discharge process\nVitals stable, dressing change to be done tommorrow\nPt c/o different taste in the mouth. vitals stable. Blood sugar controlled\nSeen by DR.A.K.Bhat\r\nC&D done.Suture line of left foot is clean.\r\nSuggested oral antibiotics.\r\n\r\nVitals stable, blood sugar well controlled. Dressing change done. OFF loading of the feet\nDoing fine. General condition good. No hypos.\nSeen by DR.A.K.Bhat\r\nLarge dressing done.Partial suture removal done.The left foot wound is healing well.Adviced:OFFLOADING of operated leg.Dressing review twice a week.\nVitals stable, sugar well controlled.\r\nSutures to be removed today or tomorrow.\n'}, {'role': 'model', 'content': 'IP Number: 34\n\nPatient Number: 173\n\nAdmission Date: 23-08-2011\n\nDischarge Date: 06-09-2011\n\nDiagnosis: chronic osteomyelitis\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\n\nClinical Exam(With BP): admitted for chronic ulcer on the plantar aspect of the Lt foot x 2 yrs,s/p amputation of the 5 th digit of the Lt foot few months ago\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nUlcer- Wagner 111 classification, on the planta aspect of the Lt foot in between the 2 and 3rd digit , probing to the bone.\n\nDiscussion: 76 yr old with H/o DM, admitted for non healing ulcer which was infected and probing to the bone. also swelling and pain in the Lt leg. X- Ray of the foot- destruction of the 2 and 3 rd metatarsal head of the LT foot. Seen by a surgeon, Started on I.V antibiotics and Insulin for good glycemic control.\r\nHe had an amputation of the 2 and 3 rd digit along with removal of the osteomyeltic fragments on the metatarsal heads of the 2 and 3 rd digit.\r\ngrafting of the skin .\r\nRegular dressing were done.\r\n\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet with small, frequent feeds adviced\r\nDiet booklet also given\r\n\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 40\n\nPatient Number: 2735\n\nPatient Name: MAMAN P JOSEPH\n\nGender: M\n\nDate of Birth: 20-09-1931\n\nAddress: VELLAPPATTIL HOUSE,ASRAMAM P O\n\nPincode: 689126\n\nPhNo: 0477 2233681\n\nAdmission Date: 29-08-2011\n\nDischarge Date: 03-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Chronic obstructive pulmonary disease, unspecified\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fmodern\\fprq1\\fcharset0 Courier New;}{\\f1\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f2\\fswiss\\fprq2\\fcharset0 Arial;}{\\f3\\fnil\\fprq2\\fcharset0 Ms Sans Serif;}{\\f4\\fnil\\fprq2\\fcharset0 MS Sans Serif;}{\\f5\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\qc\\b\\f0\\fs24 ECHO REPORT\\b0 \r\n\\par \r\n\\par \\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\pard\\intbl\\f1 Parameter\\cell Actual mm (%)\\cell Normal mm(%)\\fs22\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl AO \\cell\\cell\\f2\\fs18 25-37 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LA\\cell\\cell\\f2\\fs18 19-40 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl Epss\\cell\\cell\\f2\\fs18 < 8 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl IVSD\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDd\\cell\\cell\\f2\\fs18 35-52 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVPW\\cell\\cell\\f2\\fs18 6-11 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl LVIDs\\cell\\cell\\f2\\fs18 24-42 mm\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl EF\\cell\\cell\\f2\\fs18 50-70 %\\f1\\fs24\\cell\\fs20\\row\r\n\\fs24\\trowd\\trgaph108\\trleft-108\\trqc\\trbrdrt\\brdrs\\brdrw10 \\trbrdrl\\brdrs\\brdrw10 \\trbrdrb\\brdrs\\brdrw10 \\trbrdrr\\brdrs\\brdrw10 \\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx1081\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx2790\\clbrdrt\\brdrw15\\brdrs\\clbrdrl\\brdrw15\\brdrs\\clbrdrb\\brdrw15\\brdrs\\clbrdrr\\brdrw15\\brdrs \\cellx4590\\intbl FS\\cell\\cell\\f2\\fs18 28-41 %\\f1\\fs24\\cell\\fs20\\row\r\n\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\fs20 Mitral Valve\\b \\b0 : Normal in structure and motion\\b . \\b0 No MVP, no MR\\b \\b0 \r\n\\par \\pard\\fi720\\li1440 E/A is reversed \r\n\\par \\pard\\tx990 \r\n\\par Aortic Valve :\\b \\b0 3 cusps\\b ,\\b0 normal\r\n\\par \r\n\\par Pulmonary Valve : Normal\r\n\\par \r\n\\par Tricuspid Valve : Normal\\b ,\\b0 no significant TR\r\n\\par \r\n\\par \\pard\\fi-2160\\li2160\\tx990 LV : Normal in size and contraction\\b .\r\n\\par \\b0 No RWMA \\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \\pard\\tx2310 Normal LV systolic function\r\n\\par \r\n\\par \\pard\\tx990 Pericardium : Normal \\tab\\tab \\tab\\tab \r\n\\par \r\n\\par \r\n\\par \\pard Remarks : Normal chamber dimension\\b .\\b0 No RWMA \\b ,\\b0 \r\n\\par Normal LV function. No valvar pathology\\f1\\fs24\\tab \r\n\\par \r\n\\par \\f3\\fs20 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par Dr. Sasi Kumar\r\n\\par Consultant Cardiologyst\\f4 \r\n\\par \\f1\\fs24 \r\n\\par \\f5\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vitals stable, GRBS- 147, echo done- Normal LV Function,\r\nDyspnoea probably due to COPD. \r\nPlan- Ultrasound of the abdomen\r\n Pulmonary consultation\r\n\nVitals stable. AC - 123. Seen by urologist. ultrasound of the\r\nabdomen - enlarged prostate. Echo- Normal LV function.\r\nPlan- surgical consultation.\r\n pulmonary consultation \r\n opthalmology consultation\r\n Versalab/ vibriometer\r\n\r\nSeen by Dr.A.K.Bhat\r\nNonhealing,recurrent ulcer rt foot for 2-3 years.Pain mild.Numbness both legs.\r\nTaking trt in local hospital and dressing with neosporin powder&steroid cream.\r\nOn local examination:Ulcer dorsum of rt foot 6x6 cm. with minimal granulation& patchy slough of floor&edges.Surrounding skin is thick&fibrous.Distal pulsations are felt.Ankle movt restricted.?Varicose veins.\r\nAdvice:Rest and leg elevation.Daily dressing with metrogyl gel&ceptigras.(May benefit with intrasite gel dressing to debride slough).Arterial&venous doppler.Future Plan will be to get the granulation till the ulcer is fit for a skin graft.\r\n\nVitals stable. Versalab- Normal study\r\nVibriometer- severe neuropathy\r\nSeen by pulmonary- Severe COPD\r\nPFT done\r\n\r\n\nDr.Ramesh Nair seen the pt on 30/8/11\r\n \r\nPFT - shows obstruction with decreased PVC\r\nVitals stable AC -159, insugen R 8 units given\r\nDressing with intrasite gel daily as per surgery.\r\nOpthalmology- mild NPDR\r\npodiatry- Severe neuropathy\r\nABI normal\r\n\nSeen by Dr.A.K.Bhat\r\nDressing done with Intrasite gel.Ulcer clean and granulation +.\nVitasl stable, feels better, put on Mixtard twice a day.\r\nDressing done with intrasite gel\nvitals stable, pre - dinner- 183, FBS- 131, given insulin yeaterday.\r\nDressing done with intrasite gel yesterday, wound looking better.\r\nStill has some breathing difficulty, better with steroids\nSeen by Dr.A.K.Bhat\r\nUlcer C&D done.Granulation coming up.Slough minimal&should debride with debridace&intrasite gel.\r\n\r\nVitals stable, blood sugar conrolled , still c/o of shortness of breath.\r\nWill get Venous doppler of the Leg .Dressing change tomorrw and will evaluate to intend to Discharge tomorrow.