kauverian scientific journals

EDITORIAL

Vanakkam! The Kauverian hopes to reach you every fortnight. The articles come in a new font and format, designed by Dr. Prabhaharan, our technical editor, I hope you would find them attractive. We lead the issue with two case reports,...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Rare and complex type of MS, tumefactive multiple sclerosis

Abstract Background: Multiple sclerosis is a disease with remitting and relapsing course and the normal classification is more based on the clinical manifestation and MRI scan findings. There are rare types of multiple sclerosis where demyelination can be monophasic or polyphasic....

Dilemma of decoding a difficult fever

Abstract Background: Infectious mononucleosis (IM) is a self-limiting illness usually caused by Epstein–Barr virus (EBV). Case presentation: A 13-year-old previously healthy adolescent presented with a prolonged highgrade fever, lethargy, pharyngotonsillitis and hepatosplenomegaly. Investigations done were inconclusive. His presentation mimicked a bacterial infection....

IMAGE CHALLENGE DIAGNOSTIC IMAGE

Image challenge History A 65-years-old gentleman presented with complaints of loss of consciousness and vomiting for the past two days. Associated illnesses He was diagnosed to have systemic hypertension, diabetes mellitus, and chronic renal failure on haemodialysis. Investigation Non-contrast computed...

PATIENT’S VOICE – A BOLT FROM THE BLUE

A bolt from the blue A 30-years-old gentleman, a bachelor, was devoted to physical fitness and was in the gym, working out every day of the week, for several hours. So he did not think much of a swelling that...

THE UNIQUE MIND AN ANTHOLOGY OF POEMS

The Unique Mind Yet another tear drop cruised down her dimple-less cheek Her face was too numb for her to feel The wet glistening tear offering all the comfort it could While the entire world in silence stood Into the...

EDITORIAL

Dear colleagues, readers, potential authors, The only way to out-smart COVID-19 is to practice 2021- 22 Science, whether it be in Public Health or Clinical Medicine. Let us outplay COVID 19 by smart moves - by blocking every move by...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

SARS-CoV-2 Vaccination Before Elective Surgery

I was having a brief conversation with one of my colleagues from a different surgical specialty about the difficulties faced in providing perioperative care to surgical patients during this COVID-19 pandemic. He said he had recently deal with a 65-year-old...

A guideline for patients with diabetes mellitus, towards self-assessment of their feet

Background The advent in India, in 2020, of the calamitous and catastrophic pandemic of COVID-19 called for compulsive changes to be considered in the careful management of the diabetic foot. Diabetic limb salvage goals of prevention, preservation and protection of...

Evolution of Dashboards and its Effectiveness in Performance Management and Efficient Utilization of Time and Energy

Abstract A dashboard is an information management tool that tracks and simplifies complex data sets and leverages data visualizations, allowing the users to gain quick insight into dynamics of current performance. Dashboards are commonly used for business reviews in various...

Understanding and Use of Sensitivity, Specificity, and Predictive Values

Background We shall discuss the basic knowledge to calculate Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). We shall also discuss the advantage and limitations of these measures and how we should use these measures in our...

Anorexia Nervosa with Compulsive Exercising – A Case Report

Abstract Background: Anorexia Nervosa, a type of Eating Disorder previously uncommon in India is now on a steady rise due to globalization and increasing cultural westernization. The following case represents an unconventional presentation of symptoms to add to the scarce...

From the Desk of the Editor-in-Chief

A review of recent papers of immediate clinical significance, harvested from major international journals (1).SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes. A clinical practice guideline. https://www.bmj.com/content/bmj/373/bmj.n1091.full.pdf Clinical question What are the benefits and harms of sodium-glucose...

Section Editor

IMAGE CHALLENGE Question Question: Dark pigmentation that appears in one endocrine disease. Which one? Why? We give you the first answer – Addison’s disease. Why? We leave it to you to find out!

PATIENT’S STORY

The sequlae of a sea-voyage N and R were a very devoted couple. He was a big built man, an ex-sports man. She resigned from work to indulge him. They had a recent holiday in the Pacific, on a cruise...

The Un-Relished Performance

No lone particle of nature, a shrub or colossal glacier With the knowledge of never being relished Ever halts in its performance of its distinctive act So why must only man, who also to nature solely belongs Only carry out...

THE ELECTRONIC MEDICAL JOURNAL OF KAUVERY HOSPITALS

Guest Editorial Dr. Manivannan Selvaraj, Founder and Managing Director I greet you all on the occasion of New Year 2021! This New Year has come at the most opportune time, just as COVID-19 is giving us a respite from an...

Vascular Covid Diaries

Operative Procedure – Mar to Aug Total number of procedures = 120 Open procedures = 85 Endovascular interventions = 35 Logbook Procedures No Description Mortality Acute limb ischemia 14 Limb salvage – 10 Amputation – 4 Nil Vascular Trauma 8...

Encephalitis – a success story

Abstract Background Autoimmune encephalitis is being increasingly and frequently diagnosed in children with acute and sub-acute encephalopathy because of advances in imaging and molecular diagnostic tests. Case presentation A 6-years-old girl, with no previous neurological abnormalities, presented with history of fever for...

Intracoronary imaging

Abstract Background Intracoronary imaging modalities (IVUS and OCT) are being increasingly used to aid and attain optimal results during percutaneous interventions/angioplasties. Case presentation We report three cases where intracoronary imaging was used in preprocedural lesion assessment and aided in optimization of angioplasty...

Patient’s Voice

Patient’s Voice My name is Xxxxxx (to protect patient’s anonymity) I have had diabetes since I was 10-years-old. Unknowingly, I had some physical health problems often. Suddenly, one day I fell ill and fainted, and I was admitted to St....

THE CURE BY KAANTHAL MANIKANDAN

The Cure A warrior sent by the true ruler To quieten the battle cries of the self-proclaimed ones Taking control and taking lives Stabbing earth with shovels and knives. We’ve angered someone with unimaginable power By forgetting that we are...

SEIZURE IN A NEWBORN

Abstract Background Neonatal seizures are a common problem faced in a neonatal unit. While most of them have a common cause and a predictable course, an unusual case presents itself off and on Case presentation A 17-days-old growing preterm, admitted for feed...

SGLT 2 inhibitors in kidney disease

Introduction It is interesting to note that kidneys play an important role in contributing to blood glucose pool. In the fasting and in post absorptive state kidneys add 10–50 g of glucose (20–25% of the glucose released into the circulation)....

Editor’s message – Dr Venkita S Suresh

Vanakkam! The KAUVERIAN has resolved to beat the deadline with every issue. The link to Vol 1, Issue 3, shall be with you on or before the 28th of February. We are delighted to feature three new authors. Dr. Vinoth...

Preparing your manuscript

Case Report Kauverian e-Medical Journal invites briefly described case reports that include the following criteria: Unusual side effects or adverse interactions involving medications. Unexpected or unusual presentations of a disease. New associations or variations in disease processes. Presentations, diagnoses and...

Pulmonary valve endocarditis: a case report

Abstract Background: Pulmonary valve endocarditis is a very rare clinical scenario accounting for 1.5% of all infective endocarditis cases. Case presentation: We report a case of pulmonary valve endocarditis, who presented with fever and pulmonary regurgitation murmur, and was successfully treated with...

Upper limb replantations at different anatomical levels: a short case series Kiran Petkar

Abstract Background: Limb trauma causing complete or near-complete amputations are surgical emergencies. Re-establishing blood supply within the critical period of ischemia can save the amputated part. It requires precise re-anastomosis of the severed artery and vein under adequate magnification often using...

Re-challenging asparaginase after cerebral venous sinus thrombosis in 5-year-old with acute lymphoblastic leukemia

Abstract Background: Asparaginase is an integral part of chemotherapy in children with acute lymphoblastic leukemia. Thrombosis is a known side effect of Asparaginase. Case presentation: A 5-year-old boy developed multiple painful large joint swellings with restricted movements for two weeks, fever for...

Prevalence of vitamin B12, folate deficiency and homocysteine elevation in ASCVD or venous thrombosis

Abstract Background: Vitamin B12 and folate are essential components for the metabolism of homocysteine. Elevated homocysteine has been associated with increased risk of atherosclerotic cardiovascular disease. The aim of the study is to evaluate the prevalence of vitamin B12, folate deficiency...

HENOCH SCHOENLEIN PURPURA

History A seven-year-old boy, thriving well, who presented with a fever associated with cough and cold. He was given symptomatic treatment for the same and the fever resolved. Associated Illnesses The next day, he developed small erythematous palpable rashes, initially...

Life turns upside down for a young couple and family

Life turns upside down for a young couple and family When she rang up her fiancé from another city, and found his speech repetitive and incoherent, and mind confused with regard to time and day, she rushed down. He had...

The Humblest Wonder

The Humblest Wonder Feels so close feels so near Like the most graceful illusion But science tells me you’re real Drifting so low in the earthly sky I feel no need to soar and fly For I could reach my...

Vaccine Induced Cerebro Venous Thrombosis with Thrombocytopenia (VITT) – A Case Report

History and clinical presentation A 24 years old female, M.Sc student, Covishield vaccine taken on 11.09.2021 Headache started around 20.09.2021 - 12 days post vaccine H/o vomiting (+) Referal doctor had noted severe thrombocytopenia No significant PMH. On Examination Pallor...

Editor-in-Chief

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

EDITORIAL

Vanakkam! The KAUVERIAN is delighted to bring you three unique and hopefully memorable publications. The first collaboration between a Kauvery author and our "content creation" team appears in this issue as a pilot project. Dr. Balaji Kirushnan’s study on COVID-19...

Neurobiology of Romantic Love

Love is an innate emotion hardwired into humans. It takes many forms – maternal love – the first manifestation of love we experience/romantic love which we feel in our youth and a necessary social need to bond with others of...

An interdisciplinary approach to treatment of juvenile OCD: a case report

Abstract Background: Juvenile OCD is a rarity in India with an estimated prevalence of 0.6%. It is most often present in male children with onset prior to the age of 14 years for juvenile OCD. It is associated with male preponderance,...

Fanconi Anaemia – Need to look at the whole picture

Abstract Background: Fanconi Anemia is a rare inherited disorder, characterized by chromosomal instability, wide clinical presentation and a predisposition to cancers, especially Acute myeloid leukemia. Case presentation: A 6-years-old boy treated as a ‘Known case of immune thrombocytopenia purpura’ is presented highlighting...

The Art and Science of Preparation and Publication of Medical Research from Kauvery Hospitals

Dear colleagues, Across seven units, we at Kauvery Hospitals offer effective health care economically efficiently, energetically, and enthusiastically. COVID-19 brought the best out of all of us; we always stayed several steps ahead of the virus and its onslaught and...

FUNDAMENTALS OF STATISTICS

Measures of Central Tendency (1).Mean, Arithmetic Mean (x̄ or M) The sum of the scores in a distribution divided by the number of scores in the distribution. It is the most commonly used measure of central tendency. It is often...

Diagnostics Images

IMAGE CHALLENGE History A 65 years old man presented with complaints of fever, and cough with sputum for the past 2 weeks. Associated illnesses He also had symptoms of dysphagia, burning chest pain, and belching sensation, along with a history...

A WAKE-UP CALL FROM THE ANAESTHESIOLOGIST, BY DR. VASANTHI VIDYASAGARAN

Dr. K. Senthil Kumar Senior Consultant and Head, Department of Anaesthesiology, Kauvery Hospitals, Tennur-Trichy, Tamilnadu, India Correspondence: [email protected] The book “A Wake-up Call from the Anaesthesiologist” is a gracious and thoughtful attempt to give a glimpse into the field of Anaesthesiology...

A PATIENT’S STORY

A 11-year-old girl from Africa came to Kauvery to tell us that she had never played in her life. Long back she and the family were told that she had seizures for which she must take medicines life long and...

THE FALLACIES OF PERFECTION

The human soul, distant from the horrifying divinity of perfection Takes upon its troubled mind the deed and tries to drown in retrospection Retrospection of the conscience, they don’t choose But retrospection of all illusions of vain Rethinking only the...

EDITORIAL

Vanakkam! KAUVERIAN is back! With exciting reading!! Honouring the World Purple Day to promote epilepsy awareness, Dr. Prithika Chary writes to us on "Difficult to treat epilepsy syndromes" for the benefit of non-neurologists. Dr. Suresh Chelliah and colleagues gift the journal with an...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Difficult to Treat Epilepsy: A Management Primer for Non-Neurologists

Epilepsy is a disorder of recurrent seizures with serious implications especially when seizures are frequent, severe and of long duration. Such patients have difficult to treat epilepsy and can present a challenge in diagnosis and treatment. More significantly the epilepsy...

Clinical audit: A Simplified Approachs

Abstract Background: Clinical audit is a proven method of quality improvement. It gives a systematic way of looking at their practice and making improvements. Methods: A summary of the stages of clinical audit are presented in the form of audit cycle, in...

Rationalise and Restrict Antibiotic Use by Utilizing A Proactive Justification Form and Comparing with Earlier Antibiotic Usage in The Same Paediatric Unit in A Tertiary Care Centre

Abstract Background: The objective of the study was to find out whether introduction of antibiotic justification form restricts and rationalises antibiotic usage. Methods: This Quasi-experimental study was conducted in paediatric ward at our hospital. We evaluated the efficacy of an intervention, wherein...

COVID-19 and Fungal Infection – An Opportune Time: A Case Series

Abstract Background: The COVID-19 pandemic which originated in Wuhan, China in late 2019 and paralyzed the world in 2020 posed unique problems to certain high-risk groups, especially the elderly and the diabetics. Case presentation: The increased incidence of fungal infections...

Thymidine phosphorylase (TYMP) gene stop mutation, G38X, in a familial case of mitochondrial neurogastrointestinal encephalomyopathy

Abstract Background: Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare mitochondrial disease with a spectrum of neurological and gastrointestinal involvement and characterized Mutations in the thymidine phosphorylase (TYMP) gene. Case presentation: We present this young man with mobility issues and malabsorption who then...

Image Challenge

IMAGE CHALLENGE History A middle-aged man with no other comorbidities came with complaints of progressive exertional breathlessness since morning. He used to do routine walk for 5 km in a day. With the present condition, he could not make even...

PATIENT’S STORY

Admitted with COVID, at the age of 97, I knew the probability was high that I would leave the ward, feet first. Age was a bad card to hold in hand as I negotiated my way through the hospital, contemplating...

ANTHOLOGY OF POEMS

Is it right to be plagued by humanly needs? Mere objects which dilute in oblivion with time Wanting to be the dearest of the lot Or to be encircled by loving accomplices Must be an artist’s crime I counselled “A...

POEM

CALL ME When others forget your name, When you have no fame, Call me When people you knew see through you When they discard you like an old shoe, Call me When your eyes grow dim, And the only song...

POEM

WHO IS THERE? When things go wrong, and you need to be strong ME Who is there? When your heart fills with fears, and your cheek wets with tears ME Who is there? When life makes you bend and you...

EDITORIAL

Dear colleagues, Vanakkam! The KAUVERIAN, whether during pandemic or pandemonium, appears on time! I thank the authors and our production team. It shall be with you on or before 01 May 2021! Thought-provoking articles appear in the KAUVERIAN, Vol 1,...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Hypertension – a renal disease

Pathophysiology of Hypertension From our first-year physiology lessons we know that blood pressure is product of cardiac output and peripheral vascular resistance. Cardiac output is governed by volume status and heart rate. Peripheral Vascular Resistance is determined by vasoconstriction/vasodilatation of...

A New Cause for Confusion or Concern – A Case Series

Background The year 2020 was unique experience many physicians will enjoy talking about to students and juniors in the years to come. Present scenario differs from the previous year in the way patients present to us having symptoms and signs...

A rare case of acute aortic dissection secondary to a penetrating aortic ulcer in the ascending aorta

Case presentation A 63 years old lady who is a known hypertensive on ayurvedic treatment, presented to the emergency room (ER) with the history of sudden onset chest pain radiating to back and profound giddiness with three to four episodes...

Pacemaker in children – big shoes to fill for small foot

Abstract A 3-year-old barely weighing 13 kg presented with failure of her epicardial pacing system and was implanted a transvenous single chamber successfully taking all due precautions. Keywords: Pacemaker; Transvenous; Children Background To highlight the feasibility of implanting a transvenous pacemaker...

The Eight Roles of The Medical Teacher – The Purpose and Functions of a Teacher in The Healthcare Professions by Ronald M. Harden & Pat Lilley

Review Essay Thank you for this opportunity to read and review the book titled ‘The Eight Roles of the Medical Teacher – The purpose and functions of a teacher in the healthcare professions. Teaching has always played a central role in...

Reducing the stock items – Need to look at the whole picture

Abstract Background: In the 1980s, hospitals began implementing innovative supply chain strategies in order to reduce stocks. The intention was to improve service levels at hospitals. It was also to save quality-hours for nurses by reducing the stock as stock management...

DIAGNOSTIC IMAGES

  History A 42-years-old lady came with complaints of two weeks’ history of epigastric pain, more since that morning. She also had nausea, and reduced intake of food for the past two months. Pain was relieved by symptomatic treatment from...

Mountain behind a mountain

A 33-year-old YX did not expect this ancient French Caribbean proverb to come true in his life. The Proverb said, in pidgin French, that ‘Deye mon gaye mon’. It warned that there could be another mountain on your path, beyond...

The Disappearing Act

Are we as significant as we think ourselves to be? Am I nothing but a frivolous entity? When my arms I sway And patterns I engrave Does it set off a grain in the milky way? If fire is set...

EDITORIAL

Dear authors and readers, Vanakkam! It has become fashionable now for medical journals not to accept case reports. We at the KAUVERAIN call them case studies. If we study one case well, one patient's problem thoroughly, the education and experience...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

TO CRUSH OR NOT TO CRUSH? DON’T RUSH TO CRUSH!

Abstract Background: Oral medicines are frequently modified prior to administration to patients with swallowing difficulties or on enteral tubes. But such decisions should be taken only after due consideration of the pharmaceutical properties of drugs. To assess compliance with guidelines for...

Effectiveness of Pre – Clinical Competency Certification Program on Improving Knowledge of Clinical Practice Among Nursing Internship Students

Abstract Background: Nursing competencies are core abilities that a nurse must have to fulfill her role. This is basic to nursing and a significant parameter for freshmen nurses’ job readiness to begin their career in health care. A study was conducted...

Medical Statistics in Clinical Research – Mean, Median, Standard Deviation, p-value, Chi Squared test

Mean It is also known as an arithmetic mean, or an average. Is very commonly used in papers, so it is important to have an understanding of how it is calculated. It is one of the simplest statistical concepts to grasp....

Vertebral artery dissection with thrombosis causing neuralgic amyotrophy

Case Presentation A 34 years old female, with no known comorbidities presented to emergency room (ER) with complaints of: Sudden onset right upper limb weakness and inability to lift her right arm in the last three days History of right...

Atypical Electrical Alternans Due to Large Left Pleural Effusion

Abstract Background: Electrical alternans – beat to beat variation in QRS amplitude has been classically described in pericardial tamponade. Case presentation: We report a case of electrical alternans in a middle-aged female in the absence of pericardial effusion. Conclusion: Electrical alternans can occur...

Early presentation of a rare disorder

Background Autoimmune hepatitis (AIH) is a necroinflammatory liver disease of unknown etiology that occurs in the children of all ages. It was identified in the 1940’s and formerly called chronic active hepatitis. AIH has a wide range of presentation, from...

DIAGNOSTIC IMAGES

History A middle-aged man who was a diabetic on oral hypoglycaemic drugs was admitted for evaluation of acute febrile illness diagnosed to have acute viral pneumonia due to COVID 19. He was hospitalized and treated as a patient for 2...

PATIENT’S STORY

An 85 years aged RK was enjoying her visit to family abroad, in the company of her two daughters, which was shortly coming to a close. She was walking down the stairs when she tripped on the last two. A...

ANTHOLOGY OF POEMS

For every word is a drop of paint And the universe turns into my canvas As I watch my colors and blank space acquaint From the proudest star to the most delicate flower.   All my thoughts make the bristles...

EDITORIAL

Dear colleagues, readers, potential authors, The KAUVERIAN, Vol 1 will close with Issue 10 by end of June. Vol 2 will be launched in July. This issue has several " FIRSTs!" For the FIRST time, we open with a cover...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

GUEST EDITORIAL

When I received this opportunity to write a guest editorial for the Kauverian, I baulked at the enormity of the task in front of me. My mind immediately started framing a polite refusal which would not offend the Editor-in-Chief, Dr....

Clinical MIS – A Clinical Analyst Review

Abstract A management information system (MIS) is an information system used for decision-making, and for the coordination, control, analysis, and visualization of information in an organization. Hospital Management Information System is implemented in a hospital for managing patient care and...

Eclampsia and HELLP Syndrome: A Case Report

Abstract Background: The HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). This syndrome in general complicates 0.2–0.6% of all pregnancies but its incidence increases to 4–12% in severe preeclampsia. In about 15% cases,...

Percutaneous Device Closure in A Toddler with PDA and Interrupted IVC

Abstract Per-cutaneous occlusion of the patent ductus arteriosus is achieved by deploying an occluder from the femoral vein. Abnormalities of the systemic venous pathway such as interruption of the inferior vena cava necessitate modification of the technique of per-cutaneous occlusion....

Pediatric Car Passenger Trauma – A Case Report and A Review of Child Safety Inside a Car

Background Car travel which was a luxury in our country in the last century, has now become a way of life for our children of this century. Cars have become better; we are able to travel faster on good roads....

Use Of Antibody Cocktail, Regn-Cov2, In Two Non-Hodgkin’s Lymphoma (NHL) Patients with Mild Covid-19 Disease, At A Tertiary Care Hospital in South India: A Case Series

Abstract Severe Acute Respiratory SyndromeCorona virus 2 (SARS–CoV-2) is the cause for Corona virus disease 2019 (COVID-19). Most patients have asymptomatic or mild disease. A subset of patients developsmoderate, severe or critical disease. The prognosis isdismal with severe and critical...

Neurology Update

Introduction Any one who treats Parkinson Disease is familiar with the on/off syndrome which is a distressing complication of levodopa therapy in these patients. In addition to the progressive nature of the disease, as the disease advances the chances of...

Journal scan: A review of ten recent papers of immediate clinical significance, harvested from major international journals

1. Physical rehabilitation for older patients hospitalized for heart failure, N Engl J Med. 2021   Background   Older patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery,...

DIAGNOSTIC IMAGES

Signs of COVID-19 in the skin have been noted. But there’s another part of the body where the virus appears to have an impact: the fingernails. Following a COVID-19 infection, for a small number of patients the fingernails appear discoloured...

The Patient Is Always Right

Just before the COVID lockdown, a well-educated and articulate elderly patient was brought to my clinic in a wheelchair. He started by showing some blood tests. He wanted to know why his alkaline phosphatase was high. He was very concerned...

Humanity’s Most Cherished Fiction

Every human is tied to the strings of ‘Strange’ Not one, have I encountered, who fits in Normal’s range   Yet Normal’s non-existent face glares at me A mere flake of imagination of humanity- Tempting all who roam, all who...

Mucormycosis in COVID-19: A Clinico-Microbiological Dilemma

Abstract Mucormycosis is a fungal infection caused by a group of microorganisms belonging to the phylum Glomeromycota. Once classified under rare fungal disease, Mucormycosis is regrouped under emerging pathogens. They are ubiquitous, found mainly in soil and decaying organic matter....

ANAEMIA OR HYDROCELE – WHICH SHOULD BE DEALT WITH FIRST

Anaemia or Hydrocele - Which Should Be Dealt with First These are cases collected over several years and have been presented in this book for the sole purpose of learning and improving. While looking up the references, it was noted...

OUR EXPERIENCE WITH COVID-19 RELATED MUCORMYCOSIS

Our experience with COVID-19 related Mucormycosis: a preliminary report Niraj Kumar Joshi*, Deepika M Vijai, Kavya MuraliDepartment Of ENT, Head & Neck and Skull Base Surgery, Kauvery Hospital, Chennai, Tamilnadu, India Department Of ENT, Head & Neck and Skull Base...

DVT in a child: A case to introspect

Background Deep vein thrombosis (DVT) is rare presentation in paediatric age group. DVT as a cause of leg pain in children is often misdiagnosed, because the index of suspicion is low in children. The incidence of venous thrombo embolism increases with...

Rainbow within a storm

Case Presentation A 42 years old male with hamodynamically unstable VT after MI (S/P PTCA to LAD). DC cardioverted 22 times and on maximal doses of all class of antiarrthymic drugs. Transferred to Kauvery heart city with ongoing VT storm....

Reversal of Dabigatran in patients with intracerebral haemorrhage – a narrative review

Abstract Background: The objective of this review is to provide an overview on the current development of the specific reversal agent for Dabigatran. Anticoagulation is key to the treatment/prevention of thromboembolic events. The primary complication of anticoagulation is serious or...

STEREOTACTIC BODY RADIOTHERAPY – VT TREATMENT

Journal Club Stereotactic Body Radiotherapy - VT Treatment P. Vijay Shekhar a , R. Sakthivel b  a Consultant, Cardiologist, Kauvery Hospital, Heartcity-Trichy, India b Consultant, Cardiologist, Kauvery Hospital, Chennai, India Commentary from Dr. P. Vijay Shekhar Stereotactcic Body Radiotherapy (SBRT), which involves targeting a volume...

TO BOOST OR NOT TO BOOST? INDIAN PERSPECTIVES – COVID VACCINATION

Guest Editorial To Boost or Not to Boost? Indian Perspectives - COVID Vaccination Dr. Muralidhar Ramachandra* Consultant, Critical Care, Kauvery Hospital, Bangalore, India *Correspondence: [email protected] Introduction COVID vaccination is the only protection against the ongoing pandemic. Rapid development of efficacious vaccines,...

EDITORIAL

Dear kind patrons of the KAUVERIAN Today we launch Vol 2, issue 1. We thank our authors who made 12 issues possible in the first half of 2021. That was unimaginable when we tender footed with the first issue. Thanks...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

GUEST EDITORIAL

Pediatric Hematology and Oncology (PHO) is a relatively new area of study in medicine, yet has seen significant advances in the recent decades. The American Board of Medical Specialties approved the sub-specialty of PHO in 1973 [1]. This was after...

Convalescent Plasma Therapy in Covid-19: A Question of Timing

Convalescent plasma therapy (CPT) has a 100-year-old history. In 1890, Behring and Kitasato, published their discovery that graduated doses of sterile broth cultures of diphtheria or of tetanus bacilli, when injected, caused the animals to produce, in their blood, substances...

High Dose methotrexate in Children with Cancer Without Drug Level Monitoring – 133 Cycles Experience

Abstract Background: High dose methotrexate (HDM) is effective in decreasing extra medullary relapses in childhood leukemias and lymphomas. Availability of serum methotrexate level monitoring is limited to few centers in India. Methods: Two years data from children receiving HDM were collected (Jun...

Prenatal diagnosis in Thalassemia – Prevention is better than cure

Abstract Background: Thalassemia is one of the common hereditary blood disorders. Various clinical, psychological and financial problems make huge impact in the affected family. In India, there are nearly 42 million carriers of β-thalassemia genes. Identification of carriers and preventing births...

Improving Outcomes in Children with Cancer – Our Experience

Abstract Background: Outcome of children with cancer is steadily improving over the recent decades. Developing countries face a different set of problems in treating pediatric oncology patients as compared to developed world. Methods: Data of children receiving chemotherapy (age 0 – 18...

