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Her last ice cream

Greetings of the day !      Mrs Radha (name changed) a 28 year old female was admitted with a history of recurrent vomiting and  Jaundice of one  day duration to our hospital. She had no  history of viral prodrome , fever or any offending drug intake .She was conscious oriented,  and had  mild icterus . Her systemic examination was normal. An Ultrasound of the abdomen did not reveal any obstruction in the  biliary system .All routine investigations required were sent and the patient was started on supportive treatment. Although she had  mild elevation of Bilirubin and Liver enzymes,  her INR (coagulation profile ) was 4 times the upper limit of  normal.  While peeping into her liver cell function tests  , it was obvious that her liver was failing .She was managed as a fulminant liver cell failure in the Intensive Care Unit of the hospital.   What led to her Jaundice and high INR left all of us clueless.   In the evening at around  8pm the resident doctor on duty got an alert call from

Bumpy Roads 3rd Edition coming soon

  Greetings of the Day ! I am pleased to share that 3rd edition of my book , Bumpy Roads ,has been published by Yenepoya University  Mangalore Karnataka.  This book is my view of the many and diverse happenings in my life so far, recorded as clearly as my memory allowed.  The music of ink in this book reflects eventful periods of my life-- my real life experiences.          I do not claim to be a reputed author as I am but a humble physician from an average middle-class family. Playing with the strings of my heart, I have tried to compose tunes to resonate with yours.         This book is essentially a travelogue, but also a travelogue through life itself, containing what I hope are universal messages for all readers. I have taken the reader on a tour of all the three divisions of Jammu, Kashmir, and Ladakh  The chapter   “A Narrow escape”  in the book highlights how I survived in blast injury. Having lived through the wonderful ways in which my friends rallied round to help me, irresp

Healthy child healthy Nation

 Greetings of the day!  The child care starts right from the conception .Expectant Moms should undergo proper antenatal check ups and  focus on various maternal diseases .Gestational diabetes mellitus is one such condition which can lead to birth of big babies . Maternal hypothyroidism should be promptly treated to prevent mental retardation in the newborn .Similarly expectant moms should be screened for hepatitis B so that they are vaccinated or treated for chronic HBV in order to prevent maternal transmission of chronic HBV .  The delivery should be supervised and all possible efforts made to prevent fetal hypoxic damage to the brain of the newborn. during birth process   Then comes care of the neonate. It is very important to have your neonate examined by a child physician. Biliary atresia ( presenting as Jaundice ) is mistaken to be benign or breast milk jaundice .  The consequences are serious if this condition is not treated early .   Emphasize breastfeeding : Breastfeeding tra

Black magic - - - - - - - or Bird magic

Greetings of the day!  Down the track of Memories  Another story from King Abdul Aziz specialist hospital Taif Saudi Arabia  Mrs Noora,(name changed) the newly wed girl, in her early twenties was brought with acute shortness of breath of one day duration to the emergency room of our hospital, years back . The clinical examination was displaying bilateral wheeze suggestive of acute asthmatic attack. Oxygen at the rate of 4 liters per minute was started in addition to other treatment . She improved and was discharged with an advice for follow up.  Unfortunately she continued to have recurrent attacks of shortness of breath in the following months. She was admitted 6  times in two  month with shortness of breath . Every time a different resident doctor would  manage her symptomatically (oxygen , nebulisations) and discharge her. Due to their  personal reasons they denied detailed evaluation in the hospital  Exhausted with the number of hospitalizations,  Mrs Noora went to her father’s hom

The young man lost his vision all of a sudden !

