Branch. ADU CAMPUS. ‘VALID FOR THREE MONTHS ONLY HLT Metpalayam Road ay -Anashingam Deere Universty Camus Coiréatore Tar Nadu i Oe EG DDMMY YY y¥ * ‘UT ate Hl OR BEARER TRE < SB 474655924 CBS Code: 00220 RAMAN K /R CHANDRA PAYABLE AT PAR AT ALL OUR BRANCHES ae W2BOSKb" ELAOLGOLA: ESSGaq 3bFrom K. RAMAN Date: 11.05.2023 33, Thiyagi street, IInd cross Sri Nagar, Kavundampalayam Coimbatore 641 030 Mobile No.98947 84482 Email: krishnaiyengarraman@gmail.com To M/s.Kotak Life Insurance Co Ltd Attn: SHWETACHHATHAR, Grievance Desk Sirs, Sub: Refund of Policy amount of Rs.1,04,500/- With interest towards my Policy No.75313519 Case ID 15530714/ 15617643 Ref: My Mail dated 13.04.2023 , 18.4,2023 & 30.4.2023 Your Mail dated 10.05.2023 T have already requested to you, and I am not in a position to continue the above Policy because of my health condition. I have affected by COVID 19 and both legs has removed and there is no source of income in future. Till date I am taking treatment. M/s.Sundaram Finance representatives has wrongly diverted me to take this Policy. He has collected your Life Insurance and ICICI Prudential funds Policy also. M/s.ICICI Top Officials has visited in my house, and he accepted my health condition. He explained I am not eligible for this policy and collected my Bank account number and Pan card for necessary refund the amount collected by me through their Head office. On the same procedure, I requested your goodself to refund the amount. As mentioned in your mail I have sent all medical reports by two times. After received in your part you has given a mail, the resolution will be passed on 2" May and repeated in your mail on 9" also. Suddenly I got a mail on 10" May that you are not in a position to open the mail and also requested to send Medical reports . Two times I hadsent the reports and, there is no response from your side to refund the amount. 2 However I am sending the Medical reports in 3 time on today You are not taking any steps in your part to refund the amount of Rs.1,04,500/- with interest, I feel particularly you are avoiding my request. Tam sending my blank cheque for account number and my Pan card for your reference. Please note I am not a right person of your Insurance Plan and I explained the same to you and I misused by Agencies. For reference you have also confirmed my health condition photo. Please response properly and do the needful for necessary refund amount with interest. Thanking you, Yours faith ly, by (K. RAMAN) Enel: 1. Blank cheque for A/e purpose 2. Pan card PS: Medical reports are showing at present my health condition.s ROYAL CARE ROYAL CARE SUPER SPECIALITY HOSPITAL 1/520, L&«T Bypass Road, Neelambur, Sulur Taluk, Coimbatore - 641062 DEPARTMENT Of RADIOLOGY INTERVENTIONAL RADIOLOGY Patient Name: Mr. RAMAN K Admission No Age/Gender + 64 Years/Male UMR Neo Admission Dt : 16-Jun-2021 Discharge Dt Consultant Dr.MADAN MOHAN. B Referred By :Dr.DEVI GAYATHRI MBBS Department: RADIOLOGY Ward : SINGLE NON AC/4023 Org.Name MEDI ASSIST Patient Address: 20 THIYAGI STREET SRI NAGAR 2ND CROSS KOUNDAMPALAYAM Coimbatore , TAMIL NADU 9894784482 (UCONSULTANTS Dr. B. Madan Mohan, MD., PDCC., FINR., Consultant Interventional Radiologist. Dr.P. Sampath Kumar MD., DNB(RD)., PDCC(Cardiovascular imaging and Vascular intervention) Consultant Interventional Radiologist. Dr. C.Senthil Kumar MS, MRCS(UK)., M.Ch Plastic Consultant Plastic and Cosmetic surgeon. Dr. 