April 1st 2024 Volume - 14 Issue - 07 Rs.

3/-

OFFICE BEARERS 2024

President : Dr.Priya Karthick Prabhu

Contact No. : 9629747889
Dear Colleagues,
Imm.Past President : Dr M Doraikannan
Greetings !
President Elect : Dr K S Maheswaran
Every month our branch is becoming
more vibrant. We have bagged a Vice President : Dr B Koshalram
special appreciation award in the Secretary : Dr.SreeRamalingam
last State Council Meeting for
enrolling more new members. To Contact No. : 9080531406
keep our branch high all members Secretary Elect : Dr V Seetharam
should lend a hand.
Finance Secretary : Dr D Parameswaran
Please bring in new Life
Contact No. : 9994586560
members, FSS and PPLSSS
members. Joint Secretary : Dr.S.R.Shrinivas
Please promote our hall.

G: (Off) 0422 - 2471824

LONG LIVE IMA ! Mob : 9566365577
with warm regards, E-mail : imacoimbatore@gmail.com
Dr.C.P.Shanmugasundaram, M.S.,
Editor Website : www.coimbatoreima.com
 President’s Message
Dr. Priya Karthick Prabhu

Dear members was a grand success and was well

Greetings!
We have conducted a lot of activities in
the last month and have planned many
more in the upcoming months. Our
Women’s Day celebrations on 10th March
appreciated. Similarly we have planned
another mega event to celebrate our
Mother’s Day on May 12th. Kindly follow
the subsequent communications for
updates regarding the event.

Long live IMA

Secretary's Message
Dr. Sree Ramalingam. R
Dear Doctors,
In March, our office bearers were bustling with activity. The month kicked off with the State
Women's Wing program on International Women's Day, celebrated on March 10th. At the IMA
Hall, a comprehensive Glaucoma awareness program and screening, led by Dr. Dev Dutt
Thomas, highlighted the importance of early detection. The AMS Wing hosted an enlightening
CME on the ZOOM platform. Meanwhile, the Women Doctors Wing actively participated in five
impactful programs. Additionally, a BLS teaching program at PPG College underscored our
commitment to healthcare education. Notably, Dr. Priya Karthik Prabhu and Dr. Palanisamy
were honored with the esteemed TAMPA-LIMRA award. Furthermore, our branch's remarkable
achievement of clinching the 3rd prize statewide for inducting the maximum number of new
members was a testament to our collective dedication and growth.

Long live IMA 2

 Our President Dr.Priya Karthick Prabhu awas Dr.R. Palaniswamy a was awarded the
awarded the TAMPA- LIMRA award for TAMPA- LIMRA award for Excellence in
Excellence in Medicine 2024 on 17.3.24 at Medicine 2024 on 17.3.24 at Chennai
Chennai

Our President Dr.Priya Karthick Prabhu was

invited as Guest of Honour in the Womens President Dr.Priya Karthick Prabhu was the
Day function at Krishnammal college on Chief Guest in the Prof.Dr.SPT Gold Medal
7.3.24. Inauguration Function on 15.3.24

Anemia screening for school children at Madampatti AMS CME on Oncology

by AMS wing on 13.2.24 on 28.2.24 at Hotel Grand Regent
3
CGP virtual CME on AMS virtual CME
"Skin Cancer" was on "Obesity" was
conducted on conducted on
28.2.24 14.3.24

Dr.A.K.Ravikumar- Discussion in ETV

regarding Standard Rates for Hospitals on Our Branch has got Special Appreciation
2.3.24 Award for more enrollment
of Life Members, at State Council meeting on
17.3.24

