Earnest hands tied by pessimism

Dr.Ravi (Paediatric, )

Twin preterm babies of 25 weeks gestational age weighing 680 gram and 740 grams, born out of unplanned pregnancy, were admitted in our NICU. Though they cried at birth, they developed Respiratory distress warranting intensive care. But parents declined any active intervention despite multiple counselling by doctors. While we recall managing many high risk premies earlier, survival of these babies is at geopardy as ethical neonatal care was denied by unrelenting parents. In this weird situation, what’s the best option for responsible Neonatologist keen to save these innocent babies ?

Earnest hands tied by pessimism

Dr.Ravi (Paediatric, )

Twin preterm babies of 25 weeks gestational age weighing 680 gram and 740 grams, born out of unplanned pregnancy, were admitted in our NICU. Though they cried at birth, they developed Respiratory distress warranting intensive care. But parents declined any active intervention despite multiple counselling by doctors. While we recall managing many high risk premies earlier, survival of these babies is at geopardy as ethical neonatal care was denied by unrelenting parents. In this weird situation, what’s the best option for responsible Neonatologist keen to save these innocent babies ?

CME summary Endocrinology Cochin IMA

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

As part of IMA Kochi's academic initiative, a summary of the monthly CME of Cochin IMA conducted at IMA House, Kochi on 29/01/2020 is being published. This CME was done by the Central Kerala Endocrine Society and covered 3 endocrine topics of great relevance to every day clinical practice. Chairperson: Dr Mini Pillai. Please click on the image to view the summary.

Summary of Cochin IMA Monthly CME by CENDOS@IMA House, Kochi 29/01/2020

Dr.Mini (Endocrinology, )

As part of IMA Kochi's academic initiative, a summary of the monthly CME of Cochin IMA conducted at IMA House, Kochi on 29/01/2020 is being published. This CME was done by the Central Kerala Endocrine Society and covered 3 endocrine topics of great relevance to every day clinical practice. Please click on the image to view the summary.

A case of referred otalgia

Dr.Sheetal (General Practice / Family Medicine, )

37 yrs old male came with painful ulcer in the left oral cavity with pain in lt ear which progressed to severe burning pain in the left half of face with vesicular eruptions predominantly in the lower half of face, next day.past h/o chicken pox+. Hiv - Bcoz of predominant lt ear pain and 'stunned' feeling in lower part of face, it was suspected to b an evolving zoster oticus. Antivirals &steroids were given.7thN NAD. Audiometry N.With passage of time 5th N involv became clearer with eye involv.After skin lesions had healed,he had debilitating post herpetic neuralgia in the left ear.

Power Spiral enteroscopy -Boon in Obscure GI bleed

Dr.Praveen kumar (Gastroenterology, )

70 yr old Female came with c/o loose stools with melena.No h/o DM/HTN/CAD.She had severe Pallor and her HR 102/min BP-110/70 mm hg .Systemic examination is normal.Investigations showed low hemoglobin of 3.6 g/dl .Prbc transfusion done . USG- No evidence of CLD. OGD showed Hiatus hernia/Grade B esophagitis. No varices and Colonoscopy showed altered blood seen throughout colon and ileum. Pt underwent total enteroscopy using the newly developed Motorised Spiral enteroscopy(Olympus) which showed Angiodysplasia in jejunum and ileum.Through enteroscopy APC of the lesion done.

Transarterial radioembolization

Dr.manish (Radiology, )

TARE is considered as a palliative treatment for large HCC, especially in cases with PV tumour thrombus. After initial evaluation of the lung shunt fraction, the Yttrium90 embedded glass microspheres(beta emitting particles with mean tissue penetration length of 2.5mm -making it effective against PV tumour thrombus) are selectively injected into the feeding artery. This gentleman with bilobar HCC and PV tumour thrombus -BCLC stage C disease was down-staged to BCLC stage A post TARE. Repeat CECT showed complete resolution of the lesions and he can now be reconsidered for Liver transplantation.

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.