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In this presentation following topics are discussed. This lecture was delivered by Dr. Tayyab Saeed Akhtar at Foreign Students Academy Rawalpindi. The topics which are discussed in this lecture are; 1. Keith L. Moore Contribution to embryology 2. Events in Week two: ( also see events in first week ) 3. Bilaminar Embryonic disk formation 4. Trophoblast 5. Pregnancy test 6. Extra embryonic mesoderm 7. Connecting stalk 8. Hydatidiform mole and choriocarcinoma

It was thought that better sleep is good for health. But now we should refine our statement to "moderate sleep is good for health" . Now scientists discovered that too much sleep is bad for heart but they have also found that too little sleep has the same effects too.  Here are the details: People who sleep less than six hours per night or more than eight are more likely to suffer heart problems than people who sleep between six and eight hours, said a US study on Sunday (March 2012) The findings confirm those in previous, smaller studies, but are based on what researchers described as a nationally representative sample of 3,000 people covering five separate heart ailments and their links to sleep duration. The subjects for the study were people over age 45 who participated in a survey of health issues in US households known as the National Health and Nutrition Examination Survey. Subjects were asked to describe their sleep patterns and were also asked if they were ever tol

Dr Tayyab Saeed Akhtar Delivered lectures about embryology at  foreign students academy on following topics 1. Medical Embryology-Fertilization And First Week Of Pregnancy 2. Events In 2nd Week Of Pregnancy/Gestation And Pregnancy Test 3. Weeks 3-8 Embryonic Period Ppt Presentaion By Dr Tayyab 4. Embryological Development Of Heart 5. Embryological Development of CNS 6. Embryological Development of Lungs / Respiratory System 7. Development of GIT ( Gastrointestinal tract ) 8. Placenta, Amniotic Fluid, Umbilical Chord and fetal circulation

In this presentation following topics are Highlighted: 1. Prefertilization Events 2. Spermiogenesis 3. Oogenesis 4. Fertilization 5. First Week 6. Clevage 7. Morula 8. Blastocyst formation 9. Implantation 10. Ectopic Pregnancy

•A 35 year old female delivered a healthy baby 15 days back presented with drowsiness for 2 days. On examination she had 3/5 power on left side of body. Her MRI was performed •What is the most likely cause of this lesion and what other imaging sequence you would be looking for? Answer will be posted after five comments. Post your answer as comment. (scroll down to post comment)

In This flash video ( scroll down ) Following topics are discussed 1. Hematoxylin and Eosin 2. Cell injury and adaptation 3. Hypoxia 4. Ischemia 5. Bugs 6. Infectious diseases 7. Genetic derangements 8. Congenital diseases 9. Chemical and drug injury 10. Physical injury 11. Mechanism of Injury 12. Necrosis and types 13. Apoptosis 14. Mechanism of apoptosis 15. Cellular adaptation 16. Atrophy, Hypertrophy, Metaplasia, Hyperplasia 17. Intracellular accumulation and mechanisms 18. Fatty liver 19. Calcification Click on the video slide to move forward don't use the next button (at the bottom bar) you may miss important animations:

Brief Review about 1. Neurtorphilia 2. Eosinophilia 3. Monocytosis 4. Lymphocytosis 5. Infectious Mononucleosis 6. Downy cells 7. Monospot test 8. Acute lymphoblastic leukemia L1, L2 and L3 9. Lymphoblastic Lymphoma 10. Chronic lymphocytic leukemia 11. Hairy cell leukemia 12. Folicular lymphomas 13. Diffuse cell lymphoma 14. Burkit lymphoma 15. Mantle cell lymphoma 16. Maltoma 17. Multiple myeloma 18. Waldenstrom Macroglobinemia 19. Adult T cell leukemia/lymphoma 20. Mycosis fungoides 21. Sezary syndrome 22. Hodgkin disease 23. Acute myelogenous leukemia 24. Myelodysplastic syndromes 25. Chronic myelogenous leukemia 26. Polycythemia vera 27. Essential thrombocytopenia

Tubular reabsorption: occurs as filtrate flows through the lumens of proximal tubule, loop of Henle, distal tubule, and collecting ducts. Following Processes are used in reabsorption: Diffusion Facilitated diffusion Active transport Co-transport Osmosis Reabsorbed substances are transported to interstitial fluid and reabsorbed into peri tubular capillaries. •The luminal cell membranes are those that face the tubular lumen (“urine” side) •The basolateral cell membranes are those are in contact with the lateral intercellular spaces and peritubular interstitium (“blood” side) •The term transcellular refers to movement of solutes and water through cells •The term paracellular refers to movement of solutes and water between cells •Epithelial cell junctions can be “leaky” (proximal tubule) or “tight” (distal convoluted tubule, collecting duct)   Types Of Transport Processes: •Passive transport (simple diffusion) •Facilitated diffusion •Primary active transport •Seco

