Dr Muhammad Omar Akram

09/02/2026

09/02/2026

Acute MI Stabilization

09/02/2026

Lesions of Visual Pathways at Various levels

22/11/2025

Jo shakhs nek sifarish karta hai, uska ajr milta hai. Aur jo buri sifarish karta hai, uska wabal usi par aata hai. Allah har cheez ka nigran hai. | Surah An-...

22/11/2025

🎯The "RA Rule"

The most helpful starting point when evaluating hand arthritis is identifying what is not there.
🫆• Pearl: Rheumatoid Arthritis (RA) typically SPARES the DIP joints.
🫆• If you see significant inflammation or deformity at the DIPs, you can move RA significantly down your differential list (RA favors MCPs, PIPs, and wrists).

🎯Crucial Pearl: If you see a patient with DIP arthritis, always remove their nail polish and inspect the nails. Psoriatic nail changes correlate highly with DIP joint involvement because the nail matrix and the DIP joint are physically connected via entheses (anchoring tendons).

🎯Radiographic "Buzzwords"

If you order an X-ray of the hands, look for these specific patterns:
👉🏽• Osteoarthritis:
🫆• Joint Space Narrowing: Asymmetric.
🫆• Osteophytes: Bone spurs.
🫆• Subchondral Sclerosis: Whitening of the bone edge.
🫆• "Gull-wing" deformity: Seen in Erosive Osteoarthritis (a more aggressive subset of OA).
👉🏽• Psoriatic Arthritis:
🫆• "Pencil-in-cup" deformity: The proximal phalanx (pencil) whittles down into the distal phalanx (cup).
🫆• Periostitis: Fluffy new bone formation.

🪐The "Other" DIP Etiologies (The Zebras)
While OA and PsA are the main two, keep these in the back of your mind if the picture doesn't fit:

🎯• Gout: Tophi (uric acid crystal deposits) can form in the DIPs and may be mistaken for Heberden's nodes, but they are usually asymmetric and may appear yellow/white under the skin.
🎯• Reactive Arthritis: Can sometimes mimic the PsA distribution (Reiter's syndrome).
🎯• Multicentric Reticulohistiocytosis: A rare systemic disease that specifically targets the DIPs (causing extensive destruction/arthritis mutilans).

📌Summary Mnemonic:

To remember the nodes in Osteoarthritis:
🫆• Heberden's = High (DIP - far away)
🫆• Bouchard's = Below (PIP - closer to body)

11/11/2025

Tumor Markers

07/11/2025

Coeliac Disease

1. Definition
Autoimmune disorder triggered by gluten (wheat, barley, rye)
Causes immune-mediated damage to small-intestinal mucosa

2. Pathophysiology
Gluten → gliadin peptides
Abnormal immune response → T-cell activation
Villous atrophy
Crypt hyperplasia
Malabsorption

3. Genetics
Strong association:
HLA-DQ2 (90–95%)
HLA-DQ8

4. Risk Factors
First-degree relatives
Type 1 diabetes
Autoimmune thyroid disease
Down syndrome
IgA deficiency
Other autoimmune disorders

5. Clinical Features

A. Gastrointestinal
Chronic diarrhea
Steatorrhea
Abdominal pain
Bloating
Weight loss
Failure to thrive (children)

B. Extra-intestinal
Iron-deficiency anemia
Osteopenia/osteoporosis
Dermatitis herpetiformis
Short stature
Infertility
Neurological symptoms (neuropathy, ataxia)
Fatigue

6. Investigations

A. Blood Tests
tTG-IgA (tissue transglutaminase) – first-line
Total IgA (to rule out IgA deficiency)
EMA IgA (confirmatory)
DGP antibodies (in children)

B. Genetic Tests
HLA-DQ2 / HLA-DQ8 (to rule out disease, not diagnose)

C. Endoscopy
Duodenal biopsy:
Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes

7. Complications
Malnutrition
Iron, folate, B12 deficiency
Osteoporosis
Infertility
Lactose intolerance
Small bowel lymphoma (rare)
Adenocarcinoma of small intestine

8. Management
Lifelong strict gluten-free diet
Avoid wheat, barley, rye
Oats only if gluten-free certified
Nutritional supplementation
Iron, folate, B12
Calcium, vitamin D

Monitoring:
Symptom improvement
Antibody levels
Bone density (DEXA)
Treat complications
Education & dietician support

9. Prognosis
Excellent with strict gluten-free diet
Poor adherence → persistent symptoms, complications

07/11/2025

Approach to Metabolic Acidosis

07/11/2025

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