8. Arun. MD., PG., Diab (Boston)., Consultant Physician & Diabetologist. Dr. K. Chockalingam., MD., DM., (Cardio)., Consultant Interventional Cardiologist. Dr.Kirubanand K Jaganathan., MS, MRCSEd, M.Ch(Uro), DNB(Uro), FRCS(Urol) Consultant Urologist & Laparoscopic Urological Surgeon, Dr. M.Praveen Kumar., MBBS.,MD.,D! Consultant Anesthesiologi Dr. Balasubramaniyam. MBBS...DA A Consultant Anesthesiologist. DISCHARGE SUMMARY DIAGN Bilateral cortical limb ischemia with gangrene changes in both toes Arterial occlusions at multiple levels in bilateral lower limb arteries ‘Type 2 diabetes mellitus / Systemic hypertension / Post covid status PROCEDURE: 1. Bilateral lower limb angiogram + Mechanical thrombectomy done under GA on 17.06.2021 2. Catheter directed intra arterial thrombolysis( Alteplase) done under LA on 18.06.2021 3. Mechanical thrombectomy of residual femoral + Tibio peroneal thrombus done under conscious sedation on 19.06.2021 4. Bilateral below knee amputation done under NB + LMA 20.06.2021 Page 1 of 7} Phone : 0422 - 222 7000 Website : www.royalcarehospital.inPatient Name :Mr. RAMAN K ‘Org.Name + MEDI ASSIST a PRESENT HISTORY Mr. Raman K, 64 years male, presented with h/o pain both lower limbs since 1 month, rest pain and worsened on walking. H/o Acute back pain x 20 days back & relieved spontaneously. Now patient had bilateral cortical limb ischemia with gangrene changes in both toes & arterial occlusions at multiple levels in bilateral lower limb arteries. He was planned for peripheral angiogram & thrombectomy and admitted for the same. PAST HISTORY K/c/o Type 2 diabetes mellitus / Systemic hypertension- On treatment H/o Post covid status(01.06.2021) ON EXAMINATION Patient conscious, oriented, afebrile, Temp: 97.4°F HR - 112/min, RR - 24/min, BP - 130/90mmlg, SPO2 -96% in room air Systemic Examination: CVS - SI $2(+), RS - Bilateral air entry(+) P/A - Soft, BS(+), CNS - NFND. Local Examination: Left foot - Ischemia of toes(+); Plantar skin, patches of ischemia noted upto heel No peripheral pulses felt Right foot- Dorsum skin ischemic upto ankle, all toes ischemia(+), No peripheral pulse(*+) RADIOLOGY: Echo: 17.06.2021 Impressio Normal LV size with good LV function No RWMA/ Grade I LVDD / MR- Trace Sclerotic aortic valve TR- Trace Max Gr:22mmHg No PE / PAH/ IVC-1.4em / Aorta- Normal CT brai Findings: Study suboptimal due to movement artefacts. No gross intracranial hemorrhage. - plain: 19.06.2021 INVESTIGATIONS [Parameters Result Value Normal Value ] Date: 16-Jun-2027 CBC (COMPLETE BLOOD COUNT - COMPLETE HAEMOGRAM ) TOTAL WBC COUNT 19,000 cells/cumm 4000 - 11000 cells/cumm. ge 2 of 7Patient Name :Mr. RAMAN K Admission No :1PB20217772 4-5.5 Millions/cumm 14-18 a/dt 40-55 % 80-98 fl 26-34 pg 30-35 g/d! 18-145 % 150000 - 350000 cells/cumm 40-70 % 20-40 % 0-1 % 2-8% 2-7 % 0.7-1.2 ma/dl > 60 mifmin/1.73m2 NEGATIVE . POSITIVE : >= 0.13 NEGATIVE : < POSITIVE : > 14-18 g/dl 14-18 g/dl 135-147 mEq/L 3.6- 5.1 mEq/L 98.0 - 107.0 mEq/L 19-28 mea/t, 4000 - 11000 cells/curnm 4- 5.5. Millions/cumm 14-18 g/dl 40-55 % ‘Org.Name + MEDI ASSIST TOTAL RBC COUNT 3.28 Millions/cumnm HAEMOGLOBIN 8.7 gat. Pev 25.6 % Mev 78.081 cH 26.5 pg McHe 33.9 g/dl ROW 14.7 % PLATELET COUNT 5,59,000 NEUTROPHILS, 92% LYMPHOCYTES 05 % BASOPHIL, 00 % MoNocyTes 02% EOSINOPHILS 01% CREATININE CREATININE 0.8 ma/al EGFR 94.4 mi/min/1.73m2 INFECTIOUS VIROLOGY PANEL (ROUTINE) - HIV / HBSAG / HCV AB ANTI HIV 1 & 2 (ROUTINE) Negative HBSAG (ROUTINE) Negative HCV AB (ROUTINE) Negative Date: 18-Jun-2021 HB(HAEMOGLOBIN) HB(HAEMOGLOBIN) 7.3 g/dL. BLOOD GROUPING AND RH TYPING BLOOD GROUP “8 Rh (D) Typing “Positive” Date: 19-Jun-2021 HB(HAEMOGLOBIN) HB(HAEMOGLOBIN) 7.1 g/d ELECTROLYTES ‘Serum sodium 138 mEq/L. Potassium 3.9 mEq/L Chloride 105 mEq/L. BICARBONATE 19.9 mEq/L CBC (COMPLETE BLOOD COUNT - COMPLETE HAEMOGRAM ) TOTAL WBC COUNT 15,600 cells/curam TOTAL RBC COUNT 2.71 Millions/curnm HAEMOGLOBIN 6.4 g/d, pc 21.4% Mev 79.111 80-98 f Page 3 of 7Patient Name :Mr. RAMAN K Admission No :1PB20217772 ‘Org.Name + MEDI ASSIST cH 23.5 pg MCHC 29.7 afd! ROW 16.6 % PLATELET COUNT 5,15,000 NEUTROPHILS 90% LyMPHOCYTES 06 % BASOPHIL 00 % MonocyTes 03 % EOSINOPHILS 01% CREATININE CREATININE 0.7 maya EGFR 99.73 mifmin/1.73m2 PARTIAL THROMBOPLASTIN TIME - ACTIVATED (APTT) PARTIAL THROMBOPLASTIN TIME - 60.4 sec CONTROL. 30.4 sec Date: 20-Jun-2021 PARTIAL THROMBOPLASTIN TIME - ACTIVATED (APTT) PARTIAL THROMBOPLASTIN TIME - 78.7 sec CONTROL. 28.7 sec CBC (COMPLETE BLOOD COUNT - COMPLETE HAEMOGRAM ) TOTAL WBC COUNT 21,000 cells/curnm TOTAL RBC COUNT 2.95 Millions/curnm HAEMOGLOBIN 7.9 g/d. Pcv 23.7 % Mev 80.3.1 MH 26.7 09 MCHC 33.3 o/dl ROW 15.5% PLATELET COUNT 4,15,000 NEUTROPHILS 95% LymPHocyTes 02% BASOPHIL 00 % MONOCYTES 02% EOSINOPHILS 01% PARTIAL THROMBOPLASTIN TIME - ACTIVATED (APTT) PARTIAL THROMBOPLASTIN TIME - 103 sec CONTROL, 28.7 sec PROTHROMBIN TIME (PT) PROTHROMBIN TIME (PT) 17.6 sec INR 1.523 CONTROL, 12.4 sec 26-34 pg 30-35 a/dl 118-145 % 150000 - 350000 celis/cumm 40-70 % 20-40 % 0-1 % 2-8 % 2-7 % 0.7 - 1.2 maya > 60 mi/min/1.73m2 25.4- 38.4 sec 25.4- 38.4 sec 4000 - 11000 cells/cumm, 4-55 Millns/eumm 14-18 g/dl 40-55 % 80-98 #1 26 - 34 pg 30-35 g/dl 118-145 % 150000 - 350000 celis/eumm 40-70 % 20-40 % 0-1 % 2-8 % 2-7 % 25.4- 38.4 sec 9.1-12.1 sec 08-12 Page 4 of 7Patient Name :Mr. RAMAN K Admission No :1PB20217772 (Org.Name + MEDI ASSIST CREATININE CREATININE 0.6 mg/dl 0.71.2 ma/dl EGFR 106.25 mi/min/1.73m2 > 60 mifmin/1.73m2 POTASSIUM SERUM Potassium 3.6 mEq/L, 3.6- 5.1 mEQ/L SODIUM SERUM soium 135 mEq/L 135 - 147 meg/L HB(HAEMOGLOBIN) HB(HAEMOGLOBIN) 7.3 g/d 14-18 g/dL. Date: 21-Jun-2021 HB(HAEMOGLOBIN) HB(HAEMOGLOBIN) 7.7 afd. 14-18 g/dl. ‘TOTAL WBC COUNT TOTAL Wc COUNT 15,500 cells/cumm 4000 - 11000 cells/cumm operative Notes Name of the Surgeon: Dr. Madan Mohan / Dr. Sampath Kumar Name of the Anaesthetist : Dr. Praveen Kumar 1. Procedure: Bilateral lower limb angiogram, Thrombus aspiration and Catheter-directed thrombolysis done on 17.06.2021 to 19.06.2021 Procedure Note Left: Antegrade femoral artery accessed with SF sheath. Short sheath exchanged over a Terumo wire with 088 aspiration catheter - placed in the popliteal artery. Ace 68 aspiration catheter used for aspiration thrombectomy of distal PTA thrombotic occlusion. Further Stentriever thrombectomy performed achieving recanalization till below ankle level. Angiograms revealed distal small vessel occlusion with absent vascularity in forefoot. Distal third of ATA, DPA are occluded. A segment of mid peroneal artery is occluded. Microcatheter advanced into the left ATA and Alteplase thrombolysis continuous infu Right: \CAategrade femoral artery accessed with SF sheath. Angiogram revealed long segment occlusion of SFA, ‘occlusion of distal third of ATA, occlusion of PTA just below ankle level. Few small vessels perfusing hind foot noted, No vascularity in the forefoot. SF short