67  Yers old mle ptinet 
beofre    5 motnhs  he  has  storke  and he   had  dystonia 
and he received antibiotics    that  affect the kidney 
he suffered from stok  that   affect    dysphagi and  hoarsness of  boice andf he  foundto have  vocal conrd paralysis



he  sought medical advide  by dr mahmoud allan  and he w as prescibed   betmiga  once daily 
and  omnic 0.4 mg once 



psa  2.2
wbc     9,8  hgb     12   plt      235
abdominalus  this months hosed  bothe kdineyh are   is found   in the lower limit of normal 
rigt kdiney 9,2   with parenchimal thickness   1.1   and showed increased parenchymal echoegenecity
left kdiey  showed 8,8  cm    in the length wt=ith parenchymal echogenecity     1,2  cm     and showed normla left  


creatinine   in 2024   was  1.1
and the urine analysis normal 
brain MRV  NORMAL19/1/2026  CREATIINE  1.46


MEDICATION 
NEURO  B
BETMIGA  50 MG OCNE 
OMNIC 0.4
NEXIUM 40 MG ONCE 
AMICOR  5 MGMONCE
B12 
DELLAL
CRP  NEGATIVE 

\HE WAS   SEEN BY  DR  HAMZA  JUBRAN AND HE  ASKED FOR  WORK UP AS  ACASE OF PARANEOPLSTIC DOSEASE
ESR   12
CREATININE  .5
PSA  NEAGTIVE


PLAN 
ANCA  TEST AND ESR   C3  C4
ADD  DEFLAZORT 
J DEE  
URINE  PROTEIN/CREATIN  RATIO 
ANCA   C3  C4