Dear colleagues,
Festival season Greetings and best wishes on behalf of Kauvery Alwarpet branch.
Kauvery Hospital is very happy and proud to provide the medical support for all the five matches of ICC Cricket World Cup 2023 held in Chennai and would like to thank the Tamilnadu Cricket Association for the opportunity.
This month all the articles are contributed by the Post Graduates of the Department of Medicine which I proudly refer as the backbone of our institution. Our best wishes to my hard working PG’s.
The state conference of IMA TNSB (TIMACON-2023) is to be held in December at Erode and I request our members to register at the earliest.
Long Live IMA.
Yours in IMA service, Dr S Sivaram Kannan President
Although today, Medicine has specialty and sub-specialty fields, Internal Medicine still is the core.
It is the main arterial line.
This month’s issue carries articles of interest from Internal Medicine Department of Kauvery Hospital.
Big thanks to our patrons.
Long live IMA.
Yours in IMA service, Dr. Bhuvaneshwari Rajendran Secretary.
Dear friends
Best wishes to you and family for a HAPPY DIWALI!!!
This edition of our Journal has contributions from the Department of Internal Medicine.
Thanks to the Consultants and our postgraduates for their contributions.
Thanks to our editorial team and branding for getting the journal on time.
Your feedback and suggestions are welcome.
With best regards Dr. R. Balasubramaniyam Editor
A 35-year-old man from Bangladesh presented with intermittent mild right upper upper-quadrant pain for 2 years. His systemic examination was normal except for mild tenderness. His vital signs were normal. He is a known case of recurrent pyogenic cholangitis, S/P open cholecystectomy/ ERCP with CBD stone extraction/ stenting/ surgery with left lateral segmentectomy of liver/ Re- ERCP with CBD stone extraction/ stenting (November 2021 – February 2023). When his symptoms started 2 years back, he visited an hospital in Bangladesh and was diagnosed to have choledocholithiasis with hepatolithiasis. MRCP done showed multiple stones in left hepatic duct, common hepatic duct and common bile duct with the largest measuring 12*14 mm in CBD with upstream dilatation of intrahepatic bile duct and CHD (about 12 mm); CBD was dilated (11 mm); Gall bladder was normal in size; Pancreas was normal in morphology and signal characteristics; main pancreatic duct was normal. The liver function test revealed mildly elevated alkaline phosphatase.
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A 37-year-old male came with abdominal pain for 2 days which started after alcohol intake. A clinical diagnosis of acute pancreatitis was made. Serum lipase was 1019 U/L. Liver function test was normal. CT Abdomen plain showed chunky calcifications in head and uncinate process of pancreas with dilated main pancreatic duct. Mild peripancreatic fat stranding with adjacent duodenal wall thickening – features suggestive of chronic calcific pancreatitis. Patient was taken up for endoscopy in view of dilated pancreatic duct for assessment of ampulla which showed normal ampulla and edematous posterior wall of duodenal bulb. His Serum calcium, lipid and thyroid profile were within normal limits. He was managed conservatively and discharged after 5 days.
Dengue Shock Syndrome with Fulminant Liver Failure
A 28-year-old female, a known case of type 2 diabetes mellitus, hypothyroidism presented with high grade fever for 5 days, for which only symptomatic treatment taken. Went to primary clinic on day 6 – fever workup done – showed dengue NS1 and IgG positive. Investigations done outside revealed thrombocytopenia (Platelet:34000) and transaminitis (SGOT: 20, SGPT: 438) with total bilirubin: 1.68. No epigastric pain, vomiting, skin rashes, mucosal bleeding, syncope. On examination, afebrile, no skin rashes, tachycardic (PR 120bpm), BP: 140/90mmHg, RR: 22/min. Systemic examination showed no significant signs. Patient was admitted and started on IV fluid, liver protective drugs (SAM).
A 68-year-old female, known case of diabetes mellitus, systemic hypertension, hypothyroidism, decompensated chronic liver disease with recurrent variceal bleed and status post 3 sessions of endoscopic variceal ligation presented with complaints of light headedness and 1 episode of vomiting with fresh blood clots in vomitus and upper abdominal pain. On examination BP- 100/60 mm Hg; PR – 82/ min. Per abdomen examination showed tenderness in epigastric region. Other systems examination was normal. Patient was shifted for an emergency endoscopy which revealed large oesophageal varices with active bleed and endoscopic variceal ligation was performed. Patient was shifted to ICU for further management and was started on Terlipressin, Vitamin K, antibiotics and other supportive medications.
A 47-year-old female, known case of T2DM, with a past history of Pulmonary embolism. presented to the hospital with breathing difficulty MMRC Grade III-IV for one day.
No history of fever, cough, chest pain, palpitation, abdominal pain or vomiting. ON examination, she was conscious, oriented, tachypneic and tachycardic. No other significant examination findings. Her capillary blood glucose at presentation was 511 mg/dl and ABG showed severe High anion gap metabolic acidosis, her Urine ketone was positive and was diagnosed as diabetic ketoacidosis and was treated for the same. In the search for trigger for diabetic ketoacidosis and the patient complained of cough, we did a CT Chest- which revealed a Multifocal well defined thin-walled cysts of variable size with no Zonal predilection seen in both lungs with intervening normal lung parenchyma with the possible differential suggested as Brit hogg due syndrome and pan lobular emphysema.
Honored to have been part of the TNCA’s ICC Cricket World Cup Management team coordinating medical facilities at M A Chidambaram Stadium during the tournament. We strategically placed 10 First Aid centers and 5 Medical Kiosks around the stadium, managed by skilled paramedics, catering to nearly 500 footfalls every match, ensuring everyone’s well-being. From the Spectator Medical Room to well-equipped players’ medical facilities and ambulances, we left no stone unturned in ensuring top-tier care for all. A big salute to our dedicated medical team for raising the bar in providing accessible, quality medical support to everyone at the event!
