Fw: Re: New guidelines case discussions

[Guest guest]

provisional diagnosis; chronic periodontitis, benign salivary gland neoplasm, tori, special investigation;

1. Full mouth perio charting.2. Biopsy of lesion on palate. 3. Vitality tests 31,32. 4 palpation of the lesion5 palpation of lymph nodes6palpation of facial symmetry7 body temperature8 mobility testFrom: doc_smriti <doc_smriti@...>Subject: Re: New guidelines case discussions Date: Wednesday, 15 February, 2012, 6:15 PM

Continuing with the case...

Which radiographic view(s) do you think are justified??

1. Do you think IOPA of 31,32 is justified?

My opinion- No. Both teeth are grade 3 mobile with poor prognosis. Highly unlikely that they can be saved. An IOPA will not add the diagnosis or treatment plan. (????? please add. I am not very sure)

2. DPT??

Yes. will serve 2 purposes- 1. generalised bone loss can be measured to aid in periodontal maintenance. 2. may give an idea of the palatal lesion(though not a good one, because palate falls outside its focal trough)

3. Maxillary Occlusal view??

yes. to see extent of lesion on palate/ signs of palatal perforation..

Other special investigations:

1. Full mouth perio charting.

2. Biopsy of lesion on palate.

3. Vitality tests 31,32.

??? what else??

> > >

> > > Hi,

> > > I am sure everyone preparing for part 2 must have gone thru the new guidelines for Dtp.. There are 5 major changes for which we need to practice..

> > > 1. Taking history with Note making.

> > > 2. Written provisional diagnosis.

> > > 3. Written justification of radiograph.

> > > 4. Written description of a radiograph.

> > > 5. Written treatment plan.

> > >

> > > Starting today, I will be posting a series of cases that we've all probably discussed before, but have not covered, these finer aspects, on which, we'll now be marked..

> > > So.. Lets start!

> > >

> > > Case 1. (ORE CASE JAN 2008)

> > > patient complains of loose lower anteriors,(assuming, due to lack of feedback- 31,32 grade 3 mobile, from last 1 year,BPE 222/342) and lump in palate (assuming from 1 year), incidental finding-multiple radiolucencies in mandible.

> > >

> > > I'll start with the history notes.. Please add or correct if required..

> > >

> > > Name: Kathy Brown

> > > DOB: 5th jan 1967

> > > Add: #XYZ Street, London

> > > Occ: Newsreader

> > > Marital status: Married, 2 children- living separately.

> > >

> > > C/o: Patient complains of 1. loose lower front teeth since 1 yr.

> > > 2. lump on roof of mouth - 1 yr

> > > HOPI: 1. noticed 1 yr bk, increase since last 4 mnths, no pain, sensitive to heat & cold +nt, no sour taste/smell or pus, bleeding on brushing +nt, no F/H of gum disease, no h/o trauma.

> > >

> > > 2. Lump on palate since 1 yr, no sudden increase, no pain, no ulceration/bleeding/discharge. hard, no colour change, no h/o of similar swelling mouth or elsewhere.

> > >

> > > PDH: irregular attender, brush 1/day, no m/w or floss, no dental t/t in past.

> > >

> > > PMH: h/o diabetes 5 yrs- metformin 500mg BD.

> > >

> > > SH: Smokes 10 cig/day last 10 yrs,

> > > Alc- 10 units/week- beer

> > > No Parafunct habit.

> > > Sugar/carb intake-low

> > > Fizzy/citrus intake- low

> > >

> > > Regards,

> > > Smriti

> > >

> > > P.S Please add to these notes if required and your opinion in general. Will continue with the provisional diagnosis in some time.. Please add new cases as well for discussion.. It might be a good idea to use the same subject or heading so that we can find them easily while revising..

> > >

> >

>

[Guest guest]

Thank you so much Veena for adding to the list. Good points..

>

> > > >

>

> > > > Hi,

>

> > > > I am sure everyone preparing for part 2 must have gone thru the new

guidelines for Dtp.. There are 5 major changes for which we need to practice..

>

> > > > 1. Taking history with Note making.

>

> > > > 2. Written provisional diagnosis.

>

> > > > 3. Written justification of radiograph.

>

> > > > 4. Written description of a radiograph.

>

> > > > 5. Written treatment plan.

