General medicine

   This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs This E log also reflects my patient centre’s online learning portfolio and valuable inputs on the comment box is welcome.   case: A 50 year old female farmer by occupation resident of suryapet came to opd with chief complaints of weakness of left upper and left lower limbs since 3 days   History of present illness: patient was apparently asymptomatic 3 days ago then developed dizziness and then she developed weakness in her left upper and lower limbs following a fall weakness was sudden in onset and it was progressing in such a way that she was unable to move the left side of the body  there was also drooping of angle of

 A 35 year old male patient resident of ramachandrapuram works as daily wage labourer who is a chronic smoker and alcoholic since 20 years  He came to opd with history of painless lesions which were papules with erythematous base since 3 months which initially started over face and then extended to upper limb and lower limb and also trunk patient previously got a topical cream soap and some oral drugs from a medical shop and used it for 2 months and few lesions regressed but some persisted on earlobe,hands and trunk 12 days back he developed blackish skin discolouration over hands and feet and there was cracking of skin and ulceration associated with burning sensation since 1 week patient developed high grade fever associated with chills and rigor which was of  continuous type no known co-morbidities present and no history of similar complaints in the past on examination: face: madarosis-loss of eyebrows depression of nasal bridge also called as saddle nose skin of face and earlobe is