VOLUME -2 ISSUE - 8 2020

VOLUME -2 ISSUE - 8 2020

MIMA


MIMA

PresidentDr. S. EDWIN KINS RAJ

KINS Hospital, Kuzhithurai P.O629163

CELL : 7540083776Email: [email protected]

Hon: SecretaryDr. E. PRADEEP KUMARGheeth Hospital, Kozhivilai,Kaliyakkavilai P.O. - 629 153

CELL : 9787234321Email:[email protected]

Finance Secretary

Dr. BINISH JOSEPH .BBabu Home,Koickalthoppu,Kanjampuram P.O - 629154


EditorDr. PRIYA SOLOMON

William Hospital Campus,Main Road, Marthandam - 629 165


Co -EditorDr. VINODHINI PRADEEPGheeth Hospital, Kozhivilai,Kaliyakkavilai P.O. - 629 153


THE EDITORIALDear Friends ,

Wishing you allMerry Christmas andHappy New Year inadvance. May you all befilled with the joy andexcitement of the seasonand the hope of the newyear as the worldundergoes a great reset.

My best wishes toour National IMAPresident, Dr.J.A.Jeyalaland may Gods abundantgrace be with him toaccomplish the task whichthe circumstances bringforth to our fraternityduring his tenure.

1 2

Even during these trying times, when everyone'slife is hanging under a SWORD called COVID 19, ourIMA office bearers managed to conduct Deepavalicelebration successfully. As it was a last minutepreparation, we were not able to fully accomodateeverything.

Dr.Mahilan has been a splendid Music Quizmasterduring our Deepavali celebration and the execution hascreated an exciting show which we are proud of. ICongratulate all the participants and I express mygratitude to all our members for the overwhelmingsupport and presence.

My sincere appreciation to our Co-editorDr.Vinodhini Pradeep for being very creative andprofessional which helped me to get State Presidentappreciation award for best editor of MIMA. I expressedmy gratitude to her and all those who contributed articlesto MIMA.

My hearty congratulations to all the Office Bearersfor the awards and recognition they received from IMATNSB. Thank you all for your support.

Yours in IMA service,Dr.Priya Solomon.


MIMA


MIMA

MESSAGE FROM THE CO EDITOR

3 4

Wishing you all a wonderful Xmasand a Happy new Year in advance.

This issue, we have a special articleon Diwali in Tamil, written by our PastPresident, Dr.Senthil Kumar.

For World Epilepsy day, Dr.Leena Jayahar hascontributed a wonderful article and for World Pneumo-nia day, Dr.Dishan has contributed an article. For WorldDiabetic Day, Dr.Samuel Vijay SIngh has provided aninsight on COVID and diabetes. For World Day Of Re-membrance of victims of Road traffic accidents day, wesolicited a special article from Executive Director ofKerala Road Safety Authority, Mr.T.Elangovan whichmakes for an interesting reading.

I Congratulate the office bearers of IMAMarthandam for recieving 11 Prestigous awards fromState IMA. I also congratulate the participants of FESTA2020, the winners of SANGAMAM 2020 and also every-one who participated in RAINBOW 2020 duringlockdown times. If we remain united, we can do won-ders together as a team.

I am sure all of you will enjoy this issue. Lookingforward to your feedback as always.

Cheers and Take care Dr.Vinodhini Pradeep

PRESIDENTIAL ADDRESSWish you all a very happy &healthy

festive season. I thank the editors for yetanother wonderful MIMA issue.

My heartiest congratulations toProf.J.A.Jayalal on his election as NationalPresident of IMA. I extend my prayerful best wishes ashe begins his new journey. May the almighty guide youdear Sir, in all your decisions and my best wishes as youadvance your mission for IMA and foster a new spirit ofprogress and collaborations.

I also convey my belated Diwali wishes to all. Wehad our Diwali Celebrations in IMA Hall on Nov 29th withlots of fun, sweets and sparkles. Kids activitiescoordinated by Dr.Christina and Dr.Athira was awesomeand much enjoyed. I thank all our members andparticipants from our branch for bringing this festiveoccassion to a grand successful moment with all yourgreat support. We look forward to your cooperation andparticipation in the upcoming festival events too.

I extend my thanks to my Honorary Secretary,Dr.Pradeep Kumar and Finance Secretary, Dr.BinishJoseph for being with me throughout this journey andelevating our IMA Marthandam.

