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General Medicine

The department of medicine is one of the premier departments of M.O.S.C medical college. Patients get referred to this department mainly from the three districts of Ernakulam,  Kottayam and the hilly district of Idukki. Besides,  this department also caters to the local population. Being a major referral hospital east of the metropolitan area of Ernakulum this department serves as a tertiary care center for many hospitals from the neighboring towns and villages. In addition to patient care the department is also involved in teaching M.B.B.S students. There are four medical units headed by experienced faculty. In 2011 the department was upgraded as a post-graduate training center by the Indian Medical Council.

 

History of General Medicine Department
MOSC Medical mission hospital was started as rural Christian “Mission Hospital” on 14th September 1970. At the Inception of Hospital Dr. P. Koshy from CMC Vellore took charge as the Chief Physician. Subsequently the department was served by eminent doctors like Dr. Paul Puthooran,  Dr. Joy K. Peter (Late),  Dr. George T. Ninan,  Dr. Mariamma Kuriakose,  Dr. T.A. Subramanyam,  Dr. Eapen Punnoose,  Dr. Arun I Cheeran and Dr. C. K. Eapen (of these doctors Dr. C.K. Eapen,  present Medical Director and Prof. Dr. Mariamma Kuriakose presently Professor of Medicine are still serving the department.
The Mission Hospital has been upgraded to Medical College during 2002 under the self financing Christian Medical Colleges of Kerala state. Prof. Dr. V.K. Lakshmanakumar took over the charge of first HOD of Medicine. Subsequently four more Medicine Professors Prof. Dr. V.K. Haridas (Late),  Prof. Dr. Vishwanadhan,  Prof. Dr. Kunjamma George and Prof. Dr. T.S. Francis joined the department. 31st March 2016 Prof. Dr. V.K. Lakshmanakumar retired from service and Prof. Dr. T.S. Francis become HOD of Medicine with the following staff.

 


Academic Facilities

  1. Regular under graduate (MBBS) teaching programme including theory,  practical and integrated teaching.
  2. Regular PG teaching and training programme as per stipulation of university and MCI in the most commendable way. Three batches of PG’s passed out till now with 100% pass.
  3. Department undertake regular CME programmes every year with distinguished experts as speakers.
  4. Apart from these the department is regularly doing Medicine teaching programmes to BSC Nursing, General Nursing, MLT and DMLT corses.

Regular research activities are done in the department.


Ongoing research and publications

  1. Metabolic syndrome and its clinical correlates in a tertiary care hospital in central Kerala.
  2. Prevalence and pattern of thyroid dysfunction in patients affected by type two diabetes mellitus attending in a rural tertiary care centre in South India.
  3. Acute Kidney injury in leptospirosis,  Predictors of outcome.
  4. Assessment of Serum Magnesium level in severe leptospirosis.
  5. Aethiological profile of hepatomegaly.
  6. Clinical and biochemical Predictors for early differentiations of leptospirosis and dengue in a rural tertiary care centre at central Kerala.
  7. Ventilated associated pneumonia Incideme pattern in a tertiary care centre in South India.
  8. Transaminases as predictors of severity of dengue fever.
  9. Predictors of poisoning related mortality from a rural tertiary care centre at South India – A ten year retrospective cross sectional study.
  10. Continuing research on various aspects of Leptospirosis.
  11. Various aspects of snake bite and its management.