>

> > > >

>

> > > > Starting today, I will be posting a series of cases that we've all

probably discussed before, but have not covered, these finer aspects, on which,

we'll now be marked..

>

> > > > So.. Lets start!

>

> > > >

>

> > > > Case 1. (ORE CASE JAN 2008)

>

> > > > patient complains of loose lower anteriors,(assuming, due to lack of

feedback- 31,32 grade 3 mobile, from last 1 year,BPE 222/342) and lump in palate

(assuming from 1 year), incidental finding-multiple radiolucencies in mandible.

>

> > > >

>

> > > > I'll start with the history notes.. Please add or correct if required..

>

> > > >

>

> > > > Name: Kathy Brown

>

> > > > DOB: 5th jan 1967

>

> > > > Add: #XYZ Street, London

>

> > > > Occ: Newsreader

>

> > > > Marital status: Married, 2 children- living separately.

>

> > > >

>

> > > > C/o: Patient complains of 1. loose lower front teeth since 1 yr.

>

> > > > 2. lump on roof of mouth - 1 yr

>

> > > > HOPI: 1. noticed 1 yr bk, increase since last 4 mnths, no pain,

sensitive to heat & cold +nt, no sour taste/smell or pus, bleeding on brushing

+nt, no F/H of gum disease, no h/o trauma.

>

> > > >

>

> > > > 2. Lump on palate since 1 yr, no sudden increase, no pain, no

ulceration/bleeding/discharge. hard, no colour change, no h/o of similar

swelling mouth or elsewhere.

>

> > > >

>

> > > > PDH: irregular attender, brush 1/day, no m/w or floss, no dental t/t in

past.

>

> > > >

>

> > > > PMH: h/o diabetes 5 yrs- metformin 500mg BD.

>

> > > >

>

> > > > SH: Smokes 10 cig/day last 10 yrs,

>

> > > > Alc- 10 units/week- beer

>

> > > > No Parafunct habit.

>

> > > > Sugar/carb intake-low

>

> > > > Fizzy/citrus intake- low

>

> > > >

>

> > > > Regards,

>

> > > > Smriti

>

> > > >

>

> > > > P.S Please add to these notes if required and your opinion in general.

Will continue with the provisional diagnosis in some time.. Please add new cases

as well for discussion.. It might be a good idea to use the same subject or

heading so that we can find them easily while revising..

>

> > > >

>

> > >

>

> >

>

[Guest guest]

HiI think here we are ignoring one important information about INCIDENTAL finding of multiple radiolucencies in the jaw. I dont know at what stage will this information be provided to us...( i mean before history taking or after )

Anyways if a patient has complaint of LOOSE TEETH we should ask questions to patient keeping all the possible causes of loose teeth in mind which can be1. periodontitis 2. root fracture (asking abt trauma)

 3. root resorption (trauma)4.pathology like cyst,tumor (swelling of jaw)5. displacing occlusal contact bruxism, nailbiting etc (parafunctional habits)so. in the above history taking kindly provided by Prateebha all the questions were beautifully covered except for swelling of jaw which might give a clue to rule out that possibility as well.

And i think vitality of teeth must always be included irrespective of mobility status as it can help in differential diagnosis. for example a cyst is usually associated with a vital tooth (except a residual cyst) but a tumor/carcinoma devitalises teeth. ( its just an example though not relevant to this case)

Please correct me if i am wrong.RegardsJasmineOn Wed, Feb 15, 2012 at 7:42 PM, doc_smriti <doc_smriti@...> wrote:

 

Thank you so much Veena for adding to the list. Good points..

>

> > > >

>

> > > > Hi,

>

> > > > I am sure everyone preparing for part 2 must have gone thru the new guidelines for Dtp.. There are 5 major changes for which we need to practice..

>

> > > > 1. Taking history with Note making.

>

> > > > 2. Written provisional diagnosis.

>

> > > > 3. Written justification of radiograph.

>

> > > > 4. Written description of a radiograph.

>

> > > > 5. Written treatment plan.

>

> > > >

>

> > > > Starting today, I will be posting a series of cases that we've all probably discussed before, but have not covered, these finer aspects, on which, we'll now be marked..

>

> > > > So.. Lets start!

>

> > > >

>

> > > > Case 1. (ORE CASE JAN 2008)

>

> > > > patient complains of loose lower anteriors,(assuming, due to lack of feedback- 31,32 grade 3 mobile, from last 1 year,BPE 222/342) and lump in palate (assuming from 1 year), incidental finding-multiple radiolucencies in mandible.

