‘Anollomedics Super Speciality Hospitals reef npolomeditrnatana feces Listed rod Caco 22008 Nv cknouae wale Os er aman Aro 19009 166 Pouveor telson: Hog | = me aaa aie | vee #01 Raced BRE nfo: Uipad to| ate: 19.03] 25" oe Bae Bel COVID Vaccination: Coo Orme ge oe R ; ’ gs Cael Si alia oe or een a, Caen ne are spo 49" lg ag awa NS fo Coan Zep tomar ere (1 aE iy. toes 228s 2p at Nese ee tes a 2-5( 300s 22) vv Bes, hb uy oY yw | Plleck AuticcR Ab “fbest —> Rhema yah Goan chain 5 | From The Desk of the Internal Medicine & Critical Care y Prof (Dr) R C Ahuja - Director & HOD Dr Sushil Kr Singh - Senior Consultant Dr Mayank ‘Somani- MD & CEO Dr Shaikh Abdul Nadeem - Consultant Dr Ajaya Kumar - Director Medical Services Dr Kshitiz Awadhwal - Associate ConsultantAF Moc 2025 @ vee, Rheumatology OPO Name Mrs, Ruby Parveen_Age 46, F_UHID 555145 Date: 18.3.2025 Diet: Non-Vegetarian Milk:Yes Accompanied: Daughter Menses: Postmenopausal Breast lump: No (H) Drug allergies: NKDA ae Shuck © ARI MnsHed afb)ac- thier # Sepla Comorbidities: = 2 Vnarepite [renee ; eo. Fat he in ke ‘© Polyarthritis: St joints, EMS 1-2 hours Oral + Ocular dryness ++, Hair loss +, Photosensitvity +, RP +, Oral ulcers in 4-2 months ~ Mild cough,nosOB + Pronvinly eee Told A eee ‘+ Low backache: with radiation to B/L LL with T/N +, EMS 1 hour, Difficulty turning sidest, Nocturnal paint ~ No features 5/0 Psoriasis/ Uveitis/ 18D/ Family H/O- Vitals: N ‘No Pallor, LN, Edema, Skin changes, Nail changes Systems: OK Resp- NVBS+ Joints: Alljoints active Records: Blood:17.3.25- CBC-11.5/13220/460, Creat- 0.78, UA-5.1, Anti-CCP>300 8.3.25- RF- Neg, Stool Biofire-STEC ~~ Radiology: X ray hand- Juxta articular Osteopenia with carpal crowding, Knees- Grade 2-3 OA wary hal), Weer Pelvis and LS spine- N Others: x Impression: + Inflammatory polyarthritis- RA, 1o R/O associated CTDs © Hep 6 +ve, OM2, HT -Apllomedis Super Specialty Hosptals A ertur of Aoollomedi intertoral Lfescences Limited tormerty known a5 Mes rteationaLfercences Limited) KEC-31 Sector 8, LDA Clery Kanpur Road, Lucknow - 22602 UP India Helpline No 1800 419105691522 67 86884 w ucinowapolohospitalscom ‘EN Ne UssioUrZOHPLCORsSeInvestigations advised: fee adt lo! accyr do * ESR (WG), CRP (Quantitative), SGOT, SGPT, Urine RME © HAVONA(Quonfilebi) + ANA (IF) R Continue treatment for DM2, HT and Hep B under Physician Tab. Calten Done tablet once daily after breakfast —O oe Cap. Calbona D3 60K — one capsule twice weekly for 4 weeks with milk or tea (6) Tab. HCQS 00 me — Ce aint C thong — Sada dag) a er ge ic diame casas ncaa Tab. Zerodol P 100 mg one tablet twice daily after breakfast and dinner” dey Heal oo. S . Cap. Sompraz D 40 mg—one capsule once daily on an empty stomach in the morning « 1+ Tab. Zentel 400 mg PO single dose » . . Oralgn Nanogel local application twice daly Reviews 10 Cnt © yeh. \ Avilla we Dr Anupam Waki Imojaeateine) Di Sinica immanelooy) Depareont ofits & Reuse nissan)Apollomedics Super