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A Patient who has a stroke commonly presents with altered sensorium, dysphagia, and weakness of a part or whole side of the body depending on the extent of infarct and area of the brain that is involved. If a patient has dysphagia or altered sensorium, then he is at risk of having aspiration. So in such situation, oral or enteral feeding shouldn't be allowed during the first 72 hours at least. Professor Dr. Rauf Niazi , explained during a teaching session at PIMS hospital, "A nasogastric tube should only be passed if needed as it may actually increase the risk of aspiration. In the presence of nasogastric tube the lower esophageal sphinctor (a valve at the lower end of esophagus which prevents reflux of stomach contents back to esophagus) can't close properly and food or gastric secretions may regurgitate back to esophagus, thus, increase the risk of aspiration. If patient is at risk of aspiration or is having recurrent aspiration, then you should pass NG tube ac...

Iron deficiency anaemia is not an uncommon disorder. A large number of population is of developing countries such as Pakistan is affected by iron deficiency anaemia. Women are more affected as compared to men due to obvious reason such as menorrhagia, polymenorrhagia, Postpartum bleeding etc. Signs on Physical Examination The physical examination can show: Tachycardia Smooth tongue Brittle nails Koilonychia Pallor PICA Oesophagal webs.  Stages of Iron Deficiency Iron deficiency anaemia is divided into three stages, Stage 1 is called negative iron balance,  More iron is used than intake, but there will be no anaemia, no change in RBC morphology, but iron stores will be low. Stage 2 is called iron-deficient erythropoiesis.  Iron stores are depleted, the hypochromic picture may appear in the RBC morphology Stage 3 is the iron deficiency anaemia Haemoglobin decreases with hypochromic and microcytic RBC morphology.  Diagnosis of Iron Defici...

Dr. Farida Tahir is Associate Professor of Internal Medicine Shaheed Zulfiqar Ali Bhutto Medical University PIMS Islamabad. Shaheed Zulfiqar Ali Bhutto Medical University is one the most peristegious medical universities of Pakistan, and Pakistan Institute of Medical Sciences which comes under SZABMU is the largest hospital of the Pakistan. Complicated Patients from all around Pakistan are referred to Pakistan Insitute of Medical Sciences (PIMS, SZABMU). Pakistan Institute of Medical Sciences has all dedicated departments of subspecialties of medicine and surgery including, plastic surgery, oromaxillary & facial surgery, cardiosurgery,neurosurgery, orthopedics, trauma surgery, gastroentreology, rheumatology, endocrinology, dermatology, neurology and nephroogy among others. Dr. Farida Tahir is the Associate Professor of Internal Medicine and Vice Head of the Department of Medicine and Joint supervisor of the trainy fellows of College and Physician and Surgeons Pakistan and Doct...