Dr.Rajeev

Name: Dr.Rajeev Jayadevan

Hospital: Sunrise Hospital Cochin Kerala

Specialties: Gastroenterology, General Practice / Family Medicine

Cases

Advances in sepsis: Lecture summary Dr Abby Cyriac

Dr.Rajeev

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.

Conference Summary: National Pulmonology conference NAPCON

Dr.Rajeev

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.

Preventive measures for Ca Cervix: summary of CME 13.12.19

Dr.Rajeev

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 CA Cervix prevention CME by Amrita Medical College on 13.12.19. A version for the general public also is published on IMAlive. Click on images to view the summary.

Painful swallowing in a woman with acne

Dr.Rajeev

A 27 year-old woman with acne came with painful swallowing of ten days duration, not responding to Ranitidine prescribed by her GP. The pain was located in the mid chest. She denied medication intake. Upper GI endoscopy revealed a tiny 3 mm ulcer in the mid Esophagus. It was difficult to detect, and required careful examination. On later questioning the patient recalled taking Doxycycline recently for acne after consulting a dermatologist.

Uro-Oncology: Abstract of CME at IMA Cochin by Dr Ginil Kumar

Dr.Rajeev

As part of Cochin IMA’s academic initiative, the summary of CME programs will be published on JCP-IMA. As the abstract exceeds 600 characters, it is being published as an image. This abstract is from Cochin IMA monthly CME: Uro- Oncology by Dr Ginil Kumar from 27.11.19

CME Summary: Gynae Oncology Dr Anupama Rajanbabu

Dr.Rajeev

As part of Cochin IMA’s academic initiative, the summary of CME programs will be published on JCP-IMA. As the abstract exceeds 600 characters, it is being published as an image. This abstract is from Cochin IMA monthly CME: Gynae Oncology by Dr Anupama Rajanbabu from 27.11.19

Skin clues for diagnosis of abdominal pain

Dr.Rajeev

A 36 year old man came to Gastroenterology outpatient clinic today with three year history of upper abdominal pain, having sought multiple opinions and investigations. The pain was quite severe, intermittent, band-like and disabling. Examination revealed a few healed scars along the costal margin. On asking, he revealed a history of chicken pox in childhood, and a bout of herpes zoster 3 years ago. No tests were ordered today. He was started on Pregabalin for post herpetic neuralgia.

Conference summary series: Liver transplant updates 2019

Dr.Rajeev

Several high-quality academic conferences are being held. However, the benefits are largely restricted to those who attend. The general public and other doctors rarely receive the scientific updates presented at the conference. To rectify this knowledge gap, IMA Cochin has taken the initiative to obtain a plain English summary for each academic conference. This will be circulated among doctors. See attached images.

Reducing the number of medications leads to patient satisfaction

Dr.Rajeev

A 70 year old man who was on long-term repeat prescription of Fexofenadine (Allegra) for nasal allergy was seen at medical OP clinic by Dr M. The treatment line he followed was to alleviate symptoms, and reduce the medication burden. The patient was counselled to do steam inhalations regularly, and to use Pheniramine (Avil) only on PRN basis. The patient, although sceptical at first, was able to soon discontinue his long-term medications, and wrote to the chairman of the institute praising the doctor’s approach. The patient remarked that doctors seldom try to reduce the number of medications.

Recurrence of ulcerative colitis after patient stopped medications

Dr.Rajeev

A 46-year-old man with ulcerative colitis of 10 year duration came in for surveillance colonoscopy. He had discontinued medication mesalamine and azathioprine on his own, for no apparent reason for the past six months. Even though he had no symptoms now, his surveillance colonoscopy revealed active left-sided colitis with rectal sparing. Right colon was normal (see photos) His previous colonoscopy a year ago had been normal. He was restarted on medications, and counselled again about compliance with treatment.

A tale of two ulcers

Dr.Rajeev

Two patients, 38F and 48 M, were seen within the past two weeks and diagnosed with gastric and duodenal ulcers respectively. Both of them gave a history of pain occurring around 2-3 AM. Epigastric pain is a common problem, and ulcer is a frequently suspected diagnosis. However, most patients with epigastric pain do not have ulcer. It is therefore important to know the types of pain that indicate the presence of an underlying ulcer. None of the patients with daytime epigastric pain seen in the past month had ulcer on endoscopy. However, both the patients with 2-3 AM pain had ulcer.

Heart failure precipitated by unaccustomed exertion in an elderly male

Dr.Rajeev

An 82-year-old man presented it to gastroenterology OP clinic with bloating and hiccups following a physically strenuous trip to a place of worship the day prior. He had no coronary risk factors. Sinus tachycardia of 100 with ectopic beats, and a systolic murmur were found. He was suspected to have ischaemic heart disease and referred to cardiology immediately. He was diagnosed with acute coronary syndrome, NSTEMI with acute left heart failure. Troponin-I was elevated at 200.4. He was treated with diuretics, heparin and antiplatelet treatment, on which he improved rapidly.

Hypothyroidism as a cause of recurrent Vomiting

Dr.Rajeev

A 28 year old woman presented with recurrent vomiting of several years duration. There were no other gastrointestinal symptoms. She had no neurological symptoms. There were no allergies. Her blood tests showed a TSH of 75 and a low T4 of 2.98. She was started on Thyroxine.

Botox causes fecal incontinence

Dr.Rajeev

A 39 year old woman, a resident of Canada presented recently in India with fecal and flatus incontinence after she was given Botox 20 U x 2 doses in 1 year ago in Canada. It was done for an anal fissure. She had apparently had a normal colonoscopy prior. There are no signs of spontaneous improvement yet. This complication has affected her ability to work and overall quality of life.

Colon polyp in a 34 year old man

Dr.Rajeev

A 34 year old asymptomatic man underwent screening colonoscopy due to family history of colon cancer. A 10 mm sessile polyp was found and removed. Biopsy is pending.