>

> > > >

>

> > > > I'll start with the history notes.. Please add or correct if required..

>

> > > >

>

> > > > Name: Kathy Brown

>

> > > > DOB: 5th jan 1967

>

> > > > Add: #XYZ Street, London

>

> > > > Occ: Newsreader

>

> > > > Marital status: Married, 2 children- living separately.

>

> > > >

>

> > > > C/o: Patient complains of 1. loose lower front teeth since 1 yr.

>

> > > > 2. lump on roof of mouth - 1 yr

>

> > > > HOPI: 1. noticed 1 yr bk, increase since last 4 mnths, no pain, sensitive to heat & cold +nt, no sour taste/smell or pus, bleeding on brushing +nt, no F/H of gum disease, no h/o trauma.

>

> > > >

>

> > > > 2. Lump on palate since 1 yr, no sudden increase, no pain, no ulceration/bleeding/discharge. hard, no colour change, no h/o of similar swelling mouth or elsewhere.

>

> > > >

>

> > > > PDH: irregular attender, brush 1/day, no m/w or floss, no dental t/t in past.

>

> > > >

>

> > > > PMH: h/o diabetes 5 yrs- metformin 500mg BD.

>

> > > >

>

> > > > SH: Smokes 10 cig/day last 10 yrs,

>

> > > > Alc- 10 units/week- beer

>

> > > > No Parafunct habit.

>

> > > > Sugar/carb intake-low

>

> > > > Fizzy/citrus intake- low

>

> > > >

>

> > > > Regards,

>

> > > > Smriti

>

> > > >

>

> > > > P.S Please add to these notes if required and your opinion in general. Will continue with the provisional diagnosis in some time.. Please add new cases as well for discussion.. It might be a good idea to use the same subject or heading so that we can find them easily while revising..

>

> > > >

>

> > >

>

> >

>

[Guest guest]

An excellent point jasmine, I think the incidental finding will be after

examining the DPT. which will be given to us after the provisional diagnosis. So

our final diagnosis and treatment plan will be based on the DPT finding.

Unfortunately that seems to leave no scope for further questioning because we

have to write the treatment plan before we can talk to the patient again..

Swelling of the jaw should definitely be covered in the history.. Thanks a lot

for adding that..

Regards,

Smriti

> > >

> > > > > >

> > >

> > > > > > Hi,

> > >

> > > > > > I am sure everyone preparing for part 2 must have gone thru the

> > new guidelines for Dtp.. There are 5 major changes for which we need to

> > practice..

> > >

> > > > > > 1. Taking history with Note making.

> > >

> > > > > > 2. Written provisional diagnosis.

> > >

> > > > > > 3. Written justification of radiograph.

> > >

> > > > > > 4. Written description of a radiograph.

> > >

> > > > > > 5. Written treatment plan.

> > >

> > > > > >

> > >

> > > > > > Starting today, I will be posting a series of cases that we've all

> > probably discussed before, but have not covered, these finer aspects, on

> > which, we'll now be marked..

> > >

> > > > > > So.. Lets start!

> > >

> > > > > >

> > >

> > > > > > Case 1. (ORE CASE JAN 2008)

> > >

> > > > > > patient complains of loose lower anteriors,(assuming, due to lack

> > of feedback- 31,32 grade 3 mobile, from last 1 year,BPE 222/342) and lump

> > in palate (assuming from 1 year), incidental finding-multiple

> > radiolucencies in mandible.

> > >

> > > > > >

> > >

> > > > > > I'll start with the history notes.. Please add or correct if

> > required..

> > >

> > > > > >

> > >

> > > > > > Name: Kathy Brown

> > >

> > > > > > DOB: 5th jan 1967

> > >

> > > > > > Add: #XYZ Street, London

> > >

> > > > > > Occ: Newsreader

> > >

> > > > > > Marital status: Married, 2 children- living separately.

> > >

> > > > > >

> > >

> > > > > > C/o: Patient complains of 1. loose lower front teeth since 1 yr.

> > >

> > > > > > 2. lump on roof of mouth - 1 yr

> > >

> > > > > > HOPI: 1. noticed 1 yr bk, increase since last 4 mnths, no pain,

> > sensitive to heat & cold +nt, no sour taste/smell or pus, bleeding on

> > brushing +nt, no F/H of gum disease, no h/o trauma.

