Kauverian - Scientific Journals

Editorial

The KAUVERIAN, whether during pandemic or pandemonium, appears on time! I thank the authors and our production team. It shall be with you on or before 01 May 2021! Thought-provoking articles appear in the KAUVERIAN, Vol 1, Issue 6.

Editorial Board

Presenting the team that brings you insights and interesting cases from the world of Kauvery Hospital.

Hypertension - A renal disease ~ Dr. K. Abirami

What’s new in hypertension guidelines starts with the way we record blood pressure. All the new guidelines talk about standardised office BP measurement.
In the title of the inner page on top left it has to be added under : REVIEW

A new cause for confusion or concern ~ Dr Dominic Rodriguez

The year 2020 was unique experience many physicians will enjoy talking about to students and juniors in the years to come. Present scenario differs from the previous year in the way patients present to us having symptoms and signs of familiar but, confounded by presence of acute or past COVID-19 infection.
In the title of the inner page on top left it has to be added under : CASE SERIES

A rare case of acute aortic dissection secondary to a penetrating aortic ulcer in the ascending aorta ~ Dr Aslesha Sheth

A 63 years old lady who is a known hypertensive on ayurvedic treatment, presented to the emergency room (ER) with the history of sudden onset chest pain radiating to back and profound giddiness with three to four episodes of non-projectile, non-bilious, vomiting since that morning associated with profuse sweating.
In the title of the inner page on top left it has to be added under : CASE REPORT

Pacemaker in children – Big shoes to fill for small foot ~ Dr. Joseph Theodore

A 3-year-old barely weighing 13 kg presented with failure of her epicardial pacing system and was implanted a transvenous single chamber successfully taking all due precautions.
In the title of the inner page on top left it has to be added under : CASE REPORT

The Eight Roles of the Medical Teacher – The purpose and functions of a teacher in the healthcare professions ~ Dr. Vasanthi Vidyasagaran

Teaching has always played a central role in medical education, and with the transition to Competency-Based Medical Education, the presented framework may be particularly timely for the Indian context, as it can serve as a basis for newly adapted programs of faculty development and teacher assessment.
In the title of the inner page on top left it has to be added under : BOOK REVIEW

Reducing the stock items – Need to look at the whole picture ~ Mrs Shanthi

Reducing the stock items (medicines and consumables) to save the quality-hours of nurses has been a priority item in the agenda in ward management of hospitals.
In the title of the inner page on top left it has to be added under : MANAGEMENT PAGE

Image Challenge ~ Mr Nagarajan

A 42-years-old lady came with complaints of two weeks’ history of epigastric pain, more since that morning. She also had nausea, and reduced intake of food for the past two months. Pain was relieved by symptomatic treatment from a local hospital
In the title of the inner page on top left it has to be added under : DIAGNOSTIC IMAGE

Mountain behind a mountain

A 33-year-old YX did not expect this ancient French Caribbean proverb to come true in his life. The Proverb said, in pidgin French, that ‘Deye mon gaye mon’. It warned that there could be another mountain on your path, beyond the mountain you just climbed
In the title of the inner page on top left it has to be added under : PATIENT'S STORY

The Disappearing Act ~ Kaanthal Manikandan

Are we as significant as we think ourselves to be?
Am I nothing but a frivolous entity?
When my arms I sway
And patterns I engrave
Does it set off a grain in the milky way?
In the title of the inner page on top left it has to be added under : POEM

Editorial

Honouring the World Purple Day to promote epilepsy awareness, Dr. Prithika Chary writes to us on "Difficult to treat epilepsy syndromes" for the benefit of non-neurologists. Dr. Suresh Chelliah and colleagues gift the journal with an original article, taking over the baton from Dr. Balaji who published Kauvery Research in the last issue. It is our dream that this new found initiative and enthusiasm will blaze forth. Closely on his heels, we have Dr. Ivan Jones, presenting a case series on fungal infections in Covid, a very topical and disturbing complication in Covid. We shall look forward to receiving more such case series.

Editorial Board

Presenting the team that brings you insights and interesting cases from the world of Kauvery Hospital.

Difficult to Treat Epilepsy: A Management Primer for Non-Neurologists ~ Dr. Prithika Chary

Epilepsy is a disorder of recurrent seizures with serious implications especially when seizures are frequent, severe and of long duration.

Such patients have difficult to treat epilepsy and can present a challenge in diagnosis and treatment. More significantly the epilepsy grossly impairs quality of life and has psychosocial implications and carries high morbidity and risk of mortality (SUDEP – Sudden Unexpected Death in Epileptic Persons).