Research and Journal publications

  1. Leptospirosis in a midland rural area  of Kerala state.  Indian J Med Res 128, September 2008, pp 307-312. Mariamma Kuriakose, Regi Paul, M. R Joseph, Sheela Sugathan & T. N Sudha .
  2. Interstitial Pneumonia in Chikungunya infection. Kerala Medical Journal August 2008. Mariamma Kuriakose, Regi Paul, Anver.
  3. Leptospirosis studies:- Efficiency of crystalline penicillin  10 lakhs 6th hourly for 5-7 days  and  15 lakhs for 7-10 days.V. K. Laskshmankumar, Ajith Jacob, K. Smitha.
  4. Fatty Liver Assessment and Treatment study.   Mathew K. Jose  2009.
  5. Study on relationship between chronic alcohol & Hepatic Amobiasis. V. K. Lakashmanakumar
  6. Ittyachen A, Lakshmanakumar VK, Eapen CK, Joseph MR. Methylprednisolone as adjuvant in treatment of acute respiratory distress syndrome owing to leptospirosis - a pilot study. Indian J Crit Care Med 2005;9:133-6. Indian Journal of Critical Care Medicine
  7. Ittyachen AM, Krishnapillai TV, Nair MC, Rajan AR. Retrospective study of severe cases of leptospirosis admitted in the intensive care unit. J Postgrad Med 2007;53:232-5.      Journal of Postgraduate Medicine
  8. Emerging Infections in Kerala: A Case of scrub typhus. Abraham Ittyachen. The National  Medical Journal of India vol. 22 No. 6, 2009
  9. Intensified TB case   finding among diabetes visiting diabetic clinics and general medical clinics.  It is an operational study in the early stages. Asha Biju, M. R. Joseph. 2010
  10. Case Report:  Case report of  agramllo cytosis + cholestetic hepatic following oral nemoercazole for hyperthyroidism  annals of  Africans Medicine.
  11. Three siblings with woodhouse- Sakati syndrome in an Indian family.   Clinical dysmorphdogy 2008.  George Koshy,  Sumita Danda, Nihal Thomas, Vikram Mathews and Vijay Vishwanthan.
  12. Visual vignette -Endocrine Practice Vol 13 No.2 March- April 2007. Jubbin Jayan Jacob, Tanuvelil George, Thomas V Paul Visual vignette -Endocrine practice Vol 14 No.8 November 2008. Thomas V Paul, George Koshy, Hesarghata S. Asha, Senthil Vasan.
  13. Case Report-“Phaechromocytoma  and haemophilia an unusual combination”               Jebasingh KR, Koshy TV, Paul TV, Paul MJ, Anraha  D, Viswabandya A
  14. ‘Proptosis and Polyuna’ Pictorial Medicine-Hong Kong Med J Vol 15 No.6 December 2009
  15. George Koshy, Nihal Thomas, Simon Rajartnam, Arathi simha, Meera Thomas, Anro Viswabandya, Chandana Nagaraj.  
  16. Ittyachen AM, Jose MB, Abraham V. Autoimmune hemolytic anemia secondary to chicken pox. Ann Trop Med Public Health 2013;6:353-4 Annals of Tropical Medicine and Public Health
  17. Ittyachen AM, Krishnamoorthy S, Shanavas A. Sister Mary Joseph's Node. Am J Med. 2013 Dec 28. pii: S0002-9343(13)01109-1. doi: 10.1016/j.amjmed.2013.11.022. American Journal of Medicine
  18. Ittyachen AM, Ramachandran R. Study of acute febrile illness: A 10-year descriptive study and a proposed algorithm from a tertiary care referral hospital in rural Kerala in southern India. Trop Doct. 2014 Dec 23. pii: 0049475514566264. Tropical Doctor
  19. Ittyachen AM, Abdulla S, Anwarsha RF, Kumar BS. Multi-organ dysfunction secondary to severe wasp envenomation. Int J Emerg Med. 2015 Dec 8:6. DOI 10.1186/s12245-015-0054-7. eCollection 2015.  International Journal of Emergency Medicine
  20. Ittyachen AM, Vijayan A, Kottam P, Jose A. Aches, pains and headache: an unusual combination of hypothyroidism, vitamin D deficiency, cervical radiculopathy and cortical vein sinus thrombosis. BMJ Case Rep. 2015 Jul 8;2015. pii: bcr2015209888. doi: 10.1136/bcr-2015-209888. BMJ Case Reports
  21. Ittyachen AM, Jose MB, Benjamin JR. A case of recurrent agranulocytosis due to levamisole. Indian J Pharmacol 2015;47:565-6. Indian Journal of Pharmacology
  22. Ittyachen AM, Eapen M, Kumar R. Chilaiditi's sign. Eur J Intern Med. 2015 Nov 11. pii: S0953-6205(15)00378-7. doi: 10.1016/j.ejim.2015.11.002. European Journal of Internal Medicine   
  23. Abraham M Ittyachen, Smitha Krishnamoorthy, Arun Bhatt, Shanavas Abdulla, Jijo Oommen Roy, M. Sugathan, Kevin Ambadan, Jelty Kuriakose. Predictors of outcome in patients admitted with acute exacerbation of chronic obstructive pulmonary disease in a rural Tertiary Care Center. Journal of Family Medicine and Primary Care.
  24. Jessy Mathew, Smitha Krishnamoorthy, Linby Chacko, Jean Hannah Philip, Jinsa Elesabeth Jacob, Jeenu Ann Jose, Laonal Lal, Arun N. Bhatt. Non compliance to anti-Hypertensive Medications and Associated Factors-Community Based Cross Sectional Study from Kerala doi: 10.21276/sjams.2016.4.6.18. Scholar Journal of Applied Medical Science (SJAMS)