\nVitals stable, Steam inhalation. DRessing change done. Venous doppler tomorrow. Intend to D/C after that\nVitals stable. Venous doppler done, Intend to discharge today\n'}, {'role': 'model', 'content': "IP Number: 40\n\nPatient Number: 2735\n\nAdmission Date: 29-08-2011\n\nDischarge Date: 03-09-2011\n\nDiagnosis: Peripheral Neuropathy\n\nClinical Exam(With BP): 79 yr old with H/o DM, COPD admitted for ulcer on the dorsum of the LT foot x 2-3 yrs\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nRS- b/l rhonchi\r\nLT foot - punched out ulcer on the dorsum with slough\n\nDiscussion: admitted for ulcer on the dorsum of the Lt foot, X 2-3 yrs.\r\nPt was started in I.V antibiotics, metformin for sugar control. was put on Human Mixtard for better control.\r\nFor Dyspnoea, was seen by a cardiologist , 2D echo performed- NOrmal LVF\r\nSeen BY a Pulmonologist, PFT - Obstruction with reduced FVC, suggested combinist and Budesonide Nebs.\r\nDressing was done with Intrasite gel and debridase.\r\nPt was also seen by a urologist, ultrasound of the abdomen- en;larged prostate, put on Veltam.\r\nDuring the hospital stay, Pt had a complete Diabetic Work up.\r\n'OPthalmology- Mild NPDR\r\nSevere peripheral neuropathy.\n\nDiet: NUTRITION Dept:\r\n1200 kcal, low fat diabetic diet with small, frequent feeds adviced.\r\nNutrition booklet given\r\n\r\n\n"}]

[{'role': 'user', 'content': 'IP Number: 30\n\nPatient Number: 2663\n\nPatient Name: RAVI K.N.\n\nGender: M\n\nDate of Birth: 20-08-1946\n\nAddress: KOIKKAH\n\nPincode: 682036\n\nPhNo: 2321843\n\nAdmission Date: 20-08-2011\n\nDischarge Date: 26-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC RETINOPATHY\nCerebrovascular disease, unspecified\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\nDIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: GRBS > 300 mg/dl, on insulin infusion according to protocol. (currently at 2 ml/ hour). No specific complaints. Tolerating oral food nicely. Planned for debridment/ amputation of toe later today.\nS/b Dr . A.K Bhat \r\nLt Big toe Acute OM, TPX with pregangrens changes distal half.Tip ulcer exposing slough and bone. Distal pulsation Negative, Nail and slough were excised in bed side.In view of Chronic PVD, planned to wait and watch. \r\nAdviced Arterial doppler\r\n6:50pm Febril , Tab.Welset stat, start I.V NS 50ml /hr, continue the rest of the orders\nSeen by Dr.A.K.Bhat\r\nDressing changed.The tip of big toe looks ischemic.The tpx bone is exposed.The local inflammation has reduced.\nStop infusions \r\nActrapid 20units before Breakfast , inform prelunch\nSeen by Dr.A.K.Bhat\r\nBig toe gangrene of tip,is drying up.No active infection threatening rest of toe or foot.\r\nBetadine oint. dressing.\nbetter, vital stable, wound clean, Doppler Absent flow in anterior tibial with beyond origin, Posterior tibial artery shows biphasic flow\r\ncontinue the orders\nSeen byDR.A.K.Bhat\r\nDry gangrene tpx of big toe.\r\nVitals stable. GRBS- 122, culture report awaiting\nVitals Stable, C/o Pain in the the leg. blood sugar controlled\nSeen by Dr.A.K.Bhat\r\nDry gangrene with OM tpx of big toe.Considering the PVD,better to wait.Daily betadine oint. dressings.\r\n7:00pm Better, vItal stable , can be dischaged\nVitals stable.AC-183, Pre- dinner- 122\r\nWill discuss with Dr Bhatt, regarding the plan\n'}, {'role': 'model', 'content': 'IP Number: 30\n\nPatient Number: 2663\n\nAdmission Date: 20-08-2011\n\nDischarge Date: 26-08-2011\n\nDiagnosis: Lt Non Healing Ulcer\r\nLt TXP Oestemylitis\r\nMild BPH\n\nClinical Exam(With BP): H/o Infected wound over the Left Toe-2days. Duration of Diabetes - 15 years\r\nCurrent Medication\r\nHuman Mixtard 30/70 30-0-\r\nPrevious Blood sugar profile-FBS: 250 PPBS:300plus \r\nPolyuria, Polyphagia, Polydipsia - Yes\r\nWeight Loss- Yes\r\nBlurring of vision-Yes\r\nDiabetic Retinopathy, post status laser, Anti VEGF\r\nDiabetic eye examination- Yes\r\nBurning Sensation of feet -No\r\nNumbness of feet-Yes\r\nFalling off of foot wear-Yes\r\nSwelling of feet -Yes\r\nCornary heart Desease-No\r\nHistory of Chest Pain on Exertion/Rest-No\r\nDyslipidemia-No\r\nHypertension-No\r\nRecurrent infections- No\r\nHypoglycemia - No\r\n. CVA-Ischemic stroke -Lt hemiplegia\r\n. No family History.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Admitted for Diabetes controllled , Started on Basalblous regimen, well controlled on this, No hypos, Started on I.V Antibiotic for NoN Healing , Necrotized Wound over the Lt Finger tip with co exsisting cellulits, Debrided the Necrotic tissue, exposing the TPX, sought surgical opnion , adviced for arterial doppler, suggestive of PVD with colletral, C/S No growth, planned to discharge him on Basal bolus regimen , oral antibiotic , review aftre 1week for TPX Excsion\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet adviced\r\nDiet booklet given\n'}]

[{'role': 'user', 'content': 'IP Number: 99\n\nPatient Number: 3092\n\nPatient Name: K.M NOORJAHAN\n\nGender: F\n\nDate of Birth: 06-10-1956\n\nAddress: THACHAVALLATH HOUSE, MUPPATHADAM P.O\n\nPincode: 683010\n\nPhNo: 0484 - 3222955\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Feels better. GRBS- 198\nPatient was weak.GRBS 395mg/dl.\nDental Consaltation.Opthalmic Consultation.Check TSH,T4.Check Versa lab,Vibrometer.\nFeels better. Sugar still not controlled.Opthalmology and podaitry evaluation done.\nCheck Orsthostatic hypotension.\r\nECG done.\r\nODST to be done.\nC/o Burning sensation in the foot\r\nAdded Tab.Amitone\nVital stable, \r\nMoon face, buffole Hump,Straie\r\n\r\nDexona 1mg at 11:00pm , S.Cortisol at tomorrow 8:00am\r\n(send 1sample outside)\r\nContinue the orders\nPatient was weak.T.welset sos to be given.\nbetter,vital stable, dexomethasone suppresion test\r\n\nPatient feels much better.Low dose supressive test to be done (13/10/2011).\nfine,vital stable, continue the Dexona as adviced\nC/o burning sensation in both the legs,GRBS- 424\nVitals stable.Pelvic traction today.Tomorrow blood withdrawal at 8am.\nGC fine.S.cortisol taken.FBS-193mg/dl.\nComplaints of weakness.AC 231mg/dl.Cortisol reports awaited.\nPut Cannula, heparine 0.5ml dilute in 1ml ,push 0.5ml (Heap block) Draw serum cortisol at mid night(12am)\r\n\nBeter,on MVI\r\nSyp.Duphalac 15ml HS \r\ncontinue other\nMidnight cortisol report awaited.Complaints of generalised weakness.Slept for a few hours.FBS-172mg/dl.\nfine, vital stable\r\nAC-154\r\nDiffculty in walking, \r\nS.cortisol awaited\r\nContinue the same\nAC-138mg/dl.Planning for 24 hrs urine free cortisol level.\r\ncontinue the same\r\n\nC/o pain.GRBS-196mg/dl\nC/o genaralised weakness.Fbs still high.Slept well.Passed stools.24 hr Ufc ongoing.\nfeeling tired,GRBS-301mg/dl\r\nVital stable\r\nWithhold Amitone\r\nContinue the others\nGeneral condition slighlty better. AC- 111 mg/dl. MRI done in 1996 was discussed with radiologist who opined that she had severe spondylosis back then.\nVitals stable, sugar better controlled today.\nC/O GC weakness and head ache.\n'}, {'role': 'model', 'content': "IP Number: 99\n\nPatient Number: 3092\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 55 yr old with H/o DM admitted with weakness and uncontrollable blood sugar.Insulin dosage was titrated up according to the GRBS.She was also evaluated for cushing's during the stay. ODST was performed, cortisolAM level was high, so evaluated for high dose Suppression test. 24 hr urine free cortisol level was done, results awaiting.\r\nH/o lumbar radiculopathy Lt side, phsical therapy was done, with better relief of the pain. Pt also being evalauted ny a neurologist for the worsening radicular pain .\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet in small, frequent feeds adviced\r\nDiet booklet given\r\nGlucerna SR- 2 scoop/ day with skimmed milk- 1 cup (Bed time)\r\n\r\n\n"}]