Autologous Stem Cell Transplantation for Myeloma with CKD

Background Multiple myeloma is a clonal plasma cell disorder comprising 10% of haematological malignancies and accounts to 1% of all malignancies [1]. It has a male sex predilection affecting more African-Americans in comparison to Caucasians [2]. The median age of...

All Megakaryocytic Macrothrombocytopenia Are Not ITP

Background Thrombocytopenia with adequate megakaryocytes in marrow, other possible causes being ruled out constitutes a diagnosis called immune thrombocytopenia (ITP). Hence it is a diagnosis of exclusion and an immune mediated mechanism explains the clinical consequence. Case Presentation A 48-years-old...

Telomeropathies and Our Experience: A Case Series

Introduction Telomere is a region with repetitive nucleotide sequences at each end of a chromosome, which protects the end of the chromosome from deterioration. Progressive shortening of telomeres leads to senescence, apoptosis or oncogenic transformation of somatic cells. Inherited conditions...

Neurology Update – Neurobiology of Sleep

The earliest information about the neurobiology of sleep and wakefulness was in the 1930’s. Since then, advances in the neurosciences have been explosive and we know more about the body’s natural rhythms and the sleep/wake cycle today. Lack of sleep...

Journal scan: A review of twelve recent papers of immediate clinical significance, harvested from major international journals

(1). Help me trust you after my misdiagnosis, BMJ 2021;373 :n1175. Debilitating daily life For more than 12 years, I lived with undiagnosed chronic pain, spinal problems, pelvic floor dysfunction, gastrointestinal issues, bladder problems, bleeding tendency, and easy scarring, among...

The Brush Stroke

For every word is a drop of paint And the universe turns into my canvas As I watch my colors and blank space acquaint From the proudest star to the most delicate flower. All my thoughts make the bristles of...

A rare case of flood syndrome: a case report of fatal complication of umbilical hernia in liver cirrhosis

Abstract Background: Flood syndrome refers to spontaneous umbilical hernia rupture followed by a sudden rush of ascitic fluid, which is a rare and potentially fatal complication of liver cirrhosis with gross ascites. Case presentation: We present a case of 55-year-old gentleman with...

EDITORIAL

Only a handful of medical journals choose to publish poems. It is a very small list; the two that readily come to mind are the redoubtable NEJM, and the reflective Annals of Internal Medicine And the KAUVERIAN! Now you come...

EDITORIAL BOARD

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Cervical collar in trauma patients – friend or foe?

Abstract This article debates the efficacy of cervical collar in spinal immobilization of trauma patients with suspected spinal injury. The application of cervical collars has become a ritual of habit without solid scientific evidence. In last three decades, there has...

Oxygen conservation strategies

Abstract During the second wave of COVID-19 the entire country has seen a shortage of beds for the treatment of moderate, severe and critical patients whose respiratory system was predominantly affected and O2-therapy was a profound role in treating them....

Chronic periodontitis: a case report

Abstract Periodontitis is an inflammatory condition affecting the gingiva and supporting structures of the teeth. This can affect any age group and is caused by various factors ranging from poor oral hygiene to genetic predisposition. The clinical features range from...

Erythema multiforme in COVID-19: a case report

Abstract COVID-19 infection, declared as pandemic by WHO in 2020, may result in various patterns of dermatological manifestations. Understanding the causal relationship of skin manifestations and covid-19 infection and diagnosing them helps in managing the patients effectively. Keywords: COVID-19, Erythema multiforme,...

Secondary Synovial Chondromatosis of the knee Joint-a case report

Abstract Joint pain in an adult is a common presentation to an orthopaedic clinic. Rare conditions which cause knee symptoms should be considered in the differential diagnosis. We present a case report of synovial chondromatosis in an adult patient with...

Statistical Risk Ratio (Relative Risk) Data Analysis

The relative risk (or risk ratio) is an intuitive way to compare the risks for the two groups. Simply divide the cumulative incidence in exposed group by the cumulative incidence in the unexposed group: Risk Ratio= Cle/Clu where, CIe is the...

Journal scan: A review of ten recent papers of immediate clinical significance, harvested from major international journals

(1). Blood-Brain barrier crossing renin-angiotensin drugs and cognition in the elderly: a meta-analysis. Hypertension 2021 Hypertension is an established risk factor for cognitive decline and dementia in older adults, highlighting the potential importance of antihypertensive treatments in prevention efforts. Work...

Splinter Haemorrhage

History A 40 years old gentleman presented with three months history of fever and chills. He also had exertion dyspnea. On general examination, we found nail changes. What is your diagnosis? Answer Splinter Haemorrhage He underwent a transthoracic echocardiogram which...

Dignity matters

“The strong survive but the courageous triumph” – Michael Scott In today’s world, people think with advanced technology, anyone can be kept alive indefinitely but the question remains if it is only existence in many circumstances. What is patient dignity...

Where does time fly to?

Where does time fly to? Watching the cars as they sail by Each entrusted with a different destination, a different journey A different comfort, a different life. She pushed her warm brown hair off her shrugged shoulder For a moment,...

DIAGNOSTIC IMAGE 1

A 73-year-old gentleman was diagnosed to have of Hypertrophic cardiomyopathy with Left Ventricular Outflow Tract Obstruction (LVOTO) on straining, of 38 mm hg gradient, Systolic Anterior Motion (SAM) of Mitral Valve, grade 2, with moderate Mitral Regurgitation and severe Pulmonary...

Editorial

Dear colleagues KAUVERIAN"s first Independence Day issue is here! Appropriately enough, we launch it with the autobiography of an independent - thinking and illustrious neuroscientist - Dr. Prithika Chary. None in Kauvery who shall be reading this were born at...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

ABO incompatible renal transplant in a post COVID patient with COVID antibodies

Background COVID-19 pandemic has resulted in challenges to renal transplantation in many countries [1]. There were many countries where renal transplant program had come to a standstill. Hospitals followed the national guidelines to restart renal transplantation by testing for COVID...

Neuromyelitis Optica early presentation of an adult disorder

Abstract Background: Neuromyelitis optica (NMO) is a severe autoimmune disease of the CNS characterized by recurrent inflammatory events primarily involving the optic nerves and spinal cord. NMO is infrequent in children, but early recognition is important to start adequate treatment. Case...

The gamut of neurological disorders associated with COVID-19

Highlights The COVID-19 syndrome can present with many neurological features, besides its well - recognized respiratory and vascular manifestations Acute ischemic stroke can be one of them, with large vessel thrombosis Neurological features can also be associated with the post-COVID-19...

Anaesthetic management of patients with Takayasu arteritis

A 30-year-old woman presented to the assessment clinic for pre-anaesthetic evaluation. She was to have abdominoperineal resection for rectal malignant tumour. On eliciting drug and allergy history, she mentioned that she frequently experienced severe headache, for which she took medications,...

My Pains and Gains in Becoming A Doctor

The Prologue: Impatient to be born into an Independent India The British landed in India at Surat on August 24, 1608. The British East India Company came to India as traders in spices, a very important commodity in Europe back...

Significance testing of correlation coefficient

Interpretation The correlation coefficient is usually denoted by the letter "r" for example r = 0.8. SPSS 23.0 Software - Analyze - Correlate - Bivariate. A positive correlation coefficient means that as one variable is increasing the value for the other variable...

Journal scan: A review of ten recent papers of immediate clinical significance, harvested from major international journals

(1). Brown E et al. SGLT2 inhibitors and GLP-1 receptor agonists: established and emerging indications. Lancet. 2.21;398(10296): P262-76 Summary SGLT2 inhibitors and GLP-1 receptor agonists are used in patients with type 2 diabetes as glucose lowering therapies, with additional benefits...

While you were sleeping

A 30-year-old MV did not think much of the Chickenpox that attacked her. She was reconciled to an appearance of the pox vesicles, fever and discomfort that would last a week or two. Even in modern times, elders in the...

Subliminal Sublimes (Sonnet 1)

Sitting alone with nothing but my thought Trickled down the fogged glass pane Thinking if all I've done is all I must Not knowing what in life I've truly sought All my dreams are slowly starting to rust Worried only...

Editorial

Dear colleagues We publish a "patient's voice" - a patient's perception of pulmonology. We also give you the link to a case report on this patient, published in the Chennai Kauvery Hospital IMA Journal. You would notice how remarkably accurate...

Instructions for Authors

General Considerations 1. Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. 2. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

COVID-19 and mucormycosis: the dual threat

Background India has experienced two waves COVID-19, the latter more devastating in every parameter. The associated outbreak of mucormycosis caused very high morbidity and mortality in the country. The challenges encountered were difficulty in establishing an early diagnosis, including limited...

COVID-19 associated mucormycosis: efforts and challenges

Background: The world is still trying to come to terms with the new and strange coronavirus disease 2019 (COVID-19) which made its landfall in Dec 2019 and was declared a pandemic towards the end of January 2020. This dreaded infection...

Saccular abdominal aortic aneurysms: a case series

Background Abdominal aorta is the most common site for aneurysms in the arterial tree. Abdominal aortic aneurysms are classified as fusiform or saccular based on the morphology. Majority of the treatment guidelines concentrate on fusiform aneurysms which are more prevalent....

Trauma and OCD – A Case of a Boy with Dark Fears

Abstract Obsessive-compulsive disorder (OCD) is a common disorder that often begins in childhood and is frequently unrecognized, underdiagnosed, and undertreated. OCD is characterized by recurrent obsessions (unwanted ideas, thoughts, images, or urges) and compulsions (repetitive behaviours or mental acts) designed...

Chapter 3

Chapter 3 A 36-year-old primigravida was admitted for an elective LSCS. She had conceived following infertility treatment. Her investigations and clinical examination were within normal limits. Surgery was planned under spinal anesthesia. As the anesthetist was preparing to administer the...

Journal scan: A review of 10 recent papers of immediate clinical significance, harvested from major international journals

(1). Editorial. A sporting chance: physical activity as part of everyday life. Lancet 2021;398(10298):P365 Ahead of the 2020 Tokyo Olympics and Paralympics, The Lancet launched its third Series on physical activity (previous Series-2012 and 2016) on the importance of regular...

The Consultation Room

What is the need for this book? "Practice of medicine is more an art than science". "The time I spend in my office is more taxing on my expertise, than when I'm in the operation room." - Prof J M...

DIAGNOSTIC IMAGE

Baby S, a 7-year-old came with complaints of abdominal pain, sudden in onset, not associated with vomiting, fever or diarrhea, since the last three days. There was no history of travel, diet change or outside food intake. She complained of...

A Patient’s Perception of Pulmonology

I was admitted to the emergency facility of the Kauvery Hospital on the 7 th of August, coughing continuously for two days, and passing blood due to this extreme effort. The reason for my cough dates back to ten years...

Just a leaf

As the music played by the tea kettle A raven haired girl sat by the glass window Watching the flying leaves settle Gently on the dew of the fresh grass floor Rattling and dancing as they sail through the air...

Editorial

Dear colleagues Whatever clouds may hover on the horizon, whether monsoon or the third wave, YOUR GOOD WORK shall be carried by the KAUVERIAN every fortnight! That is our promise to you, for giving us the opportunity and the privilege to report...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Dilemma of shadows

Background Multiple ring-enhancing lesions in the brain have various differential diagnoses including neoplastic and non-neoplastic diseases. Infectious, vascular and inflammatory are non-neoplastic causes and primary brain tumour and metastasis are important etiologies for neoplastic disorders. Neurocysticercosis and tuberculoma are endemic...

One-year journey in Kauvery! Challenges in Neuroanaesthesia and Neurointensive care

It's been a year since we started the Department of Neurosciences at Kauvery Hospital Bangalore and Hosur. It has been a learning experience with some unique challenges but overall a very satisfying one so far. We present here some of...

Leadless pacemakers: The future of pacing?

"The best way to predict the future is to create it" As we look back at the history and evolution of pacemakers, permanent pacemakers were indicated for diseases of the cardiac conduction system that could disrupt normal conduction pattern and...

Clinical Therapeutics: The polymyxins, existing challenges and new opportunities

Abstract The global rise in nosocomial pneumonia caused by multidrug-resistant (MDR) pathogens and the increasingly limited antibiotic treatment options are growing threats to modern medicine. As a result, older antibiotics such as polymyxins (colistin and polymyxin B) are being used...

Decision to Take Up a Patient in The Presence of Arrhythmias

Case 1 A 50-year-old man was brought to the emergency department for an obstructed inguinal hernia. He was a chronic smoker and was also under the influence of alcohol at that time. Relevant medical history was that he was a...

Why growing public dissatisfaction about medical profession?

Though medicine is advancing leaps and bounds, ironically patients' dissatisfaction is also on the rise. There are many reasons for this unfortunate situation: High expectations, in view of the scientific advances, specialization and superspecialization of Doctors. Increased awareness of their...

JOURNAL SCAN

Journal scan: A review of 10 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Adekoya I et al. Comparison of antibiotics included in national essential medicines lists of 138 countries...

Diagnostic Image

(Source Image: Padhan and Ahmed [1]) What is your diagnosis? Diagnosis: Synovial chondromatosis It is a type of non-cancerous tumour that arises in the lining of a joint. The knee is most commonly affected; however, it can affect any joint...

The cloud over a young life

Teenager MS did not know a happy and healthy day since early childhood which was a great worry for her mother. MS has ITP which is a complex blood disease called Idiopathic Thrombocytopenic Purpura. That simply means that she tends...

The Waiting Room

Is Earth just a waiting room? A transit to someplace else? Is life just a waiting time? Alike to standing in line, To ride the sweet delights at the carnival Maybe life’s only the crowded airport we rest in between...

Author Instruction

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

Editorial

Dear colleagues KAUVERIAN the journal, like the river Kaveri, picks up what comes along its way- all gems of thought. The lead article is Dr. Andrew Fenn's update on the Tumor Board at Chennai, a very professional, thoughtful and thorough...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

The French Connection!

Abstract We studied COVID-19 associated mucormycosis based on 17 cases reported nationwide and assessed the differences with India. They differed by frequencies of diabetes mellitus (47% in France versus 95% in India), hematological malignancies (35% versus 1%), anatomical sites (53%...

Rare cause of pyrexia of unknown origin: Primary gastrointestinal non-Hodgkin’s lymphoma

Abstract Background: Primary gastrointestinal non-Hodgkin's lymphoma (PGINHL) is a rare lymphoproliferative disorder characterised by lymphomatous involvement of gastrointestinal tract in the absence of generalised lymphadenopathy, blood and bone marrow involvement. It can rarely present as intermittent fever without other localising features....

Impact of multi-disciplinary tumour board (MDT) on cancer care

What is a multi-disciplinary tumour board? A multi-disciplinary tumor board (MDT) is a meeting of doctors and other health care professionals from different specialties to help formulate treatment plans for individual patients or to get second opinions on proposed treatment...

WPW pathway ablated from uncommon location

Patient Drug resistant SVT due to WPW syndrome in a 17-year-old with history of failed ablation because of high risk location of the accessory pathway. Figures 1-5 illustrate the successful performance of a high-risk procedure from an unusual location. Fig....

Statistical hypothesis – using the t-test

The t-test is a statistical hypothesis test in which the test statistic follows a Student's t-distribution under the null hypothesis. A t-test is most commonly applied when the test statistic follows a normal distribution if the value of a scaling...

Learning from Experience – Chapters 6 and 7

A 65-year-old man, weighing 50 kg presented with severe throat pain, difficulty in talking and swallowing for two days. He gave history of his denture getting displaced while eating and trapped in his throat. On examination, he was salivating profusely...

The Consultation Room

Chapter 4: Qualifications, Certificates & Photos "Sometimes we have to see to believe, when happenings are unanticipated" To discourage unqualified 'Doctors' (quacks) from practicing, it is prudent that every qualified practitioner displays his academic qualifications, Medical Council registration certificate, as...

Journal scan: A review of 10 recent papers of immediate clinical significance, harvested from major international journals

"Human challenge trials" may help answer important questions quickly If you are going to catch covid-19, jokes Jacob Hopkins, a university student, the safest place to do it is in a hospital. So, in March Mr. Hopkins lay down on...

Diagnostic Image

    Diagnosis: Early stage of Panda/Raccoon eyes in primary amyloidosis Notes Raccoon eyes may be used to describe large dark rings around the eyes. They can signify a few different conditions that cause internal bleeding near the eyes. The blood...

When the sun sets over a good life

He was a very dignified man who had a very distinguished life, in service of the state and country. He was well over ninety. The lamp of his life was flickering from far advanced heart failure. Yet another hospitalization was...

The Deepening Dent

The grinding voice of silence Screamed past the lonely staircase Climbing combined infinity, with trips the steps make alliance So you crouch and cry with hands on ears and misery on face Watching the 'evil' tread for the shock to...

Save Farmers, Save Future

Once upon a time, there lived a boy named Arnav. He was born in Madurai. His father was a farmer. He loved agriculture. He did his schooling from Sprouts Montessori. He did research on variety of rice. He took part...

Editorial

Dear Colleagues, A new edition of the KAUVERIAN shall be winging its way to you. What gems are being held this time for you, in the beak of the bird?! 1. Our fourteen-year bard's words leap out at you through...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Repurposing anti-rheumatic drugs in COVID

Background The pandemic has taught us many things. Right from the importance of being together as a family, supporting fellow humans and be grateful for each moment gifted to us, we have learnt it all. The medical community has witnessed...

An Effective Journal Club Presentation: A Guide

What is a Journal Club? A journal club is a dedicated meeting where medical practitioners gather to discuss published articles from peer-reviewed journals. These meetings help fellows and residents keep up with current research findings, exercise their critical thinking skills,...

A Masquerader Vasculitis as Usual: Time Is Tissue

Background Wegener's granulmatosis is a rare idiopathic inflammatory disorder affecting blood vessels of upper respiratory tract sinuses, lungs and kidneys. Histopathologic evidence of necrotizing granulomatous inflammation and pauci-immune small-vessel vasculitis though non-pathognomonic, is essential for a diagnosis [1]. Serologic evidence...

A Sinister Swelling: A Case Report 

Case Presentation An 11-year-old, previously well girl was admitted with complaints of low back pain for 2 months, gradually increasing in severity. She had difficulty in walking and burning micturition for 2 days and was constipated. On admission she was...

DNB Thesis

Aim To study the significance of waist to height ratio as an early predictor in children prone to developing metabolic syndrome, in the age group 5-12 years, in a tertiary care centre in Trichy. Objectives To identify the cut off...

Statistical Regression Analysis

Definition The Regression Analysis is a technique of studying the dependence of one variable (called dependent variable), on one or more variables (called explanatory variable), with a view to estimate or predict the average value of the dependent variable in...

Learning from Experience – 11 and 12

  Case 1 A 28-year-old primigravida, known case of Myasthenia Gravis was posted for an elective LSCS. She was on tablet Pyridostigmine 60 mg twice daily. She had grade 2a disease, well controlled under medications. All other routine preoperative investigations...

The Consultation Room

Respecting the value of time of everyone, we should try to be as punctual as possible. An anxious patient tends to be more and more emotionally disturbed, if he has to wait for hours, to see the Doctor. If the...

Journal Scan

(1). Grant RW, et al. Updated USPSTF screening recommendations for diabetes, identification of abnormal glucose metabolism in younger adults. JAMA Intern Med. 2021;181(10):1284-6. The diabetes epidemic in the US continues unabated hand in hand with the concurrent epidemics of obesity...

Diagnostic Image

Slip or Block History An 89 years aged gentleman, with past history of hypertension and Coronary Artery Disease (CAD), presented to Emergency Department (ED) with an alleged history of accidental fall at a temple while climbing down the stairs. He...

Stained not torn

From the perception Of my minds still novice eye Every person is a sheet of white paper And emotions, clinking glass bottles of each uniquely staining dye All sheets born with no crinkles And slowly age with ever-beautifying wrinkles Lifeless...

Editorial

Dear colleagues, The KAUVERIAN launches its 01 February 2022 issue (vol 3, issue 3), with two debutarticles from senior consultants. Dr.Kulasekaran, Cardiac Surgeon from HeartCity, Trichy writes about "Revisiting the surgical algorithm while offering cardiac surgery during apandemic time". Drs.Keerthi...

Kauverian eMedical Journal

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

Cardiothoracic surgery in the COVID era: Revisiting the surgical algorithm

Background The COVID-19 pandemic has led to unprecedented challenges on a global scale that has not been seen for many years. The COVID-19 illness is highly contagious and lack effective treatment guideline. While the healthcare systems are already overwhelmed, the...

Review

Background Liver Transplantation is successfully done for liver failure and liver cancer in selected patients. Liver transplantation for metabolic disorders due to genetic defect is rare and done in children mostly. When the disorder is severe and causes life threatening...

Corona warrior award

About TNNMC Award Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare...

Case Series

Abstract Osteogenic benign vertebral neoplasm is a relatively rare entity with a spectrum of treatment options. Optimal treatment decision is vital for definitive tissue diagnosis, reducing recurrence, and avoiding post-operative spinal instability. In this article, we describe the indications and...

Takotsubo cardiomyopathy

Abstract Takotsubo cardiomyopathy is a close differential diagnosis of acute coronary syndrome, and can present with chest pain and breathlessness. It is caused by emotional or psychological stress caused by the unexpected death of a relative or a friend, occurrence...

Learning from Experience – Chapters 3 and 4

Case 1 A 28-year-old woman, with polycystic ovarian disease was posted for a laparoscopic ovarian cystectomy. She had no other medical illness and was assessed under ASA 1. Her preoperative investigations were within normal limits. She was taken up for...

The Consultation Room – Chapters 41 to 45

Chapter 41: Selection of drugs Some drugs, which may have duel effect, may beconveniently used, if the patient has both the symptoms. We can give several examples: for a young girl with persistent vomiting of functional nature (such as anorexia...

Journal scan

Journal scan: A review of 10 recentpapers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Agarwal R, et al. Chlorthalidone for hypertension in advanced chronic kidney disease. NEngl J Med. 2021;385:2507-19 Abstract...

Recommended Reading

Recommended Reading (1). The discovery of insulin: a story of monstrous egos and toxic rivalries. https://theconversation.com/the-discovery-of-insulin-a-story-of-monstrous-egos-and-toxic-rivalries-172820 (2). A National Strategy for the "New Normal" of Life With COVID https://jamanetwork.com/journals/jama/fullarticle/2787944?guestAccessKey=6ee5a409-7bc1-4c9f-807b-c2b8e9981f1b&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=011822

DIAGNOSTIC IMAGE

  Diagnosis: Incidentally found osteoblastic clusters in a bone marrow aspirate smear.

Poem from Staff Nurse

Ms. Delphiya Mary, Staff Nurse, Kauvery Hospital, Tennur, Trichy

Editorial

Dear readers of the Kauverian, Novelty is the spice of life; so, we begin with a new section, "Letters to the editor!". We invite you to post your thoughts on articles published elsewhere on which you have a clear view...

Author Instruction

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

Male V. Menstruation and COVID-19 vaccination

Vaccination against COVID-19 provides protection against the potentially serious consequences of SARS-CoV2 infection, but as the vaccines were rolled out into younger age groups, clinicians were increasingly approached by patients worried that the vaccine had caused a change to their...

Efficacy and doses of Ulinastatin in treatment of Covid-19 a single centre study

Background Ulinastatin is a glycoprotein extracted from fresh human urine. It inhibits the activity of various proteolytic enzymes. Patients with severe covid-19 exhibit elevated serum levels of proinflammatory cytokines IL-6, Tumour necrosis factor, IL-I Beta, characterised as cytokine storm, which...

Electronic registries in health care

Abstract Clinical registries are organized systems that collect data on patients diagnosed with a disease or condition or who undergo a certain procedure. Managing a conventional register is resource-intensive and time-consuming. Electronic Registers are conventional registers integrated with information technology....

A case report

Abstract Rheumatoid arthritis (RA) is a chronic, symmetrical, inflammatory arthritis that usually involves small joints. Mono articular arthritis involving a single large joint is not part of EULAR 2010 algorithm for the presentation of rheumatoid arthritis. Here we report a...

Anaemia in pneumonia: A case report

Background The pneumococcal vaccine has drastically reduced the incidence of invasive pneumococcal disease in Western countries. In India, the actual disease burden is not known because of the use of antibiotics before blood culture and the lack of utilization of...

Successful treatment of two cases of rare Movement Disorders

Introduction Movement disorders can manifest in numerous ways, with symptoms ranging from subtle to disabling. The first step to diagnosis depends critically on an accurate description of the abnormal movement. The neurological examination needs to be tailored to the clinical...

Analysis of variance Two-Way ANOVA

The two-way ANOVA is an extension of the one-way ANOVA. The "two-way" comes because each item is classified in two ways, as opposed to one way. For example, one-way classifications might be gender, political party, religion, or race. Two-way classifications...

Learning from Experience – Chapters 5 and 6

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 39-year-old man was admitted for a fracture neck of femur, posted for a hemiarthroplasty. During the preoperative visit, history revealed that patient was paraplegic for the past 3 years following a road...

The Consultation Room

It's important to extend due courtesies to patients referred by a Doctor and the patient appreciates that because of that, some extra attention was given. This is not to say proper attention need not be given to other patients, but...

Journal Scan

Journal Scan (1). Shi T, et al. Risk of serious COVID-19 outcomes among adults with asthma in Scotland: a national incident cohort study. Lancet Respir Med. 2022;S2213-2600(21)00543-9. Background There is considerable uncertainty over whether adults with asthma should be offered...

Recommended Reading

Recommended Reading (1). Haidar G, Singh N. Fever of unknown origin. N Engl J Med. 2022;386(5):463-477. https://pubmed.ncbi.nlm.nih.gov/35108471/ Fever of unknown origin despite a high-quality workup after a reasonable amount of time has elapsed to rule out self-limited fevers remains a...

Diagnostic Image

  Diagnosis: Itch mite scabies causing burrows.

Poem from Staff Nurse

Ms. V. Jayalakshmi, Staff Nurse, Department of Oncology, Kauvery Hospital, Tennur, Trichy

Editorial

Dear readers of the Kauverian, Abraham Lincoln went from a log cabin to the White House. Dr. Paul Farmer grew up in a mobile home in a trailer park in Florida, and went on to advise five presidents in the...

Kauverian eMedical Journal

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

An obituary, farewell to a very dear friend

I lost a very dear friend sometime during the night of Sunday, February 20th. Dr. Paul Farmer, internationally revered as the "Doctor for the world's poor", died in his sleep on Sunday night in Rwanda where he had built Africa's...

‘Vitamin D’: One vitamin, many claims!

Abstract The relationship between vitamin D and chronic disease-related clinical outcomes is controversial. In recent times, many benefits from the administration of vitamin D in various clinical settings have been claimed, starting with claims of miraculous recovery from severe and...

Implantation of Leadless Pacemaker in a middle-aged patient: An ultra-short case study

A 58-years old gentleman presented with a history of multiple episodes of pacemaker erosion since 2017. The patient had been previously implanted with a conventional lead pacemaker four to five times, on both the left and right side of the...

ABO-incompatible renal transplant at ease

Background The shortfall between organ donors and kidney transplant recipients is ever-growing. The number of patients waiting on a deceased donor renal transplant program is increasing every year according to the UNOS data. To overcome this deficit, strategies like ABO-incompatible...

