LONG CASE

FAMILY HEALTH STUDY

Ram Bhushan Das

MBBS-7th Semester
NoMCTH (Biratnagar)
 FAMILY RECORD
• Name (HOF): Dinesh Chaudhary
• Age: 56 Year
• Sex: Male
• Religion: Hindu
• Occupation: Shopkeeper
• Address: Kharji, Biratnagar, Morang
• Family Type: Nuclear
 Composition of Family
S.N. NAME AGE SEX EDUCATION OCCUPATION MARITAL RELATION
(In STATUS With
years) HOF

1. Mr. Dinesh 50 male SLC Shopkeeper Married HOF

Chaudhary

2. Mrs. Ranjan 47 female SLC Housewife Married Wife

Chaudhary

3. Mr. Rajesh 26 male Under- Civil Engineer Unmarried Son

Chaudhary Graduate

4. Miss. Manjila 21 female Inter- Student Unmarried Daughter

Chaudhary mediate (+2)
 FAMILY TREE
• Female
• Male
• Marriage
• Sibling
 HEALTH PROBLEMS IN FAMILY
• Mr. Dinesh Chaudhary suffers from
Diabetes Mellitus
• Other members are apparently healthy.
Immunization Status Of Family
• Immunization status of Mr and Mrs
Chaudhary :- unknown
• Their son and daughter are fully
vaccinated and has immunization card .
 SANITARY ASSESSMENT OF HOUSE AND
ENVIRONMENT
SANITATION
• Source of drinking water :- Piped water (tube wells)
• Storage of water :- Fills bottles or jug directly from faucet.
• Exposure to contamination of stored water :- No
• Bathroom :- Present and Drained
• Latrine :- Present and Used
• Type of latrine :- Water Seal
• Methods of refuse disposal :- Controlled Tipping
• Preventive method observed : Use of mosquito net,
phenyl
HOUSING
• Type of house :- Detached house
• Roofing :- Terrace
• Walls :- 10 inch Burnt Brick
• Flooring :- Cemented
• Lighting :- Adequate
• Ventilation :- Adequate
• cross ventilation: Inadequate
• Electricity :-Present
• Courtyard :- Present
• Kitchen :- Satisfactory
Housing continued….
• No. of rooms:-3 Living room, 1 Hall and 1 kitchen
• Storage of food article:-Metal container
• Total Floor area of living room :-100 sq.ft.× 3
• Total no. of occupants in house:-4
• Floor area per person:-75 sq.ft.
• Overcrowding :-Absent
• Dampness :-Absent
• House flooded during rain:-No
• Potential mosquito breeding areas :-Present
SOCIO-ECONOMIC STATUS
• Maternal and child health practices :
good
• Maintenance of personal hygiene : very
well
• Socioeconomic status of family: upper-
middle class (kuppuswamy scale)
• Monthly income – NRs. 35,000
• Total income and expenditure balanced
• Economic condition : moderate
 INDEX CASE
Chief complaints/HOPI
 Chronic Fatigue and malaise
 ↑urination(Polyuria), ↑thirst(Polydypsia), ↑appetite(polyphagia)
 Tingling sensation and numbness in extremities
 Blurring of vision
 Family H/O: father was diabetic
Clinical Examination
 General Examination
• Ill looking, obese (BMI-25) but Orientated to time, place and person
• No Pallor, Icterus, Cyanosis, Clubbing, Lymph Node enlargement and Dehydration
• pitting Edema present in face > both ankles
 Vitals
B.P. – 125/85 mm Hg
Pulse – 80 BPM
R.R. – 16 breathes/min.
Temp. - 37°C
Provisional diagnosis: diabetes mellitus
INVESTIGATIONS:
A. Blood glucose and glycated Hb
1. Fasting plasma glucose ≥ 126 mg/dl OR,
2. 2-hour plasma glucose ≥200mg/dl following OGTT (intake
of 75 anhydrous glucose) OR,
3. Random plasma glucose ≥200mg/dl + classic symptoms
of DM OR,
4. HbA1c ≥ 6.5%
Note – A/C to WHO repeat the test to confirm for
asymptomatic patients and never use capillary blood for
Diagnosis of DM.
B. Urine glucose and urine protein
1. Urine glucose 1-2 hour following meal to ↑sensitivity
2. 24-hour Albumin ≥ 300mg/L in urine , ketone
bodies absent.
C. c-peptide and Islets autoantibodies -Normal (rules out
Type1 DM)
D. ECG and Chest-X ray – Normal
E. GI endoscopy-no abnoramlities
F.LIPID PROFILE
 Final Diagnosis – Type 2 Diabetes Mellitus
MANAGEMENT
A. Non-pharmacological-Life style/diet modification
B. Pharmacological-
1. Oral Hypoglycemic Agents –
• DOC/First line drug – metformin
• 2nd line drug selected based on efficacy,
hypoglycemic risk,wt.effects,and other side effects
efficacy Hypoglycemic Weight Other Side costs
risk effects effects

Sulphonylurea High Moderate Gain Hypoglycemia Low

(Tolbutamide,…, )

Thiazolidinedione High Low Gain Edema Low

(pioglitazone,..)

DPP-4 inhibitor Moderate Low Neutral Rare High

(sitagliptin,…)

SGLT2 inhibitor Moderate Low Loss Dehydration High

(dapagliflogin,…)

GLP-1 agonist High Low Loss GI distress High

(exenatide,..)

Insulin(Basal) Highest High Gain Hypoglycemia Variable

 2. Treatment of HTN,Obesity,dyslipidemia CHD
if present
3. treatments of edema , muscle pain, and
infections e.g. skin lesions, and UTI care of feet .
PREVENTION and CONTROL
• Primary prevention –population strategy (diets,
exercise ) and high risk strategy ( avoid alcohol,
smoking, control cholesterol)
• Secondary prevention –early Dx and Tx
• Tertiary prevention –limitation of disabilities
e. g. blindness, renal failure,diabetic foot,CHD etc.
by organising diabetic clinics and diagnostic centre.
THANK YOU