[{'role': 'user', 'content': 'IP Number: 51\n\nPatient Number: 1410\n\nPatient Name: ZAINABA ISMAIL\n\nGender: F\n\nDate of Birth: 23-03-1941\n\nAddress: ZAINABAI HOUSE,ST.FRANCIS CHURCH ROAD\n\nPincode: 682017\n\nPhNo: 0484-3928021\n\nAdmission Date: 09-09-2011\n\nDischarge Date: 12-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: CORONARY ARTERY DISEASE\nMixed hyperlipidaemia\nPRIMARY HYPOTHYROIDISM\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: A\nAdmitted , Vital stable, Systemic Examination -NAD, \r\nTo Rule out Hyponatrimia\nNausea present, B.p 130/70mm of hg, Systemic examination -NAD\r\nInj.Novorapid 16units just before food\r\nInj. Lantus 22units at bed time\r\nContinue the same\r\nS.CReatine, sodium , potassium\r\nNovomox 1.2g BD\nc/o persistent cough, more at night. O/E- throat looks congested. BRE shows elevation of total count. Fasting blood sugars are high.\r\n11:47am Vital stable, Vomited once,Inj.Pantodac 40mg I.V OD\r\n2:00pm Vomited , adviced Inj.Emeset 4mg I.V stat\nGeneral condition fine. Blood sugars are high.\r\nNa+, K+, Creat, TC, Hb\r\n 12:30pm Vomitied Once\r\nBilious, Inj.Emeset sos\n'}, {'role': 'model', 'content': 'IP Number: 51\n\nPatient Number: 1410\n\nAdmission Date: 09-09-2011\n\nDischarge Date: 12-09-2011\n\nDiagnosis: ? Dementia\n\nClinical Exam(With BP): Mrs.Zainaba Ismail /70yr/ female, K/c/o Type 2 Diabetes mellitus, Hypertension, Dyslipidemia, CAD,Diabetic retinopathy, Diabetic Nephropathy with CRF\r\nAdmitted with Vomiting , Nausea, Decresed intake, cough, Sore throat of 2day duration , O/E Vital stable, Systemic examination with in Normal limit\r\nMild Throat congestion , RS-Clear.Lab Mild Leucocytosis, Na+, K+ with in the Normal Limit\r\nTreated with Amoxcillin +Cloxacillin , Antiemetic, Adjusted the dose of Insulin according to Blood sugar.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: K/c/o Type 2 Diabetes mellitus, Hypertension, Dyslipidemia, Diabetic retinopathy, Diabetic Nephropathy with CRF\r\nAdmitted with Vomiting , Nausea, Decresed intake, cough, Sore throat of 2day duration , O/E Vital stable, Systemic examination with in Normal limit\r\nMild Throat congestion , RS-Clear.Lab Mild Leucocytosis, Na+, K+ with in the Normal Limit\r\nTreated with Amoxcillin +Cloxacillin , Antiemetic, Adjusted the dose of Insulin according to Blood sugar.Discharge in stable\n\nDiet: Low calorie, low fat, low potassium diabetic diet adviced\n'}]

[{'role': 'user', 'content': 'IP Number: 62\n\nPatient Number: 959\n\nPatient Name: ROSANNA VINU\n\nGender: F\n\nDate of Birth: 04-06-1975\n\nAddress: VELLUKUNNEL HOUSE,COLLEGE ROAD\n\nPincode: 686122\n\nPhNo: 0482-2272141\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 21-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Obesity\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: NPO after 10:00pm\r\nPrepare\r\nInj.Pantodac 40mg i.v stat\r\nTab.Trika 0.5mg stat\r\nInj .Microtaz 4.5g i.v 1hr before shifting to OT\r\nAll the report with in normal limit, ECG Normal\r\nXray chest PA-Normal\nPain reduced , Vital stable, continue the orders\nDoing fine. Continuity study done which showed no leak or obstruction.\r\nVital stable, tolerating fluids\r\n4 pint flids till tommorow 4pm \r\nD/C Tubes tommorow\r\n\nDoing well. No pain. Intake 3000 ml, output 4.8 Lits.\r\nPlan\r\nContinuity X- ray study at 11 noon.\nVital stable, D/c cath, drain , I.V Fluid maintaince, continue same\r\nDrain 130ml, D/c at 12:00pm\nVitals stable. No complaints. drain removed. Intend to D/C tomorrow\n'}, {'role': 'model', 'content': 'IP Number: 62\n\nPatient Number: 959\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 21-09-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): admitted for sleeve gastrectomy\n\nSystolic BP: 120.0\n\nDiastolic BP: 80.0\n\nPhysical examination: Chest X-Ray :\r\n\r\nEcho Cardiogram :\r\n\r\nCoronary Angiogram :\r\n\r\n\n\nXray findings: Obese, not in any distress\r\nsystemic Exam- Normal\n\nDiscussion: 36 yr old , morbidly obese, No significant medical history admitted for Sleeve gastrectomy. It was performed 18-09-2011. Was started on I.V antibiotics. Diet was slowly advanced after the Barium study. pt is on liquid diet advanced to 60 ml/day,Drain was removed on 20-0-11. No pain or discharge from the site. Pt mobilised yesterday without any complaints\n\nDiet: NUTRITION Dept:\r\nOral fluids 100 ml/hr started for today(21/09/11)\r\nStart Oral fluids 100 ml/ 45 minutes from 22/09/11 to 25/09/11\r\nDetailed diet chart given\r\nReview on 25/09/11\n'}]

[{'role': 'user', 'content': 'IP Number: 32\n\nPatient Number: 2667\n\nPatient Name: KURIAN VARGHESE\n\nGender: M\n\nDate of Birth: 03-03-1963\n\nAddress: G-358, PANAMPILLY NAGAR, KOCHI\n\nPincode: 682036\n\nPhNo: nan\n\nAdmission Date: 22-08-2011\n\nDischarge Date: 25-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat\r\nCarbuncle rt groin crease.\r\nWill need I&D under LA.\r\nGM dressing bd.\r\n\r\nVitals stable GRBS- 237, T- 100\nSeen by Dr.AK.Bhat\r\nFor I&D under LA.Get consent.Shave.\r\n7:00pm febrile , vital stable, continue the orders\r\n\nVitals stable. Fever yesterday night. Tab welset given, C/o pain in the medial aspect of thigh.\r\nI & D today.\nSeen by DR.A.K.Bhat\r\nAfebrile.No pain.No soakage.\r\nVitals stable, Intend to D/c tomorrow\nVitals stable, Had mild increase in temp yesterday, Pain has improved. C/o diarrhoea\r\nI & D yesterday\nSeen by Dr.A.K.Bhat\r\nDressing changed.Ulcer rt.groin clean.\n'}, {'role': 'model', 'content': 'IP Number: 32\n\nPatient Number: 2667\n\nAdmission Date: 22-08-2011\n\nDischarge Date: 25-08-2011\n\nDiagnosis: Diabetic Peripheral neuropathy\r\n Diabetic Nephropathy with Microalbuminuria\n\nClinical Exam(With BP): 48 YR OLD With H/O Diabetes mellitus comes in with pain and swelling in the Rt groin\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Alert, oriented\r\nSystemic Exam -normal\n\nDiscussion: 48 yr old admitted with infected carbuncle On the RT groin and Uncontrolled blood sugar. admitted for I.V antibiotics, Insulin ( Insugen N and Insugen R ). I & D of the abscess done on 23/08/11.\r\n\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet adviced\r\nDiet booklet given\r\n\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 126\n\nPatient Number: 2841\n\nPatient Name: M K VASAPPAN\n\nGender: M\n\nDate of Birth: 13-09-1939\n\nAddress: MANTHRA HOUSE,KUMARAKAM P O\n\nPincode: 670571\n\nPhNo: 0481 2524466\n\nAdmission Date: 29-10-2011\n\nDischarge Date: 04-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Cardiomyopathy\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. There are 2 calculi of 7mm in Gallbladder.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Right Kidney shows evidence of renal parenchymal oedema.\r\n\\par No calculus or hydronephrosis. \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening.\r\n\\par No mucosalirregularity.\r\n\\par \\tab \r\n\\par Prostate\\tab\\tab : Normal in size & echo texture.\r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 There are 2 calculi of 7mm in Gallbladder.\r\n\\par Right kidney shows evidence of renal parenchymal oedema.S/O Nephritis/UTI.