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Capsule 2018 April

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Capsule 2018 April Medi Magazine kauvery A quarterly magazine from VOLUME - 23 | ISSUE 02 APRIL 2018 VOLUME All that is on the chest is not Necessarily a keloid Atypical presentation Of atypical organism Basi- frontal Arteriovenous Malformation presenting as acute subdural bleed Neonatal scrub Typhus – a rare entity Total laparoscopic excision Basilar Of choledochal cysts Artery Stroke tips for Medico-legal Epidural Blood Patch problem for Post Dural Puncture Headache A case of megaloblastic Anaemia / viral fever /acute renal failure To download this magazine This magazine is free circulation for hospitals and doctors only, Not for sale. Design and logo of kauvery hospital are property of scan this QR Code Kauvery Hospital, To get this magazine copy mail us at: [email protected] with QR scanner APP If you want to know any other details contact us on Editorial Address in your smartphone KAUVERY CAPSULE FRONT INNER AD CAPSULE MAGAZINE IN Capsule Magazine is published by Kauvery Hospital THIS ISSUE Copyright 2016 © Kauvery Hospital 01 ATYPICAL PRESENTATION PATRONS Page Number OF ATYPICAL ORGANISM Dr. S. Chandrakumar Dr. S. Manivannan 07 NEONATAL SCRUB TYPHUS – A RARE ENTITY Page Number ADVISORY BOARD Pediatric Team Dr Senguttuvan .D , Dr Suresh Chelliah , Dr K. Senthil Kumar, Dr. D. Senguttuvan Dr C.Vignesh, Dr K. Swaminathan , Dr Naresh Kumar N. Dr. Aravindan Selvaraj Dr. Pradeep, Dr. Rubini Dr. T. Senthil Kumar Kauvery Hospital, Trichy EDITOR Dr. Skanda Shyamsundar 01 EDITOR’S Page Number DESK 03 ALL THAT IS ON THE CHEST IS NOT EDITORIAL TEAM Page Number NECESSARILY A KELOID Dr. Chokkalingam S Dr. Skanda Shyamsundar Dr. Jos Jasper G Head of the Department, Dept. of Plastic & Micro Surgery Dr. Senthil Kumar S Kauvery Hospital, Trichy Dr. Senthil Kumar K Dr. Velmurugan S CO-ORDINATOR Mr. Dilip Rajkumar S 04 BASI- FRONTAL ARTERIOVENOUS Page Number MALFORMATION PRESENTING AS ACUTE SUBDURAL BLEED DESIGN & LAYOUT Dr. Jos Jasper Mr. Vahid Ali N. Head of the Department Mr. Benhar J G Kauvery Brain and Spine centre 05 COME LET’S Page Number TRAVEL Tiruchirappalli 08 TOTAL LAPAROSCOPIC EXCISION Page Number OF CHOLEDOCHAL CYSTS Dr.S. VELMURUGAN MS, FRCS(Glas), FRCS(UGI-HPB), CSST(UK) EDITORIAL OFFICE HOD & Senior Consultant-Advanced Laparoscopic/GI/Obesity/HPB/ Kauvery Hospital Liver Transplant Surgeon VI Floor, Administrative Office, Dr. Archana.R DNB(GS) Trainee #6, Royal Road, Cantonment, Kauvery Hospitals, Trichy Tiruchirappalli-620001 Call us at (431) 40 77 777 E: [email protected] W: www. kauveryhospital.com I • CAPSULE MAGAZINE • APRIL 2018 KAUVERY CAPSULE EDITOR DESK I’M NOT SURE OF THE CAUSE... I THINK IT COULD 09 HEALTHY BE DUE TO ALCOHOL. THAT’S OK, Page Number RECIPE I’LL COME BACK WHEN YOU’RE SOBER Chocolate Chai Ice Cream 09 JOKE Page Number CORNER 10 EPIDURAL BLOOD PATCH 11 BASILAR FOR POST DURAL Page Number Page Number ARTERY STROKE PUNCTURE HEADACHE Dr. Sivarajan Thandeswaran., MBBS, MRCP (London) Dr.K.Senthil Kumar M.D., PGDMLE, Senior consultant Stroke & Neurovascular medicine Sr. Consultant and Head of the Department, Anaesthesiology, Kauvery Hospital, Chennai Dr.P.Sasi Kumar M.D., D.A., Dr.M.Rayan M.D., DNB., Dr.S.Vadhan Prasanna M.D., DNB., Department of Anaesthesiology, Kauvery Hospital, Trichy 12 ROAD SAFETY 13 DEALING WITH Page Number WEEK Page Number MEDICOLEGAL ISSUES Awareness program IN DAY TO DAY PRACTICE 15 NEW PANEL OF 17 WORLD Page Number Page Number CONSULTANTS KIDNEY DAY CELEBRATION Flash Mob 19 TIMES OF INDIA Page Number AWARDS APRIL 2018 • CAPSULE MAGAZINE • II KAUVERY CAPSULE EDITOR’S DESK | ATYPICAL PRESENTATION OF ATYPICAL ORGANISM ATYPICAL PRESENTATION OF ATYPICAL ORGANISM Pediatric Team Dr Senguttuvan .D , Dr Suresh Chelliah , Dr K. Senthil Kumar, Dr C.Vignesh, Dr K. Swaminathan , Dr Naresh Kumar N. Dr. Pradeep, Dr. Rubini Kauvery Hospital, Trichy Dear colleagues and friends, A six year old girl, presented to our emergency department on day six of It gives me great pleasure to take over from Dr. S. illness, with high grade intermittent fever for six days associated with Senthil Kumar as Editor of Kauvery's Capsule magazine periumblical abdominal pain, non-bilious vomiting and loose stools for henceforth. Over the years, Capsule has become a a day. There was history of mild cough since day three of illness. No visual treat, with good content and has a very wide other associated systemic symptoms were present reach and acceptance among our referral base. I look forward to all your support to taking Capsule to even greater heights and someday, I wish it would be as popular as a "Coffee table book", with content that would interest even the common man. We are proud to have departments that are on par with the best in the CLINICAL FINDINGS AND