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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...

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...

Due to a strong request of the trainee fellows from all around Pakistan, again this year, a Mock examination for FCPS part II was held at Capital Hospital Islamabad under the supervision of Dr Siddique Akbar Satti  who is the Head Department of Medicine, former Executive directed of Capital Hospital Islamabad. and Faculty Fellow of  the Prestigious College of Physicians and Surgeons Pakistan Dr. Sidduqe Akbar Satti and Dr. Farhan are asking questions to a trainee fellow during the Mock examination Trainee fellow thanked Dr Siddique Akbar Satti for putting his efforts in creating such a memorable, useful and helpful examination scenario. I am really thankful to the organizers of this examination, This exam helped me to identify my weak points, I will elminate those point, will work on them and Inshallah will pass the final exam, one of trainee fellows commented  Dr. Siddique Akbar Satti is observing the examination skills of a trainee fello...

Dr. Hafeez A Memon is working as Deputy Registrar in a Prestigious Medical University of Pakistan, Shaheed Zulfiqar Ali Bhutto Medical University. He is a qualified pediatrician and research scholar.In his twitter Headline, he describes himself as "I am a public health professional (doctor), researcher and working for the development of the community" Dr. Hafeez Memon plays his role in the development of health sector of Pakistan. Shaheed Zulfiqar Ali Bhutto Medical University PIMS is the most prestigious Medical Institute of Pakistan. Royal College of Physicians and Surgeon of UK also have recognized this institute and agreed to accept medical trainees from SZABMU PIMS for medical training of UK.

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