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Q: A 28 y/o F comes to OPD, she is known the case of epilepsy since childhood, taking  Valproate and levetiracetam, she has been seizure free since last 11 months, she tells you that she is 8 weeks pregnant, what will you do? Answer:  In pregnancy, the incidence of seizure may increase or decrease. But seizure in pregnancy can be potentially dangerous and life-threatening, therefore, the anti-epileptic drugs which patient is taking with optimal control of seizures should be continued and the patient should be counselled about the risk of teratogenicity and benefits. More-over, anti-epileptic drugs increase the risk to 6% as compared to placebo (3%), and among anti-epileptic drug valproate possess the highest risk (up to 20%), newer antiepileptic drugs have a far lower risk of teratogenicity as compared to valproate and topiramate (which have the highest). Alternatively if patient is not pregnant and wants to be pregnant you may choose to wean her off anti-epileptics if ...

In this article, we will summarize the guidelines and recommendations about the initiation of enteral or tube feeding in a patient of acute stroke with dysphagia. Summary of Recommendations: When to start enteral feeding in a patient of stroke? Each patient of stroke should be evaluated for dysphagia as soon as possible. How to evaluate dysphagia in a patient of acute stroke? There are five ways of assessing dysphagia; Water swallowing test Multiple consistency test. Swallowing provocation test Videofluoroscopic swallowing study (VFSS) Fiberoptic endoscopic evaluation of swallowing (FEES) Videofluoroscopic swallowing study (VFSS) is the gold standard of swallowing evaluation.  Importance of starting early nutrition in a patient of acute stroke If a patient doesn't pass the swallowing evaluation. Then we should think about alternate modes of nutrition. As nutrition in a patient of stroke affects the outcome, decreases the risk of infections, bedsores, and also decrea...

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...

Alprazolam is available in the market with the trade names of Xanax, Alp and many others. It belongs to a class of drugs called benzodiazepines. Xanax is generally used to manage anxiety, stress and panic attacks. It shouldn’t be used to treat psychosis. Xanax (alprazolam) should be sold under prescription only. In developed countries, it is strictly sold under prescription but unfortunately, in many developing countries, it is being sold as an over-the-counter drug. A person can get Xanax by asking the medical storekeeper to give him some sleeping pills. He takes them, uses them according to his own wishes and when after some time, one tablet doesn’t work he adds one more. This is a very wrong practice. Alprazolam (Xanax) is not Paracetamol (acetaminophen) that can be used anywhere anytime. Many individuals do not know the proper usage of Xanax (alprazolam). Especially in developing countries where there is a lack of education and also due to the heavy flow of the patients to governme...

“Nowadays, competition has largely increased among the medical professionals, you have to be perfect in your skills in order to be successful in competitive medical examinations, such as FCPS Part II, MRCP USMLE and other exams” Said Dr. Siddique Akbar Satti, Head Department of Medicine Capital Hospital Islamabad and member of board of examination, College of Physicians and Surgeons Pakistan, while teaching his postgraduate trainees “How to do cerebellar examination”. You shouldn’t be doing minor mistakes while examining the patient physically. Because now, a minor mistake can give you a major blow which can be powerful enough to leave you behind. Dr Siddique Akbar Satti was teaching his student that how should you proceed if you are asked to do the cerebellar examination in 5 minutes in the exam. “You mustn’t miss even a minor step,” said Dr Satti. 1. Consent Wash your hands Introduce yourself to the patient Explain what you are going to do and why. After explaining your methods, ...

Tension is one of the major causes of all headaches. Tension headache is mild to moderate in intensity and feels like something is pressed inside the head. It is very uncomfortable and gives a grim look on the face of the sufferer. Other people can easily recognize him that he is suffering from some kind of tension or stress Types of Tension Headaches: 1. Episodic Tension Headache. Episodic tension headache occurs in episodes and between the episodes the person feels no symptom at all. Each episode lasts from 30 minutes to a week. Episodic tension headache occurs for less than 15 days a month for consecutive three months. 2. Chronic Tension Headache. Tension headache becomes chronic if it occurs more than 15 days a month for consecutive three months. Risk factors: Female sex is a risk factor because most of the females suffer from a tension headache. Middle age is another risk factor. Cause: Stress, tension or unsolved problem cause tension headache. Treatment. Over the counter pa...

Q: Hi there may be the dumb question I am so terrified of having a brain aneurysm I heard of two people that died instantly of them I read you could have weak arteries your whole life and not know is this true? Would my doctor be able to tell if I do by blood pressure or taking my pulse? Thank you Answer: Well if someone died of a brain aneurysm, it doesn’t mean that you will surely have that particular disease. In brain aneurysm, an abnormally dilated artery is present in the brain, which may put pressure on the surrounding healthy brain, this continuous pressure damages the brain. This result in certain symptoms, like headache, blurred vision, ataxia, loss of balance, syncope, weakness of a particular area of the body, slurred speech etc. These symptoms alarm a patient that something is wrong with him and he or she goes to a doctor. Sometimes, brain aneurysm grows rapidly and may rupture, (ruptured aneurysm) which may lead to sudden death. If you are a healthy person, and you do...

Q: Hello I have a question. My son has been on Suboxone (buprenorphine and naloxone) for approx 8 months. 1 8mg film daily. Finally, he has smartened up and wants to be rid of this lifestyle forever. So on December 17, 2012, he took his last half. He had a prescription of tramadol from a previous injury so in order to eliminate the withdrawal from the suboxone he has been taking the tramadol. If it has been 13 days without any suboxone will he still go through the physical withdrawals from it? If so how long do they typically last? If he were going to suffer any withdrawals wouldn't they have already kicked in? Thank you so much for taking the time to help me. A: Ok tell me for how long had he took opioids? and ( which drug he was addicted to). Suboxone is used to treat opioid addiction. Was he addicted to other stronger opioids? Has he encountered any withdrawal symptom?  What kind of symptoms did he have? and is he absolutely fine now? Q: If I were to have to guess I would ...

Ischemic stroke Concept:  The ischemic stroke is occlusion of a blood vessel that stops blood flow to a specific region of the brain, interfering with the neurological functions dependent on the region affected, producing deficit symptoms or characteristics, around 80% of strokes are ischemic. Ischemia can be permanent or temporary. In temporary cases, blood starts flowing back after some time. Such Ischemia is popularly known as "threat of stroke" (or Transient Ischemic Attack in medical terms). This is important because it is a sign that permanent ischemia can occur at any time if nothing is done to avoid them patient may get attacked by stroke. Signs and Symptoms:  Difficulty in speaking or understanding, loss of sensation in the limbs and balance unfold in minutes and get worse over the hours. The lack of irrigation in the brain may have given some warning sign weeks or even months before in the form of "mini attacks" in which signs appears and disappears s...