Medanta
Patient ID : ML10218914 Patient Name : Ms. Aayushi Swaroop
Gender : Female Age : 31Y
Encounter ID : 21326638 Encounter Type : Inpatient
Admission Date : 12/01/2024 12:22 Location : 1st floor Chemotherapy Day Care
Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Alok Gupta & Team
Discharge Date : 12/01/2024 17:29
Discharge summary
Diagnosis: Carcinoma Right Breast - TNBC
Stage : T2N1
Treatment given: Cycle 9 Chemotherapy with ALTAXEL
Follow up : Review in OPD with Dr. Alok Gupta on 19.01.2024
for Cycle 10 Chemotherapy with ALTAXEL with CBC+diff report
Current Treatment Plan: NACT (4cycles Dose dense AC
followed by 12T -> Surgery - BCS+AC -> RT)
Height - 164 cm Weight- 60 kgs Body Surface
Area -1.67 /m2
UHID No: ML10218914
Date Of Discharge: 12.01.2024
BRIEF HISTORY: Patient is diagnosed case of Carcinoma Right Breast - TNBC - T2N1. She was evaluated for Right
Breast lump. T2 lesion on Sono-mammography. Trucut biopsy right breast lump showed Invasive breast carcinoma,
NST. Grade 3. FDG PET CT scan - Right Breast lump, Right axillary, Bilateral neck and Mediastinal nodes. Marker
placement and Chemo-port insertion done on 29.08.2023. Left SCLN - Granulomatous inflammation, Gene expert
positive. Now patient is planned for NACT (4cycles Dose dense AC followed by 12T -> Surgery - BCS+AC -> RT).
PAST MEDICAL HISTORY: Not known.
PAST SURGICAL HISTORY: Not known.
ALLERGIES HISTORY: Not known.
INVESTIGATIONS:
FNAC from right breast lump (31.07.2023) : Proliferative breast disease with Atypia.
USG Both Breast (21/08/2023): Left breast shows homogeneous parenchyma. No cyst / mass / ductal dilatation
noted. Both axilla show subcentimeter enlarged axillary lymphnodes with echogenic hilum, largest measuring approx.
4.8 mm on right side and 3.2 mm on the left side in short axis---suggestive of bilateral reactive axillary
lymphadenopathy.
Trucut biopsy right breast lump (22.08.2023): Invasive breast carcinoma, NST. Grade 3
IMMUNOHISTOCHEMISTRY:
Estrogen Receptor (ER) Status (Clone EP1, Dako): Negative
Progesterone Receptor (PR) Status (Clone PgR636, Dako): Negative
Her2neu (Clone RBT-Her-2, BIOSB) : Negative (Score 0)
Ki67 (Clone MIB-1, Dako): ~ 60 %
PET CT (31.08.2023): FDG avid ill-defined soft tissue density lesion involving upper outer quadrant of right breast
Authorized by Dr Rahul Kumar Sinha on 13 Jan 2024 09:23 This is a computer generated report. Signature is not required.
Regd. Of f ice: Medanta Holdings Private Limited, E-18 Def ence colony , New Delhi, 110024 , India. T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 hot-line: +91(522)4 505050 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U74 14 0DL2013PT C250579
Medanta
Patient ID : ML10218914 Patient Name : Ms. Aayushi Swaroop
Gender : Female Age : 31Y
Encounter ID : 21326638 Encounter Type : Inpatient
Admission Date : 12/01/2024 12:22 Location : 1st floor Chemotherapy Day Care
Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Alok Gupta & Team
Discharge Date : 12/01/2024 17:29
parenchyma (approximately 11 o clock in position, measuring 2.3 x 2.1 x 2.4 cm, SUVmax 10.89) - primary neoplastic
disease. FDG avid enlarged cervical, left axillary and mediastinal lymph nodes - more likely infective/inflammatory than
malignancy. FDG avid tree in bud opacities are seen in the left lung, lingual lobe - infective
USG guided Trucut biopsy from left supraclavicular node (05.09.2023) : Granulomatous Lymphadenitis.
