Cardiac Failure due to heavy menstruation

Dr.SMITHY (Obstetric, )

48 yr old lady P2L2 both C-section and sterilisation done ,presented with Palpitations and breathlessness to the Cardiology OP. She had no other co-morbidities except BMI 28.Cardiology workup done. ECHO was normal. Hb was 5.4gm.Gynae Reference sent. Detailed menstrual history revealed that, for 1 year ,monthly menstrual blood loss was around 200ml (Normal 50-80ml). So over a period of 1 year she had developed Anaemia due to AUB. (Abnormal uterine bleeding). Scan -showed Bulky uterus with Adenomyosis .Anemia was corrected with Fe Sucrose Injections and Lap. Hysterectomy done

Phantom pain

Dr.Narayanan (Pain, )

Post amputation neuropathic pain ...two cases in VPS Lakeshore hospitals R0 resection sarcoma .other metastatic Opiod helped ..morphine plus adjuvants for neuropathic pain . Lasting effect by Dr Ramachandrans famous mirror therapy in both cases

Ear Pain - symptom of acute myocardial infarction

Dr.Ranjini (ENT, )

43 year old male patient presented in opd with severe (L)ear pain of sudden onset. Examination revealed no local pathology. Patient was anxious and sweating . But had no other pain during presentation. He was referred to physician to rule out MI. ECG was taken and was suggestive of inferior wall infarction. Primary angioplasty with stenting of (R)coronary artery was done. Ear pain comes as a result of auricular branch of vagus supplying the inner portion of external ear.

Easily set Dexmed infusion

Dr.Girijanandan D (Critical Care, anaesthesia, )

Dexmedetomidine is an IV sedative that does not cause respiratory depression. The following is an easy way to titrate the right dose. The infusion rates for the loading dose at 1mcg/kg (in mls/hour) of a 4mcg/ml solution is always 1.5 times the body weight. Similarly the infusion rate for the maintenance dose could be easily begun at 0.4 mcg/kg/hour dosage by calculating the maintenance rate (in mls/hour) by the equation, 1/10th of the body weight. The drug could be titrated from this infusion rate for a particular setting extending from 0.2 to 0.7 mcg/kg/hour.

Thyrotoxicosis presents as periodic paralysis

Dr.Shyma (Neurology, )

38 yr old male presented with weakness of both lower limbs of one day duration. No bladder or bowel symptoms, sensory symptoms. Neurological examination showed lower limb power of three out of five bilaterally and hypotonia of Lower limbs. Reflexes were normal, plantar flexor and no sensory level. MRI spine -normal. Nerve conduction study-Normal. Lab evaluation showed thyrotoxicosis with hypokalemia. Patient improved dramatically with treatment of the cause .

Disregard subtle clinical signs at your peril

Dr.Arun (Endocrinology, )

22 year old graduate, noticed stretch marks over her abdomen few months before presentation but was otherwise totally asymptomatic. Over the next few months, she noticed 2 kg weight gain. BP and blood glucose were normal. She had no Cushingoid features but had hyperpigmentation of knuckles. A dexamethasone suppression test was borderline abnormal. Further tests confirmed mild cortisol excess and a pituitary microadenoma on MRI. Although we initially thought a wait and watch approach is better, she continued to gain weight and was keen to undergo TNTS. Postoperatively she is in remission.

Heart failure precipitated by unaccustomed exertion in an elderly male

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

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.

Look , there is a tick !

Dr.Anuradha (Dermatology, )

A 60 year old man presented with a painful brownish raised skin lesion near the right eye of 5 days duration. On examination there was a tender shiny brownish papule near the medial canthus of right eye(Image 1). On closer examination a 'movement ' of the lesion was appreciated and it was found to be an insect(tick) that was holding on to the skin. It was removed using a fine curved forceps( Image 2). Ticks are blood sucking ectoparasites which may transmit various diseases. It may remain unnoticed on human skin until it becomes painful. This case is being presented to hightlight the importance of careful examination which may point towards the diagnosis.