IMA Journal – December 2022

Message from Team IMA Chennai Kauvery Alwarpet Branch

Dear colleagues

Greetings and best wishes from IMA Kauvery Alwarpet branch.

This month the platter of articles are contributed by our postgraduates in the Department of Internal Medicine, Orthopedic, Nephrology, Emergency Medicine, Anesthesiology and Cardiology.

Kauvery has evolved with post graduates training in DNB, DrNB and MRCEM.

Our best wishes to the all the postgraduates.

We take pride in Teaching, Training, Learning and Sharing Knowledge.

Long live IMA

Yours in IMA service,
Dr S Sivaram Kannan

Training period is the time for learning skills not just clinical but also developing interest in research and analytics.

It is also about sharing knowledge with others.

This issue carries articles from Post Graduate trainees in various specialties.

Let us encourage them to become great doctors and scientific researchers.

Long live IMA.

Yours in IMA service,
Dr. Bhuvaneshwari Rajendran

Dear friends

Happy to release this month IMA journal that was contributed by the post graduates from various departments.

The National Board has recognised various speciality and super speciality departments in our hospital. I am thankful to all the consultants and the post graduate students for sharing their work.

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

Thanks to the editorial team and the branding department.

With regards
Dr. R. Balasubramaniyam

Myelodysplastic Syndrome

A 70 year old male (Mr. G) presented to ER with complaints of giddiness for 3 days, shortness of breath(grade 2 to 3) for 3 days, fever with chills for 1 day, weight loss of 2 to 3 kgs in 6 months, lower back pain for 6 months, right eye swelling with pus discharge. Patient was evaluated at an hospital elsewhere and found to have low haemoglobin (4.3 g%) and WBC(2000/ Patient came to our Hospital for further management. Patient was a known case of benign prostatic hyperplasia, left inguinoscrotal hernia with bowel and omentum as content. He did not have any known drug allergy. Patient had a history of consumption of native medication for various illnesses in the past. He was vaccinated with 2 doses of covishield.

On arrival at ER, he was febrile (100.4 F), pale. BP-120/70 mmHg, pulse rate-111/min, respiratory rate- 22/min, SpO2- 99% in room air, CBG-226 mg/dl.

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Post Renal Transplant Patient with Headache and Giddiness


24 yrs old male, resident of Chennai who underwent live related renal transplant three years before for his End Stage Renal disease due to presumed chronic glomerulonephritis. His renal donor was his mother and was on regular follow up. His immune suppression consists of tacrolimus, mycophenolate and prednisolone. He was on regular follow up and his renal functions remained normal. He started complaining of on and off headaches and giddiness. He is a non-smoker.

He was euvolemic with well controlled blood pressure. The only abnormal finding on examination was injected conjunctiva.

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A Case Report of Pediatric Spinal Intramedullary Lipoma and its Anaesthetic Management


Spinal intradural lipomas are rare lesions constituting <1% of all intramedullary spinal cord tumors. Most of the spinal cord lipoma are associated with spinal dysraphism and are usually located in the lumbosacral region.


A 9month old female child (Wt-9kg) presented with history of developmental delay. Baby is a first-born child of non-consanguineous full term normal vaginal delivery. Post natal period was uneventful.

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Hemophagocytic Lymphohistiocytosis


Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation. It most frequently affects infants from birth to 18 months of age, but the disease is also observed in children and adults of all ages. HLH can be classified into primary and secondary HLH. The highest incidence in those <3 months. The male-to-female ratio is close to 1:1. In adults, there may be a slight
male predisposition.

Case report

19 years female, with no comorbids and no known drug allergy, presented to ER from outside hospital with…

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Dr Mirunaalini Thangavelan

Management of a case of fracture of bilateral shaft of femur with right-sided posterior hip dislocation and sciatic nerve palsy


Posterior dislocation of the hip with fracture of the ipsilateral shaft of femur occurs very rarely. Ipsilateral fractures and dislocation occur due to high-energy trauma, and reduction of hip dislocation is considered an orthopaedic emergency. Frequent concerns regarding this injury include delayed diagnosis and treatment of the hip dislocation, difficulty in reduction of the hip dislocation, avascular necrosis of the head of femur and sciatic nerve palsy. Early closed reduction of the hip joint is difficult because the long lever of the femoral shaft is affected due to loss of continuity and classical methods of reduction cannot be used. The nuances of hip joint reduction in case of associated ipsilateral fracture, and the need for emergent intervention is emphasized in this case report.

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Holt Oram Syndrome: A Case Report


Holt-Oram syndrome (HOS) also known as Hand- Heart syndrome is a very rare autosomal dominant disease caused by a mutation in the TBX5 gene located on chromosome 12. Clinically it manifests with morphological abnormalities of the upper limbs and congenital cardiac defects leading to variety of complications. Cardiac malformations go undiagnosed till late in life. With routine antenatal checkup, external physical deformities can be found out with high suspicion of congenital heart malformations as well, which can lead to early effective management. We here by describe a case of 20 year-old female with known morphological alterations of the upper limbs since birth presented with Right heart failure diagnosed to have atrial septal defect.

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