With warm wishes and God’s blessings....Dr.S.Edwin Kins Raj


MIMA


MIMA

SECRETARY’S REPORT

Dear friends,It was a great honor to coordinate

the Felicitation function for National IMAPresident Elect, Dr.J.A.Jayalal. As time wasvery short, I regret that the invitations did not reach afew in time. We also celebrated Diwali Function inMarthandam IMA Hall. It was a grand event graced byDr.J.A.Jayalal and Dr.K.Vijayakumar, Past National IMAPresident. We had a marvellous fireworks display withKids activities and an excellent Musical Quiz organisedby Dr.Mahilan, Past President, IMA Marthandam, whichstole the show. Game activities were organised byDr.Senthil Kumar, Past President of our branch.

The monthly CME was held online in ZOOM.topic was living well with COPD with an internationalspeaker, Dr.Apar Jindal. It was attended by over 100delegates from other branches too.

World Diabetes Day was celebrated by a huge rallyorganised with Dr.Lawrence Victor Joe to createawareness. News of our activities was published innewspapers.

IMA Marthandam Branch was awarded thefollowing as per the Tamil Nadu IMA Awards Committee.

1. Dr. T. Sadagopan Award for Best Branch

2. Best Branch Runner5 6

3. Branch President Runner – Dr. Edwin Kins Raj

4. Branch Secretary Runner – Dr. E. Pradeep Kumar,

5. Appreciation Award for Best Editor of MIMA –Dr. Priya Solomon

6. Appreciation Award for Women Doctors activities

7. Appreciation Award for Regular Reporting

8. Appreciation Award for organising CulturalProgramme

9. Appreciation Award for Non-Medical topics

10. Appreciation Award: Cancer Awareness activities

11. Appreciation Award for COVID activities

and a Trophy for Best Branch overallPerformance.

We dedicate these to all the members of our ProudMarthandam IMA Branch and are thankful for thesupport and guidance offered by our Senior Leaders.

I express my earnest gratitude to our President,Dr.Edwin Kins Raj and Finance Secretary, Dr.Binish Josephfor supporting me in all IMA activities.

Thanking you,Dr.E.Pradeep Kumar


MIMA


MIMA7 8


MIMA


MIMA9 10

STAGES OF PNEUMONIA

1) Consolidation

2) Red hepatization

3) Grey hepatization

4) Stage of resolution.

SIGNS AND SYMPTOMS

High fever (pyrexia), chills , productive cough

Sputum may be discoloured and may become blood-stained as the pneumonia progresses.

•Dyspnoea •Sharp chest pain

•Worsening cough •Headaches, pain

•Cyanosis •Rapid breathing

•Wheezing or grunting •Intercostal musclerecession

DIAGNOSIS

•Crackles and wheezing may be heard whileauscultating

• Chest X-ray - will show Consolidation with airbronchogram sign.

• Sputum culture and sensitivity test

WORLD PNEUMONIA DAYPneumonia is defined as “inflammation of thelung caused by bacteria, Virus, Fungi, Para-sites in which alveoli become filled with inflam-matory cells & the lungs become solid.Pneumonia kills more children than any otherinfection.

TYPES OF PNEUMONIA

According to clinical setting

A. Community acquired B. Nosocomial

C. In immunocompromised

According to site of involvement

A. Lobar pneumonia B. Lobular pneumonia

C. Bronchopneumonia D. Interstitial pneumonia

Bronchopneumonia : inflammation of the smallairways and extends into the surrounding alveolarspaces. Common bacterial organisms arestreptococcus pneumonia, hemophilus influenza,legionella pneumophilia and staphylococcus aureus.Interstitial Pneumonia: an acute inflammation ofpulmonary interstitium leading to edemaAspiration Pneumonia Results when food, drink,vomit, secretions or other foreign material is inhaled .


MIMA


MIMA11 12

Sputum test is done to determine whether it isa fungal or bacterial infection

Complete blood count : indicate the severity of thepneumonia, as well as to determine whether it is aviral or bacterial infection.

COMPLICATIONS

• Pleural effusion (Para pneumonic effusion) Couldlead to the collapse of the lungs if not treatedappropriately.

•Empyema : Pus may be present in the lungs due tothe infection.

•Lung abscess : Develops when the infection hasdestroyed lung tissue and a cavity filled with pus isformed.

•Bacteremia

•Septicemia

•Endocarditis or pericarditis

TREATMENT

• Bacterial Pneumonia : Penicillin group of drugsshould be the 1st choice, if the patient is allergic topenicillin second generation cephalosporin orqunilones or macrolides can be choosed.

•Viral Pneumonia cannot be treated with anti-biotics,as they have no effect. This type of pneumonianormally resolves over time.