Basal cell adenoma parotid: A case report

Abstract Basal cell adenoma is a very rare form of parotid tumor. Diagnosis of this disease is extremely challenging. We present a 51 yr old lady who is a known cause of an uncommon disease myasthenia gravis with this rare...

A case report

Correction of cubitus varus (gunstock) deformity in 12-year-old adolescent child with lateral closing wedge osteotomy & recon LCP fixation Senthilrajan Angamuthu Consultant Orthopaedic Surgeon, Kauvery Hospital, Salem, India *Correspondence: [email protected] Background Malunited supracondylar humerus fracture in children usually results in...

Learning from Experience – Chapters 7 and 8

Swelling in the femoral area A 60-year-old woman presented to the emergency room with diffuse painful swelling in the femoral area. She had the swelling for nearly 10 years, slowly increasing in size, and developed severe pain over the last...

The Consultation Room

Chapter 51: Doctor as patient 'Doctors make worst patients', but may not apply to all. Medical etiquette dictates that an early appointment be given to a Doctor or at a time convenient to him, if possible. As a matter of...

Journal Scan

Journal scan: A review of 10 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Doki Y. Nivolumab Combination Therapy in Advanced Esophageal Squamous-Cell Carcinoma. N Engl J Med. 2022;386:449-62. Background...

Recommended Reading

Recommended Reading (1). Schattner A. My four ages of diagnosis. QJM: An International Journal of Medicine 2022;115(1):63-4. https://academic.oup.com/qjmed/article/115/1/63/5909664 (2). Krishna Manohar SR. Pioneers of congenital heart surgery in India: historical perspective. Indian Journal of Thoracic and Cardiovascular Surgery 2021;37: 9-16....

Diagnostic Video

Diagnosis: Left paramedian midbraininfarct A 60 years gentleman, with history of diabetes, hypertension and dyslipidemia, presented to ED with h/o sudden onset giddiness, swaying to right side and with progressive inability to open the left upper eyelid, since 12 hrs....

Poem from Staff Nurse

Ms. R. Sneha, Staff Nurse, Department of Oncology, Kauvery Hospital, Tennur, Trichy

Editorial

The 15th March issue of the KAUVERIAN is a very exciting one for us in production. For one very important reason. It brings the best out of our authors! The clarion call begins with "Voices from the field". The valiant...

March – the Month for Minds to dwell on Multiple Myeloma

March is Multiple Myeloma Awareness Month Multiple myeloma is a malignancy of plasma cells which are an important component of immunity. Overall survival has increased significantly over the last two decades with availability and increased accessibility to novel agents. More...

Covid Report

Abstract Background The COVID-19 pandemic affected all countries in the world. The outbreak was first identified in December 2019 in Wuhan, China. The countries around the world cautioned the public to take responsible measures to prevent and control infections, and...

Research Protocol

Background Coronary Artery Disease (CAD) is the single most cause of mortality and loss of Disability Adjusted Life Years (DALY) globally. A large number of the global burden is limited to the Low and Middle-income countries (LMIC). Twenty-five percent of...

New Arrows in our Quiver, to direct against SARS-CoV-2 variants

Abstract Background: New treatments are needed, to be administered early in the evolution of the disease, to reduce the risk of progression of coronavirus disease 2019 (COVID-19). Methods: A summary of new, upcoming, drugs in COVID-19 has been provided here....

Out-of-hospital cardiac arrest

Background Out-of-hospital cardiac arrest (OHCA) has attracted increasing attention over the past years because outcomes have improved impressively lately. The changes for neurological intact outcomes have been poor but several areas have achieved improving survival rates after adjusting their cardiac...

Last on the list: A diagnosis seldom considered in males

Abstract Autoimmune diseases are generally more common in women than men. Sex hormones, especially oestrogen (but also prolactin and testosterone), play important roles in these diseases. Oestrogens are generally considered to enhance autoimmunity and have multiple effects on the immune...

Giant T wave inversion associated with Stokes: Adams syndrome

Abstract We have demonstrated here massive T wave inversion in the ECG of a patient who had a syncope- a Stoke Adams syndrome from complete heart block. Background Stokes-Adams or Adams-Stokes syndrome is a periodic fainting spell in which there...

Learning from Experience – Intra Operative, Chapters 9 and 10

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 75-year-old man was admitted in the emergency for a swelling on the left side of his neck which was expanding rapidly. He had undergone carotid endarterectomy 15 days ago. During his previous...

The Consultation Room

Chapter 56: Medicolegal procedures There is no bar against a private practitioner to treat accidents, poisonings or other medicolegal cases, provided prescribed procedure is followed. As mentioned already, the Doctor has to exercise extreme caution in taking history given by...

Definitions of probability

There is a number of definitions of probability proposed by many authors. However, the majority of definitions can be divided into three groups: Definitions of probability as a quantitative measure of the 'degree of certainty' of the observer of the...

Journal Scan

(1). Min A. Page Kidneys. N Engl J Med 2022; 386:673. A 21-year-old woman presented to the emergency department with a 6-week history of abdominal pain and constipation. Her blood pressure was 162/108 mm Hg. She had a history of...

Recommended Reading

1) Perkins GD, et al. Brain injury after cardiac arrest. Cardiac Arrest 2021;398(10307):P1269-78. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00953-3/fulltext As more people are surviving cardiac arrest, focus needs to shift towards improving neurological outcomes and quality of life in survivors. Brain injury after resuscitation, a...

Diagnostic Video

[video width="640" height="576" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/Diagnostic-video.mp4"][/video] Diagnosis: Dirofilaria The genus Dirofilaria includes vector-borne filarial nematodes, which are usually associated with carnivore hosts. Some Dirofilaria spp. are zoonotic; the most commonly seen species in human patients are D. repens, D. tenuis, and D....

A Thanksgiving to Cardiac Surgeons

Dr. Chiran Babu, Dr. Rajesh, and Dr. Srivatsa A 74-year-old lady presented for the first time in an emergency, with acute decompensated heart failure. She was evaluated and found to have Severe Calcific Aortic Stenosis with LV Dysfunction and was...

Editorial

The lead article reflects the very inspiring outcome of Dr. S. Aravindakumar, Chief of Cardiology, Kauvery Heartcity, Trichy mentoring Dr. Yogeswaran, MEM Resident, to learn echocardiography, and undertake a bedside evaluation of Pulmonary Hypertension in the CCU. Dr. Yogeshwaran studied...

Kauverian eMedical Journal

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

Research Article

Abstract Pulmonary Arterial Hypertension (PAH) is a chronic and progressive disease affecting pulmonary arteries which results from increased pulmonary arterial pressures and consequent pulmonary vascular resistance. As the disease progresses, the increased pressure in pulmonary arteries results in Right Ventricular...

Research Protocol

Background The left main coronary artery supplies at least two-thirds of the left ventricle. Patients with significant LMCA disease are often symptomatic due to compromised blood supply that affects a large area of the myocardium. Severe stenosis of the left...

Saving the unsavable

One lesson that I could never forget in the course of our nursing education and service was this: We are not allowed to get attached to our patients because that is against the code of conduct. But we are human,...

Case Report

Background Bilateral temporomandibular joint (TMJ) ankylosis with retrognathia and obstructive sleep apnoea (OSA) is relatively uncommon in children. The present case describes the anaesthetic management of a similar toddler who was posted for TMJ release and Interposition Arthroplasty. Case Presentation...

Case Report

Abstract Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder in which acute angulation of the SMA causes compression of the third part of the duodenum between...

Letters to the Editor

Abstract Objective: To compare the clinical effectiveness of adding a single ultrasound guided intra-articular hip injection of corticosteroid and local anaesthetic to advice and education in adults with hip osteoarthritis. Design: Pragmatic, three arm, parallel group, single blind, randomised controlled...

Diagnostic Image

Diagnosis: Right T10-T12 Dermatomal involvement in Herpes Zoster

Learning from Experience – Intra Operative, Chapters 13 and 14

A 19-year-old girl weighing 51 kg was posted for FESS with septoplasty. On examination, her pulse rate was 98/min, BP was 110/70, and no abnormality was detected on examination of cardiac and respiratory systems. She was an ASA 1 patient....

The Consultation Room

Chapter 66: Media statements & interviews The media, both print and electronic, may request for a 'short clip' from you on some current medical issue, more so if you are a senior Doctor, holding a position in some medical organization....

Journal Scan

(1). Rebecca Morelle. Scans reveal how Covid may change the brain. 2022. https://www.bbc.com/news/health-60591487 Catching Covid may cause changes to the brain, a study suggests. Scientists found significant differences in MRI (magnetic resonance imaging) scans before and after infection. Even after...

Recommended Readings

(1). Susanne Wegener. Triggers of Stroke: Anger, Emotional Upset, and Heavy Physical Exertion. https://www.medscape.com/viewarticle/968466 'Could it be that my stroke was brought on by emotional stress?' This is a common question of stroke survivors directed to their physicians at follow-up....

Editorial

Dear colleagues, Why do we write the eternal evolution of Medicine through articles, and publish them? Because there is a story to be told, to be read over and again, to reflect over and lessons to be learned. Many stories...

Author Instruction

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

SIGARAM – The Club for Children with Diabetes

Background In the ever-evolving field of medicine, the complications of, and the solutions for, any disease go hand in hand. A problem that is steadily increasing in prevalence among patients with Diabetes is Diabetes Burnout. Diabetes burnout is a state...

The hope for a better tomorrow

Abstract A 3-years-aged child suffered burns (scalds) due to accidental spillage of hot boiling water over the entire lower half of the body, below both hips, when his parents were not at home. He was severely burnt a very large...

An unusual complication of polytrauma:

Abstract A rare instance of post-traumatic Guillain-Barré syndrome (GBS), an acute, autoimmune, inflammatory, demyelinating polyneuropathy affecting the peripheral nervous system and a potentially life-threatening cause of muscle weakness, is presented. Case Presentation A 56-year-old active male, working in the police...

An enigma at the ER

Clinical Presentation On a busy Monday morning at the ER, we received 30 years aged female, with a history of acute onset of breathing difficulty for a few hours, following which she became unresponsive in a few minutes. She was...

Dynamic examination of airway

A 60 year old woman with superior mediastinal mass was scheduled for video‑assisted thoracoscopic surgery. Her complaints were dry cough, dyspnoea, and swallowing difficulty. Cough and dyspnoea worsened in a supine position. The mass was 8 cm (craniocaudal) × 5.5...

Journal Club

Background Whether surgical repair of an acute Achilles' tendon rupture by an open-repair or minimally invasive approach is associated with better outcomes than nonsurgical treatment is not clear. Methods We performed a multicenter, randomized, controlled trial that compared nonoperative treatment,...

Journal Club

Hypertension has been a largely multifactorial and difficult issue to treat in pregnancy. While we have well-defined protocols to predict, assess, prognosticate and treat pre-eclampsia, Chronic hypertension has been on a back seat with recommendations mainly about the teratogenicity of...

Journal Club

Montelukast, used in the treatment of asthma and allergic rhinitis, can cause serious mental health adverse effects such as nightmares, aggression, depression, and suicidal ideation. These adverse effects have been reported in patients of all ages, with and without pre-existing...

Conditional Probability

It is the probability of some event A, given the occurrence of some other event B. Conditional probability is written P(A|B), and is read as "the probability of A, given B". The probability that event B occurs, given that event...

Diagnostic Image

What is your diagnosis?

Learning from Experience – Intra Operative, Chapters 15 and 16

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 56-year-old woman, weighing 90 kg was posted for a laparoscopic cholecystectomy under general anaesthesia. She gave no significant history except for hypertension which was controlled with 5 mg Amlodipine. She was premedicated...

The Consultation Room

Chapter 71: Quacks The main reason for the quacks (unqualified Doctors) to proliferate and flourish, is the maldistribution of qualified Doctors in our country and their unwillingness to settle down in rural areas. While 70% of our population live in...

Journal Scan

(1). Elisabeth Mahase. Study questions relationship between statins and cardiovascular outcomes. BMJ 2022;376:o712 The relationship between the amount that statins reduce low density lipoprotein cholesterol (LDL-C) levels and the risk of death, heart attack, and stroke is "weak or inconsistent,"...

Recommended Readings

(1). Sonal Matharu. ICU is a terrible place to die': When letting go of treatment is the best choice. https://theprint.in/features/icu-is-a-terrible-place-to-die-when-letting-go-of-treatment-is-the-best-choice/917291/ Some doctors and NGOs are working to ensure that patients with terminal or incurable conditions experience a better quality of...

EDITORIAL

Dear colleagues! We at the KAUVERIAN wish you a Merry Christmas! The KAUVERIAN shall launches its new year edition with many crackling and sparkling reports from young minds. We hope these young writers would mature into confident and consummate authors. We...

Kauverian eMedical Journal

Instructions for Authors General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list,...

Junior nurses in Kauvery Hospital on the frontline against the COVID-19 pandemic

Abstract The Coronavirus disease (COVID-19) is a major global public health emergency affecting more than 120 million people worldwide, resulting in more than 2 million deaths across 199 countries. The World Health Organization (WHO) declared COVID-19 outbreak as pandemic in...

Emergency Medicine, the Emerging Specialty: Leading Light on the entrance to the Health Care Pathway

Emergency Medicine has been an emerging speciality across the world as the Leading Light on the entrance to the Healthcare pathway. It has become the public face of the hospital to the patient and his family, especially when in distress. And...

Battle of two drugs: Who won? – An unusual presentation

Abstract Organo-phosphate/insecticide ingestion is the most common modality of suicide in India, which causes excessive secretions (cholinergic effect) in our body. Anti-histamines are groups of drugs that are used in allergic reactions and are also known to have an effect...

Return of the native and a resurrected foe: A case of Rhinocerebral Mucormycosis

Case Presentation A 66 years aged woman presented to our Emergency Department with the complaints of: Decreased sensorium and drowsiness for 2 days Decreased oral intake for 2 days Recent and past medical and surgical history: Known patient of DM\HTN\Hypothyroid\CAD\CKD...

Covert invader- atypical presentation of neuronal migration disorder

Abstract Importance of MRI Brain as the investigation of choice in emergency department in Epilepsy is illustrated in this case report. Antenatal history/developmental history is relevant for diagnosis, even for adults. Keywords: Epilepsy, MRI Brain, Neuronal migration disorder, Heterotopia   Case...

Fragile heart: an unusual cause of chest pain

Introduction Eosinophilic Myocarditis (EM) is an acute life-threatening inflammatory disease of the heart. It is often an elusive diagnosis but treatment is straight forward. Very few cases of eosinophilic myocarditis have been reported in literature. Peripheral blood eosinophilia associated with...

Goldberger’s ECG sign in Left Ventricular Aneurysm

Abstract Ventricular aneurysm is a well-known complication post MI. The term aneurysm is used to describe dyskinesis or local expansile paradoxical wall motion. They are readily detected my two-dimensional echocardiography. But this case of ventricular aneurysm was picked by the...

Congenital absence of bilateral Internal Carotid Artery: A case report

Background Agenesis of bilateral Internal Carotid Artery (ICA) is a rare and infrequent abnormality. People with this abnormality would have adequate collateral circulation and remain asymptomatic. It is usually diagnosed after a stroke, seizure, transient ischemic attack or headache, when...

The Power of Purple

I stood in front of the mirror staring at my reflection, with that purple mark on my face. "But how...?" I asked myself. " There are only two elements you can master, blue:water, red:fire; what even is purple!?" My introspection...

Beads of Nature’s Rattle

What simple re-arrangement can accomplish! To not just tidy the sweet home But twist the structure of tangible objects- astonish! Atoms like Nature's toddler toys Matched and missed can create souls.   The atoms of my cradled hands Might have...

Case Report

Abstract An acute cause of neck pain and arm weakness is most commonly due to cervical radiculopathy. Rarely an extracranial vertebral artery dissection may cause a radiculopathy in the absence of brainstem ischemia. In this article, we describe a case...

Diagnostic Image

Abstract Ventricular aneurysm is a well-known complication post MI. The term aneurysm is used to describe dyskinesis or local expansile paradoxical wall motion. They are readily detected my two-dimensional echocardiography. But this case of ventricular aneurysm was picked by the...

EDITORIAL

Dear colleagues, Rising to the occasion, from Kauvery Hospital, ECB, leads this issue, from Dr. Muralidhara and his eight colleagues, the most multi- authored paper ever to be published in the KAUVERIAN. It speaks of 25 insights gained from two...

Kauverian eMedical Journal

Instructions for Authors General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list,...

Modification of Management Strategies, And Innovations, During SARS Cov2 Pandemic Improved the Quality, Criticality and Outcomes in In-Patients “Rising to the occasion”, the mantra for success in the COVID -19 pandemic

Background The COVID-19 pandemic has resulted in more than 2 million deaths globally. SARS COVID 2 is highly infectious and although most are either asymptomatic or mild to moderately ill, a substantial proportion of patients faced severe life-threatening disease. The mortality risk...

Time in Range (TIR) In Diabetes: A Concept of Control of Glycemia, Whose Time Has Come

An Overview It has been more than two years since the release of recommendations from the International Consensus Guidelines on Time-in-Range (TIR) in patients with diabetes who are on continuous blood glucose monitoring (CGM), but awareness is poor about the...

Kauvery Heart Failure Registry- A Concept

Heart failure (HF) is a global public health issue that affects all countries, rich or poor, developed or developing. It is a progressive clinical syndrome. Despite significant developments in the management of chronic heart failure, it remains a major cause...

Shorter Course of Remdesivir In Moderate Covid-19 is as Efficacious as Compared to Standard Regime: An Observational Study

Background Remdesivir is an RNA polymerase inhibitor with potent antiviral activity in vitro. It is the current recommended antiviral treatment in moderate to severe COVID-19. However, data on the efficacy with shorter course of treatment and the adverse effects are...

CASE REPORT

Abstract Massive bleeding per rectum is an uncommon presentation of small intestinal tuberculosis. We report a patient who presented with hematochezia and hypotension. The patient had normal upper and lower GI endoscopy. However, contrast CT abdomen showed active extravasation of...

Lymphoepithelial Carcinoma: A Case Report of a Rare Tumour of The Vocal Cord

Abstract Lymphoepithelial carcinoma (LEC) of the vocal cord is an extremely rare malignancy accounting for 0.2% of laryngeal cancers. It is an aggressive tumour which is rarely associated with Epstein Barr Virus (EBV) unlike LEC of nasopharynx. It should be...

Diabetic Keto Acidosis (DKA), Associated with Failed Thrombolysis with Streptokinase in Acute Myocardial Infarction

Abstract Streptokinase has been used as a thrombolytic agent in the treatment of AMI ever since 1958 when Sherry and others started using streptokinase in acute MI. This changed the focus of treatment of MI from symptomatic to specific. There...

EARNING FROM EXPERIENCE – CHAPTERS 1 AND 2

INTRA-OPERATIVE The intra-operative period is most fascinating, as we could experience a wide variety of surprises in spite of thorough checklists. These surprises may arise from machines and equipment, patients' reactions to drugs, or even decisions on the table to...

The Consultation Room

Chapter 36: Well informed patient With increasing level of literacy and the plethora of information in various media, it's no surprise, many patients do lot of 'home work', before coming to us and we have to carefully watch our words, while...

Journal scan

(1). Mahase E. COVID-19: UK approves monoclonal antibody sotrovimab for over 12s at high risk. BMJ 2021;375:n2990. The UK's medicines regulator has approved a second monoclonal antibody, sotrovimab, for the treatment of people over 12 years with mild to moderate COVID-19 who...

Recommended Reading

(1). Clinical review of salbutamol in reversible obstructive airway diseases, 2021. https://medicaldialogues.in/pulmonology/perspective/clinical-review-of-salbutamol-in-reversible-obstructive-airway-diseases-86330 (2). Pharmacological treatment of diabetes: ADA 2022 explores beyond metformin as initial therapy https://medicaldialogues.in/diabetes-endocrinology/news/pharmacological-treatment-of-diabetes-ada-2022-explores-beyond-metformin-as-initial-therapy-86295 (3). New AAOS guideline for management of hip fracture in elderly https://medicaldialogues.in/orthopaedics/guidelines/new-aaos-guideline-for-management-of-hip-fracture-in-elderly-86189 (4). Norwood...

DIAGNOSTIC IMAGE

  Diagnosis: Hypersegmented polymorphs and macrocytosis on Vitamin B12 deficiency.

Notes to Nocturne

When the antique organ is played, The crowd they dont hooray. Instead they show their gasping say, in a more subtle way. Beetoven touched those keys He showed us what he means. His music left us keen, to hear his...

Editorial

The KAUVERIAN shall arrive on 01 Apr 22 with some exciting reading. The guest editorial from Dr. Maniram, Pediatric Cardiologist, is a deeply emotive one, on " Caring for nobody's baby', on the entity of ' Adult Congenital Heart Disease'....

Kauverian eMedical Journal

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

Caring for nobody’s baby

In my last guest editorial, I had attempted to portray the need for a comprehensive pediatric cardiac facility in central Tamil Nadu. I had stressed the importance of timely recognition of critical congenital heart disease (CHD) in the newborn baby...

Special Report

Background Our world would mean nothing without women. Women are the epitome of strength and courage. Every year, March 8 is celebrated as Women's Day. On this day, we appreciate the strong, intelligent, talented, and extraordinary women in our lives....

Research Article

Abstract According to the International Diabetes Federation, there are 382 million people worldwide affected by diabetes and India has 65.1 million people with diabetes. The majority of the guidelines on diabetes care focus on the medical aspects of disease management...

The curious case of a migrating needle on the chest wall

Case Presentation The patient, a 26 years aged male, married, working in a store, presented to a hospital with chest pain, for the past 3 days. ECG showed ST changes. CT scan imaging showed the presence of needles in the...

Foreign body: A boon at times

Case Presentation A 56-year-old female, a known patient of bronchial asthma, presented with increasing symptoms for four weeks, with a history of aspiration of foreign body (nose pin screw) one month back. Chest Xray showed a foreign body (FB) in...

Cardiorenal Syndrome

[video width="1920" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/Video-Report-Cardiorenal-Syndrome-Dr.Kabilan.mp4"][/video]

What My Grandmother Knew About Dying

My memories go back a few years ago. When I assisted a bronchogenic carcinoma patient, in his 85+ years, with malignant pleural effusion. He said every day I visit- "Dr, I want to die " As a geriatrician, it wasn't...

Endovascular Therapy for Acute Stroke with a Large Ischemic Region. N Engl J Med. 2022

Abstract Background: Endovascular therapy for acute ischemic stroke is generally avoided when the infarction is large, but the effect of endovascular therapy with medical care as compared with medical care alone for large strokes has not been well studied. Methods:...

Letter to the Editor

Comprising a diverse plethora of bacterial species, the human intestinal microecology is considered a complex community. Among the many underlying etiologies that can lead to Small interstitial bacterial overgrowth (SIBO), Proton pump inhibitors (PPI) have come under the scanner owing...

Clinical outcomes of Coronary Artery Disease in Octogenarians

Background Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients above 80 years of age. Understanding the pathophysiology, epidemiology, and optimal means of diagnosis and treatment of CAD in older adults is crucial in improving...

Diagnostic Image

History A 12-year girl presented with acute gastroenteritis with severe dehydration. She was incidentally found to have this finding: Diagnosis:A Bifid Uvula Notes: Also called the submucous cleft palate. May cause velopharyngeal insufficiency, middle ear infections and nasal intonation. Prevalence...

Learning from Experience – Intra Operative, Chapters 11 and 12

A 58-year-old man presented to the emergency department with stridor. He was a known case of CA thyroid for which a total thyroidectomy was done six years ago, followed by 5 cycles of I131. The patient was hemodynamically stable: PR=108/min,...

The Consultation Room

Chapter 61: Visit by medical representatives Specific time may be allocated to see medical representatives, to avoid interruptions during regular times. It's ethical that we don't make them wait inordinately in our office, since they are considered as 'paramedical' professionals....

Journal Scan

(1). Pravesh S, et al. Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial. BMJ 2022;376:e065846 Abstract Objective: To assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused...

Recommended Reading

Sinskey J, et al. A Practical Approach to Fostering Clinician Well-Being in an Academic Anesthesiology Department. APSF Newsletter. 2022; 37(01). https://www.apsf.org/article/a-practical-approach-to-fostering-clinician-well-being-in-an-academic-anesthesiology-department/ Robert A. Harrington, MD; Ziyad Al-Aly, MD. COVID-19 and the Heart: Is Cardiology Ready? Medscape Cardiology. https://www.medscape.com/viewarticle/969206 Thomas Kron,...

colours

Colours What is yellow? Yellow is a shiny bright wall Yellow is the color of gold Yellow is like a ripe yellow plum Yellow is like a bright yellow sun What is red? Red is like flaming hot fire Red...

Editorial

The KAUVERIAN, Jul 01, 22 greets you as we enter the second half of the year The editor has reviewed the book edited, and a chapter contributed, on "Rheumatic Rarities" by Dr. Sham Santhanam, Consultant Rheumatologist at Chennai. This is...

Author Instruction

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

Ultrashort Case Report

A 62-year-old male with multiple myeloma and renal failure was diagnosed in March 2020 initially at Coimbatore, then at CMC Vellore. He chose to take native treatment for 6 months and reached us with severe peripheral neuropathy (non-diabetic). He was...

Cochlear Implantation: Expanding candidacy and Cost Effectiveness

Background Cochlear implants are the most successful sensory prostheses worldwide. A cochlear implant (CI) is a surgically implanted device for the treatment of severe to profound sensorineural hearing loss (SNHL) in children and adults. It works by transducing acoustic energy...

Spontaneous Pneumomediastinum in COVID 19 – Tertiary Care Centre Experience in South India

Abstract Background: Radiological imaging plays a vital role not only in the diagnosis but also in the surveillance of patients and guides the physician in the management of patients with COVID-19 infection. The presence of spontaneous pneumomediastinum (SPM) among the...

Amoxycillin Induced Anaphylactic Shock: A Case Report

Background Anaphylaxis is an acute, potentially life-threatening, generalized, or systemic allergic reaction that is mediated by the degranulation of mast cells and basophils. Drug hypersensitivity is one of the most frequent causes of anaphylaxis [1]. Beta-lactams are the most commonly...

An Unusual Cause of Seizures: A Case Report

Background Pseudohypoparathyroidism, a rare hereditary endocrine disorder, characterized by peripheral resistance to Parathormone (PTH) and preserved renal function, presents with hypocalcemia and hyperphosphatemia, along with high levels of PTH. This entity varies from hypoparathyroidism, where hypocalcemia results from low levels...

Case Report

Abstract Cardiac Allograft Vasculopathy is the Achilles heel of survival following heart transplantation. We discuss a case of cardiogenic shock due to severe cardiac allograft vasculopathy eight years post-transplant, which was successfully bridged to re-transplantation with ECMO/IABP as mechanical circulatory...

Educational Strategies to Promote Clinical Diagnostic Reasoning

Introduction The personal histories that clinicians and patients bring to each encounter play a significant role. The diagnosis is co-created by the patient and the diagnostic team, which can include a broad array of health care professionals. Clinical teachers are...

Rheumatic Rarities

Book Review by the Editor-in-chief of the KAUVERIAN, a book- buff! Rheumatic Rarities Editors: Dr. Sham Santhanam and Dr. Vinod Ravindran It is not often that one gets to review a book edited by a colleague. Dr. Sham Santhanam is...

Types of sampling methods in statistics

Probability sampling strategies typically use a random or chance process, although there are important exceptions to this rule. Random sampling is a strategy for selecting study participants in which each and every person has an equal and independent chance of...

