Dr Inayat ul haq Sahibzada

01/12/2025

خیبر پختونخوا میں ایڈز کے بڑھتے کیسز تشویشناک حد تک پہنچ گئے ہیں۔

صوبائی ایڈز پروگرام کے ڈائریکٹر ڈاکٹر طارق حیات تاج کے مطابق خیبر پختونخوا میں اس وقت اندازا 40 ہزار افراد ایڈز کا شکار ہیں جبکہ روزانہ 15 سے 20 نئے
مریض رجسٹر ہو رہے ہیں

Alarming.....! 😳

Copied.

30/11/2025

Important Skin problems

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゚viralシviralシfypシ゚viralシalシ

29/11/2025

Beautifully presented

19/11/2025

19/11/2025

Communicable disease incubation period .

19/11/2025

⭐ Syncope

1️⃣ Causes of Syncope — “3 Big Groups”

A. Cardiac (Dangerous!)

Think heart pump or rhythm problems
• Structural: Aortic stenosis, HCM
• Arrhythmia: Bradycardia, tachycardia, VF, AV block
• Vascular: PE, pulmonary hypertension, aortic dissection

B. Neurocardiogenic (Vasovagal)

Think over-reaction of nerves → BP drops
Triggers:
• Pain
• Emotion
• Heat
• Standing long time
• Micturition, defecation, coughing, laughing
• Carotid sinus hypersensitivity

C. Orthostatic

Think blood pressure cannot adjust when standing
• Dehydration
• Autonomic failure
• Medications
• Peripheral neuropathy
• Drug-induced

2️⃣ Work-Up — “ABC + ECG”

Basic for ALL patients
• A – Assessment (history)
• B – Bedside exam (vitals, orthostatic BP)
• C – Cardiac: ECG

If cardiac cause suspected
• Echocardiogram
• Holter or long-term monitor
• Stress test
• MRI heart
• CT chest (PE or aortic dissection)
• Right-heart catheterization

If neuro or orthostatic
• Tilt-table test
• Autonomic testing
• Try stopping suspected drugs
• Carotid sinus massage (carefully, in hospital)

3️⃣ Treatment — “Treat the Cause”

A. Cardiac
• Fix structural/arrhythmia problem
• May need meds or pacemaker/ICD
• Avoid strenuous exercise until stable

B. Neurocardiogenic (Vasovagal)
• Avoid triggers
• Increase water + salt
• Physical counter-pressure maneuvers
• Medications if frequent

C. Orthostatic
• Stop offending medications
• Increase fluids + salt
• Compression stockings
• Orthostatic training
• Medications if needed

🧠 Super Simple Memory Trick

“CAR – NER – ORTHO”
• CAR → Cardiac (dangerous)
• NER → Nerve-related (vasovagal)
• ORTHO → Blood pressure drop when standing

Work-Up: “History + ECG + Extra tests as needed”

Treatment: “Fix cause + fluids + avoid triggers”



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19/11/2025

Hemiblocks

Hemiblocks = Left Anterior Fascicle or Left Posterior Fascicle is blocked → changes QRS axis and QRS shape.

🔶 1. Left Anterior Hemiblock (LAH / LAFB)

📌 Most common fascicular block

Key ECG Signs
• Left axis deviation (usually –45° to –90°)
• Small Q in I, aVL
• Small R in II, III, aVF
• No LVH or inferior MI signs

Memory Trick

➡ “Q1 S3”
• Q in Lead I
• S in Lead III

🔶 2. Left Posterior Hemiblock (LPH / LPFB)

📌 Less common, usually occurs with disease

Key ECG Signs
• Right axis deviation (+90° to +120°)
• Small R in I
• Small Q in III
• No RVH or lateral MI signs

Memory Trick

➡ “S1 Q3”
• S in Lead I
• Q in Lead III

🔶 3. Bifascicular Blocks

Two fascicles are blocked at the same time.