Other supportive treatments are

•Bed rest

•Breathing exercises

• Analgesic administration for chest pain

• Cough suppressant in viral pneumonia

• Anti pyretics

•Oxygen therapy (when indicated)

•.Chest Physiotherapy

•Humidification - to mobilize secretions

•Breathing exercises - Localized and Diaphragmatic

•Mobilization of the patient - done to increase airentry, increase chest expansion, and to loosensecretions

Dr.Dishan.YMD Chest MedicineConsultant Pulmonologist,

Dr SMCSI Medical CollegeDr.Dishan Chest Clinic, Pammam


MIMA


MIMA13 14

Symptoms of epilepsySudden fallsBlank spellsUnexplained incontinence of urine with loss of awareness orin sleepInvoluntary jerky movements of limbsOdd events occurring in sleep eg, fall from bed,jerkymovementsEpisodes of confused behavious with impairedconsciousness

Partial seizuresWhen seizures appear to resuilt from abnormal activity in justone area of brain, they are called focal (partial) seizures.These seizures fall into two categories:

Simple partial seizuresThese seizures don’t cause loss of consciousnessThey may alter emotions or change the way things look, smell,feel ,taste or sound. They may also result in involuntaryjerking of a body part , such as arm or leg ,and spontaneoussensory symptoms such as tingling , dizziness and flashinglights.

Complex partial seizuresThese seizures involves a change or loss of consciousness orawareness .during a complex partial seizure, patient maystare into space and not respond normally to the environmentor perform repetitive movements such as hand rubbing,chewing, swallowing or walking in circles.

Generalized seizures:Seizures that appear to involve all areas of brain are calledgeneralized seizures. Different types of generalized seizuresare:

UNDERSTANDING EPILEPSYIt is a Neurological condition characterized byrecurrent seizures. When someone is diagnosedwith epilepsy, it indicates that they have had aseizure (usually 2 or more ) and have increasedrisk of further seizures.

PractIcal ILAE definition

1) At least two unprovoked seizures occurring >24 hours apart or2) One unprovoked seizure and a probability of further seizuressimilar to the general recurrence risk after two unprovokedseizures occurring over the next 10 years or

3) Diagnosis of an epilepsy syndrome.

Provoking Factors:1)Alcohol withdrawel2)Barbituate or benzodiazepine withdrawel3)Metabolic (eg, hyponatremia, hypocalcemia, hypoglycemia,hyperglycemia)4)Drugs abuse5)medications (eg tramadol,imipenam, theophylline, bupropion)

What are the causes of epilepsy ?

1) Neurological infections2) Stroke3) Genetic basis4) Head injuries5) Brain tumours6) Brain damage from prenatal and perinatal causes


MIMA


MIMA

movements such as eye blinking or lip smacking. These seizuresoccurs in clusters and cause brief loss of awareness.Tonic Seizures:Tonic seizures cause stiffening of muscles. These seizuresusually affect muscles in the back, arms , and legs and maycause to fall to the ground.

Myoclonic seizures:Myoclonic seizures usually appear as sudden brief jerks ortwitches of your arms and legs.

Atonic seizures:Atonic seizures also known as drop seizures, cause a loss ofmuscle control, which may cause to suddenly collapse or falldown.

Clonic seizures:Clonic seizures are associated with repeated or rhythmic, jerkingmuscle movements. These seizures usually affect the neck, faceand arms.

Tonic clonic seizures:They are the most dramatic type of epileptic seizure and cancause an abrupt loss of consciousness, body stiffening andshaking, and sometimes loss of bladder control or bitingof toungue.

Diagnostic tools for EpilepsyDetailed history including the seminology of seizuresRoutine neurological examinationBlood tests – to rule out provoking factors for seizureslike infections, genetic testing.

Video EEG – it’s the most helpful investigation, tomonitor the seizure pattern on video while conductingEEG while the patient is awake and during sleep.CT Brain to rule out IC bleeds/ tumoursMRI helps to detect any lesions or abnormalities inbrain which can cause seizuresAdvanced Imaging techniquesFunctional MRI (fMRI) Measures the changes in blood flow that occur whenspecific parts of brain are working. It is useful beforesurgery to identify the exact location of critical functionssuch as speech and movement, so that surgeons canavoid injuring those tissues during surgery.Positron Emission Tommography (PET)Single photon emission computerized tomography(SPECT) It is used primarily if MRI and EEG did not pinpoint thelocation in brain where seizures are originating.Antiepileptic drugsStart with a monotheraphy, if seizures persists add onsecond monotheraphy or adjunctive therapy. Inspite of2 anti epileptic drugs,if seizures persists refer toepilepsy center : reassess the diagnosis : video EEGmonitoring. If there is structural lesion in MRI Brainconsider epileptic surgery for Temporal lobe epilepsywith hippocampal sclerosis or focal epilepsy withwell defined and resectable epileptogenic lesion, to

15 16


MIMA


MIMA

proceed with presurgical evaluation then epilepsysurgery.

