മാഷ്

” What to do when i am exposed to a varicella (chicken pox)during the infective period?". One topic debated much today was about the efficiency of acyclovir as a chemoprophylactic agent in immunocompetent persons. All of us know there is a effective, safe time tested vaccine against varicella.Only problem with this is the cost, Need two doses and cost two thousand rupees for a dose . So even though this is relevant for prevention, a country like ours can not afford. Ideally all of us should get immunized against ie primary prvention. In that case the above question does nt occur. still there is answer to the above question Vaccination even after exposure (post exposure vaccination ) is effective in varicella.This is possible because the incubation period of this illness is long enough ie two to three weeks. If we give vaccine early after contact protecive level of immunity can be raised before the actual virus produce the illness. So the illness may not occur at all or occur ...

One problem case discussed by my old student Six month old baby born out of non consanguineous marriage.  Antenatal natal and post natal period uneventful and her growth and development was normal till 13 days back. Whole event started with running nose low grade fever, which was managed symptomatically.As the cough and dyspnea worsened he was put on antibiotics orally ,later became worse and was referred to him. Patient was admitted in PICU, ventilated.Clinical ,radilogical features suggestive of bronchopneumonia.Blood culture came negative.  Baby responded well. Cirulatory status normal, chest clear. Heart sounds normal,no cardiomegaly, He was stable on minimal settings on room air but could nt be weaned from ventilator There was family history of two siblings died at eight month in similar manner. One boy and one girl. His sensorium normal,eye movement normal pupils normal and facial movement normal. Tone of limbs was on lower side and deep tendon refle...

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...