IMA Journal – June 2022

Message from Team IMA Chennai Kauvery Alwarpet Branch

Dear colleagues

Greeting from IMA Chennai Kauvery.

It is indeed very prestigious and heart-warming to see Kauvery Hospitals as a centre of academic excellence.

Kauvery hospital offers postgraduate DNB and DrNB courses in broad specialties and super specialties.

This edition is a contribution from our postgraduates exhibiting a platter of interesting case discussions.
My best wishes to them.

Yours in IMA service,
Dr S Sivaram Kannan


This issue carries articles penned by many of our post-graduates doing their specialty and super-specialty training.

Kauvery hospital provides a perfect nurturing ground for these doctors, trained by experts in their respective fields.

This issue showcases their experience.

Enjoy reading!

Long live IMA.

Dr. Bhuvaneshwari Rajendran

Dear friends

Happy to release this edition of our IMA JOURNAL.

Kauvery hospital, Chennai has become a post graduate teaching institute in multiple specialties.

This edition has contributions from post graduates of every department. Thanks to all the post graduate students and their mentors.

Kindly go through the articles and give your feedback and suggestions

Thanks to Editorial team and Branding.

Long live IMA.

With regards
Dr R Balasubramaniyam

IgA Dominant Post-Infectious Glomerulonephritis - Case Report

A 69-year-old male patient who is a known diabetic for past 25 years and hypertensive for past 8 years, had h/o upper respiratory tract infection following which he developed decreased urine output for 5 days, pedal oedema and facial puffiness for 3 days and sudden onset breathlessness for which he got admitted in nearby hospital and treated as acute pulmonary oedema. 2D Echo showed normal LV function with EF-65%. CT abdomen showed normal size kidneys, bilateral perinephric fat stranding with no hydroureteronephrosis and mild prostatomegaly. Renal function worsened from creatinine of 1.9 to 4.4 in 2 days and patient became oliguric. Hence patient was referred to nephrologist. He was admitted in ICU, with Hb-8.8gm, urea-79mg, creatinine-4.6gm, Urine spot PCR-1.39. Serology was negative. CPK, CPK-MB were not high. In view of rapidly progressive renal failure and oliguria, he was initiated on Haemodialysis.

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Anaesthetic Technique During Awake Craniotomy - A Case Report

A 50 years old female was admitted with complaints of right sided weakness in the right upper and lower limb associated with occasional headaches. There was no history of vomiting and seizures. The patient was diagnosed with carcinoma in the right breast S/P BCS and underwent oncoplastic reconstruction in December 2021. There was a history of drug-induced toxicity EF of 48% along with a known case of DM, hypertension and bronchial asthma. An MRI was done and it showed a tumour in the left frontal lobe measuring 2.2*2.2 cm. As the lesion was close to the eloquent area, we performed awake craniotomy to allow monitoring of motor and language functions during the resection of the tumour.


The patient (weight- 65.1 kg, height 145cm) was in good general condition with PR- 68/min, BP- 130/80 mm…

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Accelerated Bilateral Hip Arthritis - Post Covid Sequelae or Consequence Of High Dose Corticosteroid?


Avascular necrosis of the femoral head as post covid sequelae has been reported in recent studies, however with unclear etiology. In the past, we have seen AVN of femoral head in patients with-severe acute respiratory syndrome (SARS)similarly in post covid sequelae patients are presenting with AVN. Covid 19 is known to cause multiorgan involvement, which may lead to inflammatory arthritis by triggering autoimmune reactions. A high dose of Steroid intake is one of the major risk factors of AVN. AVN due to high dose corticosteroid usually occurs in a time interval of six months to one year, whereas in post covid sequelae AVN occurs ata shorter interval from the onset of disease.

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Difficult Airway Scenario in Minimally Invasive Cardiac Surgery


Minimally Invasive Cardiac Surgery (MICS) usually requires lung isolation for proper exposure of the surgical field. Isolation of the lungs is particularly applicable in patients undergoing cardiac, esophageal and other thoracic surgeries. Traditionally the usage of Double Lumen Tube (DLT) is considered the gold standard for lung isolation. But with the increasing complexities of surgeries in geriatric, fragile patients and with difficult airway anatomy, bronchial blockers have been found to be useful.


A 74-year-old male patient was admitted with complaints of chest discomfort 1 month ago.

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Carotid Endarterectomy - Surgery for Stroke Prevention


Stroke is the third leading cause of death in the western world. Only 50-60 % of stroke survivors regain complete functional independence. The rest have varying degrees of disability. Hence it is very important to recognise the risk factors and prevent the stroke.
20% of strokes are haemorrhagic and 80% are ischemic. Causes of ischemic stroke are small vessel embolus originating from atherosclerotic plaque, cardiac source, prothrombotic conditions and other miscellaneous conditions. Carotid artery stenosis is one of the most common and correctible cause for ischemic stroke.

Case report

A 79-year-old hypertensive male with a past history of smoking presented with sudden onset right sided…

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