\r\n\\par DR.JOE ANTONY.\r\n\\par RADIOLOGIST.\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted with Altered mental status, noted to be febrile\r\nB.p- 167/61\r\nPulse ox - 96 on RA\r\nPulse- 93\nPatient was admitted with fever, delerium and vomiting. Urine routine exam shows numerous pus cells in urine. BP was 200/ 85 mm of hg on admission. Was started on NTG @5 mcg/ mt. BP came down.Vomited once in the ICU.\nUSG Abd Tomorrow\nstop NTG\r\nAfebril\r\nPR-78/min \r\nB.P 140/80mmof Hg\r\nCVS-s1s2 Normal \r\nSpo2-96% RA\r\nRS-Few basal crepitation \r\nCNS-Consious /Oriented \r\nfollow the advice\nPR-70/min \r\nB.P-132/55mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Basal crepitation \r\nPA-Soft\r\nI/O-1400/1450\r\nUSG abdomen today\nVITAL STABLE, AFEBRILE\r\nCONTINUE THE SAME\r\nHB ,TC, UREA,CREATINE, NA+,K+\nAFEBRILE\r\nvITAL STABLE\r\nCREAT, UREA\nGC better.Continue the same medications.\nVitals stable. GRBS- high, had appam in the evening.\r\nI.V NS given- stopped now- 300ml given. Lasix 40 mg every other day\nHad hematuria yesterday. now urine- clear\r\nI- 1660\r\nO- 2550\r\nErythropoetin given yesterday. urology consultation today and intend to D/C tomorrow.\nS/B Dr.Saeed Urologist\r\nHistory Noted \r\nPR-Mild Prostatomegaly\r\nimpression\r\nUTI\r\nBPH\r\nCRF\r\nadviced \r\nTab.Veltam 0.4mg 0-0-1\r\nD/C cath -CMS\r\nTab.Levoflox 500mg OD for 10days\nvital stable, fair glycemic control,Discharge\n'}, {'role': 'model', 'content': 'IP Number: 126\n\nPatient Number: 2841\n\nAdmission Date: 29-10-2011\n\nDischarge Date: 04-11-2011\n\nDiagnosis: UROSEPSIS\r\nTOXIC ENCEPHALOPATHY\r\nLV DYSFUNCTION\r\nP/S NEPHRECTOMY RIGHT SIDE \r\nDILATED CARDIOMYOPATHY \r\n\r\n\n\nClinical Exam(With BP): Admitted here with sudden onset fever, shortness of breath and delerium. He was admitted to our ICU to stabilize his general condition. In the ICU he was was found to be in urosepsis. Broad spectrum antibiotics were started. Fever came down with treatment. His serum creatinine had gone up while in the ICU.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Patient was febrile on admission and drowsy\r\nSystem- wnl\n\nDiscussion: Mr. Vasappan, 72 years old with a precious kidney (had undergone a neprectomy ealier) in CRF ( Diabetic Nephropathy) was admitted to our ICU with frank uropsepsis.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 126\n\nPatient Number: 2841\n\nPatient Name: M K VASAPPAN\n\nGender: M\n\nDate of Birth: 13-09-1939\n\nAddress: MANTHRA HOUSE,KUMARAKAM P O\n\nPincode: 670571\n\nPhNo: 0481 2524466\n\nAdmission Date: 29-10-2011\n\nDischarge Date: 04-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Cardiomyopathy\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. There are 2 calculi of 7mm in Gallbladder.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Right Kidney shows evidence of renal parenchymal oedema.\r\n\\par No calculus or hydronephrosis. \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening.\r\n\\par No mucosalirregularity.\r\n\\par \\tab \r\n\\par Prostate\\tab\\tab : Normal in size & echo texture.\r\n\\par \r\n\\par \r\n\\par \r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 There are 2 calculi of 7mm in Gallbladder.\r\n\\par Right kidney shows evidence of renal parenchymal oedema.S/O Nephritis/UTI.\r\n\\par DR.JOE ANTONY.\r\n\\par RADIOLOGIST.\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted with Altered mental status, noted to be febrile\r\nB.p- 167/61\r\nPulse ox - 96 on RA\r\nPulse- 93\nPatient was admitted with fever, delerium and vomiting. Urine routine exam shows numerous pus cells in urine. BP was 200/ 85 mm of hg on admission. Was started on NTG @5 mcg/ mt. BP came down.Vomited once in the ICU.\nUSG Abd Tomorrow\nstop NTG\r\nAfebril\r\nPR-78/min \r\nB.P 140/80mmof Hg\r\nCVS-s1s2 Normal \r\nSpo2-96% RA\r\nRS-Few basal crepitation \r\nCNS-Consious /Oriented \r\nfollow the advice\nPR-70/min \r\nB.P-132/55mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Basal crepitation \r\nPA-Soft\r\nI/O-1400/1450\r\nUSG abdomen today\nVITAL STABLE, AFEBRILE\r\nCONTINUE THE SAME\r\nHB ,TC, UREA,CREATINE, NA+,K+\nAFEBRILE\r\nvITAL STABLE\r\nCREAT, UREA\nGC better.Continue the same medications.\nVitals stable. GRBS- high, had appam in the evening.\r\nI.V NS given- stopped now- 300ml given. Lasix 40 mg every other day\nHad hematuria yesterday. now urine- clear\r\nI- 1660\r\nO- 2550\r\nErythropoetin given yesterday. urology consultation today and intend to D/C tomorrow.\nS/B Dr.Saeed Urologist\r\nHistory Noted \r\nPR-Mild Prostatomegaly\r\nimpression\r\nUTI\r\nBPH\r\nCRF\r\nadviced \r\nTab.Veltam 0.4mg 0-0-1\r\nD/C cath -CMS\r\nTab.Levoflox 500mg OD for 10days\nvital stable, fair glycemic control,Discharge\n'}, {'role': 'model', 'content': 'IP Number: 126\n\nPatient Number: 2841\n\nAdmission Date: 29-10-2011\n\nDischarge Date: 04-11-2011\n\nDiagnosis: UROSEPSIS\r\nTOXIC ENCEPHALOPATHY\r\nLV DYSFUNCTION\r\nP/S NEPHRECTOMY RIGHT SIDE \r\nDILATED CARDIOMYOPATHY \r\n\r\n\n\nClinical Exam(With BP): Admitted here with sudden onset fever, shortness of breath and delerium. He was admitted to our ICU to stabilize his general condition. In the ICU he was was found to be in urosepsis. Broad spectrum antibiotics were started. Fever came down with treatment. His serum creatinine had gone up while in the ICU.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Patient was febrile on admission and drowsy\r\nSystem- wnl\n\nDiscussion: Mr. Vasappan, 72 years old with a precious kidney (had undergone a neprectomy ealier) in CRF ( Diabetic Nephropathy) was admitted to our ICU with frank uropsepsis.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 108\n\nPatient Number: 3091\n\nPatient Name: ANNAMMA MATHAI\n\nGender: F\n\nDate of Birth: 30-03-1931\n\nAddress: KIDANGALIL HOUSE,JACOB VALLANATT ROAD,\n\nPincode: 682018\n\nPhNo: 2391837\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 18-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\nCORONARY ARTERY DISEASE\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Normal in size & echo texture. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Both Kidneys shows mild Renal parenchymal oedema \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening. No mucosalirregularity.\r\n\\par \\tab \r\n\\par Uterus\\tab\\tab : Normal in size and echo texture\r\n\\par \r\n\\par Ovaries : Normal in size and echo texture\r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par \r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 Both kidneys shows mild renal parenchymal oedema \r\n\\par S/o Renalinfection /Nephritis\r\n\\par No mass lesion or calculus detected.\r\n\\par \r\n\\par Dr.Joe Antony,MD\r\n\\par Consutant Radiologist\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Pulse Ox- low without oxygen.