Types
1. RBBB + Left Anterior Hemiblock (most common)
2. RBBB + Left Posterior Hemiblock

ECG Pattern
• Wide QRS (from RBBB)
• Axis shift (from fascicular block)

⚠ Clinical Concern

➡ High risk of complete (3°) AV block
Patient may need monitoring / pacemaker evaluation.

🔶 4. Trifascicular Block

All 3 fascicles involved:
• Right bundle branch
• Left anterior fascicle
• Left posterior fascicle

ECG Pattern
• RBBB
• Either LAH or LPH
• + AV block (1°, 2°, or alternating)

⚠ Danger

➡ Can progress to complete heart block.

18/11/2025

VT Vs SVT - Brugada Criteria In 4 Steps



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18/11/2025

How to Differentiate Mitral Regurgitation (MR) vs Aortic Stenosis (AS) on CW Doppler by envelope SHAPE

1. Timing

MR

Holosystolic signal (throughout systole).

Starts with isovolumic contraction and ends after A2 sometimes.

No clear envelope edges.

AS

Mid-systolic envelope (starts after IVCT, ends before A2).

Well-defined start and end.

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2. Shape of CW Envelope

Mitral Regurgitation (MR)

Tall, dense, triangular (early-peaking)

“V-shaped” or triangular because MR is often pressure-dependent.

Peak velocity early then falls → early systolic peak (unless severe chronic MR → rounded).

Aortic Stenosis (AS)

Parabolic, rounded, symmetric envelope

“Bullet shape”

Peaks mid-systole (late peak if severe).

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3. Velocity

MR usually has higher velocity (5–6 m/s common).

AS varies depending on severity but usually 3–5 m/s.

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4. Direction & Position of CW Line

MR CW is obtained from the apex directed posteriorly into the LA.

AS CW is obtained in multiple windows (RUP parasternal, apical, suprasternal).

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Summary

MR

Holosystolic

Triangular / V-shaped

Early peak

Very high velocity

Fills entire systole

AS

Mid-systolic

Rounded / parabolic

Mid or late peak

Duration shorter

Does not start at MVC and ends before A2



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fans

18/11/2025

Understanding INFLUENZA (FLU)🦠🧐🩺👇

Influenza is a highly contagious viral infection that affects the respiratory system — nose, throat, and lungs.
It spreads easily through droplets when an infected person coughs, sneezes, or talks.

🛑CAUSE
• Caused by influenza viruses (Types A, B — most common; C is mild; D affects animals)

🛑INCUBATION PERIOD
• 1–4 days after exposure

🛑SIGNS & SYMPTOMS

Often sudden in onset:
• High fever
• Chills
• Headache
• Severe body aches
• Dry cough
• Sore throat
• Runny/stuffy nose
• Fatigue (extreme tiredness)
• Loss of appetite
• Sometimes vomiting/diarrhea (more in children)

🛑TRANSMISSION
• Droplets (coughing/sneezing)
• Touching contaminated surfaces then touching nose/mouth
• Close contact with infected person

🛑DIAGNOSIS

Usually based on symptoms.
If needed:
• Rapid influenza test
• PCR test (more accurate)

🛑TREATMENT

Supportive care
• Rest
• Plenty of fluids
• Paracetamol or ibuprofen for fever/body aches
• Cough remedies if needed

Antiviral medications (best within 48 hours)
• Oseltamivir (Tamiflu)
• Zanamivir
• Baloxavir

These shorten illness and reduce complications.

🛑COMPLICATIONS (more common in elderly, pregnant women, and chronic illness)
• Pneumonia
• Severe dehydration
• Worsening asthma/COPD
• Sinus & ear infections
• Hospitalization
• Rare: myocarditis, encephalitis

🛑PREVENTION

1. Annual influenza vaccine
• Best protection
• Recommended for everyone ≥ 6 months old

2. Hygiene measures
• Frequent handwashing
• Cover mouth when coughing
• Avoid close contact with sick individuals
• Mask use in crowded or flu season settings







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