inotropes. She was given country, and this magazine helps to showcase our INVESTIGATIONS intravenous antibiotics after wonderful work to all of you. Most of us would be This child was febrile and obtaining blood for aerobic surprised that what is described in textbooks is being tachypneic at presentation, with culture. done on a day to day basis in Kauvery, and Capsule signs of compensated shock. In view of Pneumonia with would help to serve as the "all seeing eye" giving a Her abdominal examination hepatitis, anemia, leucopenia, sneak peek into the wonderful world of medicine. revealed mild hepatomegaly. thrombocytopenia and Other systems were normal. coagulopathy, other differentials The magazine is undergoing a slight makeover, shifting Her Q-SOFA score was three, like Sepsis with DIC / Swine flu from purely medical case based content, to a mix of indicating severe illness. (H1N1) / Leptospirosis/ SLE with medical content, interesting cases and information that Peripheral smear revealed mild autoimmune hepatitis were would make for interesting reading, with a little bit of normocytic normochromic considered. She was supported something for everyone. anemia, leucopenia, with adequate antibiotics, thrombocytopenia with other cell antiviral, blood products and We are also working on a revamped online edition with lines in normal limits. adequate hepato-supportive interactive content, and containing videos of post op Liver function tests revealed very measures. Etiological workup follow up, functional recovery, or rare procedures that high liver enzymes with normal was negative for Dengue , will make for interesting viewing overall. bilirubin level, mild leptospirosis, scrub typhus and hypoalbuminemia and bleeding Swine flu. Autoimmune workup We wish to also move to user driven content, and we parameters were deranged. was also negative. would appreciate your valuable feedback and Renal function tests were normal. Secondary Hemophagocytosis suggestions to make Capsule even better in the years CRP was very high suggestive of was considered in view of ahead. severe sepsis. persistent bicytopenia, fever & Chest xray revealed peri-hilar hepatitis, however complete Please do send your suggestions and comments to infiltrates more on right side workup ruled out that diagnosis. [email protected]. We will publish the suggestive of pneumonia. best "Letters to the Editor" in the subsequent issues, and SUBSEQUENT CLINICAL work towards implementing your suggestions for a PROGRESS better Capsule. THE WORKING DIAGNOSIS Her liver enzymes that were AND MANAGEMENT grossly elevated gradually Capsule is what it is thanks to all your support. Looking reduced from day 4 of forward to more active participation from our readers Infectious causes like severe hospitalisation after adequate and your continuing patronage....... sepsis / enteric fever / scrub hepato-supportive measures. Her typhus with features of coagulopathy was corrected compensated shock were gradually. Anemia was corrected Dr. Skanda Shyamsundar considered clinically. She was with packed cell transfusion. HOD, Dept. of Plastic & Micro Surgery resuscitated with intravenous However in view of persistent Kauvery Hospital, Trichy crystalloids, oxygen and thrombocytopenia, persistent 01 • CAPSULE MAGAZINE • APRIL 2018 KAUVERY CAPSULE ATYPICAL PRESENTATION OF ATYPICAL ORGANISM fever, oxygen dependency and DISCUSSION: humans, M. pneumoniae grows cholecystitis, and pancreatitis poor clinical response to higher Mycoplasma, the smallest relatively slowly, with visible have been reported. Elevated antibiotics, atypical organisms free-living microorganisms are formation of colonies rarely liver enzymes are rarely observed were considered. Anti- ubiquitous in nature. Of this occurring in less than 1 week during M. pneumoniae infection Mycoplasma IgM was strongly group, seventeen have been and possibly taking 3 weeks or in children. Liver involvement was positive. She was then started on identified as human pathogens. more. transitory in these patients, and intravenous azithromycin. Mycoplasma pneumoniae, recovery of liver enzymes to This child’s recovery was Mycoplasma hominis, and M. pneumoniae commonly normal range correlated directly dramatic and she was gradually Ureaplasma urealyticum found to affects the respiratory system . with resolution of mycoplasma weaned off from oxygen. Her cause disease frequently in However numerous pneumonia, as demonstrated in blood counts, liver function and children. It grows under both extra-pulmonary manifestations our patient. bleeding parameters returned to anaerobic and aerobic have been documented. normal shortly. She was conditions, but growth is more Pulmonary and extrapulmonary discharged on day nine of consistent when it is incubated in manifestations are tabulated
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