Greetings to dear esteemed IMA members!
The IMA Kauvery journal perpetuates a culture of academic excellence, fuelling our ongoing quest for medical knowledge and proficiency.
Your active participation in IMA endeavours is pivotal to our collective success.
May the forthcoming month unfold opportunities for professional growth and fulfilment.
Yours in IMA service, Dr S Sivaram Kannan President
Dear IMA members,
Greetings from Kauvery IMA.
IMA journals are helpful and are a valuable resource of knowledge for staying updated on medical knowledge and real-life cases.
Connecting with fellow doctors through these journals can be super enriching.
Here’s wishing you a fantastic month ahead too!
Yours in IMA service, Dr. Bhuvaneshwari Rajendran Secretary
Dear friends,
Happy to share the next edition of our IMA JOURNAL.
Every article illustrates the level of highly skilled patient care that spreads across various departments in our hospital.
Thanks to all contributing authors and to the editorial / branding team
Your feedback and suggestions are welcome.
Long live IMA.
With regards Dr. R. Balasubramaniyam Editor
Abstract
Post-extubation stridor is a well-recognized complication following endotracheal intubation and is most commonly attributed to laryngeal edema, vocal cord dysfunction, or subglottic stenosis. However, delayed onset stridor occurring several days after extubation is unusual and warrants evaluation for less common etiologies. Tracheal mucosal flap formation is a rare but important cause of delayed post-extubation airway obstruction. We describe a case of a 70-year-old male who developed inspiratory stridor three days after extubation, in whom video laryngoscopy revealed a tracheal mucosal flap. The patient was managed conservatively with systemic corticosteroids, nebulized therapy and positive pressure ventilation resulting in complete resolution on repeat endoscopy. This article reviews the pathophysiology, clinical presentation, diagnostic approach, and management of tracheal mucosal flap as a delayed cause of post-extubation stridor.
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Summary
A 41-year-old woman presented with progressive generalized edema and nephrotic-range proteinuria with preserved renal function. Evaluation revealed hypoalbuminaemia, dyslipidaemia, and elevated inflammatory markers. Renal biopsy showed membranous nephropathy. Detailed history revealed prolonged intake of an Ayurvedic medication for psoriasis. Heavy metal analysis showed elevated blood lead levels. After exclusion of autoimmune, infectious, and other secondary causes, a diagnosis of lead-induced secondary membranous nephropathy was made. The patient was managed with withdrawal of exposure and supportive therapy, with emphasis on RAAS blockade and edema control. This case highlights chronic lead toxicity as an uncommon but important cause of secondary membranous nephropathy.
Case summary:
A 22-year-old male with the end stage kidney disease secondary to Nephronophthisis, underwent a live related renal transplantation on 10/12/2025, with his aunt as the donor.
He received antithymocyte globulin (ATG) induction therapy followed by standard triple immunosuppression (Calcineurin inhibitor, antiproliferative agent and corticosteroids). The immediate postoperative period was uneventful, with prompt graft function and satisfactory urine output, suggestive of good early graft perfusion.
Renal disease presents a unique diagnostic challenge. Clinical manifestations such as proteinuria, hematuria, hypertension, or progressive renal insufficiency reflect functional disturbance but do not define the underlying structural pathology. Unlike many other organ systems, the kidney responds to diverse injuries with a limited repertoire of morphological patterns. The renal biopsy remains the gold standard for diagnosing medical renal diseases. A small core of renal cortex, when systematically processed and interpreted, provides detailed structural, immunologic, and prognostic information that directly influences therapeutic decisions.
Abstract:
Abdominal migraine is a functional gastrointestinal disorder predominantly seen in children, characterized by recurrent episodes of moderate to severe abdominal pain associated with migrainous features. Owing to its episodic nature and absence of definitive diagnostic tests, it is often underdiagnosed or misdiagnosed as recurrent abdominal pain.