Yoga every Sunday at IMA Hall

4
 Glaucoma Awareness CME was conducted by CGP wing
on 24.3.24 at IMA HBall.

Glaucoma screening for Drs and family members was done

by CGP wing lead by Dr.Devdutt thomas on 24.3.24 at IMA Hall

5
 Women Drs wing lead by Chairman Dr.Preethi conducted
a Health awareness programme for college students on 26.3.24.

ÜP«õ£‹ îI¬ö
«ð² â¡Â‹ õ£˜ˆ¬î‚°
ªî£™è£ŠHò˜ ªè£´ˆ¶œ÷ ªê£Ÿèœ

«ð² ðè˜ (Ýî£óˆ¶ì¡ «ð²) ꣟Á (܃WèKˆ¶Š «ð²)

ªêŠ¹ (ðF™ ªîK‰¶ «ð²) ¸õ™ (ÜPºèˆ¶ì¡ «ð²)
ÃÁ (õK¬êŠð® «ð²) æ¶ (ñùŠð£ìñ£èŠ «ð²)
à¬ó (ܘˆîˆ¶ì¡ «ð²) èöÁ (臮Šð£èŠ «ð²)
ïM™ (ïòñ£èŠ «ð²) è¬ó (ܬöˆ¶Š «ð²)
Þò‹¹ (Þ¬êðìŠ «ð²) M÷‹¹ (îèõ½ì¡ «ð²)
ð¬ø (ªõOŠð¬ìò£èŠ «ð²)

F¼‚°øœ Üøˆ¶Šð£™ & ÞQò¬õ Ãø™ 95

ðE¾¬ìò¡ Þ¡ªê£ô¡ Ýî™ å¼õŸ°
ÜEò™ô ñŸÁŠ Hø.
î°F‚°ˆ °¬øõ£ùõK캋 ðE¾ì¡ ÞQò
ªê£Ÿè¬÷„ ªê£™ðõù£è Ýõ¶ å¼õ‚° Ýðóí‹
Ý°‹; Hø ÜEèœ ÜE Ýè£
6
 IMA TNSB WOMENS DAY
Women's Day celebrations by WDW of IMA TNSB was celebrated at IMA Coimbatore on March
10th.
The event started of with an art exhibition by children and doctors. Paintings, drawings and
craft items made by them were displayed. Then Miss Prakati performed a traditional
bharathanatyam dance.
Prayers were offered by branch finance secretary Dr Parameswaran, welcome address by
branch president Dr Priya Karthick Prabhu, address by WDW chairman Dr Karuna and WDW
secretary Dr Preethi delivered secretary's report. Around 30 hospital women staff were
honoured by our state WDW chairman Umaiyal and Secretary Dr Kiruthika.
It was then followed by CME programs on Infertility by Dr Meenakshi, Dr Latha & Dr Ranjith
and Ischemic heart disease in women by Dr Priya Karthick Prabhu.
Our state president Dr Abul Hasan delivered the chief guest's address. Our state secretary
Dr Karthick Prabhu and state assistant secretary Dr Seetharam gave their felicitations.
Mammogram screening project for doctors and their family members was launched. Around
70 women doctors were recognised by our state president. Totally 100 people were awarded to
commemorate our Centenary Year. Program was attended by around 300 plus members
and family. MC was done by joint secretary Sr Srinivasan and vote of thanks by secretary
Dr Sree Ramalingam.
Regards
Team IMA Coimbatore

7
8
 CHRONIC RENAL FAILURE
Dr. A. PRABAHARAN, M.D,D.M(NEPHROLOGY)

