Evidence based date wise workflow logs collated with clickable and verifiable links 

 

Evidence based date wise workflow logs collated by the intern with clickable and verifiable link


Case 1:

Date: 08/11/2023


[2:18 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Share questions about the patient in the group to stimulate learning inputs from the other group members
[2:26 pm, 08/11/2023] Vishwanth KIMS: Is the hb level falling down or is it stable i/v/o tropical spleenomegaly
[2:31 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Can you share the trends of his falling hemoglobin?
[2:42 pm, 08/11/2023] Lasyapriya Cherukupalli: On 4/11/23 his Hb was 13 g/dl sir. On 7/11/23 it is 12.2g/dl. There is a fall in Hb sir.
[2:45 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Is that a clinically significant fall?
[2:48 pm, 08/11/2023] Lasyapriya Cherukupalli: Fall in Hb by around 1g/dL in 3 days seems significant sir
[2:48 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Any reference in the form of a thesis link?
[2:51 pm, 08/11/2023] Vishwanth KIMS: Sir is this information correct
[2:52 pm, 08/11/2023] Vishwanth KIMS: Does it fall down 0.1% everyday after bone marrow failure
[2:54 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: What is the evidence cited? 

If none then it's opinion till disproven
[3:09 pm, 08/11/2023] Lasyapriya Cherukupalli: https://emcrit.org/ibcc/transfusion/#:~:text=Erythrocytes%20have%20a%20half%2Dlife,to%20blood%20loss%20or%20hemolysis

This is from an online book called IBCC sir. It has references at the end of each topic
[3:09 pm, 08/11/2023] Navyatha Kims: Sir could this be a case of aplastic anemia?
If so is there a link between cholecystectomy and aplastic anemia?
[3:10 pm, 08/11/2023] Lasyapriya Cherukupalli: Aplastic anemia would have pancytopenia due to Bone marrow failure. He does not have pancytopenia
[3:11 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Please quote the relevant portion
[3:12 pm, 08/11/2023] Lasyapriya Cherukupalli: Can we consider this as acute anemia sir?
[3:13 pm, 08/11/2023] Lasyapriya Cherukupalli: Hemolysis can cause acute anemia along with Splenomegaly with Hypersplenism sir
[3:16 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: If you had spent a few years daily going through the hemoglobin values of all patients in any medical college you may not have thought twice about this 1 g hemoglobin fall or rise!! 

Especially when it's from 13 to 12!!
[3:18 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Let's first consider his original problem :

Your title says it's abdominal pain since 10 days 

Tell us more about how is his abdominal pain since admission 

What is the cause of his abdominal pain that we found?
[3:19 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Short of seeing any reference to this statement I would consider it opinion 

Please quote (copy paste the text) in the text message as it's very difficult to archive screenshots
[3:20 pm, 08/11/2023] Lasyapriya Cherukupalli: He complained of Lower abdominal pain sir. There were not any significant per abdomen examination findings except for scar due to past cholecystectomy and Splenomegaly sir. Currently his abdominal pain has decreased since yesterday.
[3:21 pm, 08/11/2023] Lasyapriya Cherukupalli: Okay sir
[3:21 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: References (numbers) at the end of the statements in the text are aka in text citations that can then be looked up from the list of references. 

The statements you shared probably didn't have ant in text citations as much as I could make out from the screenshots
[3:22 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Is that the same patient who came to opd with ultrasound showing splenomegaly that wasn't palpable clinically?
[3:37 pm, 08/11/2023] Lasyapriya Cherukupalli: No sir
[3:37 pm, 08/11/2023] Lasyapriya Cherukupalli: He has been referred from surgery I/v/o gross Splenomegaly
[3:44 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Okay I just checked your case report and could recognize the patient's scar! 

I can't recall being able to palpate the spleen in him. Will need to check again. Where is he?
[4:03 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Just checked along with @Lasyapriya Cherukupalli 

No clinically palpable spleen from my end 

@Kshitij Sharma @~Dr.Dinesh Datta Data capture validation is a vital element
[4:04 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Let's have a few more observer inputs on the spleen @Navyatha Kims @Vishwanth KIMS
[2:41 pm, 10/11/2023] Dr. Rakesh Biswas Gen Med HOD: Update? 

Please share his problem list and solutions offered for each of those till date
[6:24 pm, 10/11/2023] Lasyapriya Cherukupalli: He has been discharged sir. His initial complaint of pain abdomen has resolved after treatment. We treated him with Inj ARTESUNATE and Multivitamin I/V/O ? Tropical Splenomegaly

Case 2:

Date: 28/11/2023


Case 3:


[2:18 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Share questions about the patient in the group to stimulate learning inputs from the other group members
[2:33 pm, 08/11/2023] Lasyapriya Cherukupalli: It is mentioned that he consumes 90 ml of alcohol twice or thrice in a month since 30 years. Why is this specifically an Alcoholic Liver disease and not anything else?
[2:36 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Very good question 👏👏
[2:38 pm, 08/11/2023] Vishwanth KIMS: At present it is more like alcohol is the only injury caused to the liver as hepatitisb is ruled out.. and hep a sample is being evaluated
[2:39 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: So you feel it's an acute alcoholic hepatits and not a chronic alcoholic cirrhosis?
[2:41 pm, 08/11/2023] Vishwanth KIMS: Sir since it has been 30 years it is unlikely to be acute .. but alcohol maybe the only thing affecting his liver since there is no evidence of viral or bacterial cause
[2:44 pm, 08/11/2023] Dr. Rakesh Biswas Gen Med HOD: Yes but if taking 90 ml of alcohol thrice a month causes alcoholic liver cirrhosis then most of the world won't have many livers surviving! 

Should the phrase "shortness of breath" alert your LLM to express a different diagnosis?

Case 4:

Date: 08/11/2023







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