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A 35-year-old male presented to Emergency department of PIMS hospital complaining of intermittent hematuria, lower abdominal pain, and dysuria. Blood complete picture, Urine routine examination, and renal function tests were ordered along with an X-Ray KUB. X-Ray KUB revealed a Big Stone in the Urinary Bladder. The patient was referred to urology for further management. A Large stone in the urianry bladder. Courtesy of Dr. Adil Ramzan, MBBS, MD Internal Medicine A large stone in urinary bladder. Courtesy of Dr. Adil Ramzan MBBS, MD Internal Medicine, Pakistan Institute of Medical Sciences, SZABMU, Islamabad Pakistan Dr. Adil Ramzan, MBBS, MD Internal Medicine Pakistan Institue of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical Univeristy Islamabad Pakistan

Note Please left click on the slide the for transitions instead of using the "Next & Previous" buttons, as left mouse button click triggers the intra-slide animations. Gastroenterology Experts Symposium held at Skardu Shagrilla Pakistan from 4th to 7th August 2016. Dr Tayyab Saeed Akhtar, FCPS (Internal Medicine) talked about the latest (2016) guidelines regarding the management of Upper GI bleed. If you have any questions, feel free to comment below.

What is the best time to do jogging or running to promote more weight loss? Answer; Weight loss is not an easy task, you have to burn 3500 calories to lose 1 lb of weight. But if you are taking 3000 calories per day and you are burning only 2500, it means there is a net excess of 500 calories, and these 500 calories will be stored as fat or glycogen.  On the other hand, if you are taking 2000 calories and are burning 2200 calories per day, then it means, you are burning 200 calories using your body stores, which are present in the form of fats or glycogen.  According to me, and my personal experience plus professional knowledge, the best time to exercise is early morning when you wake up. The reason is, at this time, you haven't had taken anything since last 9-10 hours, therefore, at this time the working out or jogging will take energy from your body stores instead of the food that you take because your stomach has been empty and since last 5-6 hours. ...

Bariatric surgery is a surgical procedure which is done on intestine or stomach to induce weight loss.  The incident of Obesity (BMI > 30) is rising gradually and it is estimated by the end of 2025 more than 40% of the United States population will be affected by obesity.  It is not easy to deal with the obesity with diet and exercise alone, although diet, exercise, and pharmacological therapy are the first line therapies to deal with the obesity, but if the BMI becomes more than 40 then the safe bariatric surgical procedure becomes an appropriate and preferable therapy. A number of bariatric surgical procedures are being done worldwide, these include.  1. Laparoscopic Roux-en-Y Gastric ByPass (LRYGBP) 2. Laparoscopic adjustable gastric banding (LAGB) 3. The Laparoscopic Sleeve Gastrectomy (LSG) Among these procedures, LAGB has higher long term failure rates, LRYGBP & LSG are done more frequently and among these two LSG is safer, quick a...

This is the story of a 30 year old female patient who had recurrent abdominal pain for 3-4 months with no other obvious signs or symptoms. Her basic workup was normal. She underwent upper GI endoscopy. What is Ascariasis? Ascariasis is an infection of the human intestine caused by a worm or parasite called Ascaris lumbricoides (A. lumbricoides), which is a species of parasites called roundworms. Ascariasis is the commonest human parasitic intestinal infection. About 10% of the developing world which includes population of almost all of the south Asian countries, is infected with intestinal worms, according to the records of World Health Organization (WHO). Ascariasis is most common in places without modern sanitation. It’s transmitted through uncooked, or non-sterile/boiled food and water. What causes Ascariasis?  You can become infected with ascariasis after ingesting the eggs of the A. lumbricoides roundworm by any mean. The eggs are usually found in soil contaminated by...

The new session of PMDC step 3 preparation will start from 13th of July, 2016. Dr Tayyab Saeed Akhtar, FCPS Internal Medicine, conducts the classes under his supervision, The academy is there for the past 10 years and has a 90 per cent success rate. Those foreign students who need guidance and want to prepare for PMDC step 3 may apply for July 2016 session. Details are as follow.

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...