Despite several attempts at various definitions a common ground is not present to decide when a patient fits the criterion of refractory or drug resistant epilepsy, in my practice I choose to have a broader category as difficult to treat epilepsy.

Clinical audit: A Simplified Approach ~ Ms. Surya Prabha

Clinical audit, the cornerstone of clinical governance, ensures that the strategy is executed as planned, and in the process provides a framework to highlight and enable changes to be incorporated ensuring improved patient care. This paper reviews basis of clinical auditing, its methods.

Rationalise and restrict antibiotic use by utilizing a proactive justification form and comparing with earlier antibiotic usage in the same paediatric unit in a tertiary care centre ~ Dr Suresh Chelliah

introduction of justification form, usage of antibiotics decreased by 26.9% (p < 0.001), with increase in de-escalation (p < 0.001) and decrease in duration (p < 0.001).

COVID-19 and fungal infection - an opportune time: a case series ~ Dr. Ivan A. Jones

Four patients recovered and one patient succumbed to infection and thrombotic complication. Meticulous glycemic monitoring, insulin therapy, minimizing antibiotic use and very safe handling of intravenous lines should be practiced to prevent these serious infections.

Thymidine phosphorylase (TYMP) gene stop mutation, G38X, in a familial case of mitochondrial neurogastrointestinal encephalomyopathy ~ Dr. Bhuvaneshwari

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare mitochondrial disease with a spectrum of neurological and gastrointestinal involvement and characterized Mutations in the thymidine phosphorylase (TYMP) gene.

Image Challenge ~ Dr A Nagarajan

A middle-aged man with no other comorbidities came with complaints of progressive exertional breathlessness since morning. He used to do routine walk for 5 km in a day. With the present condition, he could not make even 100 m without dyspnoea. He drove the car from Trichy to Chennai, on previous day to attend a family function, and returned to Trichy on same day after spending few hours in Chennai.

A Covid survival celebration - I could have danced all night ~ Anonymous

Admitted with COVID, at the age of 97, I knew the probability was high that I would leave the ward, feet first. Age was a bad card to hold in hand as I negotiated my way through the hospital, contemplating my odds of survival from the new C. I would learn about many such bad cards during the days that followed. I watched, listened, and sensed the events that happened around me, hoping to acquire an education before time ran out on me.

Forced to be Human ~ Kaanthal Manikandan

Is it right to be plagued by humanly needs? Mere objects which dilute in oblivion with time Wanting to be the dearest of the lot Or to be encircled by loving accomplices

Call Me ~ Prithika Chary

When others forget your name,
When you have no fame,
Call me

Who is There? ~ Dr. Prithika Chary

When things go wrong, and you need to be strong
ME
Who is there?
When your heart fills with fears, and your cheek wets with tears
ME

Editor's Message - Dr Venkita S Suresh

The KAUVERIAN is delighted to bring you three unique and hopefully memorable publications. The first collaboration between a Kauvery author and our "content creation" team appears in this issue as a pilot project. Dr. Balaji Kirushnan’s study on COVID-19 and Dialysis at Kauvery Hospital Chennai received the full support of our content team and is now ready for national or international publication. I have described the process that shall be put into place when authors and KAUVERIAN shall work together on increasingly more complex and sophisticated clinical research projects.

The Editorial Board

Presenting the team that brings you interesting case reports and stories from the world of Kauvery Hospital.

Neurobiology of romantic love - Dr Prithika Chary

Love is an innate emotion hardwired into humans.

It takes many forms – maternal love – the first manifestation of love we experience/romantic love which we feel in our youth and a necessary social need to bond with others of the same species for procreation and propagation of the species to survive and thrive.

An interdisciplinary approach to treatment of juvenile OCD - a case report - Dr Aishwariya Ramesh

Identification and diagnosis of OCD for children can be arduous as they may not be forthcoming with their problem. Using a combination of pharmacotherapy and psychotherapy is insisted over just one treatment method

Fanconi Anaemia - Need to look at the whole picture - Dr. Suresh Chelliah

Fanconi Anemia is a rare inherited disorder, characterized by chromosomal instability, wide clinical presentation and a predisposition to cancers, especially Acute myeloid leukemia.

The Art and Science of Preparation and Publication of Medical Research from Kauvery Hospitals - Dr Venkita S Suresh

During the nine months from April to December 2020, Kauvery Hospitals admitted over 7,000 patients of COVID-19, with moderate, severe, or critical disease, and sent 95% of patients safely home. We also treated well over 100 doctors in the community and sent 98% of them safely home.

Those outcomes owe their genesis to the practice of Evidence-Based Medicine. That evidence now deserves to be published.