•A 42 year old lady from murree visited our hospital for the evaluation of her left leg swelling that she noticed about 2 weeks back. While entering through the gate of Holyfamily Hospital she suddenly collapsed and was rushed to Emergency Department, where she regained consciousness but was dyspneic. Her examination was unremarkable except for a respiratory rate of 32/min. • What is the likely clinical diagnosis? How it can be confirmed? And how will you further evaluate this patient? Post your answer as comment (scroll down). and answer or further follow up will be presented after 5 answers.  Answer D- dimers of the patient were advised • Patients value:   1600ng/ml • Normal value:  <200ng/ml Doppler studies were performed Venous Doppler left lower limb showed evidence of Deep Venous Thrombosis(DVT) • This is a classical scenario of Pulmonary Embolism. ECG shows Q3T3 pattern in our patient A classical ECG in a pulmonary embolism patient shows S1Q3T3 •D-dimer

Peptic Ulcer Disease (PUD): definition A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection. MORE THAN 5 mm in diameter. • MAYBE ACUTE OR CHRONIC. EROSION and Ulcer • A BREAK IN THE GI MUCOSA LESS THAN 5 mm IN DIAMETER - NOT PENETRATING MUSCULARIS MUCOSA IS CALLED EROSION. Deeper erosions are called ulcers. •EROSION MAY OCCUR IN ACID SECRETING AND NON- ACID SECRETING MUCOSA • PERISTALSIS NOT AFFECTED IN EROSION • EROSION HEALS RAPIDLY. Sites of Peptic Ulcer Disease (PUD) • PUD may occur in any area where acid and pepsin are present • Commonest sites: – Duodenum especially first part “duodenal bulb” – Stomach especially over the lesser curve • Other sites: – The lower end of the oesophagus – site of gastrojejunal anastomosis – Opposite to Meckel’s diverticulum AETIOLOGY OF Peptic Ulcer Disease (PUD) • HELICOBACTER PYLORI- ASSOCIATED ULCERS • NSAID-RELATED ULCE

An interesting case of diffuse Large B cell lymphoma presenting as cranial polyneuropathy (polyneuritis craialis) Ismail A. Khatri, MD, Fahd Sultan, MBBS, Maimoona Siddiqui, FCPS, Tayyab S. Akhter, MBBS, Arsalan Ahmed, MD (Neurology), Umair Afzal, MD Division of Neurology, Shifa International Hospital, Sector H-8/4, Islamabad, Pakistan Introduction: Polyneuritis cranialis in the absence of peripheral polyneuropathy is an uncommon neurological problem with a variety of likely etiologies. The diagnostic evaluation may be challenging. Case Report: We report the case of a 57 year old previously healthy gentleman, who presented with double vision for 3 weeks; drooping of right eyelid for 2 weeks; difficulty in swallowing liquids; and hoarseness of voice for 5 days. His examination showed right complete III rd nerve, left VI, subtle left LMN VII th , and right IX, X, XII th nerve palsy with hoarse voice and absent gag. Right hip flexors were weak (4/5) and plan

Topic discussed are: 1. Anisocytosis 2. Poikilocytosis 3. Elliptocytosis 3. Spherocytosis 4. Target Cells 6. Acanthocytosis 7. Ehinocytes 8. Schistocytes 9. Bite Cells 10. Tear Drop cells 11. Sickle cell 12 Rhouleaux 13. Basophillic stiplling 14. Howell jolly bodies, Pappenheimer bodies, Heinz bodies, Ring Sidroblasts, 15. Anemia 16. Reticulocytosis 17. Types of anemia 18. Coomb's test You can either click on the buttons to move the slides or you can simply click on a slide to move to the next slide. We hope that you will find this video informative and helpful.

Following are the clinical scenario questions Posted by Dr Tayyab Saeed Akhtar, Based on Study conducted under His own supervision at Holy Family Hospital Rawalpindi Pakistan *.  New Case Of The Month: A 35 Year Old Female Delivered... *.  Case Of The Month: Courtesy Of Dr Tayyab Saeed Akhtar HFH Rawalpindi *.  Clinical Case - Old Lady With Severe Chest Pain *.  Massive Pericardial Effusion Case: X Ray And CT Diagnosis And Treatment *.  Marfanoid Habitus/Marfan Syndrome-Signs Symptoms-Clinical Picture *.  Tetralogy Of Fallot X-Ray Diagnosis visit again for more: Thanks

Dr Tayyab Saeed Akhtar ( MO and 4rth year PG Medicine at Holy family hospital Rawalpindi ) OTHERS 1.  Diffuse Large B Cell Lymphoma Presenting As Cranial Polyneuropathy (Case Report)