CKD IS defined as either kidney damage or a •

Histologic abnormalities
decreased glomerular filtration rate (GFR) of less •
Structural abnormalities detected by imaging
than 60 mL/min/1.73 m2 for at least 3 months. Hypertension is a frequent sign of CKD but should
Whatever the underlying etiology, once the not by itself be considered a marker of it, because
loss of nephrons and reduction of functional renal elevated blood pressure is also common among
mass reaches a certain point, the remaining people without CKD.
nephrons begin a process of irreversible sclerosis Etiology
that leads to a progressive decline in the GFR. Causes of chronic kidney disease (CKD) include the
There is a rising incidence and prevalence of following:
kidney failure, with poor outcome •
Diabetic kidney disease
The different stages of CKD form a continuum. •
Hypertension
The stages of CKD are classified as follows •
Vascular disease
•
Stage 1 : Kidney damage with normal or •
Glomerular disease (primary or secondary)
increased GFR (>90 mL/min/1.73 m 2) •
Cystic kidney diseases
Stage 2 : Mild reduction in GFR (60-89 •
Tubulointerstitial disease
mL/min/1.73 m 2) •
Urinary tract obstruction or dysfunction
••
Stage 3a : Moderate reduction in GFR (45-59 •
Recurrent kidney stone disease
mL/min/1.73 m 2) •
Congenital (birth) defects of the kidney or
•
Stage 3b : Moderate reduction in GFR (30-44 bladder
mL/min/1.73 m )
2
•
•
Unrecovered acute kidney injury
Stage 4 : Severe reduction in GFR (15-29 Signs and symptoms
mL/min/1.73 m 2) Patients with CKD stages 1-3 are generally
•
Stage 5 : Kidney failure (GFR < 15 asymptomatic.
mL/min/1.73 m 2 or dialysis) Typically, it is not until stages 4-5 (GFR < 30
By itself, measurement of GFR may not be mL/min/1.73 m²) that endocrine/metabolic
sufficient for identifying stage 1 and stage 2 CKD, derangements or disturbances in water or
because in those patients the GFR may in fact be electrolyte balance become clinically manifest.
normal or borderline normal. In such cases, the Signs of metabolic acidosis in stage 5 CKD include
presence of one or more of the following markers the following:
of kidney damage can establish the diagnosis [5] : •
•
Protein energy malnutrition
Albuminuria (albumin excretion > 30 mg/24 •
Loss of lean body mass
hr or albumin:creatinine ratio > 30 mg/g [> 3 •
Muscle weakness
mg/mmol])
• Signs of alterations in the way the kidneys are
Urine sediment abnormalities
• handling salt and water in stage 5 include the
Electrolyte and other abnormalities due to
following:
tubular disorders •
Volume overload and Peripheral edema
9
•
Pulmonary edema-acute and chronic Evidence of renal bone disease can be derived from
•
Hypertension the following tests:
•
Anemia in CKD is associated with the following: Serum calcium and phosphate
•
•
Fatigue 25-hydroxyvitamin D
•
•
Reduced exercise capacity Alkaline phosphatase
•
•
Impaired cognitive and immune function Intact parathyroid hormone (PTH) levels
•
•
Reduced quality of life FGF 23
•
Development of cardiovascular disease In certain cases, the following tests may also be
•
New onset of heart failure or the development ordered as part of the evaluation of patients with
of more severe heart failure CKD:
•
•
Increased cardiovascular mortality Antinuclear antibodies (ANA), double-
Other manifestations of uraemia in ESKD, many of stranded DNA antibody levels: Screen for systemic
which are more likely in patients who are being lupus erythematosus
•
inadequately dialyzed, include the following: Serum complement levels: Results may be
•
Pericarditis: Can be complicated by cardiac depressed with some glomerulonephritis
•
tamponade, possibly resulting in death if Cytoplasmic and perinuclear pattern
unrecognized antineutrophil cytoplasmic antibody (C-ANCA and
•
Encephalopathy: Can progress to coma and P-ANCA) levels: - for granulomatosis with
death polyangiitis (Wegener granulomatosis); P-ANCA is
•
Peripheral neuropathy, usually asymptomatic also helpful in the diagnosis of microscopic
•
Restless leg syndrome polyangiitis
•
•
Gastrointestinal symptoms: Anorexia, nausea, Anti–glomerular basement membrane (anti-
