മാഷ്

9 year old boy first born, out of non- consanguineous marriage ,developmentally normal presented with a history of swelling involving the upper left thigh at 3 years of age. It gradually progressed to involve the left thigh and legs sparing the ankle and foot. Diagnosed as lymphedema and was followed up By 5 years the the swelling in upper part of left thigh reduced but, the swelling in the left leg remained the same. The boy also started developing scoliosis from 6 years of age which was gradually progressing.  He also has pain in lower part of left thigh from 6 years of age and has increased in severity for the past 1 year . Left lower limb pain was felt along the medial side of thigh above knee,episodically which was severe for short duration. He used to have episodes of pain at night waking him up last for minutes and disappear. There was no numbness,tingling sensation. He did nt have difficulty in walking,running. He use chappels without slipping off.He is going t

Before you read this write up please go through this link written about the same topic in May 2018 . Last week i had a talk with one of senior official in communicable disease. I wanted to have the latest data about the polio vaccination status of with Oral polio vaccine (OPV) and Injectable polio vaccine (IPV) both at national level and Kerala as i could nt get any data beyond 2016. What was worrying me was about the weekly report of Polio status WHO . Most of us worrying about recent political developments are blind about a real threat which any moment is likely to grip our nation. We are sitting on a time bomb. I don't know whether i am permitted to write about a govt policy . I am supposed to endorse all govt policies as a govt servant.  Yes  i ll do that . But as a person who is keenly watching all these scientific facts i feel it is my duty to warn our fellowmen about this threat. May be it is nothing like Ebola or NIPA which ll result in mass casualties .  All  the

11 year old girl who was healthy till one week back had low grade fever followed by focal seizures on right side on same day. Seizure lasted five minutes. She regained consciousness but seizure recurred after few hours. Fever subsided with one dose of paracetamol and lasted one day only. No past history of significant illness, No contact with Tuberculosis ,  no history of ear discharge,  No history of  head trauma. Born our of non consanguineous marriage,Antenatal ,natal postnatal period uneventful. Development all normal, Immunized update. No family history of any neurological disorders. On admission   Altered sensorium. EMV 10 breathing normal, BP 110/70 ,pulse 80/min,afebrile. No skin bleeds,skin  rash,No  jaundice. Eye movements normal ,pupils normal size and reaction fundus normal. other Cranial nerves normal. Motor system ,power normal ,tone lower all limbs reflexes sluggish ,plantar up going. No signs of meningeal irritation. Provisional diagnosis of

താഴെ കൊടുത്തിട്ടുള്ള ഫോട്ടോകൾ പല കുട്ടികളുടെ ആണ്.  പലപ്പോഴായി എടുത്തിട്ടുള്ളവ. പല പ്രായത്തിലുള്ള കുട്ടികളുടെ. ഇതിൽ മൂന്നു മാസം പ്രായമുള്ളവനുണ്ട്.ഏറ്റവുമൊടുവിൽ വന്നയാൾക്കു ഒൻപതു മാസം ആണ് പ്രായം. എല്ലാവര്ക്കും പൊതുവായുള്ള കാര്യം ഒരു മുഴയാണ്. പലർക്കും അത് കക്ഷത്തിൽ ആണ്.ചിലർക്ക് തോളെല്ലിന് മേലെ,ചിലർക്ക് തോളെല്ലിന് താഴെ. ഇത് രണ്ടും അല്ലാതെ ബി സി ജി എടുത്ത ഭാഗം പാണപ്പഴം പോലെ മഞ്ഞനിറത്തിൽ പഴുപ്പ് കെട്ടിയ രീതിയിൽ. ഒരു കാര്യം പ്രത്യേകം എടുത്തു പറയണം. പഴുപ്പും കുരുവും ഒക്കെ വരുമ്പോൾ നമ്മൾ വേദന കൊണ്ട് പുളയും, പക്ഷെ അതൊന്നും ഇവർക്ക് ബാധകമേ അല്ല.  ഒന്ന് നോക്കാൻ കൂടി സമ്മതിക്കാതെ നമ്മളുടെ സ്റ്റെത്തും പേനയും പിടിച്ചു വലിച്ചു കളിയും ബഹളവും. ഇങ്ങനെ ഒരു കാര്യം മൂപ്പർക്ക് പുല്ലു വില.നമ്മൾ അതൊന്നു തൊട്ടാലും ഞെക്കിയാലും ഒന്നും കാര്യമായ ബഹളവും കരച്ചിലും ഒന്നുമില്ല. എല്ലാരും പ്രായത്തിനനുസരിച്ചു തൂക്കമുണ്ട്,ബുദ്ധിവികാസത്തിനും ഒരു പ്രശ്നവും ഇല്ല , കുസൃതിക്കു ഒരു കുറവും ഇല്ല. ചിലരൊക്കെ ഒന്നും രണ്ടും മൂന്നും കോഴ്സ് മരുന്ന് കഴിച്ചവരാണ്. ഒന്ന് രണ്ടു പേര് ഇത് കുത്തിപരിശോധിച്ചു റ്റീബിയുടെ അണുക

One year old girl child normal growth and development started showing this head nodding and difficulty in sitting and standing . Mother attributes everything to a fall which happened 9 days back, fall while she was sitting and playing. She noticed this problem next day onward. (consent taken from parents for publishing this for teaching purpose) No significant illness in the past. No fever during the illness or immediate past No history of any drug intake (  Possibility of drug ingestion was thought of and excluded) Only child,born at term No significant perinatal illness, Development in all fields normal till now. No family history of any neurological illness On Examination Vitals stable. She was irritable disturbed by this unsteadiness and inability to hold neck and sit straight. No pallor No lymph node No neurocuaneous markes No rash Pulse 110/mt normal volume,. BP normal for age CNS  Head nodding and unsteadiness in sitting. Trunkal ataxia.Intention tremor wh

5 month old girl child brought  with complaint of not achieving milestones. Sixth child of non consanguineous marriage  between 35 year old mother and 39 year old father. First baby conceived after treatment of infertility.Father,he had oligospermia. There were three abortions in the first trimester, first third and fourth. Second baby delivered normally,did nt thrive and died at  64 days of age  (poor sucking and activity,respiratory distress,procedure s/o peritoneal dialysis done,birth weight-2.3 kg, and weight at 64 days wt-1.3 kg). There is only one  normal living girl child,now 3 years old. No family history of early child death, in other members or developmental delay or significant neurological illness on both parent sides. Present child- During pregnancy  mother had gestational diabetes and,was on insulin.Diabetes was well controlled.Delivered at full term LSCS 2.7 kg.female baby cried immediately after birth.Breast fed normally and was normal

First case  Previously health 12 year old boy, noticed swelling above his left ankle. Initially he was not disturbed with this as it was not painful and did nt limit his play and activities. Later he had minimal pain on brisk walking  and he observed swelling was gradually  increasing in size. He came to us three months after the onset. He did nt have  fever. No similar swelling anywhere else. He did nt have other symptoms like fatigue ,syncope bleeding manifestations. No family history of similar swelling on the body. On examination  Diffuse swelling on the medial aspect of lower limb, 4 X 4 cms. Surface normal ,there was no discoloration. No other swelling anywhere. No pallor  No lymph nodes. As the swelling was growing over the last three months we considered the possibility of malignancy.  We did a Plain X-Ray lower leg and foot AP and Lateral Differential diagnosis of lytic lesions of bone considered .   Within next three days pain increased and the sw