2 D Echo (16.09.2023): No left ventricular regional wall motion abnormality; LVEF= 60%. Normal right ventricular
systolic function. Cardiac chamber dimensions normal. No MR, No TR, No AR, No AS (aortic velocity = 1.15
m/sec).Mitral inflow pattern-normal. No apparent intracardiac clot / vegetation / pericardial effusion seen. IVC normal in
size.
HOSPITAL COURSE: Patient was admitted for Cycle 9 Chemotherapy with ALTAXEL with which was given as follows.
PREMEDICATION :
CAP. AMITANT 125 MG PO STAT
INJ. PANTOP 40 MG IV STAT
INJ.EMESET 8 MG + INJ.AVIL 45.5 MG +INJ. DEXA 8 MG IN 100 ML NS IV OVER 30 MINS
CHEMOTHERAPY :
INJ.ALTAXEL 130 MG IN 500 ML NS IV OVER 60 MINS VIA MIRA FILTER IN NON PVC BAG
IV FLUSH WITH 100 ML NS
Patient and relatives have been counselled about the nature of disease, intent of treatment, the purpose of treatment
is to possibly control the disease, decrease chances of recurrence, decrease the symptoms and possibly extend life.
Patient tolerated treatment well and is being discharged in stable condition with following advise.
DISCHARGE MEDICATIONS:
Capsule AMITANT 80 mg on D2 (13.01.2024) & D3 (14.01.2024) before breakfast
Capsule PANTOP DSR 1 cap once daily before breakfast for 2 weeks
Capsule IROMASTT 1 cap once daily for 1 month
Tablet UDF 300 mg thrice daily for 1 month
Tablet SUMO 1 tab once daily for 5 days after food.
Tablet DOM DT 1 tab twice daily for 5 days then as and when required for nausea & vomiting
Tablet BITA C 1 tablet once daily for 2 weeks
Tablet CURCUMASTT 1 tablet once daily for 2 weeks
Capsule MASTTREE GOLD 1 cap once daily for 2 weeks
Syrup LACTIF 10 ml at bedtime for constipation (Stop in case of loose stools)
PRO-FIT 3 scoops with milk three times a day
CLODEXA B Mouthwash 5 ml + 20 ml of water for gargle thrice daily
Softovac powder 3 spoon with water twice daily
LOX jelly and Diltigesic ointment for peri-anal application.
Tablet RB-MOL 650 mg 1 tablet as and when required for pain / fever
Tablet MASCOFEN 1 tab as and when required for pain
Capsule IMODIUM as and when required for loose stools
Volini gel for local application.
To continue medication advised by Dr Jugendra Singh
Authorized by Dr Rahul Kumar Sinha on 13 Jan 2024 09:23 This is a computer generated report. Signature is not required.
Regd. Of f ice: Medanta Holdings Private Limited, E-18 Def ence colony , New Delhi, 110024 , India. T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 hot-line: +91(522)4 505050 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U74 14 0DL2013PT C250579
Medanta
Patient ID : ML10218914 Patient Name : Ms. Aayushi Swaroop
Gender : Female Age : 31Y
Encounter ID : 21326638 Encounter Type : Inpatient
Admission Date : 12/01/2024 12:22 Location : 1st floor Chemotherapy Day Care
Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Alok Gupta & Team
Discharge Date : 12/01/2024 17:29
DIET : Only freshly cooked food and boiled water.
Avoid raw foods.
Strict hand hygiene and personal measures.
PRECAUTIONS : Avoid crowded areas.
NOT TO CONSUME ALCOHOL, SMOKING & TOBACCO.