Cardiovascular System Personal history : Special habits:- Smoking increases the risk of; *Cor pulmonale (disorders predispose to cor pulmonale read here) *Coronary H. D. *Atherosclerosis * Arrhythmia I. V drug Addiction increases the risk of getting Endocarditis (fungal, Staph) A- Analysis of complaint B- Ask Leading questions about Cardiovascular symptoms: 1-Symptoms of pulmonary venous Congestion (explained below) 2-Symptoms of systemic venous Congestion. 3- Symptoms of low Cardiac output. 4-Chest pain. 5-Cyanosis & jaundice. 6-Palpitation. 7-Symptoms of Peripheral vascular disease. 8-Toxic symptoms Pulmonary Venous Congestion: Causes:- LVF (left ventricular failure) M. S (Mitral Stenosis) Manifestations : - Dyspnoea -Orthopnea - P.N. Dyspnoea -Cardiac asthma -Cough -Haemoptysis Cardiac Dyspnoea: Dyspnoea = Breathlessness =uncomfortable awareness of breathing. It is mainly due to reduced elastic properties of the lung (reduced pulmonary compliance).

Local Cardiac examination: Inspection and Palpation. Percussion. Auscultation. Inspection and Palpation A- Shape of the precordium: -Precordial bulge®denotes cardiac enlargement since childhood. -Skeletal deformities : Such As kyphosis, scoliosis or pectus excavatum. These may cause alteration of the position of the heart and great vessel which may predispose to heart failure. Apex Beat: Examine for : 1-Visible or not. (causes of invisible apex ? ) 2-Site: (Apex beat is the outermost and lowermost palpable impulse on the chest wall. ) * Normally in the left 5th intercostal space, just inside the Midclavicular line (MCL) (9 cm from the mid line ). *Abnormalities in site : -Outward displacement----®Right ventricular enlargement, chest disease. -Outward and downward ®Left ventricular enlargement, ventricular Aneurysm -Displacement to Rt.-------®congenital Dextrocardia, chest disease 3-Extent : Localized apex: Normal apical impulse do not exceed an inch in diameter ( L

Gastroesophageal Reflux Disease, Causes, Mechanism, Diagnosis, Treatment and Complications Definition: According to the American College of Gastroenterology (ACG) GERD is defined as; “Symptoms OR mucosal damage produced by the abnormal reflux of gastric contents into the oesophagus”. Often this condition is chronic and relapsing. You may see complications of GERD in patients who lack typical symptoms. Mechanism: The primary barrier to gastroesophageal reflux is the lower oesophagal sphincter (LES) LES normally works in conjunction with the diaphragm If barrier disrupted, acid goes from stomach to oesophagus and causes mucosal damage and symptoms of GERD. Clinical Manifestations: Most common symptoms are; 1. Heartburn—retrosternal burning discomfort (behind the sternum) 2. Regurgitation—effortless return of gastric contents into the pharynx without nausea, retching, or abdominal contractions 3. Dysphagia—difficulty swallowing Other symptoms include: 1. Chest pain, water bras

Dr. Haseeb Sattar Lecturer of Clinical Pharmacy and Clinical Practices - University of Lahore Islamabad Campus Lecture Notes, More will be published soon. 1.  Gastroesophageal Reflux Disease (GERD)-Causes–Mechanism-Diagnosis, Treatment And Complicatons 2.  CVS Examination-Cardiac Examination-With Symptoms Analysis 3.  Analysis Of Cardiac Disease Symptoms-Cardiac Disease Symptoms 4.  Peptic Ulcer Disease (PUD)-Causes-Diagnosis And Treatment Visit again soon Thanks MedicoTips.com

Dr.Haseeb Sattar PharmD  2005-2010 Resident/House Officer in Internal Medicine   Medical Unit 2  Holy family Hospital Oct-2010 to Oct 2011 Lecturer of Clinical Pharmacy and Clinical Practices    University of Lahore Islamabad Campus   2011 to Present Awards and Honours    ·     Mumtaz Scholarship in  1st Semester  during university ·     Mumtaz Scholarship in  2 nd   Semester  during university ·     Mumtaz Scholarship in  3 rd  Semester  during university ·     Mumtaz Scholarship in  4 th  Semester  during university ·           Jiangsu  Jiasmine Govt Scholarship P.R China

Uterine Inversion: Uterine inversion either partial or complete is a serious but rare obstetric complication. In this condition the fundus of the uterus extend to, or through the cervix and it may come out of the vagina. It usually occurs in third stage of labour. This is a life-threatening condition and require prompt diagnosis and definitive treatment. Very rarely it may occur in non pregnant patients and in these patients it is usually associated with prolapsing uterine fibroids. Although it may occur in association with other tumors. Classification Of Uterine Inversion: First Degree Inversion: The inverted fundus extend to, but not through the cervix.   Second Degree Inversion: The inverted fundus extend through the cervix but remain inside the vagina Third Degree Inversion: The inverted Fundus extend outside the vagina. Total Inversion The vagina and uterus both are inverted. Causes  and Risk Factors Of Uterine Inversion: Uterine inversion is usuall