Speciality Hospitals A venture f Apollomeds international Lfescences Limited (ocmeny known as Mele Imemational Ltescences Lite) ABC See LDA Colony Kanpur Road Lucknow 22007 Apol ‘stn raaplonetaar sponse Asano Res Maine otc ane ase SBoce March 27, 2025 UHID: 555145 ‘Mrs Ruby Parveen, 46/F “Drug allergies: NKDA *Milk & products: yes *Menst:Post “Accompanied. Daughter History:DM, HT, Past TB LN, Current Hep B +ve; See history: Admitted March 2025 Apollo. ‘AKI, septic shock 7 Urosepsis ? Ac GE, Inflamm S=L PA, x 8 years, previous H/O Rx Records: Bloods: See records, RF-ve, anti CCP >300, ANA -ve, Urine leucocyte esterase +*Ve, 2-4 pus cells /HPF, CRP 2.5, ESR 48, HEV DNA detected Radiology: X ray chest, HRCT N, Hands JA openia wth carpal crowding, knees grade 2-3 OA, X ray Pelvis N 3. Miscellaneous: x Current problems: Active joints, Bloods done from else where 1 Bi Current medications: Review of old records: KGMU: Seropositive RA, MTX 20 mg + Steroids; One adm in April 22, fever & Diarrhoea, pneumonitis, , AKI, Colonic ulcers; HBSAg, anti HCV were non Feactive in 2020; Dr Jayendra HBV management, Last seen Feb 2025 Assessment: A. Vitals: OK B. General Ok, No BL (H) C. Disease: All joints active D. Others: x Impression: Seropositive RA, Need to see HBV DNA report i Investigations: 1, HBV DNA (Quantitative) ~ Referral: FUP with Dr Mayank Somani & Dr Jayendra / Scan With Gooate Lens Te Consuit OnlineMarch 27, 2025 Re 1. Continue medicines as advised by Gastromedicine: Or Jayendra ~~ 2. Continue medicines for BP and diabotes as advised by Dr Mayank Somani—~ 3.+ Tab Calten D 500 mg 1 OD after BF (enka ar aiz) —O * ‘4. Cap Calbona D3 60K 2 times @ week x Sweeks. fritn milkhea) (Smet Hah are @é 5. Tab HCQS 400 mg HS after dinner (et GaPY raTa) (Monday to Saturday) —O 6. "Tab Omnacorti § mg OD after BF (8-9.00 AM) (Hag area a ate Frater wre gs) —O 7. “Tab Zerodol P 100 mg BD ater BF & dinner (atta ak aie aH ate), 8. Cap Pre QM75 mg HS after dinner (arat'at wet ara) —O * ‘9. Oxalgin Nanogel local application 2 times a day as advised i s jew: After 1 week with reports as advised welapertanse® p09 eee # were Rn cet wt ot Xe at Ch oh cet Aa TA) Shp se otastites det ay A svar Fe ere etter (re Fo wnat ea Spe ret adja seen former BA a coe are moh RAT AO ote Ute eT emt 81 py sor emuttat vo at, ed ete Frew seem Fava aM aa He We, Ses Shes eG EL MC me, Ror aaah ate wad @ ace wy ote hy Bt ET rare tae Radar A ree aroha erm He aR one ga AE ar A a Rat ee arch ware aw & (eR, om S81 ae are Stary at oes fate fear MH she mau & fae Renta Rae fh PafRaew A vO Act at seme & ft at ref sear a ances RRA Agee sneha ea A ae at 28 x7 ap BY Atte Dr Anupam Wakhiu MO(Medicine), Div{Ciinvea) Immunoto Read. No. s6s97 ey Depaimentof Cnc! immune ogy & Rumattogy _qAPollomedics Super Spectalty Hospitals (Avent of Agelomeds iterators secavse R15] date: A14]ae Hn Us2em: wr Sig. Temp: 4 ¢% a PR. &I bH min. TI tt ere : sro Fy: BT Curent aette —a3> wy Cee) > BRO. a4¢4mmag — aaa Be Or) 8.PIM): [00/60 run. Ve Gp “Ent Av TStte Hts — ey LéAwrus 254 fle 2D Ape a STH CRS) yal Husa ted. (au aie Tee Tiree aay bn et ers ee vot eh, tomy ts aha ¥ PU tee Diet ee cise Conkame < Aetoahs bs > ®& ieee Qurstted aloced fret eve QuliorBint _, Apallomedcs Super Speclaty Horptals Apollomedi siete Pees Mes. ley poring Leoletgcteeter,/ flotta> ot WT Cnteaily a8 a too Top fan-D joo er > BeAr Tela, OT he flare op XB iF apstnert, @ bare _“ Ha veri posuterie (LR y‘Apollomedies Super Specialty Hospitals yy sie Averture ol pals Uesceres ited MA ss Se ee eceee Uke) SCM S28 (DACaony arr Rd cn 802 Apollomedics ‘ecanosar lugapalhonesan i apclchespnlascr action: se ‘24x7 Helpline: 0522 67 BB B88 Ambulance: 1800 419 1066 UHID: 555145 ‘Mrs Ruby Parveen, 49/F Drug allergies: NKDA Diagno: Seropositive erosive RA (RF-ve, anti CCP >300), ANA -ve (0) BIL Grade 2-3 knee OA DM HT Hep B on Rx from Gastromedicine Last FUP: 27/03/25; See HBV DNA report Assessment: A. Vitals: ok Investigations: HBV DNA 360 Radiology: x Rx: Yes NSAID: yes . Exercises: x General: Doing fine |. Disease: Active Others: DW Dr Jayendra, with Rx and low viral load, we can start Saaz and gradually increase Impression: Start Saaz Plan: 4. Start Saaz + Optimize Special notes/instructions: x Referral: Dr Mayank Somani & Dr Jayendra FUP Investigations: x Avatthe ENO SeanWth Goose terete cons nine Dicector- Clinical Immunology & Rheumatology Tae F : Tomer rte. HOD Rheumatoany KOMU Lehre me Fellow hematology oth avataa > eee cou i et nena hei nana! Cee eeApril 3, 2025 Rx 4. Gontinue medicines as advised by Gastromedici 2. Continue medicines for BP and diabetos as advised by Dr Mayank Somani 3. Tab Calten D 500 mg 1 OD atter BF nea ars) Cap Calbona D3 60K 2 times a week x 1 weeks (with mil/tea) (me at at are) "Tab Saaz 500 mg OD after 8F—o « Tab HCQS 400 mg HS after dinner (ara a GTA Tz) (Monday to Saturday) “Tab Omnacortl § mg OD after BF (8-9.00 AM) (Hag anka & arg Prati gerry “Tab Zerodol P 300 mg 80 after B & dinner (mad shear Fara ae) GO. 3. Cap Pre QM 75 mg HS after dinner (3a #Y GRY ara) xalgin Nanogel focal application 2 times a day as advised +4, After 3 weeks with reports as advised 7 Blood tests to be done on followup (aa # siz): CBC, SGOT, SGPT, ALP, § Creat, R Sugar **tmportnt®* Lem se aa a ea a cd aT atl re A ata ae 2. eR ate eae ta etban & yee Fe srt Rend (ae Pc ota era Bere EDA sec even OB Ha MT tno 8a He sete BN EL pr woh A wt wan wt, FOR MOTe mee tem Ere Me Wet Goh SRE HMC we eT fe Aor Ua He at A Rk Mig Mss BY cat EMMA tome Redcat & meeT H Hawa Cae ee 38 are) gare a6 ear Rot Bat en aaa 8 ae MR RCONE ome e aTE H Beit eek aks eee week Frker Ree ey eer wate a fo each eae oe Fah FP a tt ae oh aaa Bi 4. Beet A red are a arm FRU antaee eae Hae. 24 7 et J Dr Anupam Wakhiu Director MD(Medicine), Div(ciinical Immunology) Regd. No. 38607, Deparment of ie innciogy& Rheumnaiogy Apollomacies Surer Speciality Hospitals. (jMertrs ot paemecesuamationy Leese i)