JEJEUNAL AMYLOIDOSIS AS OCCULT BLEED IN POST RENAL TRANSPLANT RECIPIENT

Dr. Dr Anju (Gastroenterology, )

35 year old gentleman, diagnosed chronic kidney disease in 2010 ,received renal allograft in August 2014.His native kidney disease was IgA Nephropathy.In November 2019 he developed graft dysfunction and hemodialysis was initiated. He presented with Hb 5 g/dl. His stool occult blood was positive. CT Angiography showed jejunal loop thickening? ischemia/enteritis. Push enteroscopy revealed jejunal ulcerations with polypoidal protrusions. Jejunal biopsies showed amyloid deposition in the lamina propria with Congo red stain demonstrating apple green birefringence under polarized light.

An interesting case of colovaginal fistula.

Dr.Rithu (Gastroenterology, )

A 62 year old lady presented with history of recurrent urinary tract infection since six months , left lower abdominal pain since 3 months and occassional faeculent discharge per vaginum since 1 month. On examination there was tenderness in left iliac fossa. CT abdomen showed sigmoid diverticulitis with microperforation and pericolic abscess formation. She underwent laparotomy , dismantling of colovaginal fistula, primary closure of vaginal opening and anterior resection.

Chronic arthritis in children

Dr.Suma (Rheumatology, )

A 6 year old child came with a h/o 1 year R knee monoarthritis. Had shown many Orthopedic surgeons & Paediatricians. Progressively developed R knee fixed flexion deformity and required to be carried upstairs to her classroom on the top floor everyday . She restricted fluids and diet to avoid needing to ambulate to the toilets and has early morning stiffness. Juvenile Idiopathic Arthritis can cause considerable deformity if not appropriately treated. After intra articular steroids one can see the improvement within 24 hours itself. DMARDs and physiotherapy are the next step

Advances in sepsis: Lecture summary Dr Abby Cyriac

Dr.Rajeev (Gastroenterology, General Practice / Family Medicine, )

The concept of sepsis has changed considerably over the years. Newer methods of diagnosis and prognostic markers are discussed in this lecture by Dr Abby Cyriac focusing on sepsis especially in the cirrhotic patient. Click on images for highlights. This is part of Cochin IMA’s lecture summary series that will help other doctors enjoy the content of CME programs.

UNUSUAL CAUSE FOR PERIANAL PAIN

Dr.Seenaj (Medicine, )

49 years old lady known case of Idiopathic Thrombocytic purpura on regular follow up complained about vague pain and discomfort in the perianal area associated with constipation for the last 3 days. She also said about the feeling of something being present inside the anal region. Even though the examination was normal she was taken up for a lower GI scopy and a foreign body was removed. There was absolutely no history of trauma

Conference Summary: National Pulmonology conference NAPCON

Dr.Rajeev (Gastroenterology, General Practice / Family Medicine, )

As part of Cochin IMA’s academic initiative, the summary of medical conferences will be published on JCP-IMA. As the abstract exceeds 600 characters, it is being published as an image. This abstract is from NAPCON 2019, the recently concluded National Pulmonology Conference Cochin. Click on images to view the summary.

Cold case in hot environment

Dr.Akash (Medicine, )

Soldier posted in Srinagar came with B/L LL edema of 2 days and numbness itching pain redness. H/o trekking in snow with boots and socks drenched in cold water.O/E there was local swelling warmth tenderness decreased touch pain temperature with normal pulses.Labs revealed elevated CRP AST>ALT, CK. He was started on IV antibiotics, IV fluids, NSAIDS .TT was given.He showed improvement in clinical and lab parameters. With the history labs Trench foot was considered .It is caused by prolonged exposure to wet cold but non freezing condition (0-15C). It is a clinical diagnosis

Paraneoplastic syndromes-a diagnostic dilemma

Dr.Shyamala (Medicine, )

71 year old Male, a reformed smoker since 10 years,presented with repeated admissions for symptomatic hyponatremia to different centers. He had been investigated for common causes including endocrine conditions. At admission,Na +was 104.During examination, patient was noted to have clubbing. Chest xray was not helpful.but a CT thorax revealed the hidden culprit-a malignant lesion in the left lung.The case has been handed over to the oncologist