FOLLOWING MEDICATION TO BE TAKEN AS AND WHEN REQUIRED AFTER CONSULTING DOCTOR ON CALL
(No : 9559050013):-
In case of vomiting:
1) Tablet EMESET 8 mg STAT followed by thrice daily
2) Tablet PERINORM 10 mg STAT followed by thrice daily
3) Tablet STEMETIL MD 5 mg STAT followed by twice daily
4) Tablet DOM DT 10 mg STAT followed by thrice daily
5) Tablet DEXONA 4 mg STAT followed by once daily for 3 days
6) In case of repeated vomiting nil per mouth for 1-2 hours until vomiting stop.
In case of fever (If temperature > 100.4 F --> To do CBC and blood culture & Urine culture):
1) Tablet RB-MOL 650 mg STAT followed by thrice daily
2) Tablet AUGMENTIN DUO 625 mg thrice daily for 5 days
3) Tablet CEFTUM 500 mg twice daily for 5 days
4) Tablet LEVOFLOX 500 mg once daily for 5 days
In case of loose motions :
1). Capsule IMMODIUM / Tablet LOMOTIL 4 mg STAT followed by 2 mg every 6 hourly
2). Capsule REDOTIL 100 mg thrice daily
3). Tablet NORFLOX TZ 1 tab twice daily for 5 days
4). Tablet RIFAGUT 400 mg thrice daily for 5 days
5). Plenty of fluids ~ 3 - 4 liter / day
6). O.R.S. / Electral powder 1 sachet dissolved in 1 liter of water.
In case of constipation (To stop below medication in case of loose stools) :
1) Syrup LACTIF 20 ml STAT at bedtime followed by 2 to 3 times a day
2) Tablet DULCOLAX 2 tab at bedtime
3) Sachet MOVICOL 1 sachet in 500 ml of water at bedtime
4) SOFTOVAC POWDER 2 teaspoon twice daily with water in case of constipation
In case of oral ulcer :
1) To crush & mix tab DEXA 4 mg + 1 tab Metrogyl 400 mg + Candid mouth paint 5 drops in 5 ml Boroglycerin and to
apply orally on mouth ulcers after meals, 3 times per day (To apply for 15 minutes then spit out).
2) OINTMENT MUCOPAIN to apply locally on oral ulcers
Authorized by Dr Rahul Kumar Sinha on 13 Jan 2024 09:23 This is a computer generated report. Signature is not required.
Regd. Of f ice: Medanta Holdings Private Limited, E-18 Def ence colony , New Delhi, 110024 , India. T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 hot-line: +91(522)4 505050 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U74 14 0DL2013PT C250579
Medanta
Patient ID : ML10218914 Patient Name : Ms. Aayushi Swaroop
Gender : Female Age : 31Y
Encounter ID : 21326638 Encounter Type : Inpatient
Admission Date : 12/01/2024 12:22 Location : 1st floor Chemotherapy Day Care
Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Alok Gupta & Team
Discharge Date : 12/01/2024 17:29
3) CLODEXA / BETADINE Mouthwash 5 ml + 20 ml of water for gargle thrice daily
In case of pain :
1) Tablet RB-MOL 650 mg thrice daily
2) Tablet ULTRACET 1 tab 3 to 4 times a day
3) Tablet NAPROXEN 250 mg twice daily
4) Tablet VOVERAN 50 / 75 twice daily
5) Capsule TRAMADOL 100 mg 2 to 3 times a day
6) Capsule CELECOXIB 200 mg twice daily
In case of allergy (rash / itching) :
1) Tablet ALLEGRA 180 mg STAT then at bedtime for 5 days
2) Tablet WYSOLONE 10 mg twice daily after meals for 5 days then stop
3) BETNOVATE ointment to apply locally on rash 3 to 4 times a day
WHEN TO OBTAIN URGENT CARE:
Kindly review in OPD / Emergency in case of any problem like:-
1. Fever
2. Loose stools/motions/vomiting or passing black stools like coal tar.
3. Bleeding from any site
4. Chest pain, breathing difficulty, profuse sweating, giddiness, pain in abdomen.
5. Reduced urine output.
6. Severe weakness/severe mouth ulcers.
7. Rash over skin, swelling over body.
Contact No. for General Enquiries and Appointments - 9559050018
Contact for MEDICAL EMERGENCIES
1. Medical Oncology Duty Doctor Contact : 9559050013
2. Medanta Lucknow Emergency Duty Doctor Contact - 7428581521
For Ambulance Call and for any other medical problem for which you think urgent attention is required report to
emergency at Medanta Lucknow at the earliest possible. (7428581521 / 0522-4505050).