Fundamentals of Statistics - T. Dhasaratharaman

Understanding the fundamental of statistics and their definitions.

Image Challenge - Diagnostic Challenges

A 65 years old man presented with complaints of fever, and cough with sputum for the past 2 weeks.

A Wake-up Call from the Anaesthesiologist - Dr Senthil Kumar

Anaesthesiologists play a pivotal role in all surgical procedures and emergency health services (as analogized with the pilot in an aircraft, by the author). The author Dr. Vasanthi Vidhyasagaran is a versatile teacher and mentor to a significant number of Anaesthesiologists for more than three decades. She is also a renowned, highly regarded and efficient anaesthesiologist with vast experience in various aspects of Anaesthesiology.

The Child who never knew play

A 11-year-old girl from Africa came to Kauvery to tell us that she had never played in her life. Long back she and the family were told that she had seizures for which she must take medicines life long and avoid physical activity. When her friends and class mates ran about, chased each other, climbed trees, swam, and played football she sat and watched, drowsy and awkward under the effect of medications. Her mother was unhappy and brought her to Kauvery. Read her story.

The Fallacies of Perfection - Kaanthal Manikandan

The human soul, distant from the horrifying divinity of perfection
Takes upon its troubled mind the deed and tries to drown in retrospection
Retrospection of the conscience, they don’t choose
But retrospection of all illusions of vain

Editor's message - Dr Venkita S Suresh

We are delighted to feature three new authors. Dr. Vinoth brings to you a deeply moving report from Trichy, on a 5-year-old child with Acute Lymphoblastic Leukemia. Kauvery Hospitals is committed to offering our patientpopulation a dynamic haemo-oncology service which shall strive to achieve optimal clinical outcomes.

Preparing your manuscript

Dr. Prabhaharan Renganathan, Technical Editor, Kauvery Hospitals

Everything you need to prepare a detailed manuscript.

Pulmonary valve endocarditis

Dr D Senguttuvan, Dr P Vijay Shekar

We report a case of pulmonary valve endocarditis, who presented with fever and pulmonary regurgitation murmur, and was successfully treated with appropriate antibiotics.

Upper limb replantation at different anatomical levels

Dr Kiran Petkar

The author presents three consecutive cases presenting with such injuries at different anatomical levels that were managed at Kauvery Hospitals during the COVID-19 pandemic. Three cases were operated and in all the cases salvage of the part was possible and good recovery to functionality was seen.

Re-challenging asparaginase after cerebral venous sinus thrombosis in 5-year-old with acute lymphoblastic leukemia

Dr Vinod Gunasekaran, Dr Akila Narasimhan, Dr D Senguttuvan, Dr Suresh Chelliah

A 5-year-old boy developed multiple painful large joint swellings with restricted movements for two weeks, fever for 10 days with bilateral cervical lymphadenopathy. A diagnosis of T-cell acute lymphoblastic leukemia was made and chemotherapy was started. He developed PRES and subsequently thrombosis of left transverse sinus and sigmoid sinus while on induction regimen. He improved with anticoagulation, antiepileptic and anti-hypertensive treatment. Chemotherapy was restarted. During re-induction, he was successfully re-challenged with PEGylated asparaginase along with thromboprophylaxis and plasma transfusions based on serum fibrinogen level monitoring. Re-challenge was tolerated without complications. Child had complete neurological recovery.

Prevalence of vitamin B12, folate deficiency and homocysteine elevation in ASCVD or venous thrombosis

Dr Dominic Rodriguez, Dr Stephy George

Vitamin B12 and folate are essential components for the metabolism of homocysteine. Elevated homocysteine has been associated with increased risk of atherosclerotic cardiovascular disease. The aim of the study is to evaluate the prevalence of vitamin B12, folate deficiency and hyperhomocysteinemia in patients presenting with any atherosclerotic cardiovascular disease or venous thrombosis.

Henoch Schoenlein Purpura

Dr A Nagarajan Dr Pushkala M

Henoch-Schoenlein purpura (HSP) is a self-limited, systemic, non-granulomatous, autoimmune complex, small vessel vasculitis, with multi-organ involvement.

Life turns upside down for a young couple and family

Dr Suresh Venkita

When she rang up her fiancé from another city, and found his speech repetitive and incoherent, and mind confused with regard to time and day, she rushed down. He had been through considerable financial stress but did not have a history of affinity for alcohol or drugs. She also found him emotionally very unstable, with features of hallucination and delusion (false sensory perceptions and false beliefs). His level of consciousness was fast deteriorating and the body was becoming very rigid.