vomiting, diarrhoea GBM) antibodies: —
•
•
Skin manifestations: Dry skin, pruritus, Goodpasture syndrome
•
ecchymosis Hepatitis B and C, human immunodeficiency
•
Fatigue, increased somnolence, failure to virus (HIV), Conditions associated with some
thrive glomerulonephritis
•
•
Malnutrition Serum and urine protein electrophoresis and
•
Erectile dysfunction, decreased libido, free light chains: Screen for a monoclonal protein
amenorrhea possibly representing multiple myeloma
•
Platelet dysfunction with tendency to bleed IMAGING STUDIES
•
Laboratory studies Renal ultrasonography:
Laboratory studies used in the diagnosis of CKD can small, echogenic kidneys are observed in advanced
include the following: kidney failure involvement of the retroperitoneum
•
Complete blood count (CBC) with fibrosis, tumour, or diffuse adenopathy
•
•
Renal function test Computed tomography (CT) scanning: Useful
•
Urinalysis to better define renal masses and cysts usually
•
Serum protein and albumin levels noted on ultrasonograms;
•
Lipid profile: Patients with CKD have an For renal stone disease- CT GIVES BETTER
increased risk of cardiovascular disease DETAILS
•
Magnetic resonance imaging (MRI):
10
•
Useful in patients who require a CT scan where
in contrast is contraindicated
intrarenal vein thrombosis
•
Renal radionuclide scanning: DTPA SCAN
Useful to screen for renal artery stenosis when
performed with captopril administration; also
quantitates the renal contribution to the GFR,
DIFFERENTIAL GFR
•
KIDNEY BIOPSY---- HISTOLOGICAL DIAGNOSIS
IS VERY IMPORTANT, ESPECIALLY IF KIDNEY SIZE IS
NORMAL. In contracted kidneys, biopsy is not done
usually
•
MANAGEMENT
1. Diagnosing and treating the pathologic
manifestations of CKD
2. Delaying or halting the progression of CKD:
Treatment of the underlying condition, if possible,
is indicated
3. Timely planning for long-term renal
replacement therapy
The pathologic manifestations of CKD should
be treated as follows:
•
Anemia : When the haemoglobin level is below
10 g/dL, treat with erythropoiesis-stimulating
agents (ESAs), which include epoetin alfa and
darbepoetin alfa after iron saturation and ferritin
levels are at acceptable levels;
periodical monitoring of serum ferritin, transferrin
in needed.
Patients with low ferritin level is treated with
parenteral iron like IV IRON SUCROSE, Ferric
carboxymaltose. High hepcidin level induce
poor therapeutic response
Patients on dialysis not responding to
treatment may be treated with the hypoxia-
inducible factor inhibitor DESIDUASTAT 125 MGM
WEEKLY THRICE
•
Hyperphosphatemia : Treat with dietary
phosphate binders and dietary phosphate
restriction. Tab sevelamer, calcium carbonate with
calcitriol, ferric
•
Hypocalcemia :Treat with calcium supplements
with or without calcitriol. risk of vascular
calcification
•
Hyperparathyroidism : Treat with calcitriol or
vitamin D analogues or calcimimetics- cinacalcet
for medical parathyoidectomy
•
Volume overload : Treat with loop diuretics or
ultrafiltration/fluid and salt restriction. THIAZIDES
are not useful except metallazone. To avoid
potassium sparing diuretics
•
Metabolic Acidosis : Treat with oral
alkali supplementation-sodium bicarbonate tablets
500- 1000 mg 3 times per day/ or parenteral
isotonic sodium bicarbonate. To avoid sodium
overload
•
Uremic manifestations : Treat with long-
term renal replacement therapy (hemodialysis,
peritoneal dialysis, or kidney transplantation)
•
Hyperkalemia—calcium polysterone
sulphonates and low potassium diet
Inj calcium gluconate to block cardiac action,
glucose plus insulin infusion to induce intracellular
shift. Dialysis will remove potassium
INDICATION FOR RENAL REPLACEMENT THERAPY
Indications include the following:
1 Volume overload/ pulmonary edema
2. Severe metabolic acidosis
3. Hyperkalemia
4. Pericarditis
5. Encephalopathy
6. Uremic symptoms
7. Failure to thrive and malnutrition
8. Peripheral neuropathy-restless legs
9. Intractable gastrointestinal symptoms-
nausea, vomiting-
In asymptomatic patients, a GFR of <10ml
mL/min/1.73 m², [ irrespective of the cause of the
CKD or the presence or absence of other
comorbidities 11
 YOGA
Virabhadrasana

