മാഷ്

Our last admission day after the OP was going back to ICU to see new cases admitted. I was called by PG to rush to casualty to see a bad case. An adolescent girl, She was in distress. Periphery cold,peripheral pulses not palpable. 13 year old girl was under evaluation by our cardiology colleagues, after ECHO she was sent to radiology was some scanning and she was returning back to cardiology department. On the way back she suddenly became sick and she was bought to our casualty which is on the way to cardiology. She was holding an ECHO report, which the PG read out , dilated cardiomyopathy. She did nt have report of the procedure she underwent in radiology, But the mother said they took a scan after injecting a drug. First possibility considered was anaphylaxis to contrast agent. Oxygen started, IV line secured. But Major question to be answered here. Drug of choice is adrenalin . But the ECHO report with us says DCM, What to do Will it save. OR ... Other possibilities ...

Four year old boy bought with fever sore throat for the last four days. He was on oral antibiotics. As local doctor noticed this patch in the throat he was referred here Second child, older one is 7 years. Both of them un  immunized. No vaccine taken so far. Many kids in the neighborhood also At the time of admission child was sick, Drooling of saliva and cervical lymph node enlarged odema neck plus In view of unimmunised child developing this typical patch in the throat provisional diagnosis of diphtheria was made. Took a throat swab for gram stain, and culture and patient was put on Crystalline penicillin  Diphtheria antitoxin 80000 unit was planned. While administration rashes and BP fall occurred.Under cover of Adrenalin and supportive measures could give 100000 units of antitoxin. Differential diagnosis  To rule out other possibilities like membranous tonsillitis and Infectious mononucleosis investigations were taken. Peripheral smear taken showed no...

History in short  One year and eight month old girl born to a blind couple were bought with fever and seizure.( Both of them were blind at birth,otherwise intelligent and normal) She developed fever and at the height of fever she developed generalized seizure for which they were hospitalized. Seizure was controlled and she was playful for a while.At night again she developed seizures. lasting for two and half hours which was not controlled with usual anti convulsants and she was referred here. In between the seizures she vomited twice.She was bought deeply comatose, seizing movements controlled but occasional twitching persisting on left side, mother said the movements were more on left side. She was second child was born at term after an uneventful pregnancy. She was normal up to this age gained all milestones normally. Elder sibling born at term was normal. She developed fever,developed seizure and vomiting. Got hospitalized with intractable seizures and coma,she died ...

കുട്ടിക്കാലത്തു മഴ തുടങ്ങുന്നതും സ്‌കൂൾ തുറക്കുന്നതും മിക്കപ്പോഴും ഒരേ ദിവസം ആവും.ആ മാസം തന്നെ മിക്കപ്പോഴും ഒരു മൂന്നാലു ദിവസത്തെ പനിച്ചു കിടപ്പും ഓർമ്മയിൽ ഉണ്ട്. സ്‌കൂളിൽ പോണ്ടാത്തതു കൊണ്ട് പുതപ്പിനിടയിൽ ചുരുണ്ടു കൂടിയുള്ള കിടപ്പിനൊരു സുഖം ഉണ്ട്. കുറഞ്ഞോ കുറഞ്ഞൊന്നും ആധി പിടിച്ച അമ്മയുടെ കൈകൾ നെറ്റിയിൽ തൊട്ടു നോക്കുന്നത് അറിഞ്ഞിട്ടും അറിയാതെ കിടക്കും.പ്ലാവില കൊണ്ട് ചൂടുള്ള കഞ്ഞിയും പപ്പടവും, അത് കഴിഞ്ഞും പായിലേക്കു. നാലാം ദിവസം സ്‌കൂളിലേക്ക് പോയാലും ക്ഷീണം വിട്ടു പോവാൻ പിന്നെയും രണ്ടാഴ്ച എടുക്കും. ഫ്ലൂ എന്ന വാക്ക് കേട്ടത് പിന്നെ എത്രയോ കഴിഞ്ഞു.  ടീവിയും ചാനലും ഒക്കെ വന്നപ്പോ ജൂൺ മാസത്തിലെ സ്ഥിരം കലാപരിപാടി ആയ ചാനൽ ചർച്ചകളും പനിക്കെടുതികളും ,ഓരോ കൊല്ലവും ആവർത്തനങ്ങൾ. രണ്ടായിരത്തി ഒൻപതിൽ ആണ് H1 N 1 എന്നയിനം ഫ്ലൂ ലോകത്താകെ പടർന്നു പിടിച്ചു മരണം വിതക്കുന്ന അറിഞ്ഞത്. ആ ഭീതി ഒരു പരിധി വരെ വിട്ടു മാറിയതായിരുന്നു. പക്ഷെ ഈ കൊല്ലം അതിന്റെ ഗൗരവം ഇത്തിരി കൂടി. ഇന്ന് വരെ ഉള്ള കണക്കെടുത്താൽ ഏകദേശം അറുന്നൂറ്റി അൻപതിലധികം കേസുകൾ ഈ കൂടിയ ഇനം ഫ്ലൂ ഉണ്ടായി കേരളത്തിൽ നാല്പതു ജീവനുകൾ ക...

9 year old girl   2 nd child born out of non-consanguineous marriage  with uneventful antenatal history, with a birth weight of 2.5 kg with nohistory of  NICU admission was discharged on post natal day  2. She was readmitted with frequent episodes of non bilious vomiting and Jaundice on post natal day  3 and diagnosed as duodenal web.  Duodeno-duodenostomy was done.  She was found to have some dysmorphic facial features which were subtle. Noticeable one was   bifid thumb on left hand. There was no significant malformations in the family. She was found to have abnormal cardiac findings on follow up, was investigated and found to have Osteum secundum ASD 8mm size . She was breast fed , was attaining weight and her developmental milestones at par with her peers.  At 4 years had and episode of hematemesis  There was  no other bleeding manifestations other than malena which followed next two days. A...

12 year old boy presented to pediatrician with history of fever vomiting and abdominal pain, two days back. Pediatrician was my old student and he contacted me yesterday as this boy did nt pass urine for almost 24 hours and his renal function deteriorating. He developed conjuctival bleed and his coagulation parameters abnormal. He considered possibility of leptospirosis and was put on injection crystalline penicillin and ceftriaxone yesterday itself. He was send to us  daybefore yesterday night.  The investigation results done from outside were Total count 30000,with neurtophilia  Hemoglobin 14 gm/ dl Platelet 1.5 lakh Liver function test Total bilirubin 0.9 mg/dl,direct 0.2mg , SGPT 60 iu,SGOT 46 iu,Total protein normal  Coagulation parameters INR 3 , APTT 60  Blood urea 90mg/dl , Creatinin 4.3 mg/dl ESR 26 mms /hour  Lepto igM was negative On arrival ,  he was conscious , Blood pressure normal and capillary refill time 3 sec.p...

Six year old boy brought with nasal regurgitation of fluids and nasal twang to voice since three days. Previously normal child went to sleep normally and when he woke up mother noticed the voice change and the nasal regurgitation of fluid while he was taking breakfast. How to approach the case? click this and see the video