\r\nWith oxygen 2L- 98%\r\nCXR- mottling seen (? acute pulmonary edema)\r\nInj Lasix 240 mg IV stat and Inj Derphylline 80 mg iv stat given and shifted to the ICU\r\nMaintained on 6 lits of O2, SPO2 80-90 %\r\n\r\nICU notes 9.00 pm\r\nNTG given at 2 mics and Dobutamine given at 5 mics (on flow)\r\nSaturation improved with treatment \r\nTab Carvedilol 6.125 mg and Tab Telmisartan 40 mg given\r\nInj Clexane 0.6 mg given\r\nBP 165/ 75 mm of hg\r\nCathetrized \r\n\nBetter, Vital stable, Spo2 96 with out O2\r\nContinue the same\nSeen By Dr.Tom \r\nSymptomaticaly better\r\nVital stable, NTG/Dobutamine on flow\r\nCardiology consultation Awaited\r\nS/B Dr .SasiKumar. Cardiologist\r\nPR-80, B.P 120/80mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Rt Crepitation \r\nPrerenal azotenimia\r\nECHo Gr 3 MR, No RWMA, Normal LV Function\r\nIshemia Precipted Pulmonary odema\r\nFolow the advice\r\nConsider Tab.Amlodipin 5mg instead of Telmisartan in view of Elevated Urea /Creatinine\nPR-70/min ., B.P 128/67, CVS-S1S2Normal , RS-Rt Basal crepitation +\r\nI/O 1250/2000\r\nChanged Telmisartan to Calcheck in view of Elevated Creatinine \r\nInj .Lasix 40mg \r\nIntake restricted to 1.2l\r\nLow salt diet\nVital stable, PR-90/min , B.P 130/80 mmof Hg\r\nCVS-S1S2 Normal \r\nRs few crepitation\r\nBlood transfusion over 4hr\r\n1units today\r\nInj.Lasix 20mg i.v st\r\nInj.Avil 1/2 amp i.v stat\nBlood transfusion 1units , Inj.Avil 1 amp i.v stat\r\nWith hold Inj.Dynalix\r\nPR-89/min \r\nB.P -140/80\r\nCVS-S1S2 Normal\r\nRS-Rt Basal crepitation\r\nCNS-Consious, Disoriented\r\nMotor/sensory/Reflex -Normal\r\nContinue the same medication.\r\nI/o 1650/2850\nPR-80\r\nB.P 120/80 mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Clear\r\nPA-Soft\r\nCNS-Consious /Oriented\r\nReflex Normal\nC/O tiredness,headache\r\nBP-140/80\r\nSPO2-94 RA\r\nVitals stable.\r\n\nDoing well. Had walked in the corridor without distress. Chest is clear.\r\nInformed dr.Sasikumar\r\nPR 86/min\r\nB.P 170/80mmof Hg\r\nCVS-S1S2 Normal\r\nRS-Few crepitation\r\nCNS-Counsious/oriented\r\nadviced \r\nTab.Natrilex SR 1.5mg 1-0-0\r\nTab.Dytor 10mg insted of Lasix\r\nWithhold the Telmisartan 40mg\r\nContinue other as adviced\nS/B Dr.Sasikumar\r\nBetter, \r\nPR-80/min\r\nB.P -140/80 mmof Hg\r\nCVs-S1S2 Normal\r\nRs-Few crepitation \r\nContinue the same\r\nTab Epitus 25 1-0-1 for 1week, after 1week reduced to once aday\r\nMobilise\r\nDischarge tomorrow by evening\r\nS/b Dr Saeed\r\nUrine C/S\r\nLocal oestrogen cream\r\n\r\n\n'}, {'role': 'model', 'content': 'IP Number: 108\n\nPatient Number: 3091\n\nAdmission Date: 12-10-2011\n\nDischarge Date: 18-10-2011\n\nDiagnosis: ACUTE PULMONARY ODEMA\r\nUTI\r\nANEMIA ? GI BLEEDING\r\nMOOD SWINGS NEED EVALUATION\n\nClinical Exam(With BP): Mrs Annamma Mathai K/C/O Type2 Diabetes mellitus, Hypertension , Dyslipedimia on treatment\r\nrecently discharge from the hospital , came with Breathlessness Acute onset, No H/o PND,Admitted for evaluation\r\nPt developed Flash Pulmonary odema, treated with Antifailure measures and put her on CPAP, sought cardiology consultation\r\nECG-LBBB(Old Change), ECHO-Dilated LA, Gr3/4 MR, Normal L.V function, CKMB-Normal limit, Pulomonary odema may\r\nbe because of Ischemia, defferted Coronary angiogram in view of genaral condition and age.changed ARB to Calcium Channel Blocker in view of\r\nelevated Urea/Creatinine, Electrolytes are normal During ICU stay HB droped to 7.2mg/dl\r\nStool for occult Blood Positive,Normal stoped LMWH,Asprine, tranfused 2units of Packed cells, Shifted from the ICU,Vital stable, Adjusted the Antihypertensive .started mild Physical activity without Symptoms\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Mrs Annamma Mathai K/C/O Type2 Diabetes mellitus, Hypertension , Dyslipedimia on treatment\r\nrecently discharge from the hospital , came with Breathlessness Acute onset, No H/o PND,Admitted for evaluation\r\nPt developed Flash Pulmonary odema, treated with Antifailure measures and put her on CPAP, sought cardiology consultation\r\nECG-LBBB(Old Change), ECHO-Dilated LA, Gr3/4 MR, Normal L.V function, CKMB-Normal limit, Pulomonary odema may\r\nbe because of Ischemia, defferted Coronary angiogram in view of genaral condition and age.changed ARB to Calcium Channel Blocker in view of\r\nelevated Urea/Creatinine, Electrolytes are normal During ICU stay HB droped to 7.2mg/dl\r\nStool for occult Blood Positive, stoped LMWH,Asprine, tranfused 2units of Packed cells, Shifted from the ICU,Vital stable, Adjusted the Antihypertensive .started mild Physical activity without Symptoms. Durning hospital stay She had mood fluction . Planned CT Brain, Upper GI Endoscopy/Colonoscopy on later date.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 72\n\nPatient Number: 2647\n\nPatient Name: MANUEL P.M\n\nGender: M\n\nDate of Birth: 20-08-1949\n\nAddress: PUTHANPURARIRAPPEL\n\nPincode: 682037\n\nPhNo: 0484 - 2423723\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 27-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: seen by Dr.a.k.bhat.\r\nFr SSG under SA 23-9-2011.\r\nPreop.:Consent.IV antibiotic.Shave/betadine scrub.\r\nSkin grafting tomorrow. afebrile, sugar well controlled\nNPO after 10:30am\r\nI.V F NS 500ml over 4hrs\r\nInformed Dr.Ipye George anaesthetist\r\nCase at 3pm \r\nECG-Normal, Blood routine with in normal limit\r\nBT/CT/-Normal\r\nPT/INR-1.2\r\nInj.Vit K 1amp i.m\r\n\r\n\r\n\nVitals stable. GRBS- 173, Skin grafting to be done today.\r\nNo fever\r\n6:15pm better, PR 77, B.P-160/90MMOF HG, SPO2 97\r\niNJ.lASIX 20MG I.V\r\nNS 500ml maintaince\r\n9:30 pm Retention of urine\r\nPR-94/min B.P 140/98mmof hg\r\nBladder palpable\r\nCatherised under aseptic precaution, Urine output -600ml \r\ni.v fluid on flow, \r\nC/o pain over the site\r\nInj.Tramadol 50mg i.v stat\nBetter, pain subsided , continue the same\nDoing well. Passed stools last night.\r\nSeen by Dr.A.K.Bhat.\r\nafebrile.Some pain.Plan for first dressing on 27-9-2011.\r\nSuggested oral antibiotics.\nVitals stable. Blood sugar controlled. Dressing change probably tomorrow.\nvital stable, No pain , Continue the same\r\nTab.Ravera-D 0-0-1\nC/o constipation and bloated feeling\r\nDressing change today\r\nGRBS- sugar controlled.\r\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The skin graft of right thigh has taken up.Donor site is clean.Adviced oral antibiotic.Next dressing change on friday,30-9-2011.\n'}, {'role': 'model', 'content': 'IP Number: 72\n\nPatient Number: 2647\n\nAdmission Date: 22-09-2011\n\nDischarge Date: 27-09-2011\n\nDiagnosis: Skin Graft of the Rt thigh Ulcer\r\nDiabetes Mellitus\n\nClinical Exam(With BP): admitted for skin grafting.\n\nSystolic BP: 130.0\n\nDiastolic BP: 90.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nSystemic Exam- Normal\r\nLocal- Ulcer on the RT thigh, Healed well, healthy granulation tissue\n\nDiscussion: 62 yr old with H/o DM admitted for skin grafting, after excision of the carbuncle done on 20-08-11. he was discharged on antibiotics, advised to do regular dressings, he was admitted on 22-09-11, for skin grafting which was done on 23-09-11, Rt thigh ulcer was grafted with skin taken from the Rt thigh itself.He was started on I.V antibiotics an Insulin basal bolus regimen for tight glycemic control.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 64\n\nPatient Number: 1997\n\nPatient Name: PADMAKUMARY B (IN)\n\nGender: F\n\nDate of Birth: 22-05-1950\n\nAddress: PARIJATHAM,VALUMMEL ROAD,\n\nPincode: 682005\n\nPhNo: 2232550\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 20-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Pain subsided, better, vital stable , continue the same\r\nUSG Abd -Tommorow\nadmitted with pain in the Rt iliac fossa pain, No vomiting, No Fever\nNo Pain , NO vomiting\r\nVital stable, Tab.Blisto 2MF 1/2\r\nplan to start insulin\r\nSemisolide/Liquid diet\nPain abdomen better. USG planned soon.