Diagnostic Image

Diagnosis: Cyanosis in congenital methemoglobinemia, finger tips in comparison to mine.

Learning from Experience – Intra Operative, Chapters 21 and 22

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 28-year-old man was admitted for Webster's procedure for bilateral gynaecomastia. He was obese, weighing 130 kg; BMI=36. No history of comorbid illness. All investigations were within normal limits. He was taken up...

The Consultation Room

Chapter 86: Sharing consultation room with others This arrangement is irksome, but inevitable, in larger establishments, with several visiting consultants, coming at various times. The available consultation chambers are efficiently allotted to the 'outside' consultants, at different time slots, to...

Journal Scan

(1). Xu M, et al. Eruptive Xanthoma. N Engl J Med. 2022;386:e58. A 27-year-old man presented to the dermatology clinic with an asymptomatic rash on his back, arms, and hands that had developed 1 week earlier. He had a history...

Recommended Readings

(1). Carla Nieto Martí­nez. Nutrients and Exercise Affect Tumor Development. 2022 https://www.medscape.com/viewarticle/974751 (2). Idil Karsit. How your diet can treat diseases. https://www.bbc.com/future/bespoke/follow-the-food/how-your-diet-can-treat-diseases/ (3). Marwa Saleem. Endo Case Challenge: A Cannabis User With Excessive Sweating and Syncope at Work. 2022. https://reference.medscape.com/viewarticle/975148?src=mkm_ret_220616_mscpmrk_ous_int&uac=346576HG&impID=4334777&faf=1...

Editorial

Dear colleagues, The KAUVERIAN, Aug 01, comes to you power-packed. 1. Dr. Suresh Chelliah, from Trichy, reminds us, through a guest editorial, what vaccines adults should take. This is topical; soon we may be taking Smallpox vaccine, while waiting for...

Author Instruction

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list, Affiliations, Abstract, Keywords...

Journal Scan

Featuring six published articles from Kauvery Authors (1). Natarajan Sekar, Jithin Jagan, Arunagiri Viruthagiri, Nedounsejiane Mandjiny, Karthikeyan Sivagnanam. Management of Acute Limb Ischaemia Due to COVID-19 Induced Arterial Thrombosis:A Multi-Centre Indian Experience. Ann Vasc Dis. 2022;15(2):113-20. https://www.jstage.jst.go.jp/article/avd/advpub/0/advpub_oa.22-00012/_pdf Objective: To determine...

Myeloma

Background Most of the haemopoietic stem cell transplant (HSCT) centres are established in tier-1 cities (population of 1 million and above). Establishing a HSCT centre in a tier-2 city (0.5 to less than 1 million population) remains a challenge for...

Posterior Reversible Encephalopathy Syndrome (PRES)

Abstract Tacrolimus is widely used as an immunosuppressive drug following heart transplantation. Mild to severe forms of neurological symptoms are known to occur with use of Tacrolimus. Posterior Reversible Encephalopathy Syndrome (PRES) is one such manifestation that can present with...

Prophylactic orthopaedic surgery

Abstract We report a case of 37-years-aged male who presented asymptomatic, with unilateral proximal femoral simple bone cyst (SBCs). SBCs are cystic fluid-filled lesions encountered in proximal femur sometimes discovered serendipitously while radiologically investigating for other problems. After radiographic confirmation...

Subclavian steal: An interesting imaging scenario

Background Subclavian steal phenomenon refers to steno occlusive disease of proximal subclavian artery with subsequent reversal of flow in the ipsilateral vertebral artery. The cerebral ischemic symptoms or upper limb claudication constitutes the Subclavian Steal Syndrome (SSS). Here we present...

Spondylo-epi-metaphyseal dysplasia (SEMD)

Background Spondylo-epi-metaphyseal dysplasia (SEMD) represents a group of osteo-chondrodysplasias characterized by vertebral, epiphyseal as well as metaphyseal abnormalities. Several genes have been identified underlying the different forms. Krakow-type spondyloepimetaphyseal dysplasia is characterized by severe skeletal dysplasia, severe immunodeficiency, and developmental...

The bleeding windpipe

Abstract We describe a case of massive hemoptysis due to hypertrophied non-bronchial/bronchial arteries. They needed embolization and the paper discusses the management principles in achieving effective embolization. Major haemoptysis defined as one of the following: bleeding of more than or...

Learning from Experience – Intra Operative, Chapters 23 and 24

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 32-year-old woman, was posted for elective LSCS at 36 weeks of pregnancy, indication being the presence of a meningioma. She had increasing headache over the preceding three weeks, investigated for preeclampsia and...

The Consultation Room

Chapter 91: Geriatric patient Doctor has to face additional problems in the evaluation of diseases in very elderly for several reasons. They may be frail and not very ambulant, have impaired hearing or sight, multiple organ (cerebral, cardiac, renal etc)...

Diagnostic Image

Diagnosis: Hyperpigmentation of skin, bald tongue in pernicious anemia.

Recommended Readings

(1). Anticoagulants in Older Patients With Atrial Fibrillation. https://reference.medscape.com/recap/966174?src=0_nl_sms_0&uac=346576HG (2). American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. https://pubmed.ncbi.nlm.nih.gov/35297395/ (3). What Are the Benefits of...

Editorial

Dear colleagues, The KAUVERIAN, Aug 01, comes to you power-packed. 1. Dr. Suresh Chelliah, from Trichy, reminds us, through a guest editorial, what vaccines adults should take. This is topical; soon we may be taking Smallpox vaccine, while waiting for...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Physician, Protect thyself

According to 2011 census, there are 2.2 million health workers including 677,000 allopathic doctors accounting for 31% of the health workforce and 200,000 AYUSH practitioners accounting for 9% of the health workforce. Nurses and midwives (30%) and pharmacists (11%) are...

Foetal Medicine, the Future is here!

Background Perinatology is a subspecialty of obstetrics concerned with the care of the fetus and complicated high-risk pregnancies. Perinatology is also known as maternal-fetal medicine. Fetal Medicine which forms a part of the perinatology, deals with: Assessment and monitoring of...

Japanese Encephalitis: A common menace

Abstract Japanese encephalitis is a vaccine-preventable disease, which kills about 13690 to 20400 of about 68000 clinical cases worldwide [1]. We present two cases, one clinical and another with positive serology and wish to stress the importance of vaccination. Keywords:...

Carpometacarpal dislocation with impending compartment syndrome

Abstract Carpometacarpal (CMC) joint fracture-dislocation is a rare hand injury associated with high-energy trauma. Due to severe swelling and overlapping of bones on the radiograph of wrist-hand, dislocations are missed. If left untreated, it can lead to compartment syndrome and...

Heterotopic pregnancy

Background Heterotopic pregnancy (HP) incidence is increasing recently due to advanced artificial reproductive techniques. Incidence is 1 in 30000 in natural conception cycles. It is as high as 1in 100 to 1in 500 in Assisted Reproductive Technology (ART) pregnancies (1a)....

Femoral Trochantric and Proximal Humerus Fracture, from Diagnosis to Rehabilitation

Background The incidence of femoral fracture is generally higher in those older than 65 years; the rate of femoral fractures in the general population is 3 fractures per 10,000, annually [1]. The incidence is steadily increasing probably due to the...

My Father’s Heart Block

Case Presentation My father, 53 years of age, with past history of Diabetes, but without hypertension, complained of giddiness for three days. Clinical findings On bringing him to Heart City, on arrival, he was conscious, oriented, with a heart rate...

EPS page

CRT CSP Cases

[video width="1920" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/Video-report-CRT-CSP-CASES-Dr.-Vijayasekar.mp4"][/video]

Journal scan

From the desk of the Editor-in-Chief (1). Presha Kardile. Learning to live in a body at war with itself. BMJ 2022;377:o784. Presha Kardile explains how health professionals could have better helped her prepare for life ahead after a diagnosis of...

Learning from Experience – Intra Operative, Chapters 25 and 26

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 16-year-old girl was admitted for maxillofacial surgery, she needed a sagittal split of the mandible. Her facial symmetry was altered with a very prominent, forward thrusting mandible and a receding maxilla. Blood...

The Consultation Room

Chapter 96: Clinical trials Generally it's difficult and unethical to carry out double-blind clinical trials on patients coming to us for treatment, in an outpatient setup. Administering a controversial drug in one arm and a placebo in the other arm,...

Recommended Readings

(1). Ngofeen Mputubwele. The Agony of an Early Case of Monkeypox. 2022. https://www.newyorker.com/news/dispatch/the-agony-of-an-early-case-of-monkeypox?utm_source=nl&utm_brand=tny&utm_mailing=TNY_Daily_072322&utm_campaign=aud-dev&utm_medium=email&utm_term=tny_daily_digest&bxid=60588ce103d8544e1c38d628&cndid=64271967&hasha=b5c820dbb1de10a72bd8e6f8dee860db&hashb=67c8c2f7212222ced61205ef8d251a0b3292b7ab&hashc=9faeffcf368c29ce2138b54bd09276d01c8fd599bdf4b9aee741f4f7b9f19a33&esrc=lwg-register&mbid=CRMNYR012019 (2). Eelco F. M. Wijdicks. Identifying encephalopathies from acute metabolic derangements. J Int Med. 2022. https://onlinelibrary.wiley.com/doi/full/10.1111/joim.13538 (3). Martha Henriques. The best way to brush your teeth. 2022....

Editorial

Dr Bhuvaneswari leads this issue and makes Multiple Sclerosis come real in our minds "Its clinical sequelae are 'disseminated in space', affecting different anatomical sites, and 'disseminated in time', appearing episodically over time" Dr. Vasanthi Vidyasagaran takes a line from...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Multiple Sclerosis: An overview

Background Multiple sclerosis (MS) is an inflammatory condition that causes demyelination and axonal loss in the central nervous system (brain and spinal cord). The primary brain insult- Sclerosis, and its clinical sequelae are 'disseminated in space', affecting different anatomical sites,...

A flower born to blush unseen

It was 2:00 AM on a Sunday morning when my cell phone, which I had placed on a chair next to my bed, started vibrating. I had hoped that a vibrating mode would not disturb the rest of the sleeping...

Guest Editorial

"A PERFECT DOUBLE WHAMMY killer - STEMI and VT Storm THREAT managed successfully" ST Elevation myocardial infarction continues to be the leading cause of sudden cardiac death in India. Primary Ventricular Fibrillation still accounts for 10% immediate out-of-hospital mortality in...

Radio-frequency ablation as an effective treatment strategy in a case of VT storm post STEMI

Background The most dreaded of the varied presentations of ventricular tachycardia (VT) is the VT storm. This is defined as more than 3 episodes of VT/ VF needing cardioversion in a 24 h period. Management of VT storm is even...

Lymphatic malformation of tongue

Case Presentation A 32-year-lady presented with a bulky right side of her tongue since childhood. It has been gradually enlarging and reached a size that interfered with speech and deglutition over the last few years. Besides, she frequently got small...

Bilateral anterior shoulder dislocation in epilepsy: A case report and review of literature

Abstract Bilateral anterior shoulder dislocation is an uncommon condition. The majority of incidents are posterior dislocations, which typically happen as a result of exposure to a powerful electric shock or during diffuse tonic-clonic contractions of epileptic convulsions. We describe a...

An unusual cause of Stridor

Abstract A patient who had chronic stridor for 2 years, undergone tracheostomy first, followed by a diagnosis of bilateral abductor vocal cord paralysis for which Kashima's lateral cordotomy had been done, came for assessment 2 months later after being referred...

Monoclonal Antibodies (mAbs) – the magic bullets: A review of therapeutic applications and its future perspectives

Abstract Background: The objective of this paper is to present an overview of the ongoing development of specific Monoclonal Antibodies and discuss their therapeutic applications and future prospects. Methods: Among the emerging modes of therapies in the field of medicine,...

Write the Talk

Gist of the talk given by Dr Chockalingam at Salem Arthroplasty conference on 6th August 2022. Total knee replacements are one of the commonest orthopaedic operations performed worldwide in an elective setting. This surgery is a specialised surgery and the...

Press release and Comments

Unrelated donor stem cells transplants are reducing in number due to the availability of haplo identical donors readily in the family. People have shown a similar efficacy between Matched Unrelated Donor (MUD) transplantation and haplo So haplo is readily preferred...

Probability Distribution of Bernoulli Trials

A Bernoulli experiment is a random experiment, the outcome of which can be classified in one of two mutually exclusive and exhaustive ways, mainly, Success or Failure (e.g., female or male, life or death, non-defective or defective). So, it is...

Journal Scan

A 30-year-old man was admitted to the hospital with a 2-week history of rash and fever. Four weeks before presentation, he had taken trimethoprim-sulfamethoxazole for the treatment of folliculitis. His body temperature was 39.1°C. Physical examination revealed a morbilliform rash...

Recommended Readings

(1). The Preventable Tragedy of Polio in New York https://www.newyorker.com/news/daily-comment/the-preventable-tragedy-of-polio-in-new-york (2). Tecovirimat and tThe Preventable Tragedy of Polio in New York | The New Yorkerhe Treatment of Monkeypox - Past, Present, and Future Considerations https://www.nejm.org/doi/full/10.1056/NEJMp2210125 (3). Targeting Insulin Resistance Instead...

poem-v4i4

"சமத்துவம்" என்பதே மருத்துவத்திலிருந்து தோன்றியது தானோ என்னவோ? இனம் என்ன? குலமென்ன? குணமென்ன? தேவையில்லை! உயர்வு, தாழ்வு என்று ஏதுமில்லை! நோயென்று நாடி வருவோரை, தாய் என காத்து, பயத்துடன் ஓடி வருவோரை, நயத்துடன் சிகிச்சை பார்த்து, நம்பி கை நீட்டுவோரை , நம்பிக்கை கொள்ள வைத்து, மாத்திரைகளுடன் அன்பு வார்த்தைகள் பேசி, வலி தெரியாமல்...

Editorial

Dear colleagues, At last, some dreams of the KAUVERIAN come true! Drs Sai Soundarya and Reshma Raju publish the findings of their DNB theses on COVID- 19! Under the wise, watchful yet gentle eyes of Dr.Dominic, the two residents document...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Research

Abstract Tocilizumab, an Interleukin 6 receptor antagonist, has been used to manage the cytokine storm of COVID 19. There are numerous articles and studies on the effectiveness of Tocilizumab in the cytokine storm of COVID-19 pneumonia. It has been reported...

Research

Abstract Background: The novel coronavirus 2019 which caused the COVID-19 pandemic in the year 2020 and affected every country in the world has left behind a great deal of economic and social loss as well as loss of human lives....

Lambda-cyhalothrin and pyrethrin poisoning: A case report

Abstract The most common organophosphorus products are dimethoate and fenthion. Endosulfan is an organochlorine insecticide. They have been phased out globally due to their potential for acute toxicity, bioaccumulation and their role as an endocrine disruptor. Synthetic pyrethroid insecticides (cypermethrin...

Good Enough

Tara jumped out of her bed as the phone rang; or was it in her dream? Frantically she checked her phone for any missed calls, found none, and went back to sleep. It had been nine months since she had...

The Monoclonal antibodies (mAbs): the beginning

Abstract The objective of this paper is to present the first Monoclonal Antibody (MUROMONAB-CD3). In 1986, it was registered as OKT3, and was approved by the US FDA for inhibiting rejection in solid-organ transplantation. Moreover, OKT3 is a potent mitogen,...

Comprehensive trauma course 2022: Trauma Management & Kauvery

Dr. Aravindan introduced the course to the delegates in his talk on Trauma management at Kauvery. He briefed his background in trauma training at Ahmedabad and United Kingdom. His exposure to Advanced trauma life supports training in UK. On his...

Comprehensive trauma course 2022: Introduction to Comprehensive trauma course

I'm Dr. Venkita Subramony Suresh, Group Medical Director of Kauvery Hospitals. I have served in the Armed Forces Medical Services of India, and later that of Oman, as a Colonel. The biggest cause of trauma are wars; wars produce great...

Diagnostic Image

Diagnosis: Toe tip gangrene in cold antibody autoimmune hemolytic anemia

Learning from Experience – Intra Operative, Chapters 27 and 28

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 4-year-old, female child weighing 12 kg was posted for correction of a congenital club foot. History of birth and early years were uneventful. Normal milestones achieved. Immunization was given up to date....

The Consultation Room

Chapter 101: Twelve Commandments Twelve 'Commandments' for 'healthy and litigation-free' medical practice, compiled by me in 1990, are very crisp, easy to practice guidelines, to satisfy our patients and to maintain safe 'social distance' from the lawyers. They are self...

Recommended Readings

(1). Learning Patient Safety Culture: Turning Fog to Concrete https://www.ihi.org/communities/blogs/learning-patient-safety-culture-turning-fog-to-concrete?utm_campaign=tw&utm_medium=email&_hsmi=225671457&_hsenc=p2ANqtz-8VA78fVMe3XlNTAJU9ApVTn-48YurQSvl5e_JRWCWUDC7Ws3jFPrLL5oySYrmYdJJOxAuTVJIlEw-Or2DGxjPMWlMzRA&utm_content=225553574&utm_source=hs_email (2). Air pollution cancer breakthrough will rewrite the rules https://www.bbc.com/news/health-62797777 (3). How Strength Training Can Help You Live Longer https://www.medscape.com/viewarticle/980170 (4). Stroke of Other Determined Etiology https://www.medscape.com/viewarticle/978481 (5). Test Lp(a)...

Poem

ஐயா வணக்கம். நேற்று இரவு நலமாக வீடு திரும்பினேன். உங்கள் அணுகுமுறை இந்த கவிஞன் விரும்பியது போலவே இருந்தது. ஒரு மருத்துவருக்கான ப்ரிஷ்க்ரிப்ஷன் தயங்கித் தயங்கி இன்று ஒரு மருத்துவரிடம் போகிறேன் மருத்துவராக இருக்கும் நீங்கள் அவர் ஒரு ஆணாகவோ பெண்ணாகவோ இருக்கக் கூடும் நான் உங்களிடம் பயத்துடனும் குழப்பத்துடனும் வருகிறேன் நான் சும்மாவே எல்லாவற்றுக்கும்...

Editorial

Dear colleagues, On 16 October 2022, on World Anaesthesia Day, the Kauverian dedicates its special edition, in two parts, part 1 & 2, to students and teachers of Anaesthesia at eight Kauvery Hospitals who together do their best to keep...

The Brave New World of Anaesthesia

It is festival season all around the world and as people rejoice, we have yet another event to celebrate "The World Anaesthesia Day or The Ether Day" which falls on 16th of October. This is a day which should be...

Anesthetic considerations in Wilson’s disease for fess: A case report

Abstract Wilson's disease (WD) is an autosomal recessive disorder characterized by the accumulation of copper in various organs and tissues especially in liver, brain, kidney, and cornea- consequently causing hepatic and neurological impairment. Anesthetic management for patients with WD presents...

The painful story behind modern anaesthesia

Background Let's go back to the Stone Age. Now imagine how surgeons would have operated! It was hell even to imagine. Few hunks would restrain the patient, the surgeon would take a saw to cut the limb... Oh my god...

Anesthesia considerations for Ankyslosing Spondylitis

Abstract We report the anaesthetic management of a patient with progressive ankylosing spondylitis with severe deformity at cervical, thoracic and lumbar spines. She was admitted for restorative surgery of thoracic and lumbar spines, to improve her functional, immobility and quality...

Total intravenous anaesthesia: An overview

Abstract The objective of this article is to present an overview of a novel technique in anaesthesia known as Total Intravenous Anaesthesia (TIVA), its goals, advantages, disadvantages, different drugs and techniques used. Total Intravenous Anaesthesia (TIVA) refers to the technique...

Risk stratification for cardiac patients coming for non-cardiac surgeries

Background In pre anesthetic assessment patients are evaluated based on their comorbidities and the type of surgery that they will be undergoing. The American Society of Anesthesiologists' (ASA) Physical Status Classification System helps to categorize patient's physiological status so that...

The Anaesthesiologist’s role in fluoroscopic guided epidural steroid injections for low back pain

Background Low back pain (LBA) is a disease of chronic wear and tear mechanism that involves spine and neural complexes. Even though numerous causes of LBA have been documented, disc disease and facet joint arthritis contribute to half of the...

Awake Craniotomy

Background Awake craniotomy is used for mapping and resection of lesions in important brain areas while preserving neurological functions. Goal is to have an awake, cooperative patient for motor function assessment during tumor resection. Case Presentation A 50-year-old female, known...

Malpositioned central venous catheter: Step wise approach to avoid, identify and manage

Background Cannulating a Central venous catheter (CVC) is almost always done promptly and unhesitatingly in critically ill patients to provide effective critical care. Although ultrasonography (USG) guidance has been appreciated to improve insertion site accuracy, inadvertent complications still exist. Malposition...

Benefits outweighing risk: Neuraxial anaesthesia in a patient with Spina Bifida with operated Meningomyelocele

Abstract Spina bifida is a condition where the developing spine fails to completely enclose the neural elements in a bony canal. Failed fusion of neural arch without herniation of meninges is called as Spina Bifida Occulta. Failed fusion of neural...

Pain free CABG: newer horizon of minimally invasive cardiothoracic surgery a walk through anaesthesiologist perspective

Background Significant advances in cardiac surgery followed the introduction of cardiopulmonary bypass (CPB), which was first established in the early 1950s. Over time, refinements in surgical and anaesthetic techniques combined with improved technology and the use of intraoperative transoesophageal echocardiography...

Stellate Ganglion Block: A bridge to cervical sympathectomy in refractory Long QT Syndrome

Abstract Long QT syndrome (LQTS) is caused by malfunction of cardiac ion channels impairing ventricular repolarization. Age of presentation can be anywhere from in-utero to adulthood. For patients who continue to develop fatal ventricular arrhythmias, stellate ganglion block prior to...

Venous Malformation in Upper Airway – Anesthetic Challenges and Management: A Case Report

Abstract We present a case of venous malformation involving upper airway, who developed airway obstruction post extubation requiring re-intubation and tracheostomy. Our reflection on the management of this case highlights several important learning points. These include the importance of clear...

Editorial

Dear colleagues, Probably even before you have had time to read and digest the first 15, we are back with 10 more! They illustrate the wide range of challenges over which Anaesthesiology "operates!" The spectrum includes: 1. USG guided peripheral...

USG guided peripheral nerve block in surgery for hernia

Background Hernia is defined as "Protrusion of any viscus or part of the viscus through an abnormal opening in the walls of its containing cavity." A wide variety of anaesthetic techniques have been used for inguinal hernia repair such as...

Anaesthesia and morbid obesity: A systematic review

Abstract Over the past few decades, there has been an increase in the prevalence of obesity and its related complications and so, they more often require surgical interventions. The Anaesthesiologist has to be very aware of the related anatomical considerations,...

Patient-Controlled Analgesia

Background Although the term patient-controlled analgesia (PCA) covers a variety of techniques where patients self-administer analgesic drugs (e.g., entonox in labour or oral analgesia postoperatively), the term is usually taken to refer to self- administration of intravenous drugs. The technique...

Parapharyngeal abscess of face and neck: Anesthetic management

Background Parapharyngeal abscess is a deep neck space infection that can land up in life-threatening airway obstruction. Anesthetizing a patient with this condition is a definite challenge. In this case, we chose the option of securing the airway by awake...

3D TEE, a boon for the diagnosis of Left Atrial Appendage thrombus!

Background Atrial fibrillation (AF) is a potentially problematic cardiac arrhythmia affecting approximately 1% of adults. Stroke occurs in 5% of non-anticoagulated patients. The gold standard for preventing atrial fibrillation-related strokes is oral anticoagulation. However, contraindications and reluctance to comply with...

Anaesthetic management of difficult airway due to retropharyngeal abscess and cervical spondylosis

Abstract A 61-year-old male, with both Diabetes and Hypertension, on regular treatment, came with complaints of neck pain and fever for 1 week. Neck X-ray and computed tomography scan confirmed a retropharyngeal abscess with associated cervical spondylosis. He was posted...

Expect the unexpected – Breach in continuous nerve block catheter

Abstract The placement of continuous peripheral nerve block catheters on an ambulatory basis is increasing in day-to-day practice. There are a few reports of complications associated with peripheral nerve block catheter removal in the literature such as inability to remove...

Lignocaine nasal spray: An easy remedy for Post Dural Puncture Headache

Abstract Current treatment of post dural puncture headache (PDPH) includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for post dural puncture...

Potassium permanganate poisoning and airway oedema

Abstract KMnO4 is irritant to gastrointestinal (GI) system causing ulceration, rarely perforation and massive haemorrhage. Systemic complications can cause acute respiratory distress syndrome, pancreatitis, hepatic and renal damage, methemoglobinemia, disseminated intravascular coagulation and cardiovascular depression. The immediate concern after the...

Angioedema following anti-snake venom administration

Abstract Angioedema is a known complication of anti-snake venom (ASV) therapy for snake bite envenomation. We present a 68-years-aged male patient who presented with oropharyngeal angioedema following ASV administration who was managed using awake fibreoptic intubation, steroids and antihistaminic therapy....

Editorial

Dear colleagues Worldwide, medical journals take a break at Christmas - New Year's time. As such the last issue of the KAUVERIAN for 2022 shall emerge on or before 15 Dec 22. We open with a sumptuous section on EPS....

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Ra Fx ablation of Atrioventricular nodal reciprocating tachycardia

A 55 years Female presents with recurrent episodes of palpitation and is documented to have narrow QRS tachycardia responsive to adenosine. Tachycardia ECG was suggestive of atrioventricular nodal reciprocating tachycardia (AVNRT). An electrophysiology study (EPS) was done and supraventricular narrow...

Pace and Ablate Strategy: Conduction system pacing with AV junction ablation for drug refractory atrial arrhythmia – A novel approach

Case Presentation A 44-year-old female presented with recurrent episodes of palpitations and breathlessness. Her past history is significant for rheumatic heart disease of the mitral valve with mechanical valve replacement 8 years ago. Patient has been suffering from frequent episodes...

Why Cardiac Resynchronization Therapy (CRT) For complete heart block? A case discussion

Background Cardiac Resynchronization Therapy (CRT) is a procedure to implant a device using simultaneous pacing of the right ventricle and left ventricle (biventricular pacing). CRT is indicated in patients with low ejection fraction (typically LVEF ≤ 35%). Biventricular pacing is...

Pacemakers and Bradyarrhythmias in Diabetic Mellitus

Background Diabetes mellitus is increasing in prevalence in India and thereby places a significant burden of on our health care system. Importantly, diabetes mellitus is an important risk factor for cardiovascular diseases. Several cardiovascular disorders are a complication of diabetes...

Outcomes of Total Knee Arthroplasty in patients aged 70 years and above

Background Osteoarthritis is the most common condition affecting joints, causing pain and disability, especially in the elderly [1]. Total knee arthroplasty (TKA) has been shown to be effective in treating pain and restoring function in the majority of patients suffering...

An approach to CBC for practitioners

Background The complete blood count is the most common blood investigation done in the world, be it a primary healthcare centre in a rural area or the most advanced referral care centre in the country. It's essential for every practitioner...

Acute cerebral sinus venous thrombosis with different presentations and different outcomes: A case series

Abstract Cerebral sinus venous thrombosis (CSVT) is a relatively rare form of venous thromboembolism and accounts for 0.5 to 1% of all strokes. It is usually seen in young adults and children. Its clinical presentation is variable, making it difficult...