Dr.M.Doraikannan
Warrior Pose
Vira Mean Courageous, Warrior or
Vigorous
Badra Mean Auspicious literally
Warrior Pose
This pose is standing arum that
provide strength to Shoulders arum, thigh
and muscles of The back
Method of Practice
* stand erect while balancing body weight on both legs
proper handily
* take the right leg forward as much as you can and know tha
foot finely on the ground.
* bend the right knee unity the right thigh is almost parallel
to the ground make sure that the knee is kept directly over
ankle
* Now exhale and bend forward. gradually till your hands
touches foot
* Then inhale and raise you both hands upwards along your
body till the fingers position to the roof
12
* Now straightly bend backwards and look up.
* Maintain position for 20 counts without movement
* Then gradually exhale and bend forward and come to the
neutral positions bring back the rights leg and joins with left
foot. Repeat the same in the left leg
BENEFITS
1. Strengthen and tones leg hip and upper body
2. Improve flexibility of hips
3. Improve muscular endurance
4. It trains the body to balance and co-ordinatinate
appropriately
5. It help to improve concentration and stamina
6. It improve circulation & respiration
MENTAL BENEFITS
1. Enhance focus concentration and exhale
2. Reduce stress and tension
3. Promote mindfulness and mental resilience
Over all doing Virabhadrasana gives correct shape of the body
CONTRE INDICATION
Any one with knee pain or knee injury and back pain, or
spinal injury high blood pressure Heart disease History of
stroke.
13
 ÜÁ²¬õ
 àJ˜ õ£ö àí¾ Iè º‚Aò‹. ÜFè‹ ²¬õŠðì õ£ö ÜÁ
²¬õèÀ‹ º‚Aò‹
å¼ ñQîQ¡ õ£› è¬÷»‹, °íïô¡è¬÷»‹
b˜ñ£QŠð¶ Üõ¡ à‡µ‹ àíM™  Üõóõ˜ «î¬õ‚°
ãŸð Ü÷õK‰¶ ²¬õò£è à‡í «õ‡´‹.
à‡µ‹ àí¾ à혾‚° Ýî£ó‹
àí˜¾èœ î£¡ â‡íˆFŸ° Ýî£ó‹
â‡íƒèœ  ªê£ŸèÀ‚° Ýî£ó‹
ªê£Ÿèœ  ðö‚èˆFŸ° Ýî£ó‹
ðö‚èƒèœ  õö‚èˆFŸ° Ýî£ó‹
õö‚èƒèœ  ï숬 Ýî£ó‹
ï숬î õ£›¾‚° Ýî£ó‹
âù«õ 嚪õ£¼ ñQîQ¡ ªê£™LŸ°‹ ªêò½‚°‹
ðö‚èˆFŸ°‹ ï숬‹ Üõ˜ à‡µ‹ àí«õ
