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By Dr. Fibhaa Syed  MBBS, FCPS, MRCP, SC Endocrinology Assistant Professor of Medicine Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences Following steps should be follow while interpreting ECG. Details may be found elsewhere, in this article brief outlines regarding ECG interpretation are shared, which were explained by Assistant Professor of Medicine, Dr. Fibhaa Syed during a Post-Graduate teaching session at Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad Pakistan. Please note Normal Criteria is shared here unless specified otherwise. ECG Interpretation Steps Identification Name,  Date and Time Calibration  Normally Width = 5 squares (1 big square), (one small square = 0.04 seconds) Height = 10 small squares (1 small square = 0.1mV, 10 small squares = 1mV Rate 300 divided by Number of of large squares between two QRS complex = Rate / min Rhythm Check in lead II.  QRS ...

Patiromer is a relatively new potassium binder and studies showed it is superior to Kayexalate which has been conventionally used to lower potassium in hyperkalemia due to various causes, especially renal failure. Patiromer works by binding to free potassium available the intestine and prevent its absorption into the bloodstream. It releases positive calcium ions which are absorbed instead of potassium if needed. As free potassium readily combines to the Patiromer, thus less potassium is available for absorption, this results in a decrease in potassium blood potassium level. Patiromer is not absorbed by the gut, thus it has no systemic side effects. The side effects are mainly related to the gut. Another advantage of Patiromer over Kayexalate is that it can be given in heart failure, hypertension, and CKD etc. Kayexalate has high sodium content and this can be potentially harmful in case of heart failure, hypertension and even in advanced chronic kidney disease. Anothe...

Azithromycin a widely used broad-spectrum antibiotic used to treat community-acquired pneumonia or respiratory tract infections. It is observed that azithromycin if given with statins, may cause severe rhabdomyolysis which may lead to an acute renal shutdown. A case reported by Dr Gaurav Alreja shows a possible interaction of azithromycin with simvastatin, A 73 years old male who was given azithromycin for bronchitis, he was taking simvastatin. He presented in emergency with the acute weakness of all extremities, he was found to have abnormal renal function tests with elevated creatinine. Simvastatin was stopped, and he was started on supportive management, bicarbonate was replaced, his renal function improved, and two months later he was again started on simvastatin without recurrence of symptoms. This gives us an indication that probably the azithromycin was responsible for the acute severe rhabdomyolysis and resultant acute renal failure when was given along with the statin. So...

Sometimes it becomes difficult to choose a drug in those patients who have multiple co-morbidities. That is are suffering from more than one disease and physician needs to choose a few out of many drugs to avoid drug-drug interactions. Anti-epileptic drugs, or the drugs which are used to treat seizures, do interact with other drugs.  Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, topiramate and primidone are enzyme inducers. Enzyme inducers decrease the efficacy of a drug which is metabolized by the induced enzymes because more concentration of the enzyme will be available and the drug will be quickly metabolized and removed from the system.  Valproic acid, felbamate, rufinamide, and stiripentol, on the other hand, are enzyme inhibitors.  Therefore, we can't give these drugs to a patient who is taking a drug for any medical problem which is metabolized by the liver enzymes (eg cytochrome p450 enzyme system).  The anti-epileptic drugs which are not ...

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...

Professor Dr Rauf Niazi is the Head of Department of Internal Medicine and Endocrinology of Shaheed Zulfiqar Ali Bhutto Medical University PIMS Islamabad , Pakistan. He is well-known internist and endocrinologist of Pakistan. He has earned multiple fellowships including Fellowship of American College of Endocrinology, Fellowship of Royal College of Physician (London), FRCP (Glasgow), Fellowship of College and Physicians and Surgeons Pakistan. He trained 1000s of fellows so far, who are now serving the humanity all around the world. Clinic Address: Address :  Qadeer City Centre, Office 10, Unit 1Q, Sumbal Rd, F-10 Markaz, F-10, Islamabad 44000 Phone :  (051) 2299466