> > >

> > > > > >

> > >

> > > > > > 2. Lump on palate since 1 yr, no sudden increase, no pain, no

> > ulceration/bleeding/discharge. hard, no colour change, no h/o of similar

> > swelling mouth or elsewhere.

> > >

> > > > > >

> > >

> > > > > > PDH: irregular attender, brush 1/day, no m/w or floss, no dental

> > t/t in past.

> > >

> > > > > >

> > >

> > > > > > PMH: h/o diabetes 5 yrs- metformin 500mg BD.

> > >

> > > > > >

> > >

> > > > > > SH: Smokes 10 cig/day last 10 yrs,

> > >

> > > > > > Alc- 10 units/week- beer

> > >

> > > > > > No Parafunct habit.

> > >

> > > > > > Sugar/carb intake-low

> > >

> > > > > > Fizzy/citrus intake- low

> > >

> > > > > >

> > >

> > > > > > Regards,

> > >

> > > > > > Smriti

> > >

> > > > > >

> > >

> > > > > > P.S Please add to these notes if required and your opinion in

> > general. Will continue with the provisional diagnosis in some time.. Please

> > add new cases as well for discussion.. It might be a good idea to use the

> > same subject or heading so that we can find them easily while revising..

> > >

> > > > > >

> > >

> > > > >

> > >

> > > >

> > >

> >

> >

> >

>

[Guest guest]

Thanks for the case below. In special investigation u should write things that

we can do it e.g vitality test, x-ray, mobility test. but if biopsy needed,

blood test [in case of ulcer, sjorgens syndrome], we should ask for it when

writing DTP telling the patient reasons for referral as we r dental

practitioners. That what i think,,

Ammar

> > > >

> > > > > > >

> > > >

> > > > > > > Hi,

> > > >

> > > > > > > I am sure everyone preparing for part 2 must have gone thru the

> > > new guidelines for Dtp.. There are 5 major changes for which we need to

> > > practice..

> > > >

> > > > > > > 1. Taking history with Note making.

> > > >

> > > > > > > 2. Written provisional diagnosis.

> > > >

> > > > > > > 3. Written justification of radiograph.

> > > >

> > > > > > > 4. Written description of a radiograph.

> > > >

> > > > > > > 5. Written treatment plan.

> > > >

> > > > > > >

> > > >

> > > > > > > Starting today, I will be posting a series of cases that we've all

> > > probably discussed before, but have not covered, these finer aspects, on

> > > which, we'll now be marked..

> > > >

> > > > > > > So.. Lets start!

> > > >

> > > > > > >

> > > >

> > > > > > > Case 1. (ORE CASE JAN 2008)

> > > >

> > > > > > > patient complains of loose lower anteriors,(assuming, due to lack

> > > of feedback- 31,32 grade 3 mobile, from last 1 year,BPE 222/342) and lump

> > > in palate (assuming from 1 year), incidental finding-multiple

> > > radiolucencies in mandible.

> > > >

> > > > > > >

> > > >

> > > > > > > I'll start with the history notes.. Please add or correct if

> > > required..

> > > >

> > > > > > >

> > > >

> > > > > > > Name: Kathy Brown

> > > >

> > > > > > > DOB: 5th jan 1967

> > > >

> > > > > > > Add: #XYZ Street, London

> > > >

> > > > > > > Occ: Newsreader

> > > >

> > > > > > > Marital status: Married, 2 children- living separately.

> > > >

> > > > > > >

> > > >

> > > > > > > C/o: Patient complains of 1. loose lower front teeth since 1 yr.

> > > >

> > > > > > > 2. lump on roof of mouth - 1 yr

> > > >

> > > > > > > HOPI: 1. noticed 1 yr bk, increase since last 4 mnths, no pain,

> > > sensitive to heat & cold +nt, no sour taste/smell or pus, bleeding on

> > > brushing +nt, no F/H of gum disease, no h/o trauma.

> > > >

> > > > > > >

> > > >

> > > > > > > 2. Lump on palate since 1 yr, no sudden increase, no pain, no

> > > ulceration/bleeding/discharge. hard, no colour change, no h/o of similar

> > > swelling mouth or elsewhere.

> > > >

> > > > > > >

> > > >

> > > > > > > PDH: irregular attender, brush 1/day, no m/w or floss, no dental

> > > t/t in past.