Drug Resistant Epilepsy :Failure of adequate trails of two tolerated ,appropriately chosen and used antiepileptic drugshedules (whether as monotherapies or incombination ) to achieve sustained seizure reductionfreedom.Neuromodulation acceptable palliative option:VNS : 40-45% chance of atleast 50 % improvement inseizure frequencyThalamic stimulation: 54% of patients with atleast50% reduction in seizure frequency3

Neuropace: 47 % of patients with atleast 50%reduction in seizure frequency

Women & Epilepsy :Preconception management:1) confirm the epilepsy diagnosis2) Start folic acid 1 to 5 mg/d3) Use the most effective antiepileptic drug at thelowest dose4) Avoid valproate,topiramate,phenobarbital5) Establish baseline serum drug concentration.

Tips for Our Patients & caretakers during a seizureand thereafter:

Stay calm, let the seizure take it course. Toprotect the patient from injury - remove harmfulobjects from nearby

Cushion the head-to place something soft underthe head and loosen anything tight around theneck. Note the time how long the jerking lasts

Aid breathing by gently placing them in therecovery position once the seizure has finished

For recovery position- do gently roll the personon to his/her side as the convulsive seizuresubsides to allow saliva or other fluids to drainaway & keep the airway clear

Avoid sleep deprivation- an epileptic patientshould avoid night shifts and should have aminimum 8 to 10 hours uninterrupted sleep

Reduce usage of LED screens,Disco & flickeringlights which provoke a seizure

Never skip the Medication ,unless instructed bythe treating doctor

Follow ketogenic diet if feasible Dr.Leena Jayakar M.D (Ukraine), DNB Gen.Med, DNB Neurology Consultant Neurologist Dr SMCSI Medical College

Karakonam

17 18


MIMA


MIMA19 20

Avoid OHAs that cause hypoglycaemia and volume depletion anddosage can be reduced according to patients’ glycaemic control.Sick day guidelines need to be followed In hospitalized sick patients, insulin is preferred drug to controlhyperglycaemia

Treatment of diabetes during COVID-19: Type 1 diabetic patients should monitor the blood glucose leveland frequently check for fever with hyperglycaemia occurs. Avoid OHAs that cause hypoglycaemia and volume depletion anddosage can be reduced according to patients’ glycaemic control.Sick day guidelines need to be followed In hospitalized sick patients, insulin is preferred drug to control

hyperglycaemia

Metformin and SGLT2-I with moderate to severe illness should bestopped DPP4-I like Linagliptin can be used in patients with impaired kidneyfunction without risk of hypoglycaemia Sulfonyl Urea drugs may induce hypoglycaemia in patients withlow calorie intake. In many patients with T2DM, insulin will be preferred and needsto be initiated. Patients already treated with basal insulin will need fast actingbolus insulin to correct hyperglycaemia

Suggested measures to prevent COVID-19:

Frequent monitoring of blood glucose levels

Stabilize cardiac and renal status with comorbid conditions

DIABETES AND COVID - 19

Diabetes as a risk factor:Diabetes was a comorbidity in 22% of 32 non-survivors in a study of 52 intensive care patients.In another study of 173 patients with severedisease, 16.2% had diabetes and in furtherstudy of 140 hospitalized patients, 12% had diabetes. Peoplewith diabetes are a high risk group for severe disease.

Relationship between Coronavirus and DM Diabetes increases risk of infections Impaired immune-response to infection both in relation to cytokineprofile and to changes in immune-responses including T-cell andmacrophage activation. Poor glycaemic control impairs several aspects of the immuneresponse to viral infection and also to potential bacterial secondaryinfection in the lungs. Abdominal obesity is associated with higher risk Mechanical respiratory problems, with reduced ventilation of

basal lung sections increasing risk of pneumonia. DKD and IHD increases severity of COVID-19 Coronavirus could cause acute cardiac injury with heart failureleading to deterioration of circulation. Patients having mild disease can be home quarantined andhydration and symptomatic treatment is necessary Type 1 diabetic patients should monitor the blood glucose level


MIMA


MIMA

All nutrients including protein, vitamins and minerals need to betaken care of

Exercise shows increased immunity and gyms and swimming poolsto be avoided

Influenza and Pneumonia vaccinations are important to decreasechances of sec. bacterial infections after resp. viral infection

Proper hygiene to be taken care of which includes handwashingand to avoid contacts with affected person

Summary:Combination of a medical pandemic (COVID-19) with

a medical epidemic (DM) is very concerning. Treating diabetes toensure the patients sugar levels stays within target ranges, keepingpatients well hydrated and following the recommendations toprevent infection with the coronavirus is essential to prevent a moredevastating picture with a chronic condition such as Diabetes.

