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CSF shows normal signal intensity. cord shows normal morphology and signal. CV junction is normal. IMPRESSION - MR imaging features aree suggeastive of infective spondylitis with large pre vertebal abscess from c2 to d4 and mild epidural extension at c6 level. Etiology - likely tubercular his blood test report dated 06 apr was as under reports dtd 06 apr 2010 before AKT4 HAEMATOLOGY Haematology performed on Fully Automatic 5 part differential COULTER Haematology Analyzer Investigation Result Unit Reference Range Haemogram Haemoglobin. : 13.1 g/dl M : 13 - 18 g/dl F : 11.5 - 16.5 g/dl TLC . : 10,600 /c.mm. A : 4000 - 11000 /c.mm. DLC. Neutrophils : 68.4 % A : 50 - 80 % Lymphocytes : 22.1 % A : 25 - 50 % Monocytes : 7.6 % A : 2 - 10 % Eosinophils : 1.4 % A : < 6 % Basophils : 0.5 % A : < 2 % E.S.R. (Westregen\\\'s) : 110 mm/1st Hr F : < 20 mm/1st Hr M : < 15 mm/1st Hr R.B.C. Count. : 4.66 mil./cmm M : 4.5 - 6.5 mil./cmm F : 3.8 - 5.8 mil. /cmm Packed Cell Volume : 40.2 % M : 40 - 54 % F : 37 - 47 % Platelets Count. : 343 thousand/cmm A : 150 - 450 thousand/cmm M.C.V : 86 fl A : 76 - 96 fl M.C.H : 28.2 pg. A : 27 - 32 pg. M.C.H.C : 32.7 % A : 30 - 35 % RDW : 11.6 % A : 11.6 - 14 % Peripheral Blood Smear : RBCs are normocytic normochromic. No significant anisopoikilocytosis is seen. WBC series is normal in number & distribution. Platelets are adequate. No haemo-parasite is seen. No abnormal / immature cell is seen BIO-CHEMISTRY REPORT Biochemistry tests performed on Fully Automatic ROCHE COBAS 400 INTEGRA & HITACHI 902 / Semi Auto RA-50 / AVL 9180 / D-10 Investigation Result Unit Reference Range B. Glucose Fasting. : 78.69 mg/dl A : 70 - 110 mg/dl Liver Function Test S. Bilirubin (Total) : 0.32 mg/dL A : < 1 mg/dL --------------------------------------------------------------------------------------------------- S. Bilirubin (Conjugated) : 0.12 mg/dL A : < 0.6 mg/dL S. Bilirubin (Unconjugated) : 0.20 mg/dL A : 0.1 - 1 mg/dL S.G.O.T.(A.S.T) : 20.41 U/L S.G.P.T.(A.L.T ) : 48.57 U/L S. Alkaline Phosphatase : 74.77 U/L S. Protein. : 8.60 gm/dL A : 6.6 - 8.7 gm/dL S. Albumin : 4.01 gm/dL A : 3.5 - 5.2 gm/dL S. Globulin : 4.59 gm/dl A/G. Ratio : 0.87 : 1 HORMONES ANALYSIS REPORT HORMONE ANALYSIS DONE ON COBAS e411 ELECTRO CHEMILUMINESCENCE & ABBOTT AXSYM SYSTEMS Investigation Result Unit Reference Range S. TSH : 2.020 uIU/ml A : 0.27 - 4.2 uIU/ml BASED ON ABOVE INVESTIGATIONS and his continue temp (99 to 100) and neck pain doctor suggested that patient is suffering from pott spine( cervical spine) kindly suggest if it is 100% sure that my son is infected with pott spine or any other test is reqd to be done for confirmation i want to give treatment after only 100% confirmation of the disease and not in doubt pls how can it be confirmed Five doctors have suggested 5 types of treatment although all 5 diagnosed same disease sir, i m in total confusion kindly advice which medicine is the best in india for pott spine an advice from an expert doctor like u will be a real help to