> > > >

> > > > > > >

> > > >

> > > > > > > PMH: h/o diabetes 5 yrs- metformin 500mg BD.

> > > >

> > > > > > >

> > > >

> > > > > > > SH: Smokes 10 cig/day last 10 yrs,

> > > >

> > > > > > > Alc- 10 units/week- beer

> > > >

> > > > > > > No Parafunct habit.

> > > >

> > > > > > > Sugar/carb intake-low

> > > >

> > > > > > > Fizzy/citrus intake- low

> > > >

> > > > > > >

> > > >

> > > > > > > Regards,

> > > >

> > > > > > > Smriti

> > > >

> > > > > > >

> > > >

> > > > > > > P.S Please add to these notes if required and your opinion in

> > > general. Will continue with the provisional diagnosis in some time..

Please

> > > add new cases as well for discussion.. It might be a good idea to use the

> > > same subject or heading so that we can find them easily while revising..

> > > >

> > > > > > >

> > > >

> > > > > >

> > > >

> > > > >

> > > >

> > >

> > >

> > >

> >

>

[Guest guest]

SORRY I DID SOME MISTAKE IN THE REPLY BEFOR.. I HAVE CORRECTED IT NW.i think for this case under special investigations we will just ask for maxillary acclusal view or oblique occlusal view to see extent of lesion in palate or any perforation in palate.. thats it and refer in treatment plan accordingly.. we dont have to talk about biopsy coz we cant read it specialist will do that.. if it seems to be related to teeth in adjacent quardrant from history like pain

or any other symptoms like he had some pain in the past but no pain now.. thaen only we can think about PA to rule out dental cause.. otherwise its not reconmmended to take too many xrays in guidelines.. just only need what is required..I could be wrong in my explaination.. PLEASE DO CORRECT ME.THANX From: Ikbal al-saffar <alsaffarikbal@...> " " < > Sent: Thursday, 16 February 2012 5:48 PM Subject: Re:

Re: New guidelines case discussions

you are welcome.i just have a question befor we get carried away with all these x-rays ...are we as GDPs allowed to take all these xray views or just PA and maybe occlusal and as soon as we see it is not dental abscess (ie cyst or tumor or...)we refer for the specialist to decide what view to take ?mnay thanks From: jasmine chopra <contactjasmine288@...> To:

Sent: Thursday, February 16, 2012 5:27 PM Subject: Re: Re: New guidelines case discussions

THANKS IQBAL AND RADHIKA FOR YOUR HELP.REGARDSJASMINEOn Thu, Feb 16, 2012 at 5:20 PM, doc_smriti <doc_smriti@...> wrote:

Thank you very much Ikbal for the link and Radhika for the x-ray prescription.. Will try to write the treatment planning notes tmrw.. Any links or examples would be extremely helpful..

Kind Regards,

Smriti

> > > > >

> > > > > Hi,

> > > > > I am sure everyone preparing for part 2 must have gone thru the new guidelines for Dtp.. There are 5 major changes for which we need to practice..

> > > > > 1. Taking history with Note making.

> > > > > 2. Written provisional diagnosis.

> > > > > 3. Written justification of radiograph.

> > > > > 4. Written description of a radiograph.

> > > > > 5. Written treatment plan.

> > > > >

> > > > > Starting today, I will be posting a series of cases that we've all probably discussed before, but have not covered, these finer aspects, on which, we'll now be marked..

> > > > > So.. Lets start!

> > > > >

> > > > > Case 1. (ORE CASE JAN 2008)

> > > > > patient complains of loose lower anteriors,(assuming, due to lack of feedback- 31,32 grade 3 mobile, from last 1 year,BPE 222/342) and lump in palate (assuming from 1 year), incidental finding-multiple radiolucencies in mandible.

> > > > >

> > > > > I'll start with the history notes.. Please add or correct if required..

> > > > >

> > > > > Name: Kathy Brown

> > > > > DOB: 5th jan 1967

> > > > > Add: #XYZ Street, London

> > > > > Occ: Newsreader

> > > > > Marital status: Married, 2 children- living separately.

> > > > >

> > > > > C/o: Patient complains of 1. loose lower front teeth since 1 yr.