sheath exchanged for Neuron Max and partial aspiration thrombectomy of SFA. performed. Two microcatheters advanced into the ATA and PTA respectively. Alteplase infusion started at 0.25mg /hr into each of the arteries. The infusion in both lower limbs was allowed to run for 24 hours. A check angiogram and thrombectomy was performed at 12 hours. Angiograms at 24 hours revealed fresh thrombus in the popliteal and infrapopliteal arteries which was managed with thrombectomy. mn at 0.5 mg / hr, Name of the Surgeon: Dr. Senthil Kumar ‘Name of the Anaesthesiologist: Dr. Balasubramaniyam 2. Procedure: Bilateral below knee amputation done under NB + LMA on 20.06.2021 Details: Under NB + LMA with TCQ, patient supine, both leg painted and draped. Right leg 10cm stump marked, tibia + fibula cut with gigley saw, all major vessels ligated. Haemostasis secured. Wound closed with drain, Similarly done on left leg. Page 5 of 7Patient Name :Mr. RAMAN K Admission No :1PB20217772 " Ir sf ‘Org.Name _: MEDI ASSIST cg POST PROCEDURE COURSE Mr. Raman K, 64 years male, was admitted with above mentioned complaints. Blood investigations were done showed low Hb. Diabetologist opinion was obtained for glycemic control and orders were followed. Cardiologist fitness was taken & Echo showed Normal LV size with good LV function, He underwent Bilateral lower limb angiograms + Mechanical thrombectomy under GA on 17,06.2021( Report enclosed), Procedure was uneventful. Angiographic findings, need for intra arterial thrombolysis, complications & high possibility, bad ‘outcome(limb loss) were explained to the patient attenders. He underwent Catheter directed intra arterial thrombolysis( Alteplase) under LA on 18.06.2021. Check angiogram revealed thrombus in bilateral SEA. left infrapopliteal arteries. He had performed Mechanical thrombectomy of residual femoral + Tibio peroneal thrombus under conscious sedation on 19.06.2021 3 of units PC, 2 units of PRBC, 3 units of FFP were transfused during hospital stay. Patient had developed left foot gangrene heel & right toe ischemic blebs present, hence Plastic surgeon opinion was obtained and he underwent Bilateral below knee amputation under NB + LMA on 20.06.2021 after getting anaesthetist fitness. He was shifted to CCU for observation and shifted back to ward. Patient developed urinary retention, hence Urologist opinion was obtained and managed accordingly. He was managed with IV fluids, IV antibiotics, PPIs, analgesics, antidiabetics, antiemetics and other supportive measures. He improved gradually, ambulating, no wound soakage and discharged with the following advice. DISCHARGE ADVISE - To continue regular medications - Inform FBS, PPBS after 3 days 'SNo [Medicine Name Morning | Afternoon | Evening | Night | Days. 1 [HUMAN ACTRAPID IND 10 5 8 7 JBEFORE FOOD / UNITS 2 [HUMAN INSULATARD IND 24 = 5 6 7 JBEFORE FOOD / UNITS 3 | TRAJENTA DUO 2.5/500 MG TAB 1 = 1 14 JAFTER FOOD. 4 [TOZAR OMG TAB 1 : 14 JAFTER FOOD, 5 [CILACAR 10NG TAB 1 - - 14 JAFTER FOOD, 6 |CLOPILET 75MG TAB = T : 4 JAFTER FOOD. 7 |PREGABA NT 75"G TAB - : 1 14 JAFTER FOOD, 8 [ULTRACET TAB - 10 1 sos 9 [DOL0 650mG TAB 1 T 1 3 JAFTER FOOD Page 6 of 7Patient Name :Mr. RAMAN K Admission No :1PB20217772 ‘Org.Name + MEDI ASSIST TO [BECOSULES CAP 7 JAFTER FOOD Ti [RAPILIF 8G TAB AFTER FOOD REVIEW After 1 week with Dr.B. Madan Mohan / Dr. Senthil Kumar / Dr. $. Arun RADIOL 7. : Dr. B. MADAN MOHAN Transcribed By + VENU MD, POC, FINR