138 Vagisha Rani

This is a case of a 59 year old professor who is a resident of West Bengal. CHIEF COMPLAINT : Case of  Rheumatoid arthritis under medication.   HISTORY OF PRESENT ILLNESS- Patient was apparently asymptomatic an year and half ago.  Then she felt pain in her left wrist joint which was insidious in onset and gradually progressive in nature. It slowly progressed to the hands and shoulder on both the sides with an increased intensity causing difficulty in daily activities and sleep. She used painkillers which provided relief for sometime.  She underwent a physiotherapy for a month. She also took steroid injections twice in a local hospital in West Bengal but the pain reappeared later. There is no history of swellings, morning stiffness, malaise, musculoskeletal pain, weight loss,fever or rash. On February 2022, she went to a specialist in Hyderabad, who suggested her some medications but there was no improvement. Later she went to an OPD in Nalgonda and she got relieved from pain within 10

76 year old male farmer by occupation came with chief complaints of  Pedal edema since 20 days History of present illness  Patient was apparently normal  15 years ago he sustained an injury for right leg while working with tractor for which he developed ulcer and was hospitalized for 1 week while then he was diagnosed with Diabetes mellitus on medication.(Metformin 500 mg OD) 3 years ago he developed Blurring of vision in right eye undergone cataract surgery. 3 months ago he developed Blurring of vision in left eye. 25 days ago he developed abdominal distension. 20 days ago patient developed pedal edema in both limbs which was insidious in onset which is of pitting type extending upto the knee. He went to the local hospital and undergone some blood investigations was given some medication.(Details not known) Pitting type of edema aggrevated by walking relieved on lying down.  Patient complains of tingling and burning sensation and sobgrade 2 occasionally  No c/o decreased urine out