> > > > > 2. lump on roof of mouth - 1 yr

> > > > > HOPI: 1. noticed 1 yr bk, increase since last 4 mnths, no pain, sensitive to heat & cold +nt, no sour taste/smell or pus, bleeding on brushing +nt, no F/H of gum disease, no h/o trauma.

> > > > >

> > > > > 2. Lump on palate since 1 yr, no sudden increase, no pain, no ulceration/bleeding/discharge. hard, no colour change, no h/o of similar swelling mouth or elsewhere.

> > > > >

> > > > > PDH: irregular attender, brush 1/day, no m/w or floss, no dental t/t in past.

> > > > >

> > > > > PMH: h/o diabetes 5 yrs- metformin 500mg BD.

> > > > >

> > > > > SH: Smokes 10 cig/day last 10 yrs,

> > > > > Alc- 10 units/week- beer

> > > > > No Parafunct habit.

> > > > > Sugar/carb intake-low

> > > > > Fizzy/citrus intake- low

> > > > >

> > > > > Regards,

> > > > > Smriti

> > > > >

> > > > > P.S Please add to these notes if required and your opinion in general. Will continue with the provisional diagnosis in some time.. Please add new cases as well for discussion.. It might be a good idea to use the same subject or heading so that we can find them easily while revising..

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Good point actually. Will we ask for biopsy or will we refer to specialist who

will therefore decide biopsy / extra xrays etc. cuz if we remember from the old

system according to the RCS course we would've failed if we started talking

about stuff like that

Ahmed

> >> > > > >

> >> > > > > Hi,

> >> > > > > I am sure everyone preparing for part 2 must have gone thru the new

guidelines for Dtp.. There are 5 major changes for which we need to practice..

> >> > > > > 1. Taking history with Note making.

> >> > > > > 2. Written provisional diagnosis.

> >> > > > > 3. Written justification of radiograph.

> >> > > > > 4. Written description of a radiograph.

> >> > > > > 5. Written treatment plan.

> >> > > > >

> >> > > > > Starting today, I will be posting a series of cases that we've all

probably discussed before, but have not covered, these finer aspects, on which,

we'll now be marked..

> >> > > > > So.. Lets start!

> >> > > > >

> >> > > > > Case 1. (ORE CASE JAN 2008)

> >> > > > > patient complains of loose lower anteriors,(assuming, due to lack

of feedback- 31,32 grade 3 mobile, from last 1 year,BPE 222/342) and lump in

palate (assuming from 1 year), incidental finding-multiple radiolucencies in

mandible.

> >> > > > >

> >> > > > > I'll start with the history notes.. Please add or correct if

required..

> >> > > > >

> >> > > > > Name: Kathy Brown

> >> > > > > DOB: 5th jan 1967

> >> > > > > Add: #XYZ Street, London

> >> > > > > Occ: Newsreader

> >> > > > > Marital status: Married, 2 children- living separately.

> >> > > > >

> >> > > > > C/o: Patient complains of 1. loose lower front teeth since 1 yr.

> >> > > > > 2. lump on roof of mouth - 1 yr

> >> > > > > HOPI: 1. noticed 1 yr bk, increase since last 4 mnths, no pain,

sensitive to heat & cold +nt, no sour taste/smell or pus, bleeding on brushing

+nt, no F/H of gum disease, no h/o trauma.

> >> > > > >

> >> > > > > 2. Lump on palate since 1 yr, no sudden increase, no pain, no

ulceration/bleeding/discharge. hard, no colour change, no h/o of similar

swelling mouth or elsewhere.

> >> > > > >

> >> > > > > PDH: irregular attender, brush 1/day, no m/w or floss, no dental

t/t in past.

> >> > > > >

> >> > > > > PMH: h/o diabetes 5 yrs- metformin 500mg BD.

> >> > > > >

> >> > > > > SH: Smokes 10 cig/day last 10 yrs,

> >> > > > > Alc- 10 units/week- beer

> >> > > > > No Parafunct habit.

> >> > > > > Sugar/carb intake-low

> >> > > > > Fizzy/citrus intake- low

> >> > > > >

> >> > > > > Regards,

> >> > > > > Smriti

> >> > > > >

> >> > > > > P.S Please add to these notes if required and your opinion in

general. Will continue with the provisional diagnosis in some time.. Please add

new cases as well for discussion.. It might be a good idea to use the same

subject or heading so that we can find them easily while revising..

> >> > > > >

> >> > > >

> >> > >

> >> >

> >>

> >

> >

>