\nBetter, Vital stable, continue the same medication , Blist dose changed , CBC\nfine continue same, CBC tommorow morning , USG ABD\n'}, {'role': 'model', 'content': 'IP Number: 64\n\nPatient Number: 1997\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 20-09-2011\n\nDiagnosis: Sub Acute Appendicitis\n\nClinical Exam(With BP): admitted with abdominal pain\n\nSystolic BP: 110.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: Elderly female , not in any distress\r\nAbdomen- Tenderness over the RT iliac fossa, NO rebound or guarding\n\nDiscussion: 61 yr old with H/o HTN, DM admitted for abdominal pain. On Examination - had tenderness over the RT iliac foosa, admiited to R/o acute appendicitis.\r\nPt was started on I.V antibiotics. Ultrasound of the abdomen was done- \r\nClouding of the ileal loops. No fluid. Pain resolved. Rpt Ultrasound of the abdomen- NOrmal (20-0-11)\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, diabetic diet with small, frequent feeds adviced\r\nDiet booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 52\n\nPatient Number: 2820\n\nPatient Name: SASIKUMAR K P \n\nGender: M\n\nDate of Birth: 20-05-1953\n\nAddress: CMC 12/284, DWARAKA , CHERTHALA P.O\n\nPincode: 688524\n\nPhNo: 0478-2813722\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 20-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Admitted for Blood sugar control, Wound healing \r\nInform the reports\r\n\nFair Glycemic control, vital stable, continue the same, Dr.Bhat consultation \r\nFLP, ECG \r\nEye Check up on mondays\r\n10:00pm C/o Pain over the leg\r\nVital stable, Tab.Acfenac plus st , sos\nSeen By Dr.A.K.Bhat:\r\nC/o nonhealing wound left leg:16 days.Treated as OP in KVM,Cherthala.Repeated slough excision&dressings done with no relief of pain.\r\nOn local examination:Large ulcer upper aspect of left leg:9x8cm.with areas of granulation medially. On the lateral aspect there is 6x6 cm area of slough over the tibial anterior medial border?periosteal slough.There is a pocket of slough undermining the superior pole.Pus discharge+.\r\nDistal pulsations+.\r\nXray shows air shadow reaching upto bone.?periostitis\r\nPlan:Slough excision under SA on 12-9-2011.\r\nAdviced:Change of dressing after shaving&betadine scrub.\r\nConsent.Nil oral as per anesthetist advice.Medical fitness fr the procedure.IV Antibiotics.Chestxray.\r\n\nVitals stable. GRBS- 107, No cardiac history.\r\nPt fit for surgery\r\nSchuduled at 13/9/11, 8:00am\r\nNPO After 10pm \r\nPrepare the part\r\nConsent for Incision and Wound Curretage\r\n\nNot passed urine, Bladder not palpable, Give more fluids Orally\r\nVital stable\r\nUltrasound Abdomen - on Thursday\r\n8:00pm C/o Nausea, adviced Tab.Ravera D stat\r\n9:00PM Vomiting not subsided , Inj.Pantodac 40mg I.V, Inj.Emeset 4mg i.V stat \r\nI.V NS 500ml 75ml/hr\nPt taken to the O.T for excision and curettage\nDoing well, better, passed motion , urine\r\nContinue the same\r\nUsg ABD tomorrow\nSeen by Dr.A.K.Bhat.No pain.\r\nDressing overpadded.Plan fr change of dressing tomorrow.\r\nbetter, No pain ,\nSeen by Dr.AK.Bhat.\r\nDressings changed.The raw area of left leg looks clean.Continue treatment.\r\nDressing done by DR Bhatt, need 2 more dressings before discharge\nVital stable, Bowel and Bladder regular , Usg Abd BPH\r\nNo pain , continue the same\nNo pain ,slept well, wound healing better, fair glycemic control, B.P -160/100, recheck B.p after 1hr and inform\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Continue trt.\r\n6:00 pm No pain, PR:72/min,Bp-160/70mmof Hg, CVS/RS-NAD\r\nPlanned add Diuretic tomorrow\nDoing fine. No specific complaints.\r\nSeen by DR.A.K.Bhat.\r\nDressings changed.The raw area of left leg is clean.\r\nbetter, vital stable, Insugen 16units before dinner, Insugen N 16units at bed time\nPR-84/min , B.P -150/80mmof hg, RS-Clear, CVS-S1S2 Normal , No pain . Dreesing today\nSlept well. Pain Better. Sugars are well controlled.\nfine, vital stable\nBetter, doing well, planned discharge tommorow\nSeen by Dr.AK.Bhat.\r\nDressing changed.Raw area left leg is clean.\r\nAdviced alternate day dresings with Oxum.\nBetter, Discharge\n'}, {'role': 'model', 'content': 'IP Number: 52\n\nPatient Number: 2820\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 20-09-2011\n\nDiagnosis: NoN Healing Ulcer\r\nBPH\r\n\n\nClinical Exam(With BP): Non Haealing Ulcar over the Lt foot. Duration of Diabetes - 1995 \r\nCurrent Medication\r\nHuminsulin 25-0-0\r\nNPH 25units at bed time\r\nTab.K-PioM 0-1-0\r\nTab.Kvog 0-0-1 0.3\r\nTab.Lipinorm 10 0-0-1\r\nPrevious Blood sugar profile-FBS:142 PPBS:300 RBS: HBA1C:12\r\nPolyuria, Polyphagia, Polydipsia - Yes\r\nWeight Loss- No\r\nBlurring of vision-No\r\nDiabetic eye examination- No\r\nBurning Sensation of feet -No\r\nNumbness of feet-No\r\nNon healing Diabetic Foot Ulcer-2weekDuration\r\nsmall blister , P/s Iand D\r\nSwelling of feet -No\r\nHypertension-No\r\nDyslipidemia-yes\r\nHistory of Chest Pain on Exertion/Rest-No -Years\r\nRecurrent infections- Yes\r\nAutonomic dysfunction (orthostatic hypotension, early satiety, constipation)- No\r\n. Mother-Diabetic. Ulcer over the Lt leg measuring 10x 5\r\nEdges better, slough+\r\nSystemic Examination -NAD.\n\nSystolic BP: 150.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: K/C/O TYPE 2 Diabetes mellitus admitted with history of Non healing ulcer over the Lt Leg , Xray Leg ? Periostial rxn, No evidence incision and slough excsion done, treatted for Pseudomonas \r\ninfection , on basal bolus regimen for glycemic control , Usg abdomen done for hesitency while passing urine, found to Enlaged Prostate, \r\nResponde to the treatment .Discharge in a stable state\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, diabetic diet with small, frequent feeds adviced\r\nDiet booklet given\r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 65\n\nPatient Number: 2887\n\nPatient Name: C K GEORGE\n\nGender: M\n\nDate of Birth: 07-07-1941\n\nAddress: CHAKIATH , KUTHUKUZHI P O,\n\nPincode: 673517\n\nPhNo: 0485-2862791\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 21-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC FOOT\nEssential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Doing well\nVital stable , continue the same\nBetter, doing well, Dr.A.K Bhatt consultation \r\nRpt Hb,Tc, NA+,K+,Urea,Creatine, PT,.\r\nSeen by Dr.A.K.Bhat.\r\nLeft foot,Plantar.Recently excised callus with infection.The residual ulcer is clean.Dressing done.Adviced:Offloading.\nfebrile, Vital stable, Flapping tremors +, constipation +\r\nNovorapid 14units, lantus 26, stop Ciprofloxacin , start on Micritaz\r\n\nFoot local rise of temp still present.constipation Vital stable, TC coming down , continue the same, adjusted the dose of insulin\nVitals stable. GRBS- 140, c/o constipation. C/o discomfort while passing urine .local rise of temp in the legs\nFeels better, passed motion.No fever, Mild decrease in the temp in the leg\nSeen by Dr.AK.Bhat.\r\nSuperficial ulcer left foot is clean&healing.Adviced:Dressings once in 2 days with tbact oint.Offloading.\n'}, {'role': 'model', 'content': 'IP Number: 65\n\nPatient Number: 2887\n\nAdmission Date: 17-09-2011\n\nDischarge Date: 21-09-2011\n\nDiagnosis: Chronic Liver Disease\r\nChronic Renal Failure\r\nulcer on the plantar aspect of the lt foot\n\nClinical Exam(With BP): admitted with ulcer on the plantar aspect of the lt foot.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly male, not in any distress\r\nSystemic Exam- Normal\n\nDiscussion: 70 yr old with H/o chronic liver disease, chronic renal insufficiency admitted with superficial ulcer on the plantar aspect of the Lt foot . Pus culture taken - Staph aureus.\r\nSeen by surgeon, Ultrasound of the liver- Cirrhosis of the liver, early CKD, prostatomegaly.\r\nhe was startewd on I.V antibiotics, urine was sent for investigation\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, low potassium diabetic diet adviced\r\nDiet sheet given\n'}]