Greetings of the day ! Dear Friends : Today's story Down the track of Memories: There used to be a very good tradition of weekly grand rounds at the King AbdulAziz Specialist Hospital Taif Saudi Arabia. Every Thursday, early in the morning , the team consisting of all specialties(Internal medicine ,Gastroenterology,Rheumatology Hematology etc) would go together and discuss challenging cases admitted over the past week in the Medical department of the hospital. As I recall, on one occasion ,sudden onset blindness in a young man was presented . Dr Zaid(name changed )a young physician had developed sudden onset blindness at his home. Brought by his distraught wife in a wheel chair to the hospital Dr Zaid was down in the dumps . "Not documented means not done”. This doctrine used to be strictly followed in this hospital under the able leadership of Dr AbdulAziz Alfifi, a young physician with excellent clinical and administrative capabilities. The scrupulous medical r

Good clinical examination clinched the diagnosis

Greetings of the day  Down the track of Memories Another  story  from PGIMER Chandigarh Years back , while working as a DM student. Mr. Paul  Singh (name changed) a 49 year old thin built person presented to our  clinic at PGI Chandigarh with pain abdomen off and on for  the past 12 months .Pain was   intermittent and diffuse. He had lost around 14  kilograms of weight during this period.For these complaints he had consulted a lot of doctors. Apart from baseline investigations he had undergone UGI endoscopy twice, Colonoscopy once and all other investigations  required for evaluation of an unintentional weight loss. Based on a few small lymph nodes in his CT scan abdomen , Anti tubercular treatment  had been started by some doctor .The patient had continued treatment for 2 months without any  relief and  stopped it in despair. Ultimately Mr.  Paul Singh had been  started on anti depressants   as no definite cause  could be  ascertained by the doctors.Finally he came to PGI. That day Pr

A good clinical examination clinched the diagnosis

Greetings of the day  Down the track of memories Today story from Sir Ganga Ram hospital New Delhi Years back while working as senior resident in Medicine, a young business man Mr Raj  (name changed) was admitted for evaluation of swelling of feet of 3 weeks duration.  On evaluation he was found to be losing proteins in urine (Nephrotic range proteinuria)  A kidney biopsy was planned by the dept for this patient to know the cause of protein loss through kidneys. Sadly on the day of kidney biopsy Mr Raj  developed high grade fever and the procedure was cancelled. The treating team send all  investigations required to know the cause of fever. But there was not a single  clue from any of the  investigation sent. Mr Raj continued to drench in fever .  Finally they send a refrence to internal medicine for advice. "Ibrahim! Let us see the patient", said Dr S P Byotra  and together we went to see Mr Raj on the 3rd floor  ( the semi nursing home) of the hospital. " Hello  ji&quo

Look beyond the obvious - II

Greetings of the day! Dear Friend. Today another story from Saudiarabia Down the track of Memories King Abdul Aziz specialist hospital Taif Saudi Arabia On another occasion, Mr Zahrani (name changed), a 43 year old business man  presented with right upper abdominal pain  associated with loss of appetite of ten  days duration. Clad in long Abaya, the anxious wife of Mr. Zahrani  kept her dazzling, branded ladies purse aside and pulled the CT scan report of her beloved husband and a referral note. "Daktoor( doctor) we are worried" ,she said. The  CT scan abdomen was suggestive of a hyper dense  lesion in the segment V  of liver and the concerned radiologist had mentioned lot of differentials below for further studies. The differentials varied  from  a benign to malignant lesions of the  liver. Loss of appetite was a worrying clinical symptom in this patient and Mr Zahrani was admitted for further evaluation. The family was counselled about fine needle aspiration of this hy

Look beyond Obvious

Dear Friends Down the track of Memories Today another story from #saudiarabia "Ibrahim, please have a look of a patient admitted in ICU to bed no 4 , said   Dr Irshad Sirwal the noted Nephrologist at  King Abdul Aziz Specialist hospital Taif Saudi Arabia ,where we were working together years back. Dr. Irshad Sirwal  wanted my opinion regarding  the high liver enzymes in this patient . At around 12.30 pm I went to see the patient in ICU .  The clinical history of the patient was challenging.  Mr. Zaid (name changed ) the  27-year-old Saudi  male had  suddenly developed aggressive behavior  ,while on his work place, 6 months prior to the current presentation to our hospital. At that time, he  had been  rushed by his colleagues,  to a local psychiatric hospital and was managed with electroconvulsive therapy (EST) in addition to antipsychotic medication. He had a  normal neuro imaging (MRI brain) at that time. The patient had been put on antipsychotic medication and followed.   Sadly

