Dr Mehmood Khan Afridi

Dr Mehmood Khan Afridi Assalam o Alaikom! Islam is the way of life

I have started this page to spread awareness and help people with medical and surgical conditions and it's proper management.All the movers are welcome for any query ,I will gladly help and provide my services.

TYPES OF HEPATITIS
18/09/2025

TYPES OF HEPATITIS

Diabetic Ketoacidosis (DKA) – Management Made Simple!
17/09/2025

Diabetic Ketoacidosis (DKA) – Management Made Simple!

16/09/2025

πŸ”΅Acute Kidney Injury { AKI }
⚑KDIGO CRITERIA ⚑
~~~~~~~~~~~~~~~~~~

✍️ Definition :

✏️Rapid decline in the Glomerular Filtration Rate "GFR" over hours to days with retention of nitrogenous waste products ( ↑Urea & ↑Creatinine) with disturbed electrolytes , Acid base and Fluid homeostasis .

β­• According to the international [Kidney Disease Improving Global outcome] ( KDIGO) Foundation
πŸ‘‡πŸ‘‡πŸ‘‡πŸ‘‡

β–ΆTo diagnose AKI , the patient must have one or more criterion of the following :

1️⃣ Increase in Serum Creatinine β‰₯ 0.3 mg/dl within 48 hours

Ex πŸ‘₯
Patient has baseline creatinine 1.2 , and within 48 Creatinine becomes 1.8

⚑Change in creatine = 1.8 - 1.2 = 0.6
β–Ά So it means > 0.3 ---> AKI ‼️

---------------------

2️⃣ Increase in serum Creatinine by β‰₯ 1.5 Γ— baseline ( known or have presumed to have occurred within prior 7 days)

---------------------

3️⃣ Urine Volume < 0.5 ml/kg/hr for 6 hours

Ex πŸ‘₯

if a patient's weight : 100 kg , so if Urine output becomes < 300 ml over 6 hours , he has AKI !!
‡️

#0.5 ml/kg/hr ➑️ 0.5 Γ— 100 = 50 ml/hr
--> in 6 hours ➑️ 50 Γ— 6 = 300 ml over 6 hrs

πŸ’¬πŸ’¬πŸ’¬ Then , You have to do Staging of Acute Kidney Injury { AKI} ( optional ) ❗

⚑ KDIGO classification of AKI
=========================

πŸ’« Stage 1
==========

πŸ”΅ Serum Creatinine criteria

πŸ”Ž 1.5 - 1.9 times of baseline creatinine
Or β‰₯ 0.3 mg/dl in < 48 hours

πŸ”΅ Urine output criteria

πŸ”Ž UO < 0.5 ml/kg/hrs for 6 - 12 hrs

πŸ’« Stage 2
==========

πŸ”΅ Serum Creatinine Criteria

πŸ”Ž 2 - 2.9 times of baseline creatinine

πŸ”΅ Urine Output Criteria

πŸ”Ž UO < 0.5 ml/kg/hrs for β‰₯ 12 hrs

πŸ’« Stage 3
=========

πŸ”΅ Serum Creatinine Criteria

πŸ”Ž β‰₯ 3 times of baseline Creatinine or increase in serum Creatinine β‰₯ 4 mg/DL or initiation Of Renal replacement therapy ( RRT)



πŸ”΅ Urine output Criteria

πŸ”Ž UO < 0.3 ml/kg/hr for β‰₯ 24 hrs
Or anuria β‰₯ 12 hrs ( < 50 - 100 ml over β‰₯ 12 hrs

16/09/2025

🚨 Spot the Difference: Life-Threatening Emergencies

πŸ’” Cardiac Tamponade
πŸ”» Hypotension
πŸ”» JVD
πŸ”» Muffled heart sounds

🫁 Tension Pneumothorax
πŸ”» Hypotension
πŸ”» JVD
πŸ”» Absent breath sounds

πŸ“ Listen carefully to ❀️ & 🫁 to differentiate!

Fibromyalgia!Many Clinical features of the CFS/Myalgic Encephalomyelitis and Fibromyalgia Overlap, While MSK pain predom...
16/09/2025

Fibromyalgia!

Many Clinical features of the CFS/Myalgic Encephalomyelitis and Fibromyalgia Overlap, While MSK pain predominates in Fibromyalgia whereas,Lassitude dominates Myalgic Encephalomyelitis/CFS.
Physical Examination is Normal Except for Trigger Points of pain produced by palpation.
There are no specific biomarker for Fibromyalgia and Lab studies are Generally Normal.
Fibromyalgia is diagnosis of Exclusion.

"Abdominal Pain" Differential diagnosis!!Mnemonic βœ…"ABDOMINAL"
15/09/2025

"Abdominal Pain"
Differential diagnosis!!

Mnemonic βœ…
"ABDOMINAL"

Alzheimer's Disease 5A's πŸ–ΌοΈπŸ‘‡πŸ»
15/09/2025

Alzheimer's Disease 5A's πŸ–ΌοΈπŸ‘‡πŸ»

15/09/2025

Pneumonic For heart Murmurs πŸ˜•

1. MSAID - Mitral Stenosis; Aortic insufficiency (Diastolic Murmur)

2. MIASS - Mitral Insufficiency; Aortic Stenosis (Systolic Murmur)

3. Mitral - Axilla; Aortic - Sternal

13/09/2025

Pharmacologic Roles of Vitamins

when vitamins are used like drugs rather than just to correct a deficiency.

