IMA Journal – December 2021

Message from Team IMA Chennai Kauvery Alwarpet Branch

Dear colleagues

Greetings and best wishes from Chennai Kauvery.

 At this outset, I congratulate the organisers of CIMCON- TIMACON 21 for the great show and the Academic Feast.

 I sincerely thank the State Office Bearers for recognising and awarding our branch with 6 awards.

 On behalf of our branch I wish to congratulate the State President Dr Palanichamy, State Secretary Dr NRTR Thiagarajan and State Finance Secretary Dr Alagu Venkatesh, a very successful tenure.

Long live IMA

Yours in IMA service,
Dr S Sivaram Kannan

Dear friends

Happy to release our IMA journal for this month.

Kauvery hospital has once again won awards for Exemplary IMA activities. My congratulations to everyone.

My best wishes to you and family for Merry Christmas and a Happy New Year.

Let us hope for a world with less threat from COVID and Pollution.

Long live IMA.

Yours in IMA service,
Dr. Bhuvaneshwari Rajendran

Dear friends

Happy to you all once again.

Glad to share that Kauvery IMA bagged multiple awards this year too. Joint runners for the BEST IMA BRANCH, Joint runners for the Branch President, Dr. S Sivaram Kannan, Joint Runners up for BEST BRANCH SECRETARTY Dr. Bhuvaneshwari,  State Appreciation for Exemplary Performance for our COVID Activities,  State President Award for Exemplary Social Activities to Dr. S Sivaram Kannan.

Glad to inform that our IMA journal has been awarded for the exemplary performance for our journal.

This is made possible by all our Consultants, Post Graduates and our Editorial Team.

My sincere thanks to everyone. And my heartiest congratulations to all the IMA award winners.

Best wishes to you and family for a Merry Christmas and for a very Happy New Year.

With regards
Dr. R. Balasubramaniyam

Anaesthetic Management in a case of Ludwig’s Angina


Ludwig’s angina is a rare but potentially fatal condition mainly involving the submandibular & retropharyngeal spaces, characterized by a rapidly progressive inflammation & cellulitis of the soft tissues of the neck and floor of the mouth. The term “Ludwig’s angina” is a misnomer, as it is not related to angina pectoris or heart disease. It was first described by Wilhelm Fredrich von Ludwig, a German physician in 1836. The most life-threatening complication of Ludwig’s angina is airway obstruction. Prior to the development of antibiotics, mortality for Ludwig’s angina exceeded 50%. As a result of antibiotic therapy, along with improved imaging modalities and surgical techniques, mortality currently averages less than 10%.

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Troponin Rise in Sepsis - When to Consider Coronary Angiography

Troponins are cardiac regulatory proteins that mediate the interaction between actin and myosin. Cardiac troponin I and T are sensitive and specific biomarkers of myocardial injury. There are various etiologies for elevated troponin values such as renal disease, acute pulmonary embolism, sepsis, heart failure, myocarditis, aortic dissection, cardiac contusion, cardiotoxic chemotherapy and strenuous exercise. Increase in troponin levels does not always equate to myocardial infarction.


There are studies, which shows that in patients who were diagnosed to have sepsis and elevated troponin, coronary artery disease was ruled out indicating other possible mechanisms for the rise of the biomarker.
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Esophageal Hematoma

A woman, aged about 70 years came to the ER with a history of haematemesis and vomiting after eating sweets. Severe pain in the neck and throat, specifically on swallowing, was also present. The blood reports were normal and a CT neck scan showed no sign of the presence of any foreign body. She was admitted for further investigation and diagnosis with the possibility of a foreign body not being ruled out.

A 70-degree rigid endoscope was used to perform a video laryngoscopy under local anaesthesia. A smooth hemorrhagic lesion was observed in the post-cricoid region. Congested and edematous arytenoids were seen to be greater on the left side than on the right.

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Pneumoperitoneum in PEG Placement. Does It Have Any Clinical Significance?

PEG has become a method of choice for providing enteral access and nutritional support to patients who are unable to take oral feedings. Various complications have been known to occur after PEG placement including skin site infection acute hemorrhage, aspiration and perforation. Air that is insufflated at the time of PEG procedure by endoscopy and air that enters the peritoneal cavity through a puncture site on the gastric can also develop into Pneumoperitoneum.


A 51 years gentleman came here with complaints of high grade intermittentfever x 1 day.

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An interesting case of thunder clap headache following blood transfusion

Thunderclap headache (TCH) is defined as a high-intensity headache with an abrupt onset, reaching its peak intensity within less than one minute and lasting for more than five minutes. This type of headache is usually indicative of serious underlying causes and is rarely a primary disorder. Here we are reporting an interesting cause of thunderclap headache in an adolescent girlwho received blood transfusion

Case report
A 14 year old girl was admitted to our emergency department with complaints of headache over the past two days which became unbearable for the last two hours prior to admission.

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Severe Anaemia in a Dialysis Patient

Mr.S, 54 yrs old gentleman, is on regular dialysis for his chronic renal failure due to Diabetic nephropathy. He was known to have Ischemic heart disease and underwent single vessel angioplasty, few months before. He was on dual anti platelet therapy post angioplasty.His chronic renal failure was managed by thrice weekly dialysis, dietary support, erythropoietin thrice weekly for his anaemia, calcium supplementation, and sugars were controlled with insulin.

He maintained haemoglobin at 10 grams and there was gradual drop in his haemoglobin. He complained of epigastric pain but there was no hemetemesis or malena.

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