IMA Journal – October 2021

Message from Team IMA Chennai Kauvery Alwarpet Branch

Dear colleagues

Greetings and best wishes from IMA Chennai Kauvery Branch.

On behalf of our branch I wish to Congratulate Dr. NRTR Thiagarajan, Dr. Senthamil Pari and Dr. Abul Hassan and other newly elected state office bearers.

I wish them all a successful tenure and assure our fullest cooperation.

Long live IMA

Yours in IMA service,
Dr S Sivaram Kannan

It is Navarathri Festive time.

It is also time to honour our work and education.

We have another IMA journal issue filled with pearls of wisdom.

Long live IMA.

Yours in IMA service,
Dr. Bhuvaneshwari Rajendran

Dear friends

It is my pleasure to meet you all once again through our IMA journal.

Thanks to our Editorial team for their active participation in getting the scientific articles at high standards.

Our wish is to make our journal a truly academic one that conforms the standards of any other indexed journal.

We look forward to your suggestions.

Long live IMA.

With regards
Dr. R. Balasubramaniyam

Cerebral Malaria – Is It Always Falciparum?

What Is Malaria?

Malaria is a life threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In the early stages, the symptoms of malaria may be similar to other bacterial or viral illnesses.

In rare cases, malaria can impair the functioning of all the vital organs of the body, leading to multi-organ failure. Severe falciparum malaria is defined as the involvement of one or more organs (impaired consciousness, convulsions, renal impairment, jaundice, pulmonary edema, significant bleeding, shock) along with falciparum parasitemia >10 %. Severe vivax malaria is similar to falciparum, but there are no parasite density thresholds. Severe knowlesi malaria is also similar to falciparum but the parasite density is 1%.
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Is Thrombocytopenia The Important Marker???


Dengue is an infectious disease caused by the Arbo virus of the flaviviridae type spread by the Aedes mosquito. The clinical features of dengue range from acute undifferentiated fever in a mild form, classically known as dengue fever, to the severe clinical and potentially fatal Dengue hemorrhagic fever/ Dengue shock syndrome. Thrombocytopenia is a major and common finding seen in both mild and severe cases and it is significantly proportionate with of severity of dengue progression. Severe illness is characterized by hemodynamic changes, increased vascular permeability, hypovolemia and shock. Thrombocytopenia and platelet dysfunction are commonly seen in dengue and are related to the outcome. Different mechanisms have been hypothesized to explain DENV-associated thrombocytopenia, includes bone marrow suppression and peripheral platelets destruction.
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Arrhythmia induced Cardiomyopathy (AiCM)

Traditionally, any persistent or frequent episodic tachycardia are known to cause and/or worsen left ventricular (LV) dysfunction and heart failure, which is influenced mainly by the burden, i.e., rate and duration of tachycardia, besides the tachycardia type. Now, there is increased clinical awareness in considering atrial fibrillation (AF) with adequate rate control and premature ventricular contractions (PVCs) as a unique cause of reversible non-ischemic cardiomyopathy.

A more inclusive term of arrhythmia induced cardiomyopathy was suggested to comprise all the three clinical entities-tachycardia-induced cardiomyopathy (T-CM), AF-CM and PVC-CM.1

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Delirium in Older Adults

Scenario 1
An 80-year-old woman has been admitted to your ward after an episode of a fall. She seems to be loudly talking to herself, but it is incomprehensible. She has an anxious demeanour and repeatedly pulls at her bedclothes. She argues with the nursing staff and has angrily refused to have a blood sample taken.
Scenario 2
A 74-year-old gentleman is recovering from a heart attack and wants to rest in the bed. He is polite and sleepy, and he is not interested in eating or drinking. Sometimes his speech is incoherent and he doesn’t seem to follow what is said to him.
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Hypothermia - A Major Patient Concern


Hypothermia is a commonly encountered issue when patients undergo surgery and frequently associated with patient discomfort and shivering. Decrease in temperature can result in significant detrimental effects. Strategies to reduce heat loss should be one of our patient concerns and care.

Heat loss occurs primarily from the skin of a patient to the environment through several processes, including radiation, conduction and convection, and evaporation. Heat from core body tissues is transported in blood to subcutaneous vessels, where heat is lost to the environment through radiation.

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