Greetings from the Editorial team of Chettinad Health City Medical Journal! We take immense pleasure in bringing out this first issue of the 6th Volume. We would like to take this opportunity to thank all the authors and reviewers who have supported the Journal. This issue of the Chettinad Health City Medical Journal carries two original articles, three case reports, one review article and one classroom article. A number of Interns and Post-graduates are contributing and in-turn getting benefitted by learning the valuable skill early in their medical career.

Stomatocytosis is a rare hemolytic disorder occurring due to abnormal lipid bilayer of RBC membrane. In a suspected hemolytic disorder, unconjugated hyperbilirubinemia out of proportion to drop in hemoglobin suggests a probable underlying Bilirubin uptake/ metabolism problem in liver. Gilbert’s syndrome is the commonest among them. Though genetic testing can be used to confirm it, it is generally a clinical diagnosis in a patient with indirect hyperbilirunemia and normal liver and hematological tests. Single dose Rifampicin test may be used for confirming the diagnosis. Association of abnormal serum lipids and RBC lipids have been found in Abetalipoproteinemia in which Acanthocytes (spur cells) are seen. Here we present a 25 years male who had abnormally low serum lipid levels and stomatocytes presenting as hemolytic jaundice.

Gastric neuroendocrine tumors (NETs) develop from neuroendocrine cells. Gastric NETs are usually discovered as submucosal lesions during upper gastrointestinal endoscopy. NETs are graded into 3 types based on mitosis and Ki-67 index. We describe a case of upper GastroIntestinal Bleeding which was diagnosed to be a well differentiated type III neuroendocrine tumor of the stomach.

Hemifacial spasm is a hyperactive rhizopathy of the seventh cranial nerve. It is usually ascribed to vascular compression of the facial nerve at the root exit zone. Tumors, vascular malformations are unusual causes of hemifacial spasms. We report one young adult presenting with hemifacial spasms as a sole manifestation. On imaging it was found to be having large cerebellopontine angle epidermoid cyst and was managed surgically.He had good relief of hemifacial spasms after surgery. Hemifacial spasms as a sole presentation of cerebellopontine angle epidermoid cyst is relatively rare. Only few cases are reported in the literature.Patients with hemifacial spasms should have imaging to exclude structural causes at the cerebellopontine angle and brainstem.

Zika viral infection is an emerging viral infectious disease. Most of the cases are asymptomatic, a few may present as a very severe illness, rarely leading to death. The common presentation is a febrile illness with rash, myalgia, arthralgia, conjuctivitis and headache. Congenital Zika virus syndrome produces a wide range of Central Nervous System and ocular abnormalities in newborn. Studies have also suggested a strong association between Zika virus infection and Guillain-Barre’ syndrome. Primary route of spread is by the bite of Aedes mosquito and vertical transmission. It can also spread by sexual route and blood transfusion. Diagnosis is by RNA-Nucleic acid testing (RNA-NAT) and RT-PCR. Like other Flaviviral illnesses (Dengue, Yellow fever and Chikungunya), there is no specific treatment for Zika viral illness other than symptomatic treatment. So prevention is the main modality stressed.

I am glad to note that all your results are normal and you have no apparent major health problem. Of course I acknowledge that you continue to have pain but please feel relieved that there is no cause for concern or alarm. I am also very happy to note that you have a very healthy lifestyle.

The following are the uniform requirements for manuscripts submitted to the Chettinad Health City Medical Journal, which are in accordance with “Uniform requirements for Manuscripts submitted to Biomedical Journal” developed by International Committee of Medical Journal Editors (October 2001).

Management of sepsis and septic shock has been greatly evolved since the initial publications of Surviving Sepsis Campaign (SSC) guidelines in 2004. But still these conditions are associated with high mortality in patients admitted to the hospital as well as to the intensive care unit. From time to time experts have gathered information and new evidences for the betterment of care of these patients as well as to decrease the high rate of mortality associated with sepsis and septic shock. The guidelines have been revised in 2008 and 2012. The recent guideline, which is published in 2016 have taken into consideration of the best available evidences for the management of sepsis and septic shock till date. While they have incorporated few evidence based recommendation, definitions and newer modalities of assessment for the management of sepsis and septic shock; at the same time they have revised the previous recommendations based on the recently published evidences against these recommendations. Overall these guidelines will greatly help all the physicians involved in the care of sepsis and septic shock patients and will help in improving the outcome of these patients. Till new evidences are available, these recommendations will guide physicians taking their best clinical decision for the management of sepsis and septic shock.

Endometriosis is an estrogen dependent condition commonly seen in women of reproductive age group and most often these women present with infertility and pelvic pain / dysmenorrhea. It is not clear whether endometriosis is the cause of infertility/ pelvic pain/ dysmenorrhea or it is just an associated condition. In the reproductive age group women, the incidence of endometriosis is 10 – 11%1 whereas the incidence is more than 30%1 in infertile population. The common sites of endometriosis are ovaries, fallopian tubes, posterior wall of the uterus, cul-de-sac, broad ligament, round ligament. Extra pelvic sites are intestines, urinarybladder, ureters, lungs, extremities, skin, and central nervous system. Ovaries are being the commonest site of endometriosis

Abstract Hyperinsulinemia and hyperandrogenemia are the hormonal changes which are linked to the pregnancy complications seen in women with Polycystic Ovary Syndrome (PCOS). Aim : This study was done to determine the complications that can occur in pregnant women with polycystic ovary syndrome, and to ascertain whether the complications are related to PCOS per se or the Body Mass Index (BMI) of the women.

The endoscopic transoral approach offers a risk-free access to midline and ventral lesions of the craniovertebral junction. Benefits of this approach include 1) Direct exposure to ventral lesions (bony pathology, granulation tissue etc) possible through this route alone; 2) Avascular plane of dissection through median pharyngeal raphe and clivus; 3) Less injury to brainstem structures as head is kept in an extended position.

To establish the correlation between Magnetic Resonance Imaging (MRI) characteristics and intra-operative consistency of meningiomas and establish the correlation between MRI characteristics and histological subtype of meningiomas.