humankind may i request u to kindly atleast suggest me which option i opt for the treatment of TB starting from 06 apr 2010 he was on option 2 for one month and changed to option 5 from 05 may 2010, do he really need complete bed rest, what precautions he need to take, what sud he eat and wat not, any other care/advice pls option 1 AKT 4 1 kit in morning oflaxin 1 OD 400 mg tab liv 52 2tabs BD option 2 AKT 4 daily for 1 month tab pyridoxine 10 mg daily for 1 month philadiflion collar(MGRM) also complete bed rest was advised option 3 rest in bed for 22 hrs for 1 and half month tab Rcinex 300+600 mg daily in morning tab oflox 400 mg daily in morning shelcal-1 cobadex-1 ciplection 1 all above for 5 monthes somi brace to be worn by pateint option 4 DOTS option 5 Tab R-Cinex 300 mg + 600 mg – 1 OD – 2 months (before breakfast) Tan Ethambutol – 800mg – 1OD – 2 months (Afternoon ) Tab. Pyraziharide 750mg –1-0-1 - 2 months Tab. Pyridoxine 20mg – 1OD – 2 months Tab. Hifenac 100mg – 7-10 days – 1-0-1 Repeat ESR, LFT Phildelhia Cervical Collar reports dtd 28 apr 2010 after 3 weeks of treatment HAEMATOLOGY Haematology performed on Fully Automatic 5 part differential COULTER Haematology Analyzer Investigation Result Unit Reference Range Haemogram Haemoglobin. : 14.7 g/dl M : 13 - 18 g/dl F : 11.5 - 16.5 g/dl TLC . : 8,300 /c.mm. A : 4000 - 11000 /c.mm. Differential Leucocyte count Neutrophils : 57.7 % A : 50 - 80 % Lymphocytes : 31.7 % A : 25 - 50 % Monocytes : 7.0 % A : 2 - 10 % Eosinophils : 3.0 % A : < 6 % Basophils : 0.6 % A : < 2 % E.S.R. (Westregen\\\'s) : 45 mm/1st Hr RBC Count 5.29 Packed Cell Volume (Hematocrit) : 42.7 % Platelets Count. : 217 thousand/cmm A : 150 - 450 thousand/cmm M.C.V : 81 fl A : 76 - 96 fl M.C.H : 27.9 pg. A : 27 - 32 pg. M.C.H.C : 34.5 % A : 30 - 35 % RDW : 13.9 % A : 11.6 - 14 % Peripheral Blood Smear : RBCs are normocytic normochromic. No significant anisopoikilocytosis is seen. BIO-CHEMISTRY REPORT Biochemistry tests performed on Fully Automatic ROCHE COBAS 400 INTEGRA & HITACHI 902 / Semi Auto RA-50 / AVL 9180 / D-10 Investigation Result Unit Reference Range B. Glucose Fasting. : 75.46 mg/dl A : 70 - 110 mg/dl Liver Function Test S. Bilirubin (Total) : 0.22 mg/dL A : < 1 mg/dL S. Bilirubin (Conjugated) : 0.10 mg/dL A : < 0.6 mg/dL S. Bilirubin (Unconjugated) : 0.12 mg/dL A : 0.1 - 1 mg/dL S.G.O.T.(A.S.T) : 32.47 U/L M : < 40 U/L S.G.P.T.(A.L.T ) : 75.94 U/L M : < 41 U/L S. Alkaline Phosphatase : 72.14 U/L M : 40 - 129 U/L S. Protein. : 8.40 gm/dL A : 6.6 - 8.7 gm/dL S. Albumin : 4.74 gm/dL A : 3.5 - 5.2 gm/dL S. Globulin : 3.65 gm/dl A/G. Ratio : 1.30 : 1 Investigation Result S. TSH : 3.520 kindly give ur views 1.isnt sudden fall of ESR to 45 from 110 within three weeks is noticable? 2.or it may happen? 3.what is the relation of ESR to AKT4? 4.in the report before AKT4 started the Lymphocytes was 22.1(less) but in latest report it is 31.7(within limits). is improvement due to AKT4 medicine? 5.now SGPT(ALT) wl come down or it may rise further? 