Hopefully, with some promising new vaccines on the horizon, wewill get over this pandemic soon.

Dr.Samuel Vijay SinghMBBS,MD(GEN.MED),D.DiabPerinba Hospital,Kulasekharam

21 22

WORLD DAY OF REMEMBRANCE FORROAD TRAFFIC VICTIMSThis day is to remember those who died or wereinjured from road crashes .Road crashes are theleading cause of death among young people.Every 6 seconds someone is killed or seriouslyinjured on the world’s roads.

Common causes for Road traffic accidents –Indian Scenario

India has just 1% of the world’s vehicle fleet. But, it accounts for11% of global road fatalities and injuries. 1.5 lakh people werekilled and 4.7 lakh people were injured in 2018.

Driving under the influence of alcohol and other psycho-activesubstances is a major cause. The risk of a road traffic crash startsat low levels of blood alcohol concentration (BAC) and increasessignificantly when the driver’s BAC is above 0.04 g/dl.Use of helmets, seat-belts and child restraints can lead to 42%reduction in the risk of fatal injuries and 69% reduction in the riskof head injuries.Post-crash Management Delays in detecting and providing carefor those involved in a road traffic crash increases the severity ofinjuries. Care of injuries after a crash has occurred is extremelytime-sensitive: delays of minutes can make the difference betweenlife and death. Traffic crash reduction –the success story of TamilNadu State

TN has been able to reduce road fatalities by 25% in 2018.


MIMA


MIMA

The approach followed by Tamil Nadu is discussed below:

Identification of Accident Black-spots using Geographical In-formation System

Setting up Accident & Emergency Initiatives and Post-crashManagement

Punitive measures like suspension of driving licenses andbooking of traffic offenders.

Under the TN Accident & Emergency Initiative (TAEI), public hospi-tals around the vulnerable areas were equipped with multi-disci-plinary critical care facilities. 108 ambulance networks were locatednear these vulnerable locations. By doing this, the response time ofambulance services got reduced to 13 minutes in urban areas, and17 minutes in rural areas. TAEI integrated 26 medical college hospi-tals, 31 district hospitals and 21 government hospitals located atstrategic locations across the state. Standard Operating Procedures(SOP) were followed, with onus on relying early information of in-coming patient, improved surge capacities and trained medical staff,delay and confusion had been avoided. Referral system was notinsisted for accident victims in major hospitals.

Other policy decisions include: setting up dedicated enforcementwing in districts and strict punitive actions by suspending drivinglicenses for dangerous driver actions.

By strengthening post-crash management, the statewas able to re-duce 20% road accidents in 2019.

The public health system that received huge investment duringCovid19 pandemic, could make use of the improved facilities and

resources to effectively deal with road crash casualties, once theCovid19 induced burden eases out.

Another suggestion is to integrate 108 ambulance network withprivate operators. Once the ambulance console system is put inplace, data from the consoles can be used to supplement crashdata and derive a wholesome understanding of crash prevention/post-crash management system. Based on the analysis of crashdata, District level interventions can be formulated and imple-mented.

If traffic laws on drink-driving, seat-belt wearing, speed limits,helmets, and child restraints are not enforced, they cannot bringabout the expected reduction in road fatalities and injuriesrelated to specific behaviours. Thus, if traffic laws are notenforced or are perceived as not being enforced it is likely theywill not be complied with and therefore will have very littlechance of influencing behaviour.

Road Safety is a joint responsibility. Collective actions areneeded from enforcement agencies, medical experts, roadengineers to ensure safe mobility of people. Many developedcountries have achieved sharp reduction in fatality by concertedactions.

We must avoid this preventable ‘man-made disaster’. Role ofmedical doctors are highly essential in reducing the severity ofRoad Traffic Victims.

- T. ELANGOVANExecutive Director, Kerala Road Safety Authority,Trivandrum Former Director, National TransportPlanning and Research Centre (NATPAC).

23 24

VOLUME -2 ISSUE - 8 2020

Documents

Transcript of VOLUME -2 ISSUE - 8 2020