Medicine by Prof. Tariq Waseem

06/08/2025

Physicians Forum Saleem Memorial Trust Hospital
Today's Case:

A 77 year old male who is known Diabetic, hypertensive, IHD status post CABG and had a minor ischemic stroke with complete recovery 2 years ago. He also had mild cognitive impairment. He started feeling weakness in both his legs and needed support to walk. Weakness progressed to involve upper limbs over 3-4 months. Sphicteric control and cranial nerves remain intact. There was no sensory loss. (He underwent an MRI of the spine, nerve conduction studies, and EMG, but records were not available at the time of admission to this hospital)
10 days ago, he fell in the bathroom where he went himself with the support of a cradle walker.
He got superficial injuries to his face and neck and had a mild confusional state.
He underwent a CT scan of Brain and MRI of Cervical Spine. Multiple level ospteophytes in cervical spine and age related cortical atrophy of the brain were reported.
A provisional diagnosis of cervical myelopathy was suggested. A cervical collar was applied. After a brief stay in ICU and consultation by neurologist and neurosurgeon, he was transferred to the medical floor.

O/E
He had flaccid quadreparesis, hypotonia, Power 2/5 in lower limbs, and 3/5 in upper limbs. Tendon reflexes were absent. Planters were mute, and there was no sensory level. Cranial nerves were all intact.

Previous NCS showed
Unevokeable CMAP intibilaand Common peroneal nerves bilaterally.

Unevokable SNAPinsural nerves bilaterally
Low SNAPin median and ulnar nerves bilaterally
Prolonged F waves latency in bilaterally ulnar nerves.
Impression: Chronic Symmeterical Distal Sensory Motor Neuropathy.

A diagnosis of CIDP was made.

CSF sample has been sent from analysis.

The report will be shared.

Plans:
? Steroids
? Immunosupression
?IVIG
Follow-up will be shared.

05/08/2025

Fortnightly meeting of Physician Forum at Saleem Memorial Hospital Lahore.

Date & Time
Wednesday 6th August 2025 at 10.00 am.

"A 72 year old male with Progressive Quadreparesis for 6 months."
Presenter:
Dr. Aimen PGY 4
Supervisor:
Professor Tariq Waseem

Venue: Auditorium Saleem Memorial Hospital Lahore.

Zoom Link:
Meeting ID: 823 1961 8715
Passcode: 646122

05/08/2025

Join us on Zoom
Saleem Memorial Hospital is inviting you to a scheduled Zoom meeting.

Topic: Saleem Memorial Hospital's CME on Beyond HBA1C Control
Time: Aug 5, 2025 02:30 PM Islamabad, Karachi, Tashkent
Join Zoom Meeting
https://us06web.zoom.us/j/9023051234?pwd=IzntB8Ga23QUeHutw0JpnjhyW1uw48.1&omn=84750691801

Meeting ID: 902 305 1234
Passcode: 11223344

02/08/2025

Type 2 Diabetes Mellitus Management Beyond HbA1c.
Register for free to attend the session Saleem Memorial Trust Hospital on Tuesday 5th August 2025 at 2.30 pm
Click to register: https://docs.google.com/forms/d/18MMF_RY5-l72E4xHA7Es0nyvV9aXzLFxRDDJMG7n-ws/edit

30/07/2025

Saleem Memorial Hospital Medical Education Centre presents a CME session on GLP-1 agonists in management of Type 2 Diabetes Mellitus titled " Beyond HbA1c Control."

26/07/2025

Thrombosed Brachial AV fistula in left cubital fossa in a patient on maintainence hemodialysis.

24/07/2025

EFSITORA: is a basal insulin with a flat pharmacokinetic profile and long half-life that allows for once-weekly administration.

In a recent article published NEJM the once a week insulin was compared with Once a day insulin glargine as an add on to OHA in adult type 2 DM patient having average HbA1c of 8.2% at baseline.
Once weekly insulin was non inferior to glargine in achieving target HabA1c of around 7.0% at 52 weeks.
The amount of insulin required was less by 43 units/ week in patients receiving Once Weekly insulin. There was lesser hypoglycemic episodes reported with Efsitora. The dosage titration to achieve glycemic target were less with Efsitora( 2 as compared to 8 with glargine.

This may revolutionise the Insulin therapy for type 2 DM.

In previous treat-to-target trials, adjustments to the dose of basal insulin have been made at least weekly, according to fasting blood glucose levels. A fixed-dose regimen of insulin efsitora alfa...

18/07/2025

16/07/2025

Physician Forum Case today:

A 61-year-old lady known diabetic had mild fever, dry cough, and rapidly progressive dyspnea.
BP 110/ 70, JVP was raised, pulsus paradox and muffled heart sounds.
Cardiomegaly on CXR
CBC, RFTs, LFTs, Trop I were all normal.
Echocardiography confirmed pericardial effusion with signs of temponade.
Urgent parecentesis was refused by the patient but was performed 3 days later in another hospital and 115 ml fluid was drained. Follow up CXR and Echo showed NO RESIDUAL EFFUSION.
Fluid analysis was Exudative.
ANA, ENA profile, TSH, T Spot TB tests were normal. Mamography is awaited. She was prescribed tabs. Colchicine 0.5 mg TID for 1 week and continued on OHA.
7 days later, the patient was comfortable.

How to manage her further?

Should we go for further investigations for Etiology?

Should empirical ATT be started?

Should we prescribe Steroids?

15/07/2025

Join us on 1st and 3rd Wednesday of every month at 10.00 am. for Physician Forum meeting at Saleem Memorial Hospital Lahore, where intersting and challenging cases are presented and shared by postgraduate trainees and junior consultants, supervised by senior faculty.
You can join us on Zoom from your home, office, or unit and be part of this academic activity.

Zoom meeting link:
https://us06web.zoom.us/j/82319618715?pwd=X9aPIepUeV0sSoiuIbXgaysIFi2LcH.1

Meeting ID: 823 1961 8715
Pass code: 646122

11/07/2025

11/07/2025

Thrombolysis followed by IV antiplatelets (Tirofiban) in acute ischemic stroke due to large vessel occlusion.

In patients with acute ischemic noncardioembolic stroke who underwent thrombolysis within 4.5 hours after onset, early tirofiban increased the likelihood of an excellent functional outcome. The incidence of intracranial hemorrhage was low but higher with tirofiban than placebo. (Funded by the Fundamental Research Funds for Central Universities; ASSET-IT ClinicalTrials.gov number, NCT06134622.)

Source: NEJM