Diet and nutritional care for DDLT: A case study

Background A 57-years old female was admitted for DDLT. Relevant investigations were done. Covid-19 RT-PCR was negative pre-operatively. After anaesthetic clearance, cardiologist opinion and written informed consent, she underwent DDLT on 22/10/2022. After the procedure patient was shifted to the...

Vaccine for Dengue (Dengvaxia CYD-TDV)

Aim The objective of this paper is to present an overview of the first dengue vaccine Dengvaxia (CYD-TDV) and its therapeutic application. Dengvaxia Dengvaxia is a vaccine used to protect against dengue disease in people aged 6 to 45 years...

Diagnostic Image

Diagnosis: A 12-year-old boy with a stiff elbow (with no movements) 80 days following injury to the elbow. He had dislocated elbow which was reduced with closed manipulation

Learning from Experience – Intra Operative, Chapters 31 and 32

A 28-year-old woman was posted for hysteroscopic removal of a fibroid polyp in a day-care setting. On pre-operative examination, she was anaemic with haemoglobin of 7 gm/dl. All other investigations were within normal limits. She was taken up for the...

Recommended Readings

(1). Anthony S. Fauci. It Ain't Over Till It's Over...but It's Never Over - Emerging and Reemerging Infectious Diseases. 2022. https://www.nejm.org/doi/full/10.1056/NEJMp2213814 (2). Annette M. Esper, et al. Systematized and efficient: organization of critical care in the future. Crit Care. 2022;...

காவிரித்தாய்

நோயில்லா வாழ்வு காண அயராது உழைக்கும் காவேரியே, நோயோடு வருபவர்களை கனிவோடு உபசரிக்கும் காவேரியே, நோயின் குணமறிந்து சிறப்பு சிகிச்சை தரும் காவேரியே, அனுபவ மருத்துவர்களை பணியமர்த்தி நோயாளியின் துயர் துடைக்கும் காவேரியே, தாயும் சேயும் நலம் பெற சேவை செய்யும் காவிரியே, தென்னகத்தில் ஈடில்லா மருத்துவப்பணி செய்துவரும் காவேரியே, வணங்குவார் காவேரியின் நலன் பெற்ற...

ATLAS OF HAEMATOLOGY AND HEMATOONCOLOGY

Diagnosis: Doughnut cells in anaplastic large cell lymphoma. Diagnosis: Signet ring cells infiltrating a bone marrow aspirate indicating metastatic adenocarcinoma. Diagnosis: Binucleate lymphoplasmacytoid cell and Rouleaux formation in a patient with Waldenstorm macroglobulinemi. Diagnosis: Peripheral smear with Leucoerythroblastic blood picture...

Editorial

Dear colleagues The KAUVERIAN brings you topical, thoughtful, trendy themes each time. As ever, the 15 Nov issue shall reach you on or before the date! 1. The most definitive answer to the question everybody asks oneself "Why write a...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

Case reports and Case series:

We as clinicians are in the era of 'evidence-based medical practice'. Does 'practice-based evidence' still matter, is it still relevant? Yes indeed! 'Case reports or case series' help in generating 'practise-based evidence'. The idea for research or for generating a...

Usefulness of NEWS 2 score in monitoring patients with cytokine storm of COVID-19 pneumonia

Abstract There is a need for uniform assessment of inpatients with critical illness to assess progress and to guide decisions. NEWS 2 score is a simple validated score which we used to monitor patients during the cytokine storm phase of...

Treatment approach for extensively Drug-Resistant Tuberculosis (XDR-TB)

Background India has the highest estimated burden of tuberculosis infection globally, with nearly 35-40 crores Indian population having the infection, of which 26 lakhs people are estimated to develop tuberculosis (TB) disease annually. This demographic may change after the ongoing...

Modified Lichtenstein mesh repair, for a patient of Coronary Artery Disease, Heart Failure and with Implanted Cardioverter- Defibrillator

Case Presentation A 62 years old male, a resident of Udupi, was refused surgery for a symptomatic right inguinal-scrotal hernia at a hospital of international repute in Mangalore as high risk. He had undergone an implantable cardioverter-defibrillator (ICD) 2 years...

Fever-induced Brugada Syndrome

Case Presentation A 70-years-aged male patient, known to have diabetes, presented with complaints of fever, and cough for 3 days, followed by an episode of syncope. The patient was evaluated elsewhere during which ECG showed ST elevation in V1 and...

Pulmonary Thrombo Embolism: When to Thrombolyse?

Abstract Pulmonary embolism (PE) is the third most common cause of cardiovascular death. Multidetector computed tomography pulmonary angiography (CTPA) is the investigation of choice in imaging a patient with a suspected pulmonary embolism. Often doing CTPA on a critically ill...

Ultra-Short Case Report

It was an elderly male with chronic liver disease and hepatic encephalopathy refractory to the medical line of management. He had a large splenorenal shunt found on CT. A large volume of portal blood entering the systemic circulation was the...

Learning from the failure of Nebacumab

Background In our series of articles on Monoclonal Antibodies, we now present the second one, on Nebacumab, a human monoclonal antibody (mAb). Nebacumab, also known as HA-1A, was a human IgM monoclonal antibody that could bind to the lipid A...

Journal scan

A review of 20 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Charlotte Debras, et al. Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort. BMJ...

Learning From Experience Intra Operative Chapters 29 and 30

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] Case 1: A 25-year-old lady was posted for oesophagoscopy and dilatation of a stricture oesophagus following corrosive poisoning. Being a minor procedure, she came to the OP at 9 AM, as a day...

Recommended Readings

(1). Richard Smith. A neurosurgeon confronts his death. 2022;400(10362):P1505-6. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02089-X/fulltext When I worked at The BMJ, I came to see that we had a glut of personal views that followed a predictable pattern: "I thought I was a good doctor,...

Poem

செம்மையாகுமே வாழ்வு, உடலும் மனமும் சீரானால். அறிவோமே நோய்க்காரணம், வியாதியும் தெளிவில்லா மனமும் சூழலும் என்று உணவே மருந்து என்றனர் முன்னோர். குணத்தை உண்டு பண்ணுமாம் உணவு, எனவே உண்ணுங்கள் உணவை அவரவர் தேவையறிந்து. உண்போம் இயற்க்கை உணவு. தவிர்போம் இரசாயன உணவு. தவிர்க்கலாமே உடல் உபாதைகளை, சரியான நேரத்தில் ருசித்து புசித்தால். முன் தூங்கி,...

Editorial

Dear colleagues 01 Mar is "Celebration Day" at the KAUVERIAN! We have a rain of articles from our accomplished colleagues!, The lead article from Dr. S. Aravinda Kumar on Heart Transplantation is perfectly timed. Kauvery Hospital Chennai announced on 24...

Editorial Board

Editor-in-Chief Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India Email: [email protected] Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery...

Heart transplantation: Life beyond the end of life

Background Although the first human heart transplantation was performed in 1967, the annual number of transplants only began to grow substantially from the eighties, declining again after 1996, due to the shortage of donor hearts. Worldwide the mean age of...

Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal

Background The use of azithromycin reduces maternal infection in women during planned cesarean delivery, but its effect on those with planned vaginal delivery is unknown. Data are needed on whether an intrapartum oral dose of azithromycin would reduce maternal and...

Medial retropharyngeal nodal region sparing radiotherapy versus standard radiotherapy

Medial retropharyngeal nodal region sparing radiotherapy versus standard radiotherapy in patients with nasopharyngeal carcinoma: open label, non-inferiority, multicentre, randomised, phase 3 trial Abstract Objectives: To address whether sparing the medial retropharyngeal lymph node (MRLN) region from elective irradiation volume provides...

Proximie: Patient safety in surgery – the urgent need for reform

Proximie: Patient safety in surgery - the urgent need for reform This report considers the number of safety incidents in surgery occurring in the NHS since 2015 and calls for action to improve surgical safety. It also highlights the perceptions...

Analysis of femoral neck fracture in octogenarians and its management

Analysis of femoral neck fracture in octogenarians and its management The 6 million population in India above 80 years in 2013 will rise up to 30 million in 2050 [1]. The grand elderly suffers from co-morbidities like osteoporosis, medical problems,...

Adult Immunisation in Clinical Practice: A Neglected Life Saver

Adult Immunisation in Clinical Practice: A Neglected Life Saver Background In a developing country like India, infectious diseases (ID) are an important reason for an enormous disease burden, causing morbidity, mortality and disability [1]. Infectious diseases can occur in people...

“Icing” The Eyes

"Icing" The Eyes Case Presentation A 65-year old lady was referred to our neurology clinic with drooping of her right upper eyelid. There was no diplopia, despite the ptosis being present for 2 weeks. There was no history suggestive of...

Doppler vascular mapping in Arterio Venous Fistula (AVF)

Background Doppler is the property of a sound wave to change its frequency when a source and the observer are in relative motion. First identified by an Austrian physicist Christian Doppler in 19th century, Doppler has a tremendous impact on...

Cosmesis and cure: Radiotherapy in basal cell carcinoma of the dorsum of nose – A case report

Cosmesis and cure: Radiotherapy in basal cell carcinoma of the dorsum of nose - A case report Abstract Local therapy is the mainstay in basal cell carcinoma and the decision between primary surgery vs definitive radiotherapy is based on factors...

Pulmonary Hypertension and Portal Hypertension

Pulmonary Hypertension and Portal Hypertension Pulmonary Hypertension When the pressure in the blood vessels in the lungs becomes high, the condition is referred to as pulmonary hypertension (PH), also referred to at times as Pulmonary Artery Hypertension (PAH). The distinction...

Comprehensive review of Drug-Induced Cardiotoxicity

Comprehensive review of Drug-Induced Cardiotoxicity Abstract Objective: The objective of the paper is to discuss drugs that induce cardiotoxicity, and their mechanisms. Methods: Drugs that cause cardiotoxicity interrupt the key myocardial functions through various mechanisms some of which find mention...

Statistics – Data Collection – Case Study Method

Statistics - Data Collection - Case Study Method Case study research is a qualitative research method that is used to examine contemporary real-life situations and apply the findings of the case to the problem under study. Case studies involve a...

Atlas of Haematology and Hematooncology

Atlas of Haematology and Hematooncology Diagnosis: Dapsone induced skin erythema and hermolytic anemia Diagnosis: Cyanosis in congenital methemoglobinemia, finger tips in comparison to mine. Diagnosis: Hyperpigmentation of skin, bald tongue in pernicious anemia. Diagnosis: Toe tip gangrene in cold antibody...

PRE-OPERATIVE Chapters 1 and 2 – Learning from Experience

PRE-OPERATIVE Chapters 1 and 2 - Learning from Experience Case 1: Mentally disabled patient with dental abscess A 35-years old, mentally handicapped, well-built person, being cared by his mother, was admitted with suspected dental abscess, complaining of inability to feed...

Chapter 2. Uncertainties in medicine in spite of advances

Chapter 2. Uncertainties in medicine in spite of advances Introduction Medicine unlike physics or mathematics is at best a scientific study rather than pure science. There have been rapid advances in medicine with the use of modern technology. However, as...

No Splendid Child

No Splendid Child No cursed goddess, no divine being, No splendid child birthed from the molten Earth, Or even not a plain sensical being. But I may hold no premonitions, And no music may play from my throat, But I...

Editorial

Dear colleagues (1). "Break Heart Pass coming up!" Charles Bronson, yesteryear macho hero of Hollywood, pulled the whistle on the train he was steaming up the hill. He looked out the engine and announced what was coming up ahead. Break...

Editorial Board

Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T. Sundararajan Kauvery Hospital, Salem Dr. S. Velmurugan Department of Surgical Gastroenterology, Kauvery Hospital, Cantonment, Trichy...

A Young Girl Lost in the Storm

Abstract It's a story of an unfortunate young girl who presented with fever, gastrointestinal symptoms, and pancytopenia and later lost her battle due to uncontrolled immune responses in a short time. Keywords: fever; pancytopenia; hemophagocytosis; immune system Background It's about...

ECMO as a bridge to Transplant: A case report

Background Extracorporeal membrane oxygenation, also known as extracorporeal life support, is an extracorporeal technique of providing prolonged cardiac and respiratory support to patients whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to...

Renal anemia – from bench to bedside

[video width="1920" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/Renal-anemia-from-bench-to-bedside-Dr.-R.-Balasubramaniyam.mp4"][/video]

Mission Possible

Mission Possible [video width="1920" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/Mission-Possible-Dr-Rammohan-S-Bhat.mp4"][/video]

New kids on the block – Update on diabetic nephropathy therapy

New kids on the block - Update on diabetic nephropathy therapy [video width="1920" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/New-kids-on-the-block-Dr-Kishor-Kumar.mp4"][/video]

Infections – Trade off in Transplants

Infections - Trade off in Transplants [video width="1920" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/Infections-Trade-off-in-Transplants-Dr-K.-Abirami.mp4"][/video]

To Give Or Not to Give – Primer on Bicarbonate Therapy

To Give Or Not to Give - Primer on Bicarbonate Therapy [video width="1920" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2023/04/To-Give-Or-Not-to-Give-Primer-on-Bicarbonate-Therapy-Dr.-S.-Vigneshwaran.mp4"][/video]

Sialendoscopy: Shifting paradigms in treatment of salivary gland disease

Sialendoscopy: Shifting paradigms in treatment of salivary gland disease Background Sialendoscopy offers a duct centric approach to management of salivary gland diseases. Majority of salivary gland diseases like sialadenitis are due to ductal pathologies like stone, stricture, or stenosis. Sialendoscopy...

Gait imbalance in a senior due to Chronic Immune Sensory Polyneuropathy (CISP)

Background Gait imbalance and falls are common in elderly persons and have devastating consequences, with substantial morbidity and mortality. Maintaining postural control requires a complex integration of sensory inputs, central processing, motor coordination and musculoskeletal function to perceive environmental stimuli,...

Statistics – Mcnemar Test

Statistics - Mcnemar Test T. Dhasaratharaman* Statistician, Kauvery Hospitals, India *Correspondence: +91 90037 84310; [email protected] *Correspondence: Tel.: email: In statistics, McNemar's test is a statistical test used on paired nominal data. It is applied to 2 × 2 contingency tables...

Atlas Of Haematology And Hematooncology

Atlas Of Haematology And Hematooncology Diagnosis: Xanthelasma Diagnosis: Eschar over scrotum in case of Scrub typhus. Serology was positive for Scrub typhus IgM and he has transaminitis, pseudo thrombocytopenia Diagnosis: Sclerodactyly is a localized thickening and tightness of the skin...

PRE-OPERATIVE Chapters 3 and 4 – Learning from Experience

PERI-OPERATIVE Chapter 03 Disulfiram Like Reaction A 42-year-old man presented to the casualty, with degloving injury to his right forearm. He was a case of drunken driving. He was immediately prepared for surgery to salvage his limb. Initial workup and...

Changing trends a challenge to the already trained

Chapter 3: Changing trends a challenge to the already trained Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP Is it not a bit unnerving what doctors call what they do is "practice"? - George Courtin It is astonishing with how...

Journal scan

Journal scan: A review of  35 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Tulika Chatterjee. A Case of Gigantic Unruptured Abdominal Aneurysm Successfully Treated With Endovascular Repair (EVAR). 2022....

Recommended Readings

(1). Cecilia Lazea, et al. ROHHAD (Rapid-onset Obesity with Hypoventilation, Hypothalamic Dysfunction, Autonomic Dysregulation) Syndrome-What Every Pediatrician Should Know About the Etiopathogenesis, Diagnosis and Treatment: A Review. Int J Gen Med. 2021;14:319-326. https://www.dovepress.com/rohhad-rapid-onset-obesity-with-hypoventilation-hypothalamic-dysfuncti-peer-reviewed-fulltext-article-IJGM Abstract: Rapid-onset obesity with hypoventilation, hypothalamic dysfunction,...

EDITORIAL

Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India *Correspondence: [email protected] Dear colleagues Vanakkam! The May Issue comes bursting with papers from different Kauvery Hospitals, and different specialties Our authors range from Masters in publication to maiden efforts from novices...

EDITORIAL BOARD

KAUVERIAN e-Medical Journal Editor-in-Chief Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India Email: [email protected] Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr. T....

PREGNANCY POST-RENAL TRANSPLANT

Pregnancy Post-Renal Transplant Balasubramaniam Chief of Nephrology, Kauvery Hospital, Chennai All is well that ends well! A 24-years-aged female, presented to us with End Stage Kidney Disease 3 years before for which she underwent a live-related renal transplantation. Her renal...

BALLOON-OCCLUDED RETROGRADE TRANSVENOUS OBLITERATION

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) of gastric varices: A case report V. Senthilvelmurugana,*, P. Santhosh Kumarb, N. Raam Prasanthc, K. Arivarasand aHOD, Department of Radiology, Kauvery Hospital, Trichy bConsultant Radiologist, Kauvery Hospital, Salem cResident Radiology, Kauvery Hospital, Trichy dConsultant Gastroenterologist,...

REVERSE SHOULDER ARTHROPLASTY FOR ROTATOR CUFF ARTHROPATHY

Reverse Shoulder Arthroplasty for Rotator cuff arthropathy J. Mohan Kumar1, Vijay Kulkarni2, Chandrakanth3 Senior Consultant Orthopaedics and Shoulder Specialist, Kauvery Hospital, Electronic City, Bangalore Consultant Orthopaedician, Kauvery Hospital, Electronic City, Bangalore Abstract Reverse shoulder arthroplasty (RSA) is increasingly gaining popularity...

THE AMBUSH A TEAM APPROACH

The Ambush: A team approach Kiruba Nandhini, S. Vadivel Kumaran, Balaji Kirushnan, R. Balasubramanian Medical Gastroenterologist and Hepatologist, Kauvery Hospital, Chennai Nephrologist, Kauvery Hospital, Chennai Case Presentation Mr. X, 83 years old male, known to have Carcinoma Prostate on Immunotherapy...

ENDOSCOPIC TRANS-SPHENOID APPROACH FOR PITUITARY ADENOMA EXCISION

Endoscopic Trans-sphenoid approach for Pituitary Adenoma excision: Multidisciplinary care and patient outcomes Krishna Chaitanyaa, Sridutt Bhadria, Sheelu Srinivasb Department of Neurosurgery, Kauvery Hospital Electronic City, Bangalore Department of Otolaryngology, Kauvery Hospital Electronic City, Bangalore Background Pituitary adenomas are benign tumours...

A STUDY ON PRESENTATION AND OUTCOME OF BULL GORE INJURIES IN A GROUP OF TERTIARY CARE HOSPITALS

A Study on Presentation and Outcome of Bull Gore Injuries in a Group of Tertiary Care Hospitals D. Suryaprabha* Chief Clinical Pharmacist and Assistant Manager - Clinical Research, Kauvery Hospitals, India *Correspondence: +91 98414 86267; [email protected]   Abstract Background: Bull Gore...

A CASE OF INTERNUCLEAR OPHTHALMOPARESIS AS THE FIRST MANIFESTATION OF MULTIPLE SCLEROSIS

A case of Internuclear Ophthalmoparesis as the first manifestation of multiple sclerosis Sanjai Kumar1, Ravikumar2 1Duty Medical Officer, Department of Emergency, Kauvery Hospital, Tennur, Trichy 2Consultant Neurologist, Kauvery Hospital, Tennur, Trichy Objective Internuclear Ophthalmoparesis (INO) is the second most common...

GRANULOMATOSIS WITH POLYANGITIS AND LUNG INVOLVMENT (WEGENER’S DISEASE)

Granulomatosis with Polyangitis and Lung involvment (Wegener's Disease) Shankavi Mohanraj Medical Officer, Kauvery Hospital, Tennur   Background Granulomatosis with polyangiitis (GPA) is one of the Antineutrophil Cytoplasmic Antibody (ANCA) associated small vessel vasculitides involving various organs such as nasal septum,...

RITUXIMAB (RITUXAN, MABTHERA) IN THE TREATMENT OF B-CELL NON-HODGKIN’S LYMPHOMA

Rituximab (Rituxan, Mabthera) in the Treatment Of B-Cell Non-Hodgkin's Lymphoma A. Kaviyarasi Clinical Pharmacist, Kauvery Hospital, Hosur Correspondence: [email protected] Abstract Rituximab is a monoclonal, anti-CD20, chimeric humanized antibody. The FDA initially approved it as an anti-neoplastic drug to treat B-cell cancers....

STATISTICAL SIGNIFICANCE

Statistics - Statistical Significance Statistical Significance signifies that result of a statistical experiment or testing is not occurring randomly and is attributable to certain cause. Statistical significance of a result could be strong or weak and it is very important for...

Atlas Of Haematology And Hematooncology

Atlas Of Haematology And Hematooncology Dr. R. M. Subbaiah* Consultant Hemato-Oncology, Kauvery Hospital, Trichy, India *Correspondence: [email protected] Diagnosis: Familial Methemoglobinemia type I. Diagnosis: Strong Positive Mantoux reaction (Tuberculin test) showing ulceration in a patient with Tuberculosis. Diagnosis: Smudge cells and mature lymphocytes in chronic...

PRE-OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE

PERI-OPERATIVE Chapter 05 Disulfiram Like Reaction Dr. Vasanthi Vidyasagaran* Department of Anaesthesiology, Kauvery Hospital, Chennai, Tamilnadu, India *Correspondence: [email protected] A 29-year-old woman, near term, was admitted to the obstetric unit with complaint of inability to feel foetal movements. There was no...

Chapter 4: Diagnostic process often reversed

Chapter 4: Diagnostic process often reversed Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP We need proper balance in medical approach - Mark Twain Before you examine the body of a patient, be patient to hear his story, once you learn...

Journal scan: A review of 25 recent papers of immediate clinical significance, harvested from major international journals

Journal scan: A review of 25 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Amrou Sarraj, et al. Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med....

Recommended Readings

Recommended Readings (1). David A Warrell et al. Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet 2023;401(10385):P1382-1398. There is increasing recognition of the public health importance of snakebite envenoming. Worldwide annual incidence is likely to be...

ஆரோக்கியம் நம் கையில்

ஆரோக்கியம் நம் கையில் GK. Balasubramani, Senior Physiotherapist, Kauvery Hospital, SalemCorrespondence: [email protected] எல்லாமே சிலகாலம்தான், உண்டாகும் பலமாற்றம்தான் தினம் காலையில் காண்பது புதுமுகம்தான்,   மாலை உடலில் காண்பது சோர்வுதான்,   நினைத்து கொள்வோம் நாமெல்லாம் விஞ்ஞானிகள்தான்,   உண்மையில் நாமெல்லாம் வெறும் வியாபாரிகள்தான்,   வயதுள்ளவரை உன் உழைப்புமட்டும்தான்,   அதில் நீ...

வெற்றியின் பாதை

வெற்றியின் பாதை GK. Balasubramani, Senior Physiotherapist, Kauvery Hospital, SalemCorrespondence: [email protected] மலருக்கு இல்லை - அது உதிர்கிற துன்பம் - ஒரு நறுமணம் தந்தே - பல மனங்களை வெல்லும்..!! உடலுக்குள் இல்லை - உன் உறுதிக்குள் உண்டு - ஒரு லட்சியம் கொண்டால் - நீ நிச்சயம் வெல்வாய்..! கல்லுக்குள் இருந்தே தண்ணீரும்...

Editorial

Dear colleagues The first three reports on The KAUVERIAN, 01 Feb issue shall be three original studies We lead with Dr. Chockalingam and Dr. Ramkumar's paper, from Trichy on 'Prevalence of vitamin D deficiency in a multi-speciality hospital orthopaedic outpatient...

Editorial Board

Editorial Board Editor-in-Chief Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India Email: [email protected]   Board of Subject Editors Dr. P.R. Ramasamy Department of Orthopaedics, Kauvery Hospital, Tennur, Trichy Dr. Prithika Chary Department of Neurosciences, Kauvery Hospital, Chennai Dr....

Prevalence of vitamin D deficiency in a multi-speciality hospital orthopaedic outpatient clinic

Objective To assess the prevalence of Vitamin D deficiency and toxicity in a general Orthopaedic set up and the benefits of treatment. Aim is also to highlight the importance of this condition in patients presenting without fractures Materials And Methods...

Esomeprazole induced Hypoglycemia

Abstract Esomeprazole, the (S) - isomer of omeprazole, is the first proton pump inhibitor (PPI) developed as a single isomer for the treatment of acid-peptic disease by specific inhibition of H+ K+- ATPase in gastric parietal cells. Keywords: Hypoglycemia, Whipples...

Dynamic external fixator for unstable intra articular fractures of Proximal Interphalangeal Joint (PIP): “Suzuki” frame

Abstract Proximal Interphalangeal joints of finger fractures are quite common, and management plans for these injuries, either conservative or surgical, find it always challenging to achieve the full range of movements. Various surgical procedures achieve a good radiological outcome that...

How to Practice Academic Medicine and Publish from Developing Countries? A Practical Guide, Springer Nature, 2022

Samiran Nundy, Atul Kakar, Zulfiqar A. Bhutta Who is an 'ideal doctor', though most of us want to be one! The true meaning of the word 'doctor' in Latin is 'teacher'. A 'doctor' should treat the patients, teach the students,...

WINTNCON 2022 – Scientific Program

WIN-TNCON 2022- Auspicious beginnings Women in Nephrology (WIN) was founded in 1983 by women in the field of Nephrology as an offshoot of International Society of Nephrology. The overriding goal was to develop and provide mentors to women in the...

Pulmonary Thrombo Embolism: A state of the art review

Abstract Pulmonary embolism ( PE) is the third most common cause of cardiovascular death. Multidetector computed tomography pulmonary angiography (CTPA) is the investigation of choice in imaging a patient with suspected pulmonary embolism. Keywords: Pulmonary Thromboembolism, Thrombolysis Pathophysiology   Acute...

Role of Artificial Intelligence in improving EHR/EMR and Medical Coding and billing

Background Patient medical records have long been viewed as inflexible, difficult to use, archaic, and costly to configure. However, these records are critical to improving the patient experience throughout their care journey. They provide healthcare professionals with the information needed...

Monoclonal Antibodies: Edrecolomab and Abciximab

Edrecolomab This medication was never approved by the FDA, but was the first monoclonal antibody approved for a cancer indication, in Germany (1995). Edrecolomab is a murine IgG2A monoclonal antibody that targets the human tumor-associated antigen Ep-CAM (17-1A). In a...

Atlas of haematology and hematooncology

Diagnosis: Small vessel vasculitic lesions involving left thumb and foot in a patient with Wegener granulomatosis Diagnosis: Left LMN type facial Palsy in a patient with Aplastic anemia and Herpes zoster Diagnosis: Palpable purpurae in Henoch Schonlein purpura Diagnosis: Reactive...

Journal scan

Journal scan: A review of 15 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). van Dyck CH., et al. Lecanemab in Early Alzheimer's Disease. N Engl J Med. 2023;388:9-21 Background...

Learning from Experience – Intra Operative, Chapters 31 and 32

[caption id="attachment_5935" align="alignnone" width="1200"] Anaemia or Hydrocele[/caption] A 68-year-old man was posted for a TURP. He had no significant past medical or surgical history, and all his routine preoperative investigations were within normal limits. He was taken up for surgery...

What doctors must learn: Doctor, look beyond science

It is said that change is the only constant. I joined medical college more than six decades ago and I have noticed a seachange in the science of medicine, medical teaching, and medical practice. The science of medicine has advanced...