DR. ALOK GUPTA
DM (MEDICAL ONCOLOGY)
TATA MEMORIAL HOSPITAL, MUMBAI
DIRECTOR
MEDANTA - LUCKNOW
DR. OM PRAKASH SINGH DR. RAHUL KUMAR SINHA DR. SAGAR VERMA DR. AMIT KUMAR
Authorized by Dr Rahul Kumar Sinha on 13 Jan 2024 09:23 This is a computer generated report. Signature is not required.
Regd. Of f ice: Medanta Holdings Private Limited, E-18 Def ence colony , New Delhi, 110024 , India. T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 hot-line: +91(522)4 505050 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U74 14 0DL2013PT C250579
Medanta
Patient ID : ML10218914 Patient Name : Ms. Aayushi Swaroop
Gender : Female Age : 31Y
Encounter ID : 21326638 Encounter Type : Inpatient
Admission Date : 12/01/2024 12:22 Location : 1st floor Chemotherapy Day Care
Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Alok Gupta & Team
Discharge Date : 12/01/2024 17:29
DR. AMIT KUMAR
SR. CLINICAL ASSOCIATE SR. CLINICAL ASSOCIATE CLINICAL ASSOCIATE CLINICAL ASSOCIATE
MEDICAL ONCOLOGY MEDICAL ONCOLOGY MEDICAL ONCOLOGY MEDICAL ONCOLOGY
You can book Medanta Care Services from your mobile phone-
For Appointments :0522-4505050
For Emergency and Ambulance Services :0522-4505050 / 1068
For Home Sample Collection (Only for Lucknow) :0522-4505050 or +91-9559050050
For Home Medicine Delivery (Only for Lucknow) :+91-7521905050 (Call / Whatsapp)
For Home Care Nursing :91-9151032826 (Call / WhatsApp)
Preventive Health Check-UP packages starting 999/-onwards :0522-4505050
. Access your Medical reports and follow up with Doctors through video conferencing by downloading Medanta
eCLINIC App or by visiting www.medantaeclinic.org
. Activate your eCLINIC account using the Patient's UHID registered at Medanta (ML********)
. For any assistance or query regarding eCLINIC / Telemedicine please call 0522-4500801 or write to
lko.telemedicine@medanta.org
Happy to get your feedback on our services:-
You will receive a message post discharge, please ensure to visit the link (insights.zykrr.com) through your mobile
phone and share your valuable feedback / suggestions.
Authorized by Dr Rahul Kumar Sinha on 13 Jan 2024 09:23 This is a computer generated report. Signature is not required.
Regd. Of f ice: Medanta Holdings Private Limited, E-18 Def ence colony , New Delhi, 110024 , India. T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 hot-line: +91(522)4 505050 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U74 14 0DL2013PT C250579
Medanta
Patient ID : ML10218914 Patient Name : Ms. Aayushi Swaroop
Gender : Female Age : 31Y
Encounter ID : 21326638 Encounter Type : Inpatient
Admission Date : 12/01/2024 12:22 Location : 1st floor Chemotherapy Day Care
Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Alok Gupta & Team
Discharge Date : 12/01/2024 17:29
Authorized by Dr Rahul Kumar Sinha on 13 Jan 2024 09:23 This is a computer generated report. Signature is not required.
Regd. Of f ice: Medanta Holdings Private Limited, E-18 Def ence colony , New Delhi, 110024 , India. T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 hot-line: +91(522)4 505050 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U74 14 0DL2013PT C250579