[{'role': 'user', 'content': 'IP Number: 125\n\nPatient Number: 3045\n\nPatient Name: BEENA THOMAS\n\nGender: F\n\nDate of Birth: 23-12-1953\n\nAddress: LISSIE BHAVAN, VANNIYAM PARAMBILHOUSE\n\nPincode: 682010\n\nPhNo: b 9496680115\n\nAdmission Date: 29-10-2011\n\nDischarge Date: 02-11-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par \\tab\\tab \\b ULTRASOUND SCAN REPORT\\b0 \r\n\\par \r\n\\par \r\n\\par \r\n\\par Liver\\tab : Mild fatty changes. No evidence of any focal lesion. \r\n\\par extrahepatic biliary radicals are not dilated. Portal vein is normal. \r\n\\par \r\n\\par Gall Bladder\\tab\\tab : Well distended. No calculus or sludge.CBD is not dilated.\r\n\\par \\tab .\r\n\\par Pancreas\\tab\\tab : Normal in size & echo texture. No calcification. No duct dilatation.\r\n\\par \r\n\\par Spleen\\tab\\tab\\tab : Normal in size & echo texture. No evidence of any focal lesion.\r\n\\par \r\n\\par Kidneys\\tab\\tab : Normal in size & echo texture. No calculus or hydronephrosis. \r\n\\par \\tab\\tab\\tab Ureters are not dilated.\r\n\\par \r\n\\par Urinary Bladder\\tab : Well distended. No calculus. No wall thickening. No mucosalirregularity.\r\n\\par \\tab \r\n\\par Uterus \\tab\\tab : Normal in size & echo texture\r\n\\par \r\n\\par Ovaries : Normal.\r\n\\par \r\n\\par \r\n\\par No free fluid in the abdomen.\r\n\\par \r\n\\par Impression : Mild Fatty Liver.\r\n\\par \r\n\\par DR. JOE ANTONY\r\n\\par RADIOLOGIST.\r\n\\par \\tab \r\n\\par \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab \\tab\\tab \r\n\\par \\tab\\tab\\tab\\tab\\tab\\tab\\tab\\tab \r\n\\par \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par \r\n\\par DR.JOE ANTONY\r\n\\par RADIOLOGIST.\\f1\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 4:30am\r\nFever with Chills and rigor\r\nWound Healthyfollow the orders\r\n \r\n Vital stable , continue the same\r\nUrine routine pending\r\nUrine RE- Numerous pus cells\r\nWill give I/2 amp AVil\r\n\r\n\r\nallergic to cipofloxacin\r\nAdviced Amikacin 500mg i.v B.D\r\nTab.Welset 500 1-1-1-\nAFEBRILE ,VITAL STABLE , CONTINUE THE SAME \r\nSTOP AMIKACIN \r\nSTART ON inj. piperacillin+tazobactum 4.5mg i.v bd \r\ncontinue the other\nCBC/S.cr/ Urea\r\nUS Abd -Tomorrow\r\nContinue the same\nshivering early morning, Inj.avil 1amp given\r\nTab.Welset\r\nNormal saline\r\ncame for rounds\r\nSleeping, Temp 100\r\nVital recoring with in the normal limit\r\ncontinue same\r\nTab.Welset 500mg 1-1-1\nDoing fine. No chills or rigors.\r\nHB, TC, URE tomorrow\r\nChase culture reports\nSeen by Dr.A.K.Bhat.\r\nUlcer left foot is clean.Daily biofill-AB dressing.\nVital stable , afebrile\r\nContinue the same \r\nC/S Entercocci\r\nsensitive to ciprofloxacin\nPt feels better.Discharge today.\n'}, {'role': 'model', 'content': 'IP Number: 125\n\nPatient Number: 3045\n\nAdmission Date: 29-10-2011\n\nDischarge Date: 02-11-2011\n\nDiagnosis: FEVER UNDER EVALUATION\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Beena thomas,57yrs old is a known case of Type 2 DM/Primary HTN/Primary hypothyroidism was admitted with shivering and abdomen discomfort..diagnosed to have urinary tract infection, started on I.V antibiotics ultrasound of the abdomen was done. seen by Dr.Bhatt, adviced daily biofill AB dressing.Patient discharged on stable condition\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 58\n\nPatient Number: 2858\n\nPatient Name: E.K POTHEN\n\nGender: M\n\nDate of Birth: 20-04-1945\n\nAddress: EDASSERIATHU HOUSE,MANJUMMEL P.O\n\nPincode: 683501\n\nPhNo: nan\n\nAdmission Date: 14-09-2011\n\nDischarge Date: 16-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: B P H\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: ADMOTTED WITH HISTORY OF PANIC ATTACK, FEW HYPOGLYCEMIC EPISODE, ADMITTED FOR EVALUATION\nComprehensive check yup done today . will evaluate and discuus th plan tomorrow\nVital stable, FBS-198, No hypo at night, Systemic examination -NAD, Report awaited\nNo Hypos, vital stable, sleep distured becacause of the nocturia, changed the dose of lantus\n'}, {'role': 'model', 'content': 'IP Number: 58\n\nPatient Number: 2858\n\nAdmission Date: 14-09-2011\n\nDischarge Date: 16-09-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): K/c/o Diabetes Type2 on Insulin, Essential hypertension, Dyslipedimia, Coronary heart Disease, admitted with h/o frequent symptomatic hypoglycemic episode , stoped premixed insulin at night, started on Basal bolus regimen , adjuised the dose of insulin according to the fasting,prelunch,predinner Blood sugars. evaluated for coplication found to have Mild NPDR both eyes, Mild Neuropathy, educated him about the Hypoglycemic managment, blood sugar testing. foot care, eye care. No Hypoglycemic episode during the hospital stay. \r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Mr.E.K.Pothen 66yr old gentelman K/c/o Diabetes Type2 on Insulin, Essential hypertension, Dyslipedimia, Coronary heart Disease, admitted with h/o frequent symptomatic hypoglycemic episode , stoped premixed insulin at night, started on Basal bolus regimen , adjuised the dose of insulin according to the fasting,prelunch,predinner Blood sugars. evaluated for coplication found to have Mild NPDR both eyes, Mild Neuropathy, educated him about the Hypoglycemic managment, blood sugar testing. foot care, eye care. No Hypoglycemic episode during the hospital stay.\n\nDiet: nan\n'}]

[{'role': 'user', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nPatient Name: SAJITH KUMAR\n\nGender: M\n\nDate of Birth: 14-04-1968\n\nAddress: CHELAYIL HOUSE, NEAR K.S.E.B\n\nPincode: 682005\n\nPhNo: nan\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC RETINOPATHY\nDIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Blood sugars are 634 mg/dl. Patinet is comfortable. Vitals are fine.\nConsious , oriented , febril , HR-82, BP- 150/90 RS-B/l Basal crepitation , Cvs -JVP Elevated , S1,S2 Normal \r\nAdviced Tab.Welset sos, Planned Cardiology consultation tommrow, statrt Inj.Metrogyl 100 i.v 1-1-1, Tab.Levofloxacin 500mg . Surgical Debridement on friday\nFebrile,Vital stable, Continue the same medication , prepare for the wound debridement under local \r\n\nTemp-99.2, PR-82, BP-130/80, Systemic Examination -NAD \r\nAdviced ECG/XrayChest -PA Veiw, \r\nadjusted the insulin dose, inform Prelunch, predinner, continue othe medication as Advice \r\nInform OT Staff,\nGeneral condition better. Slept well. Passed stools. Scheduled for debridement today. AC- 140 mg /dl. To be shifted to the recovery/ ICU at 9AM\r\n\r\n29/07/2011\r\nOperation done....\r\nSlough Excision of Right Heel Ulcer done under L/A.\r\nAfter adequate preparation and draping, the Ulcer slough was Excised For about 2X2 inches.