The Humblest Wonder

Feels so close feels so near
Like the most graceful illusion
But science tells me you’re real
Drifting so low in the earthly sky

Editor's Message - Dr Venkita S Suresh

The Kauverian hopes to reach you every fortnight.

The articles come in a new font and format, designed by Dr. Prabhaharan, our technical editor, I hope you would find them attractive.

We lead the issue with two case reports, from Drs. Bhuvaneswari and Pushkala. Case reports will never lose their charm. They briefly and briskly convey a clinical encounter and spark a lesson that emits light for a while. Case series can carry that torch forward. We welcome both case reports and case series. So write away!

The Editorial Board

Presenting the team that brings you interesting case reports and stories from the world of Kauvery Hospital.

Rare and complex type of MS, tumefactive multiple sclerosis

~ Dr Bhuvaneshwari Rajendran, Dr Gayathri Ramkumar

We present a patient with tumefactive multiple sclerosis (TMS) with a typical relapsing and remitting course initially but later exhibited secondary progression.

Decoding a difficult fever

~ Dr Pushkala Mittur Sundararajan

A 13-year-old previously healthy adolescent presented with a prolonged high grade fever, lethargy, pharyngotonsillitis and hepatosplenomegaly. Investigations done were inconclusive. His presentation mimicked a bacterial infection. However, his illness persisted and worsened despite appropriate antibiotic therapy. Finally, a serological test was done which was strongly positive for EBV infection. The antibiotics were stopped and he recovered with symptomatic management without any complications.

Excitement of setting up the first tumor board

~ Dr M Banupriya

The excitement of setting up the first tumor board – multidisciplinary team meeting in oncology at Kauvery hospitals.

'Image Challenge - Diagnostic Imaging

~ Dr A Nagarajan

A 65-years-old gentleman presented with complaints of loss of consciousness and vomiting for the past two days. He was diagnosed to have systemic hypertension, diabetes mellitus, and chronic renal failure on hemodialysis. Non-contrast computed tomography of the brain was done.

Patient's Voice - A bolt from the blue

What felt like a muscle pull, but wasn't so simple!

The unique mind - An anthology of poems

Yet another tear drop cruised down her dimple-less cheek. Her face was too numb for her to feel. The wet glistening tear offering all the comfort it could

Kauverian : The Electronic Medical Journal of Kauvery Hospitals

Editorial Message from Dr. Manivannan, Founder and Managing Director of Kauvery Hospitals; and Dr. Venkita Suresh, Group Medical Director of Kauvery Hospitals and Editor-in-Chief of Kauverian Medical Journal

Vascular COVID Diaries

- Dr Arunagiri Viruthagiri, Dr Nedunchezhian Manjini

A collection of the most critical COVID-related vascular complications.

Autoimmune Encephalitis: A success story

- Dr Akila Narasimhan, Dr PV Nimisha, Dr Suresh Chelliah, Dr Duraisamy Senguttuvan, Dr Sivagurunathan Panchanathan, Dr Bichalu Mythili

Autoimmune encephalitis is being increasingly and frequently diagnosed in children with acute and sub-acute encephalopathy because of advances in imaging and molecular diagnostic tests.

Intracoronary Imaging: A case study

- Dr S. Aravinda Kumar, Dr P. Vijay Shekar, Dr Suraj Narasimhan

Intracoronary imaging modalities (IVUS and OCT) are being increasingly used to aid and attain optimal results during percutaneous interventions/angioplasties. We report three cases where intracoronary imaging was used in preprocedural lesion assessment and aided in optimization of angioplasty results.

A patient's voice

What goes on in a patient's mind, as written by one of our patients

'Cure' by Kaanthal Manikandan

A warrior sent by the true ruler
To quieten the battle cries of the self-proclaimed ones
Taking control and taking lives

Seizure in a new born

- Dr Suresh Chelliah, Dr Senthilkumar Kalyanasundaran, Dr Abinaya Sethupathy, Dr Meganathan Pachamuthu

A 17-days-old growing preterm, admitted for feed assessment following parental concern about nasal regurgitation of feeds, developed recurrent seizures requiring multiple anti-epileptic drugs. After the common causes were ruled out, exome sequencing was done. 22q11 deletion conclusive of DiGeorge syndrome was diagnosed.

SLGT 2 inhibitors in Kidney Disease

- Dr R. Balasubramaniyam, Dr Balaji Kirushnan

It is interesting to note that SGLT2 inhibitors beyond diabetic control has emerged as the major treatment with cardio vascular and renal benefits. Every trial has proven their role in reducing their superiority over placebo in reducing the morbidity and mortality associated with cardio vascular and renal diseases.