b˜ñ£Q‚Aø¶.
Þ¬øõ¡ îò£KŠ«ð ÞòŸ¬è àí¾. ÞòŸ¬è àíM™
ޡ𺇴. ñQî¡ îò£K‚°‹ àí¾ ê¬ñˆî àí¾. ªêòŸ¬è
àíM™ ¶‡ðº‡´.
ÜÁ²¬õè¬÷»‹ ²¬õŠð¶ ° ñ†´‹ . ªî£‡¬ì‚°
W› â‰î ²¬õ»‹ ªîKò£¶.
A¡ ¸QŠ ð£èˆF™ ÞQŠ¬ð ²¬õ‚è º®»‹ àŠ¹‹,
¹OŠ¹‹, A¡ æóƒèO½‹, èꊹ àœ ï£‚A½‹ ªîK»‹
²¬õò£°‹.
«îQ¡ ²¬õ èꊹ . Þ¶ àe› c¼ì¡ èô‰¶ ÞQŠ¹
²¬õ¬ò‚ ªè£´‚Aø¶.
ÜÁ²¬õèO™ â™ô£¼‚°‹ H®ˆî ²¬õ ÞQŠ¹
14
ÞQŠ¹
ÞQŠ¹ ²¬õ ÞòŸ¬èò£è ê‚è¬ó, 輊ð†®, ðöõ¬èèœ,
輋¹, ªõ™ô‹, èŸè‡´, ñ…êœ ÌêE, ꘂè¬ó õœO‚Aöƒ°
«ðg†ê‹ ðö‹, ñ£¾Š ªð£¼†èœ ñŸÁ‹ ¹OŠ¹ ªð£¼†èœ ÞÁFJ™
ÞQŠ¹Šªð£¼÷£è ñ£P¾´Aø¶.
àì‹H¡ àìù® ê‚F‚° ÞQŠ¹ ÜõCò‹. àì‹H¡
õ÷˜„C‚°‹, àÁŠ¹‚èœ Yó£è ªêò™ð쾋. ͬ÷ º¿ ê‚F»ì¡
«õ¬ô ªêŒò ÞQŠ¹ ÜõCò‹. ÞîòˆFL¼‰¶ ªõOõ¼‹
ÞóˆîˆF™ àœ÷ °À«è£v êˆF™ 30% ͬ÷ â´ˆ¶‚
ªè£œAø¶. ÜKC, «è£¶¬ñ, î£Qòƒèœ ñŸÁ‹ Aöƒ°èO™
裘«ð£ ¬ý¯«ó† ÜFè‹ àœ÷¶. Þ¶ ÞQŠ¹„ êˆî£èñ£P ê‚F
ÜO‚Aø¶.
«î¬õ‚° ÜFèñ£è ÞQŠ¬ð„ ꣊H†´M†´ ÜîŸè£ù àì™
à¬öŠ¹ Þ™ô£ñJ¼Šð àì™ ð¼ñù£°‹, ÜFèñ£è àìL™
«ê˜‰î ÞQŠ¹ ªè£¿Šð£èñ£P õJÁ H†ì‹, Þ´Š¹ ÝAòõŸP™
«ê˜‰¶M´Aø¶. àì™ ð¼ñù£è, Obesity õ¼Aø¶, ꘂè¬ó «ï£Œ,
Þóˆî‚ ªè£FŠ¹ õ¼Aø¶. ¬è, 裙èO™ ãŸð´‹ ¹‡ Ýø£¶.
ÞQŠ¹ ÞóˆîˆF™ °¬ø‰î£™ àì™ ªñL¾, «õ¬ôJ™ «ê£˜¾,
õ£‰F, ñò‚è‹ õ¼‹ ͬ÷J™ ªêò™ð£´èœ °¬ø‰¶M´‹.
Ü÷õ£è ÞQŠ¹ ꣊H†ì£™ õ£» ñŸÁ‹ Hˆîˆ¬î êñ¡ ªêŒ¶
î¬ê¬ò õ÷ó„ ªêŒ»‹. à콂° ê‚F ªè£´‚°‹,
ÞQŠ¹ ÜFè‹ ê£ŠH†ì£™ H®õ£î °í‹ õ¼‹.

IMA
Guest House
Disclaimer : IMA assumes no responsibility for the authenticity or reliability of any product, equipment, gadget or
any claim by medical establishments / institutions / manufacturers or any training programme in the form of
advertisements appearing in CIMA and also does not endorse or give any guarantee to such products or training
programmes promote any such thing or claims made so far.

Published by Dr.S.Karthick Prabhu (Founder) on behalf of Coimbatore Branch of Indian Medical Association.
Printed by V.Sampathkumar Printed at Premier Printing Press, 77, Karunanidhi Nagar, Trichy Road, Sungam,
Ramanathapuram, Coimbatore - 641 045, and published from 92, Syrian Church Road, Coimbatore - 641 001.
Editor : Dr.C.P.Shanmugasundaram 16