Vitamin A (Retinoids)
β€’ Dermatology: Acne vulgaris, psoriasis, photoaging (topical or oral retinoids like tretinoin, isotretinoin, acitretin)
β€’ Oncology: Acute Promyelocytic Leukemia (all-trans retinoic acid, ATRA)

Vitamin B3 (Niacin / Nicotinic Acid)
β€’ Dyslipidemia therapy: ↓ LDL, ↓ triglycerides, ↑ HDL (though less used now due to side effects)

Vitamin B6 (Pyridoxine)
β€’ Drug-induced neuropathy prevention: With isoniazid, hydralazine, cycloserine, penicillamine
β€’ Seizure control: Rare pyridoxine-dependent epilepsy in neonates

Vitamin B9 (Folic Acid / Folinic Acid)
β€’ Neural tube defect prevention in pregnancy
β€’ Chemotherapy rescue: Folinic acid (Leucovorin) rescues normal cells after methotrexate; also used with 5-FU to enhance effect

Vitamin B12 (Cobalamin)
β€’ Treatment of megaloblastic anemia
β€’ Neuropathy management (subacute combined degeneration, diabetic neuropathy adjunct in some regions)

Vitamin C (Ascorbic Acid)
β€’ Enhances iron absorption in iron-deficiency anemia
β€’ Antioxidant therapy: Being studied in sepsis and critical illness (high-dose IV vitamin C)

Vitamin D (Calcitriol, Alfacalcidol, etc.)
β€’ Osteoporosis therapy (with calcium, bisphosphonates, etc.)
β€’ CKD: Calcitriol/active analogs to suppress secondary hyperparathyroidism
β€’ Hypoparathyroidism: Vitamin D analogs as hormone replacement

Vitamin E (Tocopherol)
β€’ Antioxidant use: Under research in non-alcoholic steatohepatitis (NASH), Alzheimer’s disease, ataxias

Vitamin K
β€’ Antidote for warfarin overdose
β€’ Prevention of hemorrhagic disease in newborns (prophylactic IM injection at birth)Pharmacologic Roles of Vitamins

when vitamins are used like drugs rather than just to correct a deficiency.

Vitamin A (Retinoids)
β€’ Dermatology: Acne vulgaris, psoriasis, photoaging (topical or oral retinoids like tretinoin, isotretinoin, acitretin)
β€’ Oncology: Acute Promyelocytic Leukemia (all-trans retinoic acid, ATRA)

Vitamin B3 (Niacin / Nicotinic Acid)
β€’ Dyslipidemia therapy: ↓ LDL, ↓ triglycerides, ↑ HDL (though less used now due to side effects)

Vitamin B6 (Pyridoxine)
β€’ Drug-induced neuropathy prevention: With isoniazid, hydralazine, cycloserine, penicillamine
β€’ Seizure control: Rare pyridoxine-dependent epilepsy in neonates

Vitamin B9 (Folic Acid / Folinic Acid)
β€’ Neural tube defect prevention in pregnancy
β€’ Chemotherapy rescue: Folinic acid (Leucovorin) rescues normal cells after methotrexate; also used with 5-FU to enhance effect

Vitamin B12 (Cobalamin)
β€’ Treatment of megaloblastic anemia
β€’ Neuropathy management (subacute combined degeneration, diabetic neuropathy adjunct in some regions)

Vitamin C (Ascorbic Acid)
β€’ Enhances iron absorption in iron-deficiency anemia
β€’ Antioxidant therapy: Being studied in sepsis and critical illness (high-dose IV vitamin C)

Vitamin D (Calcitriol, Alfacalcidol, etc.)
β€’ Osteoporosis therapy (with calcium, bisphosphonates, etc.)
β€’ CKD: Calcitriol/active analogs to suppress secondary hyperparathyroidism
β€’ Hypoparathyroidism: Vitamin D analogs as hormone replacement

Vitamin E (Tocopherol)
β€’ Antioxidant use: Under research in non-alcoholic steatohepatitis (NASH), Alzheimer’s disease, ataxias

Vitamin K
β€’ Antidote for warfarin overdose
β€’ Prevention of hemorrhagic disease in newborns (prophylactic IM injection at birth)

❇️ Pheochromocytoma Points to Remember:β†’ Tumor of chromaffin cells (neuroendocrine cells) of the adrenal medullaβ†’ Secret...
13/09/2025

❇️ Pheochromocytoma Points to Remember:
β†’ Tumor of chromaffin cells (neuroendocrine cells) of the adrenal medulla
β†’ Secretes catecholamines (mostly norepinephrine, sometimes epinephrine, rarely dopamine)

▢️ Pheochromocytoma Rule of 10s
β†’ 10% bilateral
β†’ 10% extra-adrenal (paragangliomas)
