Medicine by Prof. Tariq Waseem

22/01/2026

Pakistan Society of Internal Medicine is conducting a Preconference Satelite Workshop on "the Management of Electrolytes disturbances" by experienced Physicians and Nephrologist Saleem Memorial Hospital Lhr. On Saturday 24th January 2026 at 2.00 pm.

Register on link below or via QRscan...

We are recognized leader in quality patient care, advocacy, education and enhancing career satisfaction for internal medicine experts.

12/12/2025

Join us for Physician Forum Meeting at 2.00 pm Saturday 13th December 2025 at Saleem Memorial Hospital Lahore or on Zoom link:

https://us06web.zoom.us/j/9023051234?pwd=IzntB8Ga23QUeHutw0JpnjhyW1uw48.1&omn=83281252036

21/11/2025

Gene Specific Triggers for Arrhythmias in Long QT Syndrome.

Long QT syndrome (LQTS) is a leading cause of sudden death in young persons, with a prevalence exceeding 1 in 2000. It is caused by variants in genes encoding primarily for potassium-ion and sodium-ion channels. The major genes associated with three types of LQTS are KCNQ1, KCNH2, and SCN5A and are named Type 1, 2, and 3 respectively.

Gene-specific triggers for arrhythmic events in long QT syndrome have been identified.
1. Persons with long QT syndrome type 1 are at increased risk whenever sympathetic activity increases, as during emotional or physical stresses, especially swimming.
2. Persons with long QT syndrome type 2 are at increased risk when exposed to sudden noises, especially if they are at rest or asleep and are woken abruptly; they are also exquisitely sensitive to low plasma potassium levels and to QT-interval–prolonging drugs,
3. Female patients are at high risk during the postpartum period, probably owing to sleep disruption causing rebounds of the arrhythmogenic rapid-eye-movement sleep.

Gene Specific treatment for LQTS.
1. Since the mid-1970s, beta-blockers have represented the mainstay of therapy for patients with LQTS, and their efficacy has been repeatedly confirmed independent of the genotype.
2. Most, but not all, long QT syndrome type 3 variants respond to mexiletine. Recent data show that in almost 70% of patients with long QT syndrome type 2, the QTc is shortened with mexiletine.

Further Reading: NEJM Nov 20, 2025

19/11/2025

Join us in person or on Zoom for fortnightly meeting of Physician Forum on Saturday 22nd November 2025 at 2.30 pm.

08/11/2025

Celebrating World Diabetes Day at Saleem Memorial Hospital Lhr on 14th and 15th November 2025. Activities include Free Screening and Diabetes risk in our Walk-in-clinics. Free Consultation by diabetologists, Free advice about diet and exercise at home and workplace in Diabetics. Learn and understand sessions for patients and their families on Insulins, GLP-1 RA, and oral hypoglycemic agents.
A scientific sypmosium titled 3-D Diabetes with updates on diabetic screening, GDM, Diabetes Prevention and Reversal.

Join us in Fight against Diabetes.

06/11/2025

Intravascular Ultrasound (IVUS) in management of Acute Coronary Disease.
Case Presentation in this week's Physician Forum at Saleem Memorial Hospital Lhr by Department of Cardiology.
Join us o this Saturday 8th November 2025 in person or on following Zoom link

https://us06web.zoom.us/j/82270070517?pwd=GPWWifDzaHPvFTrVI3EV8b2cF1d1G1.1

Meeting ID: 822 7007 0517
Passcode: 11223344

03/11/2025

25/10/2025

Physicians Forum: Today's Case

A 60-year-old lady who is known Diabetic and hypertensive on Oral Hypoglycemic Agents and ARBs noticed gradually increasing abdominal distension for past 6 months and low grade fever. She visited various health care facilities and worked up for Ascites. Two months ago peritoneal aspiration confirmed Exudative Ascites with high lymphocytes. She was started on antituberculous treatment (Rifa-4) which she took for 3-4 weeks but her distension increased. 1 week before admission to hospital she developed watery diarrhea, decreased urine output and fever 100 F. She was started on some antibiotics in addition to ATT. She then developed the rash mainly over calves and feet but also on forearms and trunk(See the attached picture). She also complained of severe abdominal Pain.
On examination she had tense ascites with tender abdomen, bowel sounds were audible. There were no stigmata of CLD and rest of the examination was unremarkable.
Lab Work: Creatinine 3.2, Urine C/ E microscopic haematuria, Normal Coagulation profile. Normal CBC.
A Diagnosis of drug induced Vs Malignancy related vasculitis was considered.
CA 125 was elevated (550).
Therapeutic Peritoneal Aspiration was performed and repeat fluid analysis came "POSITIVE FOR MALIGNANT CELLS". A CT scan chest and abdomen showed widespread nodules in Perotonium, omentum and around adenexae, which were otherwise reported Normal.
ATT was stopped, she was started on Prednisolone in tapering dose. Her rash improved, Creatinine returned to normal levels. Today the case was discussed in physician Forum which is a MDT platform based at Saleem Memorial Hospital.
A final diagnosis of Ovarian Malignancy/ Peritoneal Carcinomatosis, Henoch Schonlein purpura secondary to ATT/ Malignancy, AKI precipitated by diarrhea.

Oncologist recommended: CT guided peritoneal/ Omental biopsy for histopathology.

Suggestions comments are welcomed.

24/10/2025

Join us either in person or on Zoom for our fortnightly Physician forum case presentation at Saleem Memorial Trust Hospital on Saturday 25th October at 2.00 pm for discussion on a challenging case of an elderly lady presenting with Exudative Ascites who developed a purpuric rash following treatment initiation.

Click here to join on Zoom

https://us06web.zoom.us/meetings/82270070517/invitations?signature=6UDFOc4s-wRrWclSoJ39WNNOYXY48qf15R7uygqXR5g

11/10/2025

Today’s Case at Physician Forum:

A 37-year-old female diagnosed Rheumatoid Arthritis for 5-6 years. She has been on different DMARDs with little response and is on steroids. Recently, she started on salazodine but developed a papular skin rash. She was worked up for latent TB before starting on biological. IGRA came positive, and she was started on ATT, which she took for 3 weeks.
She has chronic microcytic, hypochromic anamia unresponsive to IV iron for 5-6 years, and Hb has always been 6-7 G/dl.
She presents with high-grade fever, persistent vomiting, and abdominal pain.
Blood and urine cultures had no growth.
Extensive workup for active TB, including CXR, HRCT chest, and Sputum, were negative.
Procalcitonin and TLC were raised.
She was started on Solumedrol 500 mg IV OD, IV antibiotics, anti emetics, and PPI.
Anti DS DNA turned out to be positive.
HbsAg and Anti HCV were negative.
Autoimmune hepatitis screening negative.

Points discussed.
1. Which tests are more specific and sensitive to diagnose latent TB in low - and middle income countries like Pakistan where BCG vaccination is a routine.
2. What ATT regime and for how long to treat latent TB.
3. She is planning to start family and have a baby. What are treatment options?
4. Does she have RA, SLE, or MCTD.
Discussion was joined on Zoom by eminent Rheumatologists and Pulmonologist, oncologist, and internist, in addition to scores of PGRs.

Case was presented by Dr. Najam PGY4 and moderated by @⁨Hunza Malik SR SMTH⁩.