w~ Consultant Interventional Radiologist Reg Ne. : 84204 Page 7 of 7% ROYAL CARE Von ROYAL CARE SUPER SPECIALITY HOSPITAL LTD. 1/520, L&T Bypass Road, Neelambur, Sulur Taluk, Coimbatore - 641062 ‘making if etter ([ NAME: RAMAN, AGE/GENDER : 64 Vears/Mi REF BY: DR. B MADAN MOHAN IRN NO : 0198627 _ 1 ‘ADMISSION TYPE : OutPatient _ EXAM DATE: 01.06.2021 —— CT LOWER LIMB PERIPHERAL ANGIOGRAM Glinical History: Subacute limb ischemia, Findings: ‘Abdominal aorta — No significant stenosis/occlusion. No dissection/aneurysm. RIGHT: ‘Common iliac artery Normal External iliac artery Normal Internal iliac artery Normal Common femoral artery: Normal Deep femoral artery Normal Superficial femoral artery Long segment occlusion of mid and distal SFA for a length of about 23 cm Popliteal artery Normal Infrapopliteal arteries: - ATA - Occlusion of distal third of ATA and DPA. + TP trunk- normal. + PTA ~ Occlusion of distal PTA below the ankle joint, + Peroneal artery - normal LEFT: Common iliac artery Normal External iliac artery Normal Internal iliac artery Normal Common femoral artery Normal Deep femoral artery Normal Phone : 0422 2227000 Website : www.royalcarehospital.in > & ) st Q F ra 5 ns FA a = rs & = rn aROYAL CARE St ROYAL CARE SUPER SPECIALITY HOSPITAL LTD. 1/520, L&T Bypass Road, Neelambur, Sulur Taluk, Coimbatore - 641062 ing life better ( NAVE RAMAN K—— MN NO: 0188697 ‘AGE/GENDER : 64 Years/M ‘ADMISSION TYPE : OutPatient _]| REF BY DR. B MADAN MOHAN EXAM DATE :03.06.2021 : ‘Superficial femoral artery : Focal eccentric atheromatous plaque / thrombus in distal SFA causing 80% stenosis, Popliteal artery: Partial thrombus in P4 segment of popliteal artery for a length of 3.5cm causing maximum of 90% stenosis. Infrapopliteal arteries: - ATA - Occlusion of distal third of ATA and DPA. + TP trunk normal, - PTA - Occlusion of distal third of PTA below the ankle joint. ~ _ Peroneal artery - Severe stenosis and occlusion in mid third for § cm. Thorax screening : Multifocal peripheral predominant patchy areas of groundglass opacities and fibrosis in both lungs. IMPRESSION: RIGHT: Long segment mid and distal SFA + infra popliteal occlusions disease as described. LEFT: Short segment partial thrombus in popliteal artery + infra popliteal occlusions as described. To consider Possibility of thrombotic occlusion. CT-CHEST SCREENING: ‘Multifocal peripheral patchy areas of predominantly fibrosis and groundglass opacities in both lungs — LUkely resolving phase of COVID pneumonia, CORADS 5. CT severity score 6/25 (Mild). le Dr. P.Sampathkumar MD, DNB., POCC Consultant Radiologist ‘Report Approved Date & Time: 01. 21 16:51 Phone : 0422 - 2227000 Website : www.royalcarehospital.in DEPARTMENT OF RADIOLOGYROYAL CARE making life be Name :Mr.Raman Age:64 yrs / Male Date :17.06.2021 RCB:0198627 Ward :V-E Ref:Dr.K.Chockalingam Echocardiogram Report ro IMPRESSION Normal LV size with Good LV function No RWMA / Gr I LVDD / MR - Trace Sclerotic Aortic valve TR - Trace Max Gr:22mmHg. No PE/PAH/IVC - 1.4cm Aorta - Normal Dr. K. Chockalingam., MD., DM., (Cardio)., Consultant Interventional Cardiologist. ei ROYAL CARE SUPER SPECIALITY HOSPITAL LTD. Ne 1/520, L&T Bypass Road, Neelambur, Sulur Taluk, Coimbatore - 641062 Ph 0422 222 7000 372 F, Dr. Naniappa Road, Coimbatore - 641 O18. Ph 0422 - 400 1000, 22 33000 RCSSH and CNRT 20, KIN Medical Centre, Padanur Road, Coimbatore 64! I contact@royalcarehospitalin Web wwwroyalcarehosprtalin