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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'}]