മാഷ്

6 year old boy. 1st child of non consanguineous marriage , developmentally normal unimmunised with no significant past history now presented with c/o low grade fever since 6 days associated with throat pain on day 1 of illness. On day 2,was taken to hospital and was treated as Out patient  basis. On day 3, developed 5-6 episodes of vomiting. On day 4,mother noticed swelling side of neck , which was gradually increasing in size So he was hospitalised on same day and started with Iv Ceftriaxone. On day 5, fever decreased but vomiting persisted. Day 6, swelling increased over right side and minimal swelling over left side and was referred to here i/v/o suspecting diphtheria. At admission, child was conscious, sick looking, Pulse rate 90/mt, good volume,occasional irregularity. Respiratory rate 24/mt, afebrile, swelling side of neck below mandible and ears both sides. tonsillitis with greyish white membrane in tonsil and posterior pharyngeal wall with bleeding spots and ...

Hope NIPAH won't lead to any secondary case this time. This small write up is  not looking  things lightly,but analyzing the situation  comparing the previous years experience. This time  with early diagnosis containment,and awareness creation within such a short period was wonderful. Administration,  media and people from all walks of life  joined hands to achieve this comparatively relaxed state of affairs. This time no panic,awareness about the condition &need of precautions  reaching even to the layman and preparedness to tackle even the worst situation. Isolation and management facilities are set up in most of the major institutions. Calicut having the best experience taking the lead. In this context, sharing few thoughts/ dilemmas which most of us facing at this stage. Arrangements made in different institutions vary depending on the infrastructure manpower. But basic points considered will be same 1.Pick up the possible cases earl...

In a busy out patient clinic you may not be in a position to go in depth about all cases. Common problems ll be disposed fast, cases which needs workup ll be admitted. Cases previously admitted and worked up we ll  through their discharge notes fast. Few of them visiting frequently  are too familiar, and we may not check the note book in detail. Here i am posting  a mistake i made in the last context  even though it was not a major one. This case in fact is a dilemma in decision making also.Hence a share few points i learned from managing him Four and half year old boy came to OP with history of contact with chickenpox. He was on regular follow up since he was diagnosed as Kawasaki disease with involvement of coronary arteries. He was managed in the usual lines with Intravenous gamma globulin 2 gm per kg and aspirin.As the coronary arteries were dilated on follow up ECHO he was put continuing low dose aspirin 3 mg per kg daily. Aspirin, a time tested dru...

എൺപതുകളുടെ ഒടുക്കത്തെ ഏതോ ദിവസം, തൃശൂരിൽ ഡ്യൂട്ടി എടുക്കുമ്പോ ഒരുപത്തു മാസക്കാരനെ കൊണ്ട് വന്നു. ഉച്ചമുതൽ നിർത്താത്ത കരച്ചിലും ചർദ്ധിയും. “പനിയുണ്ടോ “ “ഏയ് ഇല്ല “ കുട്ടിയെ നിലത്താണോ കെടത്തി ഉറക്കിയത്? വല്ലതും കടിച്ചതോ കുത്തിയതോ വല്ലോ ആവ്യോ എന്ന് ആസകലം തിരിച്ചും മറിച്ചും ഒന്ന് നോക്കി “അതൊന്ന്വല്ല ഡോക്ടറേ “ “ നിങ്ങൾ അല്ലാതെ വല്ലോരും കുഞ്ഞിനെ എടുത്തോണ്ട് പോയിരുന്നോ ? പണ്ട് ഇത് പോലെ ഒരു അവസരത്തിൽ കുട്ടിയെ നോക്കുന്ന പെണ്ണിന്റെ കയ്യിൽ നിന്ന് കുഞ്ഞു വീണതും അവൾ പേടിച്ചു അക്കാര്യം മറച്ചു വെച്ചതും ഓർത്തു..തലയ്ക്കു ക്ഷതമേറ്റ കാര്യം അറിയാൻ വൈകിപ്പോയ ഒരോർമ്മ മനസ്സിൽ വെച്ചാണ് ചോദിച്ചത് “ അതൊന്നും അല്ല .നിങ്ങൾ കുഞ്ഞിന് വല്ലോം മരുന്ന് കൊടുക്കൂ.ഈ കരച്ചിൽ ഒന്ന് നിൽക്കട്ടെ .” കുഞ്ഞിനൊപ്പം അമ്മയും അമ്മൂമ്മയും നിലവിളിയും കണ്ണ് തുടക്കലും ശ്രദ്ധിച്ചിരുന്നു, വാക്കുകളിൽ കലിപ്പ് പടരുന്നത് തിരിച്ചറിഞ്ഞു സത്യം പറഞ്ഞാൽ ഒന്ന് നേരാം വണ്ണം പരിശോധിച്ച് നോക്കാൻ ആവണ്ടേ. വയറും ചെവിയും, കാലും കയ്യും ഒക്കെ തിരിച്ചും മറിച്ചും നോക്കി, കല്യാണ യന്ത്രം പുറത്തെടുത്തു നോക്കി.ചിലപ്പോ അതിനു വല്ല നൂലും കുടുങ്ങി കിടക്കും...

” 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 ...