Recommended Readings

(1). Raja Sabapathy S. Managing Failure. J Hand Surg. 2022;27(6):933-934 https://www.worldscientific.com/doi/pdf/10.1142/S2424835522010020 Failure is the state when a desirable, or intended, objective is not met and is the opposite of success. When anyone talks or writes about failure it is always...

I Whisper Secrets In My Ear

I whisper secrets in my ear, Frenzied but divine. And like some sordid wine, I gulp and glug and spit, yelling morose cheers Until in blood it soaks what for what I pine. This blood, my own, primitive, plain and...

EDITORIAL

Dear colleagues The KAUVERIAN's sole mission is to project outstanding original work by Kauverians. Our talented colleagues can facilitate that by taking the trouble to write about their original work. This issue begins by felicitating Drs Vinod Gunasekaran, RM Subbaiah,...

Instructions for Authors

Instructions for Authors General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title, Author list,...

Mismatched Haploidentical Bone Marrow Transplantation in a 10-year-old boy with relapsed refractory acute lymphoblastic leukemia, at Trichy

Mismatched Haploidentical Bone Marrow Transplantation in a 10-year-old boy with relapsed refractory acute lymphoblastic leukemia, at Trichy Vinod Gunasekaran 1 , Subbiah RM 2 , Prabhakaran Shankaralingam 3 , Senthil Kumar K 4 ,Rakesh Manohar 5 , Suresh Chelliah 6 , Senguttuvan D 6 1 Paediatric Hematology Oncology BMT, Kauvery Hospital, Trichy, Tamilnadu, India...

ST-Segment Elevation is not always Myocardial Infarction

ST-Segment Elevation is not always Myocardial Infarction Vigneshvarprashanth Umapathy 1,* , Joseph Theodore 2 , G. Dominic Rodriguez 3,* 1 Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India 2 Consultant Interventional Cardiologist and Electrophysiologist, Kauvery Hospital  Heart City, Trichy, India 3 HOD Internal Medicine, Kauvery Hospital, Tennur, Trichy,...

Acyanotic Congenital Heart Disease, repaired, evolves into a Cyanotic Congenital Heart Disease and presents with an atrial tachycardia

Acyanotic Congenital Heart Disease, repaired, evolves into a Cyanotic Congenital Heart Disease and presents with an atrial tachycardia Ramya Rajesh MEM Resident, Kauvery Hospitals, Trichy Background Eisenmenger syndrome refers to any untreated congenital cardiac defect with intracardiac communication that leads...

Family medicine – caring for you for the whole of your life. A Lost and Found Art

Family medicine - caring for you for the whole of your life. A Lost and Found Art Neha. N DNB Resident, Kauvery Hospital, Trichy, Cantonment World Family Doctor Day, held every year on May 19, is a day to highlight the...

The Principles and Practice of Family Medicine

The Principles and Practice of Family Medicine Anna Maria DNB Resident, Kauvery Hospital, Trichy, Cantonment Family Medicine It is an independent academic discipline and specialty of medical science that developed as a counterculture in response to rapid fragmentation of medical...

Complete Heart Block

Complete Heart Block Ambiga* Senior Staff Nurse, Kauvery Heartcity, Trichy, India *Correspondence: +91 85086 98000; [email protected] Abstract A retired 78-year-old man experienced giddiness and chest pain. They initially went to a local nearby clinic and received emergency care. They made the diagnosis...

Sick Sinus Syndrome (SSS)

Sick Sinus Syndrome (SSS) S. Umarani1, N. Indhumathi2 1Assistant Nursing Superintendent, Kauvery Heartcity, Trichy, India 2Non Critical Ward Incharge, Kauvery Heartcity, Trichy, India *Correspondence: Tel No: +91 8508698000; [email protected] Abstract Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction...

The First Ever National Award Comes to Kauvery Hospital Chennai & Heart City for Safety and Workforce Category in IMC RBNQA Milestone Merits Recognition 2022

The First Ever National Award Comes to Kauvery Hospital Chennai & Heart City for Safety and Workforce Category in IMC RBNQA Milestone Merits Recognition 2022 Dhanasekar. S* Assistant General Manager, Head Business Excellence, Kauvery Hospitals, India *Correspondence: +91 8925808444; [email protected] Background The...

Diagnostic Image

Diagnostic Image Dr. R. M. Subbaiah* Consultant Hemato-Oncology, Kauvery Hospital, Trichy, India *Correspondence: [email protected]   Diagnosis: Incidentally found osteoblastic clusters in a bone marrow aspirate smear.

PRE-OPERATIVE CHAPTERS 7 AND 7 – LEARNING FROM EXPERIENCE

PERI-OPERATIVE Chapter 07 Hypothermia in an Elderly Patient Dr. Vasanthi Vidyasagaran* Department of Anaesthesiology, Kauvery Hospital, Chennai, Tamilnadu, India *Correspondence: [email protected] An 80-year-old man weighing 50 kg, who was diagnosed with carcinoma of stomach, was posted for radical gastrectomy. The anaesthetic...

Chapter 5: Super-specialist – boon or bane

Chapter 5: Super-specialist - boon or bane Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP We have run into the law of diminishing returns in health care, where we are doing more and more, with higher and higher technology, at...

Journal scan: A review of 42 recent papers of immediate clinical significance, harvested from major international journals

Journal scan: A review of 42 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Major Extremity Trauma Research Consortium (METRC), et al. Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a...

RECOMMENDED READINGS

(1). Cora Guerin. One Heart Defect, Many Lives. 2023 https://www.medscape.com/viewarticle/991248_6 Returning to school proved harder than I expected. At first, everyone celebrated my return, but eventually, the excitement died down, and people stopped acknowledging me. I don't think they understood...

நேரம் ஒதுக்கு

நேரம் ஒதுக்கு GK. Balasubramani, Senior Physiotherapist, Kauvery Hospital, Salem *Correspondence: [email protected] சிரிப்பதற்கு நேரம் ஒதுக்குங்கள் - அது இதயத்தின் இசை. சிந்திப்பதற்கு நேரம் ஒதுக்குங்கள் - அது சக்தியின் பிறப்பிடம். உடற்பயிற்சிக்கு நேரம் ஒதுக்குங்கள் - அது இளமையின் இரகசியம். படிக்க நேரம் ஒதுக்குங்கள் - அது அறிவின் ஊற்று. நட்புக்கு நேரம்...

மருத்துவரின் மகத்துவம்

மருத்துவரின் மகத்துவம் GK. Balasubramani, Senior Physiotherapist, Kauvery Hospital, Salem *Correspondence: [email protected] மருத்துவர்களின் சேவை உலகிற்கு தேவை, சிறு பிணியானாலும் பெரும் பிணியானாலும் கனிவோடு சேவை செய்வோர் எங்கள் மருத்துவர், கருணை உள்ளம் கொண்டோர் எங்கள் மருத்துவர், தன்னலம் பாராது பெருந்தொற்று காலத்திலும், சேவை செய்வோர் எங்கள் மருத்துவர், விபத்து கண்டோர் உயிர் காக்க...

EDITORIAL

Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India *Correspondence: [email protected] Dear colleagues The highlights of the KAUVERIAN, 01 July 2023! Mucor is back! Actually, it never went away, after COVID. It has popped up at our hospitals with distressing...

Instructions for Authors

Instructions for Authors General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts...

Surgical Management of Covid-19 Associated Rhino-Orbito-Cerebral-Mucormycosis (Ca-Rocm) – A Single Centre Experience

Surgical Management of Covid-19 Associated Rhino-Orbito-Cerebral-Mucormycosis (Ca-Rocm) - A Single Centre Experience Hari Meyyappan1, Hari Prasad2, Balaji M3, Abhishek Johnson Babu3, Ganesh Kumar MS4, Naseeba5, Meena Nandhini R5 1ENT Head and Neck Surgeon, Kauvery Hospital, Cantonment, Trichy 2ENT Head and...

Knee Joint Preservation Surgeries

Knee Joint Preservation Surgeries Mohan Kumar J, Vijay Kulkarni, Chandrakanth Department of Orthopaedics, Kauvery Hospital, Electronic City, Bengaluru Abstract With increasing life expectancy, there is a growing demand for the preservation of native articular cartilage to delay prosthetic joint replacements,...

Guest Editorial Comments

Guest Editorial Comments Dr. S. Chockalingam* Senior Consultant - Orthopaedic Surgeon, Kauvery Hospital, Trichy - Cantonment Knee Joint Preservation Surgeries Comments Knee joint preservation term is increasingly used for procedures which aims to either avoid or postpone joint replacement surgery....

Ventricular Septal (VSR) closure with ASD device

Ventricular Septal (VSR) closure with ASD device T. Joseph* Consultant Interventional Cardiologist & Electrophysiologist, Kauvery Hospital, Trichy - Heartcity, India *Correspondence: [email protected] Case Presentation A 65-years-aged woman from Thiruvarur developed ventricular septal rupture (VSR) following a massive anterior wall MI. She...

Newer Calcium Debulking Angioplasty technique of Orbital Atherectomy

Newer Calcium Debulking Angioplasty technique of Orbital Atherectomy T. Joseph* Consultant Interventional Cardiologist & Electrophysiologist, Kauvery Hospital, Trichy – Heartcity, India *Correspondence: [email protected] Case Presentation The newer calcium debulking angioplasty technique of orbital atherectomy was introduced for the first time. Shared...

An hour-long CPR to restart the heart

An hour-long CPR to restart the heart Vigneshvarprashanth Umapathy1,*, S. Aravindakumar2, Z. Mohamed Ghouse Khan3, Nithish4, Jasper Shekinah5 1Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India 2Chief Consultant Interventional Cardiologist, Kauvery Heart City, Trichy, India 3Consultant Emergency Physician, Incharge of...

VT or SVT with aberrancy?

VT or SVT with aberrancy? Vigneshvarprashanth Umapathy1,*, S. Aravindakumar2, Priyanka B3 1Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India 2Chief Consultant Interventional Cardiologist, Kauvery Heart City, Trichy, India 3Duty Medical Officer, Department of Cardiology, Kauvery Heart City, Trichy, India *Correspondence: [email protected]...

Pituitary Neuroendocrine Tumor (PitNET)

Pituitary Neuroendocrine Tumor (PitNET) P. Aarthi1, Vigneshvarprashanth Umapathy2,* 1Staff nurse, Kauvery Hospital, Tennur, Trichy, India 2Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India *Correspondence: [email protected] MRI brain - Pituitary gland enlargement measuring 1.1cm noted. Endoscopic transnasal transsphenoidal surgery - a surgical...

VSD Device Closure

VSD Device Closure Hemalatha R1,*, Sheeba2 1Nursing Supervisor, Kauvery Heartcity, Trichy, India 2 Staff Nurse, Kauvery Heartcity, Trichy, India *Correspondence: [email protected] Abstract Ventricular Septal Defect (VSD) is the most common congenital cardiac anomaly in children and second most common congenital abnormality in...

PDA Device Closure

PDA Device Closure Hemalatha R1,*, Ms.Ranjitha2, 1Nursing Supervisor, Kauvery Heartcity, Trichy, India 2 Senior Staff Nurse, Kauvery Heartcity, Trichy, India *Correspondence: [email protected] Abstract Patent Ductus Arteriosus (PDA) is a common form of congenital heart disease and forms about 5-10% of congenital heart...

Iron Deficiency Anemia, Post MVR

Iron Deficiency Anemia, Post MVR Vijayalakshmi G*, Indumathi, 1Non Critical Ward Incharge, Kauvery Heartcity, Trichy, India *Correspondence:[email protected] Abstract A 50-year-old female, euglycemic and normotensive, known case of RHD - S/P MVR (2012), came with a history of giddiness, palpitation &...

Torsades de Pointes

Torsades de Pointes Vijayalakshmi G Non Critical Ward Incharge, Kauvery Heartcity, Trichy, India *Correspondence:[email protected] Foreword We nurses at Heart City see Ventricular Tachycardia very often, which provoked interest in Torsades de Pointes. Background Torsades de pointes is a type of...

Quality improvement project to Reducing the Malnutrition Rate of ICU patients from 43% to 20%

Quality improvement project to Reducing the Malnutrition Rate of ICU patients from 43% to 20% Rajeswaria, Katheeresanb, Sivagamic, Sowndaryad, Dharmendrane aSenior Dietitian, Kauvery Hospital, Salem bSenior Assistant Nursing Superintendent, Kauvery Hospital, Salem cAssistant Nursing Superintendent, Kauvery Hospital, Salem dJunior Executive...

Long term use of Amiodarone in Cardiac patients: A Clinical Audit

Long term use of Amiodarone in Cardiac patients: A Clinical Audit N.R. Vijayalakshmi, Assistant Manager, Kauvery Hospital, Heartcity Abstract Background: Amiodarone is widely prescribed, largely due to its efficacy in the management of both supra ventricular and ventricular arrhythmia's. Despite...

Statistical Independent Events and Probability

Def: The independent t-test, also called the two-sample t-test, independent-samples t-test or student's t-test, is an inferential statistical test that determines whether there is a statistically significant difference between the means in two unrelated groups. In probability, two events are...

PERI-OPERATIVE Chapters 9 and 10 – Learning from Experience

PERI-OPERATIVE Chapters 9 and 10 - Learning from Experience Mesenteric Vein Thrombosis Dr. Vasanthi Vidyasagaran* Department of Anaesthesiology, Kauvery Hospital, Chennai, Tamilnadu, India *Correspondence: [email protected] A 10-year-old boy weighing 60 kg was admitted with persistent abdominal pain following a blunt injury...

Journal scan: A review of 40 recent papers of immediate clinical significance, harvested from major international journals

Journal scan: A review of 40 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief [1]. Reinoud E. Knops et al. A Dual-Chamber Leadless Pacemaker. N Engl J Med. 2023 Jun 22;388(25):2360-2370....

EDITORIAL

Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India *Correspondence: [email protected] Dear Kauverians, The KAUVERIAN is both proud and privileged to publish the FIRST report on the da Vinci Robotic Assisted Radical Prostatectomy! Dr. Pramod, Consultant Urologist, on behalf of...

Kauverian Medical Journal

Kauverian Medical Journal Instructions for Authors General Considerations Research manuscriptsshould comprise: Front matter:Title, Author list, Affiliations, Abstract, Keywords Body matter:Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter:Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front...

First da Vinci Robotic Surgery in Carcinoma Prostate: A Case Report

First da Vinci Robotic Surgery in Carcinoma Prostate: A Case Report Pramod URO TEAM Kauvery Hospital, electronic city. Bengaluru Case Presentation A 66 year old male presented with h/o dysuria and obstructive voiding symptoms and was on alpha blockers for...

Black burden or Taylor the saviour: A case report

NS. Sushmithaa,*, K. SenthilKumarb, S. Indu Priyadarshinia, D. Chockalingamc aDNB Anaesthesiology, Kauvery Hospitals, Trichy bSenior Consultant & Head, Department of Anaesthesiology, Kauvery Hospitals, Trichy cSenior Consultant, Department of Orthopaedics, Kauvery Hospitals, Trichy *Correspondence:[email protected] Abstract Alkaptonuria, also called Black bone disease...

Analysis of differences in Oncology practice between the United Kingdom and India

Analysis of differences in Oncology practice between the United Kingdom and India AN. Aswin1, Apurna Jegannathen2, AN. Vaidyswaran3 1Consultant Radiation Oncologist, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu, India 2Consultant Clinical Oncologist & Clinical Lead, Royal Stoke Hospital, University Hospital of...

A Case of Takayasu Arteritis

A Case of Takayasu Arteritis B. Priyanka1,*, Vigneshvarprashanth Umapathy2,*, S. Aravindakumar3 1Duty Medical Officer, Department of Cardiology, Kauvery Heart City, Trichy, India 2Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India 3Chief Consultant Interventional Cardiologist, Kauvery Heart City, Trichy, India *Correspondence: [email protected] (Priyanka...

Idiopathic Dilated Pulmonary Artery (IDPA)

Idiopathic Dilated Pulmonary Artery (IDPA) Meenadarsini Dhamothiran, S Aravinda Kumar* Department of Cardiology, Kauvery Hospitals, Heatcity, Trichy, Tamilnadu *Correspondence: [email protected] Case: A 41- year-aged, female, non-diabetic and non-hypertensive. She underwent evaluation for exertional dyspnea, class II. She was found to have...

ECG Atlas

ECG Atlas Tall R wave in V1 Vigneshvarprashanth Umapathy* Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India *Correspondence: [email protected]   (1) Misplaced leads - Leads V1 and V6 interchanged (2) Right ventricular hypertrophy (RVH) (3) Pulmonary embolism causing right ventricular hypertrophy; 'S1Q3T3'...

Unusual cause of Dysphagia: A case report

Unusual cause of Dysphagia: A case report S. Meenatchi1, K. Arivarasan2 1Physician Assistant, Kauvery Hospital, Trichy Cantonment 2Consultant Gastro Enterologist, Kauvery Hospital, Trichy Cantonment Abstract Dysphagia is defined as difficulty in swallowing. The condition results from impeded transport of liquids,...

Tu Youyou: The scientist who discovered artemisinin

Tu Youyou: The scientist who discovered artemisinin Vinitha Marimuthu*, Clinical Pharmacist, Kauvery Hospitals, Trichy-Cantonment, Tamilnadu *Correspondence: [email protected] Tu Youyou is a Chinese Pharmaceutical Chemist and Malariologist, who is best known for discovering Artemisinin, a drug used to treat Malaria. Discovery of...

Continuing Nursing Education (CNE) on Risk assessment tools, to assess vulnerable patients at Kauvery Hospital, Tennur

Continuing Nursing Education (CNE) on Risk assessment tools, to assess vulnerable patients at Kauvery Hospital, Tennur Lucy Grace. T* Nurse Educator, Kauvery Hospital, Tennur, Trichy *Correspondence: [email protected] Background Continuing Nursing Education (CNE) on "Risk assessment tools used to assess the vulnerable...

DIAGNOSTIC IMAGE

DIAGNOSTIC IMAGE Dr. Vadivel Murugan, Kauvery Hospital, Trichy, Tamilnadu Diagnosis: Milky serum in Hypertriglyceridemia

PRE-OPERATIVE CHAPTERS 11 AND 12 – LEARNING FROM EXPERIENCE

PERI-OPERATIVE Chapter 11 Neuroleptic Malignant Syndrome and Hyperpyrexia Dr. Vasanthi Vidyasagaran* Department of Anaesthesiology, Kauvery Hospital, Chennai, Tamilnadu, India *Correspondence: [email protected] Case 1 Young man with severe burns was posted for wound debridement under general anaesthesia. History suggested antipsychotic drug treatment....

OLD AND NEW – MAKE THE BEST OF THE TWO

Chapter 6. Old and new - make the best of the two Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP Old is gold but new may be a diamond but don't forget it is the gold that holds the diamond...

Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals

Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Mental checklists, constant vigilance: A day living with type 1 diabetes. https://www.statnews.com/sponsor/2023/06/16/mental-checklists-constant-vigilance-a-day-living-with-type-1-diabetes/ No two days are...

Recommended Readings

Recommended Readings (1). When Did Medicine Become a Battleground for Everything? https://www.medscape.com/viewarticle/994502 In recent years, it's felt more and more like every cultural battle is a medical one. A look at how it happened and how it's changing the medical...

EDITORIAL

EDITORIAL Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India *Correspondence: [email protected] Dear Kauverians, The KAUVERIAN and NIGHTINGALE have been staggered to the 8th and 22nd of every month from September 2023 to accommodate the K-WAY Newsletter which appears on...

INSTRUCTION TO AUTHORS

Kauverian Medical Journal Instructions for Authors General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front...

A pregnant patient with DKA, septic shock and a lactate mystery

A pregnant patient with DKA, septic shock and a lactate mystery Priya R, Arun BV, Sinthiya D, Kalaiselvan MS*, Arunkumar AS Department of Critical Care Medicine, Kauvery Hospital, Kovilambakkam, Chennai *Corresponding author: [email protected] Abstract Diabetic ketoacidosis (DKA) is a life-threatening complication...

Radical Thymectomy in Myasthenia Gravis through Partial Sternotomy approach: A report on three patients

Radical Thymectomy in Myasthenia Gravis through Partial Sternotomy approach: A report on three patients Venkatesa Kumar, Anakaputhur Rajan1, Anton Prem Thilak1, Chandrasekar Purushothaman2 Arun Kumar Govindarajan2, Siva kumaran Subbarayan2, Harikrishnan Subramanian2, Raghuram Arani Raghavendrarao1 1Department of Cardiothoracic Surgery, Kauvery Hospital, Alwarpet,...

In-utero blood transfusion in two etiologically distinct anaemic fetus

In-utero blood transfusion in two etiologically distinct anaemic fetus Deepti Raghuram, Chitra Ganesh, S. Suresh, Sudarshan Suresh Department of Fetal Medicine, Kauvery Hospital, Electronic City, Bengaluru Case Presentation Case 1 A 33-year-old Mrs. P, a multiparous woman in her fifth...

RARE CAUSE OF PULMONARY HYPERTENSION

Rare cause of Pulmonary Hypertension Priyanka B1,*, Arjun G2, S. Aravindakumar3 1Duty Medical officer, Department of Cardiology, Kauvery Heart City, Trichy, India 2MEM Postgraduate, Kauvery Hospital, Trichy, India 3Chief Consultant Interventional Cardiologist, Kauvery Heart City, Trichy, India *Correspondence: [email protected] Abstract Hereditary...

Acute Rheumatic fever is still an enigma

Acute Rheumatic fever is still an enigma S. Aravinda Kumar1, Priyanka Kamaraj2 1Chief Consultant Interventional Cardiologist, Kauvery Heart City, Trichy, India 2Duty Medical Officer, Department of Cardiology, Kauvery Heart City, Trichy, India Abstract Acute Rheumatic fever (ARF) is a serious...

A remarkable journey: Managing LQTS in a 43-year-old female with recurrent syncope and seizure

A remarkable journey: Managing LQTS in a 43-year-old female with recurrent syncope and seizure S. Aravinda Kumar1,*, R. Haridha Devi2 1Chief Consultant Interventional Cardiologist, Kauvery Hospital, Heartcity, Trichy 2Duty Medical Officer, Kauvery Hospital, Heartcity, Trichy *Correspondence: [email protected] Abstract Long QT syndrome...

An unusual case of Acute Coronary Syndrome

An unusual case of Acute Coronary Syndrome S. Aravinda Kumar1, Arjun G2, Ka Suganthan Nithish3, M. Shamutra3 1Chief Consultant Interventional Cardiologist, Kauvery Heart City, Trichy, India 2MEM Postgraduate, Kauvery Hospital, Trichy, India 3Duty Medical officer, Department of Cardiology, Kauvery Heart...

Reversible cause of severe LV Dysfunction in Left Bundle Branch Block

Reversible cause of severe LV Dysfunction in Left Bundle Branch Block S. Aravinda Kumar1, S. Sujibala2 Department of Cardiology, Kauvery Hospital, Heartcity, Trichy 2Duty Medical Officer, Kauvery Hospital, Heartcity, Trichy *Correspondence: [email protected] Abstract Left Bundle Branch Block (LBBB) is an electrocardiographic...

A case study on Rhino-Orbital-Cerebro- Mucormycosis

A case study on Rhino-Orbital-Cerebro- Mucormycosis Yazhini. N MEM Resident, Kauvery Hospital, Cantonment, Trichy Background Mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds/fungi live throughout the environment-they...

Snakebite and its management

Snakebite and its management Arul Kumar First-year MEM.CCT, Emergency Medicine, Kauvery Hospital, Cantonment, Trichy Background Snakebite affects between 1.8 to 2.7 million people worldwide each year, and it is estimated to cause between 80,000 and 138,000 deaths. A mixture of...

Total Elbow arthroplasty in Post Traumatic arthritis

Total Elbow arthroplasty in Post Traumatic arthritis Mohan Kumar J, Vijay Kulkarni Department of Orthopaedics, Kauvery Hospital, Electronic City, Bengaluru *Correspondence: [email protected] Abstract Elbow arthritis is a very painful condition with limited movements and restricting the day to day activities. Not...

Wellens Syndrome: An ECG finding not to miss!

Wellens Syndrome: An ECG finding not to miss! Selva Maheshwari1, Deep Chandh Raja2,*, Vidya Saketharaman3 1Physician Assistant, Kauvery Heart Rhythm Services, Kauvery Hospital, Chennai 2Cardiologist and Clinical Lead of Cardiac Electrophysiology, Kauvery Heart Rhythm Services, Kauvery Hospital, Chennai 3Consultant, Emergency...

Dr. C.R. Rao Wins Top Statistics Award a look back at his pioneering work

Dr. C.R. Rao Wins Top Statistics Award a look back at his pioneering work Dr. Calyampudi Radhakrishna Rao, FRS, alias C.R. Rao, was an Indian-American mathematician and statistician. He was an emeritus professor at Pennsylvania State University, and Research Professor...

PRE-OPERATIVE Chapters 13 and 14 – Learning from Experience

PRE-OPERATIVE Chapters 13 and 14 - Learning from Experience PERI-OPERATIVE Chapter 13 Pheochromocytoma Post-operative Diagnosis Dr. Vasanthi Vidyasagaran* Department of Anaesthesiology, Kauvery Hospital, Chennai, Tamilnadu, India *Correspondence: [email protected] Case 1 A 25-year-old man assessed under ASA I was posted for a...

Chapter 7. Doctor-patient relationship

Chapter 7. Doctor-patient relationship Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP Doctor is both a scientist and humanitarian, his most decisions lie in the field of patient relations David Allman Doctor patient relationship is critical to the placebo effect...

Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals

Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Josh Serchen, et al. Preparing for Future Pandemics and Public Health Emergencies: An American College of...

EDITORIAL

Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India *Correspondence: [email protected] Dear Kauverians, The KAUVERIAN, 08 Oct issue leads with an exotic title - "Frozen Elephant Trunk procedure in Chronic Aortic Dissection" from the CTVS team at Chennai. Two reports...

INSTRUCTION TO AUTHORS

Kauverian Medical Journal Instructions for Authors General Considerations Research manuscriptsshould comprise: Front matter:Title, Author list, Affiliations, Abstract, Keywords Body matter:Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter:Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front...

FROZEN ELEPHANT TRUNK (FET) PROCEDURE IN A 52 YEARS OLD CHRONIC AORTIC DISSECTION PATIENT

Frozen Elephant Trunk (FET) Procedure in a 52 years old Chronic Aortic Dissection patient Anton Prem Thilak1,*, Venkatesa Kumar Anakaputhur Rajan1, Chandrasekar Purushothaman2, Arun kumar Govindarajan2, Siva Kumaran Subbarayan2, Harikrishnan Subramanian2, Raghuram Arani Raghavendrarao1, R. Anantharaman1 1 Department of Cardiothoracic Surgery,...

DIAGNOSING AND MANAGING EISENMENGER SYNDROME IN A YOUNG MALE

Diagnosing and Managing Eisenmenger Syndrome in a Young Male Aravinda Kumar1, S. Sujibala2 1Department of Cardiology, Kauvery Hospital, Heartcity, Trichy 2Duty Medical Officer, Kauvery Hospital, Heartcity, Trichy *Correspondence: [email protected] Abstract Eisenmenger syndrome is a rare and complex condition that arises as...

STEMI EQUIVALENT BUT STEMI!

