Content validity of a Fetal Radiology Assessment and Diagnostic Score-India (FetRADS- India) for early identification of at-risk pregnant women

Dr.Praveen (Public Health, )

Non-invasive radiology imaging techniques can be used to identify pregnant women at risk for adverse fetal and maternal events. The FetRADS-India categories have been developed, using content validation, for the risk stratification of pregnancy to help initiate appropriate early management for high risk pregnant women including referral to advanced care or tertiary care units.  The FetRADS-India score has six levels with increasing scores for higher risk of adverse fetal events and subset scores based on fetal structure, growth and environment. Read at: http://bit.ly/FetRADS-India

Advanced carcinoma of male breast

Dr.Kanakambaran (General Surgery, )

Case of advanced carcinoma of male breast. He is from most literate region of Kerala, not from remote highrange Village where health care facilities were not adequately available in the 1990s.

Fistulated Colonic carcinoma

Dr.Kanakambaran (General Surgery, )

A 65 year old man with bowel symptoms underwent Ba Enema. Colonoscopy was not available in our hospital during that time. Ba Enema examination revealed a growth in the transverse colon fistulating into tye stomach, contrast was clearly visible in his stomach. He was treated surgically followed by post operative chemo therapy.

A cough syncope which could have been prevented?

Dr.Sheetal (General Practice / Family Medicine, )

59 yrs old, male pt, k/ c of HT, CAD,occasional smoker had 2 episodes of cough syncope resulting in a black eye,lacerated wound over forehead n haemartrosis knee. H/o dry hacky cough since few mths which persisted despite t/t. O/e no chest signs.xray -increased BVM.lab-mild leucocytosis,ESR 28.Holter monitoring N.He was treated with antibiotics, bronchodilators n antitussives. Drug history revealed ACE inhibitors which was stopped. He responded to t/t with no recurrence of syncope. On follow up he was free from cough. The incidence of ACE-I induced cough is reported to be 5-35%. ( Lit rev.)

Opioids in ICU settings

Dr.Narayanan (Pain, )

Those under opioids for chronic pain management on shift to ICU for medical or surgical causes have lesser need for opioids Some do well even after stoping them but once back to room they develop pain and need older dose Strange observation in many cases Does other issues divert the brain from pain

Mysterious presentation of tuberculosis

Dr.Anupama (Oncology, Gynaecological, )

A 24 yr old unmarried lady came with lower abdominal pain no systemic symptoms. Post right salpingooophorectomy for endometriosis 4 years ago. She had an 8cm complex left adnexal mass, elevated CA 125 (148). MRI showed an enhancing mass with papilary projections and complex septaions suggestive of malignancy. Laparoscopy showed a 10 cm pelvic mass with adhesions and greenish necrotic discharge. Adhesiolysis and cystectomy was done. The geneXpert was positive for tuberculosis. Biopsy: fibrinoid necrosis with lymphoplasmocytic infiltration. After ATT, her abdominal pain decreased.

Fever, rash and renal failure

Dr.Anup (Infectious Disease, )

59 yr old man with no co-morbid illness. Travel to Wayanad; followed by fever - day 9 at presentation. Initiated on Piptaz by primary care doctor. Persistent fever, progressive renal failure and then maculo-papular truncal rash. Stopped Piptaz, started on Doxycycline with full recovery. Scrub IgM +

Bilateral Pneumonia - R/O Heart Disease

Dr.Madhu (Cardiology, )

A 40 year old gentleman was being treated for bilateral pneumonia. As he had ongoing symptoms, he was sent for an echocardiogram which revealed Severe Calcific Mitral Stenosis. Patients being treated for “Bilateral Pneumonia “ often have underlying heart disease - ACS / Valvular Heart Disease / Myocarditis etc. An echocardiogram is mandatory prior to discharge of such patients - else the diagnosis would be missed.