Water Bottle :Your best companion

 Greetings of the day ! “Thousands have lived without love, not one without water ” has been aptly quoted by the the British poet W H Auden years back. Water is essential .It helps in the digestive process , maintains body temperature and in the removal of waste products from the body . Water intake also helps to prevent formation of kidney stones. It also helps to fight fatigue ,when dehydration is the cause. Studies have shown that water boosts metabolic rate up to 30 percent within an hour and helps to accelerate weight loss by 44 percent. Thus water is the safest, simplest, and cheapest way to shun off extra weight which is so dangerous. The average daily requirement of water is 2.5 liters in women to 3 liters in men .Water demand increases in hot climates ,as we sweat a lot and during exercise as well. While 20 % of water comes from the food we take , an additional amount of water in the form of beverages /plain water should be taken to

Keep Dementia at Bay, Act now!

Greetings of the day ! Mr. Kapoor (name changed) the 76 year old retired officer , nicknamed as 'Raj Kapoor' in his youth for he used to be well dressed and a highly polished gentleman of the locality. He had been living with his wife and children happily till 2017 . Mr & Mrs Kapoor once upon love birds were ageing gracefully and were enjoying life to its full but now they were fighting on simple and pity issues. One day on a sunny day, while returning from a shopping mall ,Mr Kapoor could not find his way back home. He went on moving from one corner to the another for almost an hour till a passerby helped him out and accompanied him back home. Mr Raj (name changed) his son felt happy to see his father back but surprisingly Mr. Kapoor shouted at him , ''you are the one who did black magic on me' otherwise I never experienced this before . Mrs Kapoor looked at her husband and strengthened his belief .Both fel

Thank you so much subscribers

  Greetings of the day!  I am pleased to share the statistics of my Blog Gastroenterology Desk. Thank you so much for your likes and shares. Such a statistics would have not been possible without your support. While NATURE, the genetic susceptibility to any illness is unalterable, NURTURE, the environmental factors influencing the disease process, particularly cancer must be taken care . Gastroenterology Desk Blog, is my little effort with immense Love. I hope all subscribers will act upon the advice I post in this Blog from time to time. Please note, I do consult various reputed websites before composing any post. With sincere regards Dr Ibrahim Masoodi

Thyroid function test interpretation.

Greetings of the day!  Thyroid function tests are often required in Gastroenterology to evaluate high liver enzymes, constipation etc.In addition it is extremely important to identify hypothyroidism in Pregancy and in Infancy to prevent mental retardation in the new born   Today let us revise how to interpret thyroid function tests: Step 1 :First choose TSH,  Step 2: Free T4 or index, Step 3: Radio active Iodine uptake (RAIU)   See the number. Is it low, normal or high? A) TSH high and FT4 low= PRIMARY HYPOTHYROIDISM B)TSH low and FT4 LOW= SECONDARY HYPOTHYROIDISM( Pituitary) if TRH low (Hypothalamus) C)TSH high FT4 normal= SUBCLINICAL HYPOTHYROIDISM D))TSH high and FT4 HIGH= PITUITARY HYPERTHYROID (TUMOR) E)TSH low and FT4 normal= SUBCLINICAL THYROTOXICOSIS F)TSH low FT4 high, diffuse RAIU +TSI & Anti-TSH-receptor Ab. =GRAVE’S DISEASE G)TSH low and FT4 high, focal RAIU= ADENOMA H)TSH high and FT4 LOW + Anti-thyroglobulin ab.+ Anti TPO= HASHIMOTO’S THYROIDITIS I) FT4 NORMAL and low