STEMI equivalent but STEMI! Aravinda Kumar1,*, R. Haridha Devi2 1Chief Consultant Interventional Cardiologist, Kauvery Hospital, Heartcity, Trichy 2Duty Medical Officer, Kauvery Hospital, Heartcity, Trichy *Correspondence: [email protected] Abstract In the field of medicine, the ability to recognize and interpret electrocardiograms (ECGs) is...

TEMPORARY HEAL CAN POSSIBLY KILL!

Temporary heal can possibly kill! Silvera Samson Raj* MRCEM Resident - 1st year, Department of Emergency Medicine, Kauvery Hospital, Chennai, India *Correspondence: [email protected] Abstract Eucalyptus oil is a traditional herbal medicine widely used for a number of common ailments. Extreme toxicity...

UNDERSTANDING PUBERTY

Understanding Puberty Dr. Karpagambal Sairam Consultant Obstetrician, Gynaecologist and Fertility Specialist, Kauvery Hospital, Chennai, India *Correspondence: [email protected] Puberty is a normal physiological process in all animal species. We shall guide our children and parents sail through this process which can vary...

THE IMPORTANCE OF STATISTICS IN HEALTHCARE

The importance of statistics in healthcare T. Dhasaratharaman a,*, M. Kiruba b,c, R. Shriram b,c aAssistant Manager - Statistician, Kauvery Hospitals, Trichy bInternship, Kauvery Hospitals, Trichy cMSc Statistics, Bharathidasan University, Trichy *Correspondence: [email protected] The field of statistics is concerned with collecting, analysing, interpreting, and presenting data. In the...

JOURNAL SCAN: A REVIEW OF 44 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS

Journal scan: A review of 44 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Lorenzo DAntiga, et al. Gene Therapy in Patients with the Crigler-Najjar Syndrome. N Engl J Med...

DIAGNOSTIC IMAGE

DIAGNOSTIC IMAGE Dr. R. M. Subbaiah* Consultant Hemato-Oncology, Kauvery Hospital, Trichy, India *Correspondence: [email protected] Diagnosis: Myeloblasts of peripheral blood smear of a patient with acute myeloid leukaemia.

PRE-OPERATIVE CHAPTERS 15 AND 16 – LEARNING FROM EXPERIENCE

Self-medication With Thyroxin - Hyperthyroid State PERI-OPERATIVE Chapter 15 Dr. Vasanthi Vidyasagaran* Department of Anaesthesiology, Kauvery Hospital, Chennai, Tamilnadu, India *Correspondence: [email protected] A 55-year-old woman was posted for removal of a thrombus from her left upper limb as an emergency. She...

CHAPTER 8. DOCTOR-DOCTOR RELATIONSHIP

Chapter 8. Doctor-doctor relationship Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP What you do not want done to yourself, do not do to others - Confucius Ultimate test of relationship is to disagree but to maintain mutual respect -...

EDITORIAL

Dear Kauverians, The unique Trichy initiative of Clinical Audits and Clinical Reviews marches on with one audits and two reviews. Dr Thilakavathy audits prevalence of Streptococcus Pneumoniae in and around Trichy. Two stalwart and intrepid anaesthesiologists Dr. Khaja Mohideen and...

INSTRUCTIONS TO AUTHORS

Kauverian Medical Journal Instructions for Authors General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front...

PREVALENCE OF STREPTOCOCCUS PNEUMONIAE SEROTYPES IN AND AROUND TRICHY AND ITS CLINICAL RELEVANCE

Prevalence of streptococcus pneumoniae serotypes in and around Trichy and its clinical relevance: An audit Thilagavathy Microbiologist, Kauvery Hospital, Cantonment, Trichy  Background Abstract Pneumococcal disease is a leading vaccine preventable disease globally, and especially in India. Invasive pneumococcal disease is...

ANAESTHETIC MANAGEMENT OF A PATIENT WITH HUGE GOITER: A CASE REPORT

Anaesthetic management of a patient with huge Goiter: A case report S. Nirmal Kumar Consultant Anaesthesiologist, Kauvery hospital, Cantonment, Trichy Background Enlarged long standing thyroid swellings often leads to, Pressure effects - airway obstruction, dyspnoea, dysphagia, vocal palsy. It also...

EUGLYCEMIC DIABETIC KETOACIDOSIS A RARE CAUSE FOR DELAYED EXTUBATION

Euglycemic diabetic ketoacidosis a rare cause for delayed extubation: A case report Marutheesh M Gayathri krishna Reddy, Murali jayaraman, Harish Mallapura Maheshwarappa consultant anesthetist, Kauvery Hospital, Hosur Consultant Surgical Gastroenterology, Kauvery Hospital, Hosur Director Critical Care, Kauvery Hospital, Banglore Consultant...

SUCCESSFUL PREGNANCY IN ASD PATIENT – COMPLICATED BY SEVERE PULMONARY ARTERIAL HYPERTENSION

Successful pregnancy in ASD patient - complicated by severe Pulmonary Arterial Hypertension Ramya1, N. Suchitra2, T. Joseph3 1MEM Resident, Kauvery Hospital, Cantonment, Trichy 2HOD and Senior Consultant, Obstetrics and Gynaecology, Cantonment, Trichy 3Consultant Cardiologist and Electrophysiologist. Heart City, Trichy Background...

ENDOCRINE COMPLICATION OF GROWTH HORMONE SECRETING TUMOR: A CASE REPORT

Endocrine complication of growth hormone secreting tumor: A case report Dharsshini N Clinical Pharmacist, Kauvery Hospital, Cantonment, Trichy Abstract Pituitary tumors pose diagnostic and management challenges due to diverse presentations and potential complications. This case highlights the endocrine complexities of...

EFFICACY OF EARLY DIAGNOSIS AND DEVELOPMENT APPROACHES OF PAEDIATRIC OCCUPATIONAL THERAPY ON ACUTE DISSEMINATED ENCEPHALOMYELITIS: A CASE REPORT

Efficacy of early diagnosis and development approaches of paediatric occupational therapy on acute disseminated encephalomyelitis: A case report M. Mahendran* Kauvery hospital, Unit of Hamsa Rehab for kids Trichy, Tamil Nadu *Correspondence: [email protected] Abstract This case study investigates the efficacy of...

POST OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE

POST-OPERATIVE Chapter 5 Chest X-ray for Neck node biopsy - NPPE Dr. Vasanthi Vidyasagaran* Department of Anaesthesiology, Kauvery Hospital, Chennai, Tamilnadu, India *Correspondence: [email protected] A 30-year-old lady was posted for a neck node biopsy under day care Anaesthesia. She gave history...

CHAPTER 12. MILES TO GO – BEFORE TEACHING BECOMES LEARNING

Chapter 12. Miles to go-before teaching becomes learning Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP Education is not learning of facts but training the mind to think Albert Einstein Student, you dont study to pass the test but study...

JOURNAL SCAN: A REVIEW OF 26 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS

Journal scan: A review of 26 recent papers of immediate clinical significance, harvested from major international journals From the desk of the Editor-in-Chief (1). Jonathan N. Hourmozdi et al, Myocardial Bridging February 1, 2024, N Engl J Med 2024; 390:e11....

காவேரி – 25

தென்னூரில் ஊற்றெடுத்து கண்டோன்மண்டு வரை பாய்ந்து மக்களின் உள்ளத்தை நிறைவாக்கி அவர்களை ஆளூம் அழகே   ஆறுதலின் புகலிடமே நம்பிக்கையே முடியாது என நினைத்து வந்த என்னை முடியும் வரை போராடி மறுபிறப்பு அளித்தவளே படிப்படியாய் வளர்ந்தாய் அநேகருக்கு படிகளாய் மாறினாய் ஏறி மேலே வந்தவர் அநேகர் வாழ வழி தேடியவருக்கு வாழ்வு தந்தாய் வழி...

POEM – மண்ணில் பிறந்தது சாதிப்பதற்குத்தான்

Poem - மண்ணில் பிறந்தது சாதிப்பதற்குத்தான் மண்ணில் பிறந்தது சாதிப்பதற்குத்தான் இமயம் தொட முடியாது என்றார்கள் இமயம் தொட்டு வந்தான் சாதனையாளன் ! நிலவிற்கு செல்ல முடியாது என்றார்கள் நிலவிற்கு சென்று வந்தான் சாதனையாளன் ! ஆழகடலில் நீந்த முடியாது என்றார்கள் ஆழகடலில் நீந்தி வந்தான் சாதனையாளன் ! மனிதன் பறக்க முடியாது என்றார்கள் மனிதன்...

EDITORIAL

Dear Kauverians, The KAUVERIAN, our Open Access Online Journal accredited to the National Medical Library, New Delhi, and bearing the ISSN 2584-1572, brings yet another unique issue to you on 08 Apr 24. We open with Dr. Chockalingam's “Audit of...

EDITORIAL BOARD

Editor-in-Chief Dr. Venkita S. Suresh Group Medical Director, Kauvery Hospitals, India Email: [email protected] Board of Subject Editors Dr. D. Senguttuvan Chief Consultant Paediatrician, Kauvery Hospital, Trichy Email: [email protected] Dr. N. Suchitra HOD and Senior Consultant, Obstetrics and Gynaecology, Kauvery Hospital,...

Audit Appraisal: An overview

Background Change; Continuous Intermittent Occasional Continuous Continuous incremental change is Kaizen Intermittent When clearly what we are doing is good, we don’t change for the purpose of changing Even this can be audited to have a pat on our backs...

Intra Ventricular antibiotics: Our experience

Definition and sign Meningo-Ventriculitis is an Infection of the meningeal and ventricular space. Meningo Ventriculitis may cause fever, headache, nausea, and change in mental status, meningeal irritation, and seizures.It can occur as part of skull base fractures or as part...

Transfusion Reactions: A clinical audit

Abstract Aim Stabilize blood volume, when essential Improve tissue oxygenation Ensure adequate hemostasis Ensure right blood of right quality to the right patient at the right time Methods and methodology Sep 2023 to Feb 2024 – 59 patients were given...

Postoperative pain management

Background Pain is a subjective phenomenon that is an unpleasant sensory and emotional experience, associated with actual or potential tissue damage. Acute pain is a  “normal, predicted, physiological response to an adverse chemical, thermal or mechanical stimuli”. Serious suffering that...

Rising concerns of Carbapenem resistant Enterobacteriaceae and the options available: An overview

Background Carbapenem-Resistant Enterobacteriaceae (CRE) was posing a dilemma in effective healthcare delivery. About one half of patients were from rural areas, 63.64% from sub-urban and 42.27% from urban areas who had significant E. coli and Klebsiella spp infections. The male:...

Ultrashort case report on VF storm in immediate Post CABG Period—‘Angry Purkinje Syndrome’

Background The Angry Purkinje Syndrome is a rare but important cause of ventricular tachycardia storm after CABG surgery Mechanism: short-coupled ventricular ectopy in the absence of acute myocardial ischaemia and transient peri-infarct Purkinje fibre irritability. Ablation, Quinidine and Intra Cardiac...

Lynch syndrome, diagnostic challenges and management: A case report

Abstract Aim and objective To highlight a rare case of Lynch Syndrome and the challenges associated with its diagnosis and management. Materials and methods A 68 year old male who had a family history of colonic neoplasms came with complaints...

Bilateral posterior shoulder fracture – dislocation due to seizure, an uncommon injury: A case report

Background Shoulder fracture dislocations are commonly noted in the anterior direction. Posterior fracture dislocation can be missed due to its rarity, and difficulty in diagnosing with simple anteroposterior radiograph. A proper lateral view is often difficult in the emergency setting....

Navigating amlodipine overdose: A multi-disciplinary approach in a 23 year old female

Abstract Calcium Channel Blockers (CCB) are prescribed in a variety of cardiovascular conditions. Amlodipine is a Dihydropyridine CCB. Toxicity is seen in doses up to 5-10 times the therapeutic dose and sets within 30 to 60 min following ingestion. Unlike...

Exploring the interplay between sleep patterns and behavioural characteristics in individuals with Autism Spectrum Disorder (ASD)

Abstract This study delves into the intricate relationship between sleeping patterns and behavioral traits in individuals diagnosed with autism spectrum disorder (ASD). While sleep-related challenges are frequently reported among those with ASD, the precise impact of these challenges on their...

POST OPERATIVE Chapters 7 and 8 – Learning from Experience

POST-OPERATIVE  - Chapter 7 Delayed recovery - Metformin and Lasix for weight reduction A 45-year-old woman weighing 70 kg was to undergo abdominal hysterectomy for uterine fibroid. Her preoperative examination was normal, all routine investigations, including blood sugar were normal....

Chapter 13. Art of communication and counselling

He that won’t be counselled can’t be helped                                                             Benjamin Franklin He was a patient with a diagnosis that he could not understand                                                             Maggie Stiefwater Introduction Communication and counselling are essential skills that every doctor must learn....

Journal scan: A review of 20 recent papers of immediate clinical significance, harvested from major international journals

(1). Daniel C. Chung et al. Cell-free DNA Blood-Based Test for Colorectal Cancer Screening. N Engl J Med 2024;390:973-983. Abstract Background Colorectal cancer is the third most diagnosed cancer in adults in the United States. Early detection could prevent more...

மருத்துவமனையின் தேவதையே

அன்று எமனோடு போராடினால் ஒரு பெண்! தன் கணவனுக்காய்………ஒரு முறை…..புராணத்தில் நீயோ நித்தமும் போராடிக் கொண்டு தான் இருக்கின்றாய்…. முன் பின் தெரியாதவர்களுக்காய் பலமுறை….நிஜத்தில் யார் கூறியது இன்றும் தீண்டாமை தழைக்கிறது என்று? பாவம் அவர்கள் உங்களை கண்டதில்லை போல……. தொற்றும் நோயோ ? தொற்றா நோயோ ? தொட்டுதவி தொண்டு செய்யும் உன் உள்ளத்தில்...

மருத்துவ சிந்தனை விருந்து

சுவாசிக்கும் காற்று ஆழ்ந்து, நுரையீரலினுள் செல்ல வேண்டும். மதுவிற்கு அடிமையாகாதே, மதுப்பழக்கத்தால் கல்லீரல் கெடும். ஒரு கால்வீக்கம் உடனே கவனி, இது யானைக்காலின் அறிகுறி. இரு கால் வீக்கம் இப்போதே கவனி, இது சிறுநீரக பாதிப்பின் அறிகுறி. ஆறாத வாய்ப்புண், மார்பக கட்டி, ஐம்பது கடந்தும் பசியின்மை, அதிக உடல் எடை குறைதல் இது புற்றுநோயின்...

Editorial

Dear Kauverians, Vanakkam The 08 May issue of the KAUVERIAN brings to you the remarkable work done by Kauverians in serving patients. Some young authors debut on this issue of the KAUVERIAN We open with a major retrospective study on...

Instructions for Authors

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title,...

Cardiac surgery in an octogenarian Indian population

Abstract Background: With increase in the elderly population, octogenerians requiring cardiac surgery have also increased in India. Previous literature suggest that surgical intervention performed in selected patients with preserved physical and mental health can provide acceptable outcomes with good quality...

Mycotic Aortoiliac Aneurysm: A case series

Abstract Mycotic aneurysms are rare and usually occur secondary to embolization of septic foci. Early diagnosis is crucial. They have high risk of rupture/complications and can pose a difficult management challenge especially in an acute setting. We describe the management...

The Scorpion Block—A Sting operation

Abstract Subarachnoid block is the preferred technique of anaesthesia for lower abdominal and lower limb surgeries. Resistance or failure to achieve the block with local anaesthetic agent by various routes is an uncommon but known phenomenon. Various factors have been...

Arterial Thoracic Outlet Syndrome: A case report

Case presentation Chief Complaints A 59 years old male working as a goldsmith had the following complaints, Pain - left upper limb since 7 days Coldness - left hand since 1day Numbness – all fingers of left hand since 1day...

Infective endocarditis in adult congenital heart disease: A case report

Background Infective endocarditis (IE) is a severe and potentially life-threatening infectious & inflammatory condition and has been continuously evolving over the last 3-4 decades as highlighted by many studies from the developed world. It is characterized by the inflammation of...

Takotsubo cardiomyopathy: A case report

Background Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or broken heart syndrome, is a reversible cardiac condition characterized by transient left ventricular dysfunction often triggered by emotional or physical stress. This case report details the presentation, diagnostic workup, and management...

Cerebral Venous Thrombosis (CVT): A case report

Abstract Cerebral venous thrombosis (CVT) is a relatively rare neurological disorder that may result in significant morbidity if not diagnosed and managed promptly. The clinical presentation of CVT is nonspecific and highly variable with acute, subacute, or chronic onset. It...

Hemophagocytic Lymphohistiocytosis in Dengue

Background Dengue fever, a viral illness transmitted by the Aedes mosquito, has become a significant public health concern in India. The impact is significant, as dengue fever can cause severe illness and in some cases, lead to life-threatening complications like...

A prospective observational study on the prescription of Guideline Directed Medical Treatment (GDMT) for Heart Failure at Kauvery Heart City

Abstract Background: Heart failure (HF) is a debilitating cardiovascular condition associated with significant morbidity and mortality. Guideline-Directed Medical Therapy (GDMT) has been established as a cornerstone in the management of HF, yet there remains a need for further understanding of...

Guideline-Directed Medical Treatment (GDMT) of Heart Failure at Kauvery Hospitals: A clinical audit

Background Heart failure (HF) is a complex clinical syndrome that involves abnormalities in the structure or function of the heart, thereby reducing cardiac output and impairing the delivery of blood to metabolizing tissues. Patients with HF present to tertiary care...

POST OPERATIVE Chapters 9 and 10 – Learning from Experience

POST-OPERATIVE  - Chapter 9 A 70-year-old man was posted for bilateral varicose vein surgery (vein stripping and saphenous-femoral ligation). His veins were huge and tortuous. He had a history of MI 5 years ago, reasonably stable, on coronary vasodilators. All...

Chapter 14. How to keep updated in busy medical practice?

Is there a need to keep updated? Medical science is dynamic and only constant is the change. Diseases caused by hitherto unknown organisms have cometo light while well controlled older infections surface again. Large number of drugs are available and...

Journal scan: A review of 15 recent papers of immediate clinical significance, harvested from major international journals

(1). Margarida Lucas Rocha, Published April 3, 2024, N Engl J Med 2024; 390:1218. Secondary Hypertrophic Osteoarthropathy A 55-year-old woman with a 29-pack-year history of smoking presented with a 1.5-year history of pain in her fingers, wrists, hips, knees, and...

சிந்தனையே சிறப்பு

சிந்தனையே சிறப்பு சிந்தை சொல்லும் இது தேவை என்று அதை தேடி அழையும் போது அந்த சிந்தனையே சிதைந்து விடும் சிதைந்த சிந்தையே என்று திரும்புவாய் மருந்துகளால் முடியவில்லை மருத்துவமும் உனக்கு முன்னால் தோற்று தான் நிற்கிறது உனக்கான வாய்ப்பு நீ சிந்திக்கும் வரைதான் ஆனால் இழந்தாயே உன் வாய்ப்பை அதை சிதைத்ததால் சிந்தையே துவண்டு...

தோல்வியே வெற்றியின் பாதை

தோல்வியே வெற்றியின் பாதை   தயக்கத்தைவிட மிகப்பெரிய தடையேதும் கிடையாது, அதைநீ தாண்டாமல் எதையும் அடைய முடியாது. ஒன்பது கிரகங்களும் உனக்காய்மட்டுமே உலவாது, ஆருடத்தையே நம்பிஇருந்தால் அப்பியபீடை அகலாது. அனுபவம்தான் ஆண்டவன் அவனைநீ தேடிப்போ, கோவில்கோவிலாய்ப் போவதைவிட வெற்றியை நாடிப்போ. யார்தான் தோற்கவில்லை எதற்குநீ வெட்கவேண்டும், எம்முயற்சியும் செய்யாதோர்தான் வெட்கவேண்டும். ஐம்புலத்தின் காதைமட்டும் அவ்வப்போது ஊமையாக்கு,...

Editorial

Dear colleagues, In Kauvery, Data is King, Queen and Citizen! As quaternary and tertiary hospitals, where we practise cutting edge medicine and undertake complex, sophisticated and effective surgeries, interventions, procedures and processes, and conduct post graduate and graduate programs for...

Results of Mechanical Thrombectomy in acute stroke: A case study in a Tier 2 city in India

Abstract Stroke is a leading cause of mortality and morbidity worldwide, with ischemic stroke being the most common type. Mechanical thrombectomy (MT) has emerged as a highly effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO)....

A clinical audit—cost effective way of managing superficial chest wound infections post sternotomy

Abstract Sternal wound infection in post cardiac surgery leads to worrisome complication. This recorded Incidence of 1–5% and Mortality as high as 30% if left untreated (mediastinitis). This audit was conducted to study the cost effective way of managing superficial...

Dental implants: Our experience and expertise

Background Anterior teeth are usually replaced soon due to aesthetic reasons. Posterior teeth are more often neglected. When an upper or lower first molar is missing, the opposite molar gets supra erupted, adjacent teeth get mesially and distally tilted, causing...

A non-randomized retrospective study on the management of pediatric septic arthritis

Background Septic arthritis results from presence of microbial agents in the joint space. Though uncommon, septic arthritis must be ruled out in any child presenting with a painful joint. Septic arthritis is a true orthopedic emergency and a delay in...

Analysis of femoral neck fracture in octogenarians and its management

Background The six million populations of people in India above eighty years in 2013 will rise up to thirty million by 2050[1]. The very elderly suffer from co-morbidities like osteoporosis, medical problems, financial problems and most of them are dependent...

Airway management of a huge thyroid: A case report

Abstract Enlarged, and long-standing, thyroid swelling often leads to airway distortion and altered anatomy thereby making intubation a challenge to anaesthesiologist. Here we report a case of long standing papillary carcinoma of thyroid with tracheal narrowing posted for Total thyroidectomy,...

Cardiac Arrhythmias in the ER setting

Introduction Cardiac arrhythmias are deviations from the normal electrical activity of the heart, leading to irregular heart rhythms. They can arise from abnormalities in impulse generation or conduction within the heart's electrical system. Arrhythmias are categorized based on their origin...

Effectiveness of tactile-spatial oriented approach based paediatric occupational therapy intervention for children with Infantile Hemiplegia

Abstract Background: Infantile hemiplegia refers to brain injuries that occur in either high-risk infants, leading to hemiplegia or total paralysis of one side of the body, including the upper and lower extremities. The main purpose of this article is to...

Corporate citizenship in healthcare: Nurturing social responsibility

Abstract This article explores corporate citizenship in healthcare, emphasizing its significance, principles, challenges, exemplary initiatives, and future trends. Corporate citizenship transcends profit-centric models, urging healthcare corporations to prioritize societal well-being. Guided by principles of ethics, community engagement, and environmental stewardship,...

Guillain-Barré syndrome: A case report

Background The clinical journey through Guillain-Barré syndrome follows a typical pattern that can be readily divided into its constituent phases and components. Demyelinating and axonal forms of the syndrome occur in varying proportions across different geographical regions, and clinical variants....

POST OPERATIVE Chapters 11 and 12 – Learning from Experience

POST-OPERATIVE Chapter 11 Hypercalcemia in Malignancy A 35-year-old woman, one year postnatal, lactating until 3 months ago was posted for radical mastectomy for carcinoma breast. She had had three cycles of chemotherapy prior to surgery. On examination, she was reasonably...

Chapter 15. How to be rational in practice?

Rational man is guided by his thinking, by a process of reasoning, not by his feelings or desires –                                                                         Ayan Rand Rational practice is to be taught not in a lecture hall but at the bedside of patients where...

Journal scan: Elsevier’s Medicine, Current Issue, Volume 52 Issue 6, June 2024, Seminar on Poisoning

Abstracts General aspects of poisoning Epidemiology of poisoning Accidental poisoning is most common in children, but deliberate self-harm becomes predominant in teenagers and early adulthood. The epidemiology of poisoning can be studied using mortality data, hospital admission rates and enquiries...

Recommended Readings

Recommended Readings (1). Dietary Guidelines for Indians - Indian Council of Medical Research https://main.icmr.nic.in/sites/default/files/upload_documents/DGI_07th_May_2024_fin.pdf (2). India- Specific Guideliness for enchancing Head & Neck cancer treatment : Oral cancer Task Force’s big leap forward https://www.linkedin.com/pulse/india-specific-guidelines-enhancing-head-neck-cancer-hcg-zwmfc?utm_source=share&utm_medium=member_android&utm_campaign=share_via (3). Guidelines on Emergency Cooling for...

இயற்கை சொல்லும் செய்தி

இயற்கை சொல்லும் செய்தி ஒரு இலை உதிர்ந்து கொண்டே சொல்கிறது, இந்த வாழ்வு நிலை இல்லாதது என்று. ஒரு பூ மலர்ந்து கொண்டே சொல்கிறது, வாழ்வில் ஒரு நாளாவது கௌரவமாக வாழ வேண்டும் என்று. ஒரு மேகம் பொழிந்து கொண்டே சொல்கிறது, கசப்பினை உள்வாங்கிக் கொண்டு நல்லவற்றை பகிர வேண்டும் என்று. ஒரு மின்னல் உருமிக்...

Editorial

Dear colleagues, The KAUVERIAN of 08 Jul 24 shall reach you power - packed with "original work". Dr .Chockalingam et al., present a 'Rare organism causing Septic Arthritis of hip joint'. Dr. Joseph Theodore et al present 'ICD implant in...

Instructions for Authors

General Considerations Research manuscripts should comprise: Front matter: Title, Author list, Affiliations, Abstract, Keywords Body matter: Introduction, Materials and Methods, Results, Discussion, Conclusions. Back matter: Acknowledgments, Author Contributions, Conflicts of Interest, References. Case study and Review manuscripts Front matter: Title,...

A rare organism causing septic arthritis of hip joint

Abstract Septic arthritis of hip joint is caused by inoculation or invasion of joint space by microorganisms leading to arthritis. It can be either direct inoculation or by haematogenous spread or by contiguous infection from nearby tissue. The most common...

ICD implant in 6 year old with Jervell and Lange-Nielsen (JLN) syndrome

Introduction Jervell and Lange-Nielsen syndrome (JLNS) is a rare autosomal recessive disorder characterized by congenital bilateral sensorineural hearing loss and prolonged QT interval, which can lead to life-threatening cardiac arrhythmias. This syndrome is a subtype of long QT syndrome (LQTS)...

A clinical audit on Bariatric/Metabolic surgery

Background Bariatric surgery is the umbrella term for all weight-loss surgeries reserved for obese patients. We performed this study on the measures taken for these surgeries and the outcomes. Burden of Obesity   WHO classification [table id=232 /] Definition of...

Clinical audit on Nil per Oral (NPO)

Abstract Aim To reduce prolonged fasting or inadequate fasting prior to Anaesthesia by proper patient education and care, thereby preventing its complications. Purpose of the audit Fasting before general anesthesia aims to reduce the volume and acidity of stomach contents,...

A non-randomized clinical study on heat stroke

Background Heat stroke is a life threatening condition, characterized by increase in core body temperature >40c along with central nervous system manifestation.   Introduction During the month of March and April 2024, temperature in Tamilnadu reached sky high.It went max...

Stress cardiomyopathy with posterior reversible encephalopathy syndrome in Eclampsia

Abstract Eclampsia is a multi-system disorder characterized by new onset of generalized tonic -clonic seizures which typically lasts 60 to 90 secs, occur during antepartum (20 weeks after gestation) intrapartum and postpartum period in a pre eclamptic patient, and has...