Notable achievements:

  • Human leptospirosis was identified for the first time in Kerala in this department in the year 1997.
  • The first report of scrub typhus from Kerala in indexed literature came from this department in the year 2009.

FUTURE VISION
We can plan for 150 UG admissions with 6 medical units. This will require general ward bed s 30 x 6 = 180, an addition of 60 general ward beds.

  • Faculty and Residents
  • Professor and HOD   
  • Additional Professors/Associate Professors
  • Assistant Professors  
  • Senior Residents            
  • Junior Residents

Infrastructure

 

  • General ward with 180 beds
  • High dependency unit with 12 beds
  • Intensive Care Unit with 18 beds
  • Faculty and residents rooms as per IMC recommendations

We can plan for 8 PG admissions by 2025 and we require 5 more Assistant Professors for this (Total 11 Assistant Professors).
Measures to improve general ward admission (minimum of 70% to 80% of bed strength) This can be done by

  1. Reducing the general ward expenses for the patients (only cost of medicines and investigations to be charged).
  2. All admissions to medicine and concerned specialties from casualty should be to medical wards to increase bed occupancy and patients transferred to concerned specialties on the next day.
  3. Fully computerized OP and IP care with paper less record keeping.
  4. Boosting of research to enrich medical treatment and increased pace of published papers.
  5. Work together for patient friendly centre of excellence.

Facilities

  • Output patient (O.P) services

A general OP is conducted every day from 9 AM till the registered patients are over by the different medical units in rotation. A evening paid OP where patients can see the physician of their choice by the payment of a small fee is conducted every afternoon. Advanced booking with telephone facility is also available. Besides attending to patients teaching is also undertaken by the faculty in the OP. Special executive check-up facility also is undertaken by the Medicine department. The details are available at the hospital enquiry.


  • Casualty Service

A fully equipped round the clock casualty service is available with sufficient senior physicians, Residents and Interns.
Inpatient (I.P) services:

  1. Medical Wards
  2. Medicine Intensive Care MICU/IMCU

  • Medical Wards

Wide arrays of wards are available for inpatient management. Round the clock attention is given to the patients in these wards. A senior faculty is on call 24-hours a day and is assisted by post-graduate trainees and interns.


  • Medicine intensive care unit (MICU)

We have a ten bedded ICU for management of critically ill patients. There are automated facilities for monitoring of pulse, blood pressure, temperature, respiration and oxygen saturation. Both invasive and non-invasive ventilators of the highest standards are available. There is an in house doctor to take care of all emergencies in the ICU. Besides we have dedicated nursing staff trained in critical care. For those critically ill patients who need dialysis, facilities are available in the ICU itself. One of our faculty is also trained in critical care. In case of an exigency patients are also admitted in the other ICU’s of our hospital.


  • Intermediate care unit (IMCU)

Patients who need more than ward care but less than intensive care are admitted in our IMCU. This is also managed by dedicated nursing staff. Most procedures done in the ICU except assisted ventilation are done in the IMCU.
Patients get admitted to our department through the casualty or the OP. Being a health care facility in a rural area we also have rich experience in treating snake envenomations and pesticide poisonings, problems unique to the rural community. Immense efforts are taken by the department to maintain cordial relationships with the sister departments of our hospital. Consultations are always seen on time and points are discussed with senior faculty so as to give the best medical attention possible. As we are aware of rising health costs and the strain it has on our community every effort is taken to practice medicine in a cost-conscious manner. Mechanization has widened the inter-phase between doctor and patient often leading to a loss of human touch. Every effort is taken to overcome this when we treat our patients. Our house-surgeons and post-graduate trainees are also trained in this manner.