6.what are the future complications on the health of lever after the AKT 4 course is completed? 7.since akt4 was started, 10 ml (2 times a day)of liv 52 and Pyridoxine 10 mg a day is being given to him. do u suggest any change in it? 8.even than akt4 can effect the liver? 9.can we go for MRI in place of X Rays? 10.is MRI more harmful than X Ray? or X Ray is more harmful? 11.what is the periodicity we go for X Rays/MRI and ESR tests? his blood report dated 14/05/10 after 5 weeks of start of ATT is as under Haemoglobin. 14.1 g/dl TLC . 8,700 /c.mm. Differential Leucocyte count Neutrophils : 56.5 % A : 50 - 80 % Lymphocytes : 33.0 % A : 25 - 50 % Monocytes : 7.1 % A : 2 - 10 % Eosinophils : 2.9 % A : < 6 % Basophils : 0.5 % A : < 2 % E.S.R. (Westregen\\\'s) : 43 mm/1st Hr Liver Function Test S. Bilirubin (Total) : 0.20 mg/dL S. Bilirubin (Conjugated) : 0.09 mg/dL S. Bilirubin (Unconjugated) : 0.12 S.G.O.T.(A.S.T) : 17.55 U/L M : < 40 U/L F : < 32 U/L S.G.P.T.(A.L.T ) : 25.83 U/L M : < 41 U/L F : < 33 U/L S. Alkaline Phosphatase : 68.38 U/L M : 40 - 129 U/L F : 35 - 104 U/L S. Protein. : 8.20 gm/dL A : 6.6 - 8.7 gm/dL S. Albumin : 4.43 gm/dL A : 3.5 - 5.2 gm/dL S. Globulin : 3.77 gm/dl A/G. Ratio : 1.17 : 1 S. Creatinine. : 0.62 mg/dL M : 0.7 - 1.2 mg/dL F : 0.5 - 0.9 mg/dL S. Uric Acid. : 13.48 mg/dL M : 3.4 - 7 mg/dL F : 2.4 - 5.7 mg/dl wat are ur overall comments on the report? my querries are 1. there is no change on ESR from the earlier report i.e. it was 45 on 28 apr. is it that now medicine is not effective? 2. we have changed from akt4 on ur advice to Rcinex 600+300, pyrazinamide 1500mg, Ethambutol 800mg. as body wt of my son is 67 kg. 3. sud we revert back to akt4? 4. or there may be any other reason for no change in ESR value. 5. his SGOT(AST) is now down to 17.55 from 32.47. reason? 6. his SGOT(ALT) is now down to 25.83 from 75.94. reason? 7. is that now medicine is not effecting his lever? 8. or medicine is not at all effective? 9 S. Creatinine is 0.62. anything to worry? what are the effects of lower value? 10. S. Uric Acid is 13.48. anything to worry? what are the effects of higher value? 11. can thr be a chance to get \\\'gout\\\' due to high uric acid? 12. sud i discontinue taking pyrazinamide now? 13. sud i start taking the medicine advised by Dr SM Tuli(he is the best doctor for pott spine in india) that does not contain pyrazinamide and ethambutol which are responsible for raised uric acid? 14. how serious is raised uric acid? his earlier x-ray report dated 01/04/10 was straightening of spine is seen with loss of normal curvature suggestive of muscle spasm irregularity of articular surface of c5 seen prevertebral soft tissue thickening is seen cystic lesion seen anteriorly at body of c6 disc spaces are normal no cervical rib is seen now x-ray of spine lat view dated 14/05/10 is \\\"compared with previous film- soft tissue thickening appear more marked.\\\" pls advice has his condition is improved ? or otherwise thickening of soft tissue is good or not Please Login to Answer the Question LOGIN

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