Intro-Reversible Cerebral Vasoconstriction Syndrome (RCVS): An ultra-short case report

Background Intro-Reversible Cerebral Vasoconstriction Syndrome (RCVS) encompasses various conditions characterized by temporary narrowing of multiple cerebral arteries, often leading to symptoms such as sudden, severe headaches, and occasionally accompanied by neurological issues such as stroke or seizures. While the typical...

A 2 am Tamponade: Critical call to action

Abstract A 52-years - aged male, with chronic kidney disease (CKD) on hemodialysis, admitted for pulmonary edema secondary to volume overload, and with severe metabolic acidosis and hyperkalemia, from Day 1 of admission. Despite initial treatment, he continued to experience...

Immune Checkpoint Inhibitors, and in combination with JAK inhibitors: The modelling for the future

Abstract Background:. Checkpoint Immunotherapy has revolutionized cancer treatment in the past decade for many cancer patients. This review explains how the immune checkpoint inhibitors (ICIs), when combined with JAK Inhibitors, give a good outcome. Methods: The recent studies related to...

Optimizing the patient journey in hypertrophic cardiomyopathy—Patient and clinician perspectives: Summary of CME from Medscape

Background Hypertrophic cardiomyopathy (HCM) is a genetic heart disorder characterized by abnormal thickening of the heart muscle, which can lead to obstructed blood flow and other complications. Effective management of HCM requires a comprehensive, patient-centred approach involving both medical and...

ER Intervention

  Before                                                                           ...

Diagnostic Images/Videos

[video width="478" height="850" mp4="https://www.kauveryhospital.com/wp-content/uploads/2024/07/Diagnostic_videos.mp4"][/video]   Discussion A clot in the left atrium as seen on Trans esophageal echo Multiple embolic Infracts in brain Paroxysmal Atrial Fibrillation   Dr. Deepak Krishnamurthy Cardiologist

A randomized controlled trial: Different types of blinding

Background Blinding means withholding which group each participant has been assigned to. Studies may use Single-, Double- or Triple-blinding. Single-blinding occurs in many different kinds of studies, but double- and triple-blinding are mainly used in medical research. A trial can...

Journal scan –  June

Drug-Induced Oxidative Hemolysis (1). Wing Kit Lam et al, Published April 24, 2024, N Engl J Med 2024;390:1513,DOI: 0.1056/NEJMicm2312581, VOL. 390 NO. 16 A 57-year-old woman with a history of depression and insomnia presented to the emergency department with a...

Journal scan –  July

Inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease: the ORFAN multicentre, longitudinal cohort study (1). Kenneth Chan et al, Published:May 29, 2024DOI:https://doi.org/10.1016/S0140-6736(24)00596-8, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00596-8/fulltext Summary Background Coronary computed tomography angiography (CCTA) is the first line investigation for...

Post-Operative Chapters 13, 14

POST-OPERATIVE  - Chapter 13 Post inguinal-hernia repair A 30-year-old male patient with ASA1 physical status was taken up for inguinal hernia repair under spinal anaesthesia. 2.5 ml 0.5% heavy Bupivacaine with 25 mcg Fentanyl was administered in the intrathecal space...

Chapter 16. How to enjoy medical practice?

The best way to enjoy your job is to imagine yourself without one                                                                         Oscar Wilde When you enjoy what you do, work becomes a play –                                                                         Martin Yan What does the word “enjoy” mean to you?...

Driving business growth with 5S and lean strategies: A transformative session for corporations in the Trichy region

Introduction In an era where efficiency and productivity are paramount, the 5S and Lean methodology stands out as a powerful tool for driving business growth. Recently, Business Excellence & HR Teams in coordination with CII Trichy Zone have conducted an...

Poem: 25 – வருடங்களாக காவேரி

ஒரு நொடிப் பொழுது எடுத்த முடிவு 60 நொடிகள் ஒரு நிமிடமாகி 60 நிமிடங்கள் ஒரு மணித்துளி ஆகி 24 மணி நேரம் ஒரு நாள் கணக்காகி 365 நாட்கள் சேர்ந்து ஒரு வருடமாகி இப்படியாக சிறுக சிறுக சேர்த்த வருடத் துளிகள் கோர்த்து 25 வருடங்கள்... மிக நீண்ட பயணம் இது காவேரியின் பயணம்......

Editorial

Dear Colleagues The KAUVERIAN appears on 08 August, proud to publish KAUVERY DATA each time! We open with Dr. Chockalingam's audit from Trichy, carrying a cautionary tale, on the perils of not assuring that 'diagnoses' are highlighted and correctly documented'...

A Data Audit: Tool for Good Clinical Practice

Introduction The clinical data was collected during the course of patient care or as part of clinical research. Electronic medical records were compiled with the data collected during the course of patient care. The clinical data is a staple resource...

Ortho rehab audit at Kauvery Hospital, Trichy

Background Do Ortho patients need rehabilitation? Fragile patients have multiple medical co-morbidities and deteriorating health conditions, which may lead to falls and fractures. It may not be safe to send them home early; rehabilitation processes would help the patient and...

Endovascular Thrombectomy in young patient with a stroke – surgical procedure decompressive craniotomy

Case Presentation A 35-years aged man with no significant past medical history presented to Emergency with weakness of right upper and lower limb, and loss of speech. MRI Brain done outside had shown left MCA territory infarct, with M1 occlusion,...

Secondary HLH (Hemophagocytic Lymphohistiocytosis): An ultra-short case report

Introduction Hemophagocytic Lymphohistiocytosis (HLH) is a rare but potentially life-threatening hyper-inflammatory condition characterized by excessive immune activation. It can be primary (genetic) or secondary to infections, malignancies, or autoimmune diseases. This case report presents a rare instance of secondary HLH...

Prone ventilation: A case series

Case presentation Case 1 A 30- years- aged male with Diabetes, Alcohol addiction, and chronic pancreatitis was admitted unconscious, intubated at the hospital of the National Lignite Corporation (NLC.) ER interventions GCS - 2T, HR - 171, Sat - 84...

Dermatologic Emergencies: A case series

Background Dermatologic problems represent about 15–20% of visits to family physicians and emergency departments [1]. Dermatologic emergencies are often a challenge for clinicians to diagnose and manage as they often resemble one another. Some of the dermatologic emergencies include Stevens-Johnson syndrome/toxic epidermal necrolysis,...

Managing DKA at the ER

Case presentation A 48 years aged female was brought in a state of unconsciousness GCS - E2 V2 M4, Pupils - 2.5B/L ERTL Course in ER – initial assessment 5min TOA Airway - secretions present Breathing - RR – 46/min...

Podcast – Managing DKA at the ER

[video width="1440" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2024/08/Managing_DKA_at_the_ER-1-1.mp4"][/video]   Podcast [video width="852" height="480" mp4="https://www.kauveryhospital.com/wp-content/uploads/2024/08/Podcast_-_DKA_Dr._Karuppaiah.mp4"][/video]

Insertion of tunneled hemodialysis catheter through the collateral vein adjacent to the thrombosed right jugular vein.

Background The primary site for a tunneled hemodialysis catheter (THC) insertion is the right internal jugular vein (IJV) followed by the left IJV, subclavian vein, and femoral veins. We report a chronic hemodialysis patient who had completely occluded jugular veins...

Access failure with dysfunctional tunnelled haemodialysis catheter in the presence of exit-site infection

Background Over-the-wire exchange is standard treatment for patients with tunneled hemodialysis catheters (THCs) that fail to maintain sufficient extracorporeal blood flow. However, this well-known procedure is unsuitable in the presence of exit-site infection (ESI). We report successful replacement of THC...

Video – A multidisciplinary approach to preventing sudden cardiac death

[video width="1440" height="1080" mp4="https://www.kauveryhospital.com/wp-content/uploads/2024/08/Multidisciplinary-approach-to-SCD-Kauvery-PG-lecture-6July2024-1.mp4"][/video]     Dr. Priya Chockalingam

Dasatinib in pediatric Chronic Myeloid Leukemia: An overview

Background Chronic myeloid leukemia (CML) is a cancer of white blood cells, characterised by unregulated growth of myeloid cells in the bone marrow due to a characteristic chromosomal translocation called Philadelphia chromosome [t (9;22)]. This translocation leads to BCR-ABL gene...

Dyslipidemia management: Indian perspective

Background Coronary Artery Disease in India Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India Compared to Europeans, Indians get CVD at least a decade earlier and in their most productive midlife years. Incidence in young...

Pharmacological stress testing: Assessing heart health without exercise

Introduction Pharmacological stress testing is a diagnostic procedure used to assess the heart's function and detect potential issues, particularly in patients who are unable to exercise adequately. This test combines the use of stress-inducing medications with either electrocardiography (ECG) or...

Journal scan: A review of 15 Ethics with clinical significance, harvested from a major international journal

Special Edition on Ethics: Healthcare Ethics and Communication| Volume 52, Issue 7, P403, July 2024 (1). Introduction John Saunders Published: May 28, 2024 DOI: https://doi.org/10.1016/j.mpmed.2024.04.005 This edition of Medicine is with a focus on ethical issues, medical humanities and philosophy...

Post-Operative Chapters 15 and 16

POST-OPERATIVE Chapter 15 Nerve Blocks in Day Care Case 1 A 45-year-old woman was posted for diagnostic arthroscopy of her right knee in view of her arthritic symptoms. She had no significant past medical or surgical history. It was thus...

Chapter 17. How to find time for the family

Time is free but it’s priceless, you can’t own it but can use it, you can’t keep it but can spend it, once you lose it, you can’t get it back                                                                                                 Harvey Mackay If you are too busy...

Poem – உனக்காக நீ

உருவம் உன்னுடையது உருவகப்படுத்துதல் உன்னை பொருத்தது உன் நிழல் கூட உன்னைத்தான் தொடர்கிறது உணர்வாய் உன் வலிமையை நீ உன் திறன் அறிந்து கொள் நீ உன் திறமை அறிந்து கொள் நீ உன் செயல்பாட்டை அறிந்து கொள் முடிவில் நீ உனக்கானதை அறிந்து கொள் உனக்காக நீ மட்டும் தான் இருக்கிறாய் என கர்வம்...

Editorial

Dear colleagues Original Work and Kauvery Data shall feature prominently as ever in the September 08 issue of the KAUVERIAN. Dr .Chockalingam, who has tirelessly propagated both, leads this issue with his Clinical Audit on 'A silent disease- Osteoporosis' at...

An audit: A silent disease-Osteoporosis

Introduction Osteoporosis: The Silent Disease A silent disease - does not have any typical symptoms and you may not even know you have the disease until you break a bone. Characterised by low bone mass and micro architectural deterioration of...

An approach to antibiotic therapy: A primer for all specialties

Background Judicious use of antibiotics and appropriate early initiation for the right patient The factors that determine the patients in Casualty as sick NEWS2 (National Early Warning Score) RR SpO2 BP Pulse Conscious level Temperature qSOFA (Quick Sequential Organ Failure...

Audit on pediatric Cholesteatoma

Introduction Anatomy of Ear Ear consists of 3 parts External ear Middle ear Internal ear Middle ear contains 3 tiny bones – the ossicles Malleus/Hammer Incus/Anvil Stapes/Stirrup Middle ear is divided into Epitympanum Mesotympanum Hypotympanum Facial nerve leaves the brainstem...

Clinical audit: ER to ICU transit time

Background Several studies done in the past two decades tried to evaluate the association between prolonged ER stay and outcomes in the ICU. Reference has been made to  a few of those studies like Donald B chalfin, Caroline N. L....

A case report on Multiple myeloma: Value of pre and post-treatment MRI

Abstract In this report, we present a 71-year-old male patient, with Multiple Myeloma, who presented to the Radiology department at Kauvery Hospital, Alwarpet, Chennai, India with complaints of severe backache and paraesthesia in both lower limbs. There was a history...

Unrelated donor bone marrow transplantation in 3 year old with Acute Myeloid Leukemia

Happy to share this new milestone, A 3 year old child with AML was refractory to 2 cycles of intense induction chemotherapy. He received a 3rd course of salvage chemotherapy and the disease was controlled. There were no full matched...

Infective endocarditis: A case series

Background Infective endocarditis is the inflammation of the endocardium, the inner lining of the heart, as well as the heart valves. Clinically, infective endocarditis may present with a multitude of signs and symptoms, and clinicians should consider this diagnosis in any patient...

A Retrospective observational study on Scrub typhus paediatric population in Kauvery Hospitals, Trichy

Introduction Scrub typhus is an acute infectious disease caused by the bacterium Orientia tsutsugamushi. This pathogen is transmitted to humans through the bite of infected larval mites, known as chiggers, which are common in rural and forested areas of the...

Clinical Pharmacy Approach: To a patient on multiple anticonvulsants for “Difficult to control’’ seizure disorder

Case presentation A hypothetical patient, A 30-years-aged male Seizure Type: Intractable refractory epilepsy, on multiple anticonvulsants Current Medications [table id=300 /] Patient has a known history of seizure disorder for 20 years. He has been on multiple antiepileptic drugs (AED)...

An analysis of the Urea to Creatinine Ratio (UCR) in different cardiac surgeries

Abstract Serum creatinine and urea (Blood Urea Nitrogen-BUN) are the most important biomarkers in the assessment of pre-operative renal function and in the prediction of adverse outcomes in cardiac surgery. Many bio-markers have been studied to date but there is...

Journal scan – 1

(1). Gupta N, Boodman C, Jouego CG, Van Den Broucke S. Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis. BMC Infect Dis. 2023;23(1):884. Published 2023 Dec 18. doi:10.1186/s12879-023-08893-7 Orientia tsutsugamushi is a gram-negative organism belonging...

Journal Scan – 2

Chilblain Lupus Erythematosus (1). Wei-Yao Wang etal,.Published July 24, 2024,N Engl J Med 2024;391 : e6, DOI: 10.1056/NEJicm2400724,VOL. 391 NO. 4 A 29-year-old woman with a history of systemic lupus erythematosus presented to the dermatology clinic with a 2-week history...

Post-Operative Chapters 17 and 18

POST-OPERATIVE  - Chapter 17 Pneumothorax following Removal of Sharp FB in Airway A 2-year-old child weighing 14 kg was admitted with history of possible foreign body (FB) in the airway with recurrent bouts of coughing. He was feeding poorly since...

Chapter 18. How to be legally safe in medical practice?

Many doctors don’t need laws to tell them to act responsibly, few others try to find the ways around the laws                                                                                                                         -Plato Only thing more dangerous than ignorance is arrogance                                                                                                                         -Albert Einstein Moral duties of a...

Poem – காவேரியின் மாரத்தான்

மாரத்தான் ஓட்டம், தந்திடுமே மாற்றம்.   உடலின் உயிர்நாடியாம் இதயம், இதய ஆரோக்கியத்திற்காக காவேரியின் மாரத்தான் ஓட்டம்.   காந்தி ஸ்டேடியத்தில் இருந்து ஆரம்பிக்கும் எங்கள் ஓட்டம், ஹஸ்தம்பட்டி மற்றும் ஏற்காடு மலையடிவாரம் வழியாக வந்து சேரும் எங்கள் கூட்டம்.   ஓடினால் சீராகுமே ரத்த ஓட்டம், வலுப்பெறுமே இதயமும் நுரையீரலும்.   இதனால் சீராகமே...

Poem – ஆரோக்கியம் என்னுடையது

உணவு அது எனக்கான தேவை ஆரோக்கியம் அது‌ எனக்கான அவசியம் எத்தனை முறை சாப்பிடுகிறோம் என்பதில் இல்லை எப்படி பட்டதை சாப்பிடுகிறோம் என்பது எதார்த்தம் ஆரோக்கியம் உன் தேடல் ஆனால் உணவே உனக்கான மருந்தாகும் முறைப்படி சாப்பிட வேண்டும் முறையாக சாப்பிட வேண்டும் முழுமையாக சாப்பிட வேண்டும் முறு முறுப்பில்லாமல் சாப்பிட வேண்டும் உண்பதின் முழுமை...

Editorial

Dear Kauverians, The 08 October edition of the KAUVERIAN is here, reflecting your original work. We continue the Kauverian crusade against Antimicrobial Resistance by presenting Kauvery Data on Antibiogram at Kauvery Hospital Tennur, by Dr Rajarajan and team. Dr. Rajarajan...

Clinical audit on antibiogram

Background An antibiogram is a collection of antimicrobial susceptibility test results from cultures performed over a specific period. A table shows how susceptible a group of organisms is to different antimicrobials. Antiprograms are typically generated for a specific health care...

Renal transplantation in marrow dysfunction: A case series

Background We have done renal transplants in 3 patients with aplastic anaemia. As far as our search is concerned, we found 1 case report of such a scenario in the world, only one case report from Manipal hospital Bengaluru published...

Empowering lifesavers: Impact of BLS and PALS training for PICU and critical care nurses

Background Incidence of Cardiac Arrest in Pediatric Population; [table id=320 /] Introduction: Importance of BLS and PALS BLS (Basic Life Support) First-responder interventions are critical for survival High-quality CPR Early defibrillation PALS (Paediatric Advanced Life Support) Focused on systematic assessment...

Myotonia congenita: A case series

Introduction Myotonia congenita is a rare genetic neuromuscular disorder characterized by the delayed relaxation of muscles after voluntary contraction, a phenomenon known as myotonia. This condition affects the skeletal muscles, causing muscle stiffness, cramping, and, in some cases, hypertrophy (increased...

Utilization of Inj. Sovateltide: A novel injectable formulation

Abstract Sovateltide, a highly selective endothelin-B receptor agonist and synthetic analog of endothelin-1, is a neural progenitor cell therapeutic agent for the treatment of acute cerebral ischemic stroke (ACIS), hypoxic-ischemic encephalopathy (HIE), spinal cord injuries and Alzheimer's disease. In May...

Retroperitoneal sarcoma: A report of two cases

Abstract Retroperitoneal sarcomas are rare tumors, with the potential for late presentation due to their location, lack of significant symptoms at an early stage and availability of space for expansion. For the same reason, along with their proximity to vital...

Traumatic simultaneous bilateral femur and tibia shaft fracture in an 8-year-old male child: An unusual case report

Introduction Bilateral simultaneous fracture of femur and tibia are very rare in children. There have been few reports on traumatic bilateral femur and femoral neck fractures in paediatric age group [1]. This type of injury is caused by high velocity...

Echocardiography in the assessment of shock

Introduction Echocardiography has evolved to become a crucial noninvasive imaging modality in the critically ill patients. Its portability, safety, and widespread availability allow for the rapid diagnosis of life-threatening cardiac problems and rapid exclusion of cardiac disease in critically ill...

Plasma combats angioedema: A case report

Introduction C1 esterase inhibitor deficiency, also known as hereditary angioedema, results in the unchecked production of the vasodilator bradykinin. This increase in bradykinin leads to an increase in smooth muscle relaxation in the walls of blood vessels and resultant edema...

A case report and video presentation on a 9-year-old boy who underwent PAPVC

Case Presentation A 9-year-old boy who underwent surgical repair of PAPVC (right upper pulmonary vein) 6 months back. There was mild PV stenosis evident from the first post-op echocardiogram We obtained a CT angiogram but decided to wait as the...

Interventional Radiology: Large gastric varices

Case Presentation A 47-year-old male with alcohol-related CLD, Presented with massive upper GI bleed. He was incubated and was on support. An upper GI scopy revealed Lower oesophageal varices. Then it was ligated, and Gastric varices were partially treated with...

Interventional Radiology: A case of active PV bleeding post-D and C day 12

Case Presentation A patient with an active delayed hemorrhage on the 12th day of D and C (Dilation and Curettage). The reason is unclear. This could be iatrogenic because we see cases of AVM (Arteriovenous malformations) secondary to such procedures,...

Diagnostic Images: Exencephaly

A case of Exencephaly was diagnosed at 12 to 13 weeks of gestation at Maa Kauvery and the fetus successfully terminated. Dr. J. Sharmela Devi Consultant Radiologist

A short case report on Hyperdontia (extra teeth)

Case Presentation A 10-year-old kid visited our dental department with complaints of an unerupted front tooth and malalignment. On Examination Intra oral examination reveals Missing 11 (central incisor). Radiological examination (OPG) reveals a supernumerary tooth hindering the eruption of 11....

Post-Operative Chapters 19 and 20

POST-OPERATIVE - Chapter 20 Post Procedure Haemorrhage - Can Alternative Medicine Be a Cause A 35-year-old woman with a two days history of missed abortion was posted for evacuation of the uterus. She was taken up under TIVA with Propofol...

Chapter 19. How to deal with incurable disease?

Never must the physician say disease is incurable, nature has hidden powers and mysteries                                                             -Morris Fishbein I don’t have a choice about incurable disease butthere are other choices in life to make                                                             -Michael Fox   Concept of “cure”...

CII CFO Excellence award: A recognition of exceptional leadership

Introduction Mr. Anand Babu Kumarasamy, the Chief Financial Officer of Kauvery Hospitals, was recognized as the Healthcare Sector CFO of the Year at the CII CFO Awards 2024. The prestigious award was presented on 19th Sep’ 2024, at Hotel Taj...

Journal scan

(1). Kristine T. Gapuz et al. Vitamin C–Induced Oxalate Nephropathy: An Underappreciated Consequence of Dietary Supplements. Annals of Internal Medicine: Clinical Cases. 2024;3(9). Abstract Oxalate nephropathy is an uncommon and often-missed cause of acute kidney injury. A careful history of...

Poem – மறுக்காதே மறவாதே

எழ மறுத்தால் காலை கதிரவனில்லை! விழ மறுத்தால் நீர் வீழ்ச்சியில்லை! ஒளிர மறுத்தால் அழகு நிலாயில்லை! பூக்க மறுத்தால் கவரும் மலரில்லை! வீச மறுத்தால் குளிரும் காற்றில்லை! சுட மறுத்தால் எரிக்கும் தீயில்லை! இயங்க மறுத்தால் சுழலும் பூமியில்லை! உழைக்க மறுத்தல் உனக்கு வாழ்க்கை இல்லை! உடல் பரிசோதிக்க மறுத்தால் உனக்கு ஆரோக்கியம்யில்லை! எனவே உங்கள்...

Editorial

Dear colleagues, The 08 Nov 24 edition of the KAUVERIAN continues its mission to publish your original work, which is the record of your service that was rendered to your patients, with care, compassion and competence. We open with two...

An audit: Microvascular Free Flaps

Background Microvascular tissue transfer A free flap is a tissue flap, including blood vessels, skin, fat, and sometimes muscle, bone, nerve that is detached from one part of the body and reattached to another part of the body. Anastomosis of...

DSME Programs – Lessons learned

Background Despite significant advances in diabetes management, the majority of people with diabetes (PWD) do not achieve target glycemic control (HbA1c). Poor treatment adherence and diabetes self-management practices may be contributing factors. Targeting unmet psychological needs in these people can...

Surgical Reconstruction Of Acromio Clavicular Joint Dislocation Using Double Endobutton – A Case Report

Abstract Background: Acromioclavicular joint (ACJ) dislocation accounts for around 3–10% of all the injuries occurring around the shoulder girdle. Here we have discussed surgical management for a patient to treat type-3 ACJ dislocation. Summary: This is a case of type-3...

Complex Iliac Artery And Venous Reconstruction In Case Of Polytrauma – Case Report

Case Presentation A 42-year-old (nulliparous) female presented with an alleged history of a road traffic accident (two-wheeler versus bus). She had sustained injury to her right lower abdomen and was not able to move her right lower limb. There was...

Basics of statistics- from of a clinician’s perspective

Measures of central tendency Mean The mean is a fundamental measure of the central tendency in statistics, calculated by summing all values in a dataset and dividing by the total number of values. This simple yet powerful metric provides an...

A comprehensive review on Rabies: Clinical aspects and treatment

Introduction Rabies is a dangerous zoonotic disease caused by Lyssavirus type 1. Rabies is an acute, progressive encephalomyelitis. The case-to-fatality rate is the highest of any infectious disease. 100% fatal yet nearly 100% preventable. The 40% of victims are children...

Lateral Medullary Syndrome – Case Report

Abstract Lateral medullary syndrome or Wallenberg syndrome is the syndrome that occurs due to thrombosis, emboli, or dissection of the vertebral artery or PICA. It is the most common posterior circulation ischemic stroke. Posterior circulation strokes represent about 20% of...

Postpartum ischemic stroke – case report

Abstract Stroke is a leading cause of maternal morbidity and mortality. The incidence of stroke in women during pregnancy and the postpartum period is approximately triple the incidence of stroke in non-pregnant women of similar age.1 The majority of maternal...

Proning Saves Lives

Case Presentation A 28-year obese (BMI 36, non-smoker, non-ethanolic) male, cab driver by occupation. Severe community-acquired pneumonia (viral to begin with then secondary bacterial) – treated outside for 5 days. On admission 60% FIO2, severe ARDS with P/F ratio of...

Video – A challenging case of Recurrent craniopharyngioma with supra and infra tentorial cyst and hydrocephalus

[video width="640" height="480" mp4="https://www.kauveryhospital.com/wp-content/uploads/2024/11/video-v6i9.mp4"][/video]

Event: Update on Atrial Fibrillation

Overview On September 2, 2024, the department of Cardiac Electrophysiology& Pacing at the Kauvery Hospital hosted an insightful “Update on Atrial Fibrillation". The event was presided by Dr Adam S Budzikowski. This event aimed to shed light on the latest...

Investigating the Role of Activity-Based Configurational Developmental approach in Managing Mitochondrial Leukodystrophy in Children

Abstract This case study looks at how an activity-based configurational developmental approach helps manage mitochondrial leukodystrophy in children at unit of Kauvery Hospital, Hamsa Rehab in Trichy, Tamil Nadu. Even though these disorders have different causes, children often experience similar...

Post-Operative Chapters 21 and 22

POST-OPERATIVE  Chapter 21 Respiratory Obstruction Due to Adenoid Pack An eight-year-old boy, weighing 30 kilograms was posted for Adeno-tonsillectomy. On examination, his lungs were clear, airway showed Mallampati Class 2, and pulse rate of 108 beats/min. All his investigations were...

Chapter 20. How to deal with failure of treatment

Many medicines few cures                                                             -Benjamin Franklin Success is not final, failure is not fatal, it is the courage to continue that counts                                                             -Michael Fox Meaning of “getting well” To a patient, it connotes total recovery back to original...

Journal scan: A review of 12 recent papers of immediate clinical significance, harvested from major international journals

A 9-Year-Old Child with a Large Thoracic Mass (1). Chenghao Chen, JAMA. Published online October 3, 2024. doi:10.1001/jama.2024.16482 Case A previously healthy 9-year-old boy presented to a primary care clinic with a 10-day history of a nonproductive cough without fever,...

Poem – தன்னம்பிக்கையும் விடாமுயற்சியும்

மனிதா வெற்றி என்பது, ஒருநாள் கூற்று இல்லை. பல நாள் பயிற்சியும், விடா முயற்சியும் சேர்த்து பல பிரச்சனைகள் பல அவமானங்களுக்கு மத்தியிலும், உன் இழப்புக்கும், பொறுப்புக்கும் நடுவினில் உனக்கென ஓர் ஓட்டம் அது தான் வெற்றி. இந்த ஒரு வெற்றி உனக்கும் வேண்டுமெனில், எழுந்து வா முயற்சி செய் போராடு. உன் உடம்பிலிருந்து வழியும்,...