\r\nThe slough did not seem to extend to the bone.\r\nThe Residual Ulcer after Excision, Bleeding was satisfactory.\r\nUlcer Haemostasis achieved.\r\nABGEL and Compression Dressing given.(DR. A.K. Bhat).\r\n\r\nPOST OPERATIVE ORDERS/INSTRUCTIONS:\r\n\r\nStrict Right Leg Elevation and Bed Rest.\r\nTPR/BP Monitoring.\r\nWatch For Bleeding.\r\nContinue IV Antibiotics.\r\nInject. Tramadol IM S.O.S\r\nPlanned for change of dressing in Recovery Room 31/07/2011.\r\n\nSeen by Dr.A.K.B\r\nPt afebrile.\r\nAdvice no wt.bearing on rt.leg .\r\nFor C/D tomorrow in OT Recovery.\npt alert, had an episode of hypoglycemia yesterday, ( sweating) GRBS- 86 .\r\nNo fever, chills\r\nPost debridement yesterday, No pain\r\ndressing tomorrow.\r\n\nSeen by Dr. A.K.Bhat and Dr. Tom Babu.\r\nDressings have been changed.\r\nThe Ulcer of the Right Heel looks CLEAN.\r\nNo Residual Pus or Slough.\r\nNo Evidence of Cellulitis.\r\n\nNo fever, No pain, Vitals stable, Dressing done yesterday, switched to oral antibiotics\nNo complaints, vitals stable,dressing to be done today by DR Bhatt, Intend to discharge tomorrow.\r\nAC- 93, Insugen R 24 units given. Midnight GRBS- 130\r\n10:00am Doing well, No Hypos, awating for surgeon for dreesing , adjusted the insulin dose according to the GRBS, planned discharge\r\n2:00pm s/b Dr.A.K.Bhatt , dressing changed , ulcer of the Rt heel looks clean except for some slough of the floor , part of which excised , Abgel compression dressing given , surronding skin and soft tissue inflamation subsided, continue the same Treatment .\r\n\nVital stable,GC-Better,Systemic Examination-NAD\r\nPredinner -165, adviced InsugenR 22units , Insugen N 26units at bed time \r\nPlanned discharge on 4/08/2011\nAfebrile, No pain, AC- 160, Insugen R 24 units given\r\nSeen and dressing change done by Dr A.K. Bhatt yesterday,\r\nDressing to be changed tomorrow again and Intend to D/c tomorrow.\nSeen by Dr.A.K.Bhat\r\nDressing changed.The ulcer right heel looks clean.\r\nAdvice:Dressing change as OP once in two days.No weight bearing on ulcer area.Oral antibiotics for one week.\nVital stable ,one episode of hypoglycemia , Dressing change today, continue the same\n'}, {'role': 'model', 'content': 'IP Number: 4\n\nPatient Number: 266\n\nAdmission Date: 26-07-2011\n\nDischarge Date: 04-08-2011\n\nDiagnosis: Infected Non Healing Ulcer\n\nClinical Exam(With BP): 43 yr old with H/O DM admitted for Infected non healing Ulcer. S/P debridement of the the ulcer by DR A.K.Bhatt on 29-07-2011.\r\nTreated with Broad spectrum I.V Antibiotics , and tight control of sugar by basal insulin( INsugenN ) and three time regular insulin ( InsugenR).\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: lab results attatched\n\nXray findings: nan\n\nDiscussion: Controlled blood sugar with Basal bolus regimen, under antibiotic cover, wound debridement done , adviced to continue the insulin , off loading , regular dressing\n\nDiet: \r\n\n'}]

[{'role': 'user', 'content': 'IP Number: 25\n\nPatient Number: 2584\n\nPatient Name: VARGHESE VITHAYATHIL \n\nGender: M\n\nDate of Birth: 27-04-1932\n\nAddress: VITHAYATHIL HOUSE,28/886, CHERUPARAMBATH\n\nPincode: 682020\n\nPhNo: 2313076,\n\nAdmission Date: 17-08-2011\n\nDischarge Date: 27-08-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: S/b Dr. Bhatt, Ascending Synovial infection ,C&S Pus taken , continue the same treatment, plan may need I&D under SA\npt admitted with severe pain in the plantar aspect of the Lt foot. + erythema + tenderness, Non healing ulcer in the interdigital space .\nSeen by Dr.A.K.Bhat\r\nPus discharging sinus lt foot.Synovial sheath infection+.\r\nNeeds I&D under spinal anesthesia.\r\nPreop.:Consent.C&D before surgery after betadine scrub.IV antibiotics.\r\n6:00pm Febrile, Drowsy, Vital stable . Check Sodium /Potassium, Preanesthetic checkup \r\nContinue the same\r\n7:30pm Wake up from sleep, feeling hungery, Mild dehydration , Systemic examination-NAD\r\nTomorrow ECG, Xray chest-PA\r\nMaintaince I.V Fluids NS 50ml/hr\r\nLantus 8units at bed time, Actrapid 8units before dinner\nVitals stable. sugar better controlled. No pain present now.\r\nZoledronic acid given yesterday.\nGeneral condition staus quo. Getting ready for debridement today. Blood sugars are under reasonable control. Not taking food adequately.\nIn ICU, B.P 153/70, CVS-S1S2 Normal , RS-NVBS\r\nCan start Orally\r\nStop 5% Dextrose\r\nContinue NS 500ml over 4hrs\r\nInsugen 8units before dinner\r\nLantus 12units at bed time \r\nInj. Clexane O.4 mg S/c \r\n\nFine, oriented , Vital stable, Intake-750 out put 450\r\nRS-Clear, CVS-S1S2Normal, PA-NAD\r\nShift to Room\nSeen by DR.A.K.Bhat\r\nNo pain.No soakage.\r\nPlan for change of dressing tomorrow IN OT.\r\nRepeat Blood R/E\r\n8:00pm Better,vital stable, Systemic examination -NAd\nDoing well. Blood sugars are on the low side. Appetite is picking up. Pre dinner- 164 mg/dl,AC- 88 mg/dl. Planned for dressing today.\nSeen by Dr.A.K.Bhat\r\nDressing changed Lt foot Plantar ulcer, relatively clean , some residual slough excised, No Residual pus\r\nAdd Clindamycin 300mg TID\nSeen by DR.A.K.Bhat\r\nAfebrile.No soakage.\r\nVital stable, AC- 163\r\n\nfine,No temp,Vital stable, Wound clean, dressing due, continue the same\r\nBlood routin-22/8/11\nSeen by DR.A.K.Bhat\r\nDressing changed.The raw area sole of left foot looks clean except for some slough on plantar area which was partially excised.\r\n8:15pm Vital stable , continue the orders\nVitals stable, No complaints, sugar controlled\nSeen by Dr.A.K.Bhat\r\nAfebrile.No pain.\r\nVitals stbale. c/o vertigo, will check orthostatic B.P\nVitals stable. Blood sugar controlled, No Pain, No loose motion\r\nDressing change done yesterday by Dr Bhatt\nSeen by DR.A.K.Bhat\r\nDRessing changed.The raw area lt.foot looks clean.\r\nSuggested oral antibiotics.\r\n7:00 pm Better , Vital stable, No giddness Today ,continue the oders\nVitals stable, AC- 104, NO vertigo after sitting up. \r\nwill get physical therapy on the case\nBetter, Vital stable,sleep good,\nDoing well, NO Hypos, Vital stable, No Giddness, Wound healing satisfactory, Planned to continue the same order\nSeen by Dr.A.K.Bhat\r\nDressings changed.The lt sole ulcer is clean and healing well.\r\nAdviced:Dressings on alternate days.Metrogyl gel&Cuticell.\n'}, {'role': 'model', 'content': 'IP Number: 25\n\nPatient Number: 2584\n\nAdmission Date: 17-08-2011\n\nDischarge Date: 27-08-2011\n\nDiagnosis: ?Charcots Foot \r\nAbscess over the Lt foot\r\nNon healing stump (3 rd toe)\n\nClinical Exam(With BP): Non Healing diabetic foot ulcer (amputation stump) Lt 3rd toe (amputation done in June)\r\nSwelling over Lt foot. \r\nCurrent meds-\r\n Tab Glyciphage 500 mg 1-0-1\r\nTab Glimy 2 mg 1-0-1\r\nDyslilidemia - Yes\r\nTab Aztor 5 mg 0-0-1. Acutely swollen Lt foot - ? Charcots foot.\n\nSystolic BP: 120.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: Elderly male. alert , oriented, not in any distress\r\n\n\nDiscussion: 79 yr with H/o DM , peripheral neuropathy, comes in with swelling and pain in the Lt foot. Pt was admitted for I.V antibiotics, Insulin ( Novorapid and Lantus) and I & D and debridement of the Lt foot by Dr Bhatt.\r\n\r\n\r\n\n\nDiet: \r\nNUTRITION Dept:\r\nLow calorie, low fat diabetic diet with small, frequent feeds adviced.\r\nNutrition booklet given\r\n\n'}]