β†’ 10% malignant
β†’ 10% pediatric
β†’ 10% familial (but actually up to 40% are hereditary)

βœ”οΈ Associated Syndromes (Autosomal Dominant)
β†’ MEN 2A & 2B
β†’ Von Hippel-Lindau (VHL)
β†’ Neurofibromatosis type 1 (NF1)

βœ”οΈ Clinical Presentation
πŸ›‘ Classic triad
β†’ Episodic headache
β†’ Sweating (diaphoresis)
β†’ Palpitations/tachycardia

🩺 Other signs
β†’ Hypertension (sustained or paroxysmal)
β†’ Anxiety, tremors, weight loss
β†’ Orthostatic hypotension (due to volume depletion)
β†’ Hyperglycemia (catecholamines inhibit insulin)

βœ”οΈ Diagnosis

Initial test (high-yield):
β†’ Plasma free metanephrines or 24-hr urinary catecholamines/metanephrines

Confirmatory test:
β†’ Clonidine suppression test (in special cases)

Imaging:
β†’ CT/MRI of abdomen (for adrenal mass)
β†’ MIBG scan if extra-adrenal or metastatic

βœ”οΈ Treatment

Preoperative medical management:
β†’ Ξ±-blocker first: Phenoxybenzamine (non-selective, irreversible)
β†’ Then Ξ²-blocker: Propranolol or atenolol (to control tachycardia)
❗ Never give Ξ²-blocker first β†’ unopposed Ξ±-vasoconstriction β†’ hypertensive crisis

Definitive:
β†’ Surgical resection

βœ”οΈ Complications
β†’ Hypertensive crisis
β†’ Arrhythmias
β†’ Cardiomyopathy (catecholamine-induced)

❀️ Aortic Dissection β€” clinical caseπŸ”Ž Clinical Case: Sudden Severe Chest PainπŸ‘¨β€πŸ¦³ Patient: 58-year-old male with uncontro...
12/09/2025

❀️ Aortic Dissection β€” clinical case

πŸ”Ž Clinical Case: Sudden Severe Chest Pain

πŸ‘¨β€πŸ¦³ Patient: 58-year-old male with uncontrolled hypertension

⚑ Onset: Sudden, severe β€œtearing” chest pain radiating to the back

πŸ“Š Vitals: BP 190/110 mmHg | HR 110 bpm | SpOβ‚‚ 96% | RR 24/min

βœ‹πŸ€š Exam: Unequal pulses in upper limbs

πŸ‘‰ Think Aortic Dissection when pain is abrupt, severe, tearing + pulse deficit

🚨 Red Flags on Physical Examination

⚑ Abrupt, severe chest/back/abdominal pain

βœ‹ Pulse deficit / BP difference >20 mmHg between limbs

🧠 Neurological deficits (stroke, syncope, spinal ischemia)

🎢 New early diastolic murmur (Aortic regurgitation)

⬇️ Shock, hypotension, tamponade signs

πŸ–ΌοΈ Imaging & Investigations β€” β€œWhen Time = Blood”

πŸ–₯️ CT Aortogram β†’ Gold standard (sensitivity >95%)

πŸ«€ TEE (Transesophageal Echo): Useful in unstable patients

🩻 Chest X-ray: Widened mediastinum, abnormal aortic contour, pleural effusion

πŸ§ͺ Labs:

D-dimer ↑ (may help rule out if very low)

CBC, renal function (contrast safety)

Troponin (to rule out ACS differential)

🩺 Classification (Stanford System)

πŸ”΄ Type A: Involves ascending aorta β†’ Surgical Emergency (cardiothoracic repair)

🟠 Type B: Limited to descending aorta β†’ Medical therapy first (unless complications)

πŸ’Š Initial Emergency Management

πŸ›Œ Strict bed rest, monitoring in ICU

πŸ’‰ IV opioids (morphine/fentanyl) for pain control

❀️ Beta-blockers: Labetalol, esmolol β†’ HR < 60 bpm

πŸ’Š If BP remains high β†’ IV vasodilator (nitroprusside/nicardipine) only after beta-blockade

🎯 BP Target: SBP 100–120 mmHg

πŸš‘ Type A β†’ Urgent Surgery

πŸ’Š Type B β†’ Medical management (unless rupture, malperfusion, expansion)

βœ… Key Takeaways

Classic triad: Sudden tearing pain + pulse deficit + mediastinal widening

Stanford A = Surgery | Stanford B = Medical first

Time = Blood β†’ Rapid diagnosis and transfer to cardiothoracic team

Always control pain, HR, and BP before definitive treatment 🌹

Address

Pakistan Islamabad
Islamabad
44000

Website

Alerts

Be the first to know and let us send you an email when Dr Mehmood Khan Afridi posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Shortcuts

Share

Share on Facebook Share on Twitter Share on LinkedIn
Share on Pinterest Share on Reddit Share via Email
Share on WhatsApp Share on Instagram Share on Telegram

Category