Dr. Kashif khaskheli

30/11/2025

Unfractionated Heparin (UFH) Dose for Pulmonary Embolism (PE) 🫁
Unfractionated heparin (UFH) dosing in PE is weight-based and given as a continuous IV infusion, preceded by an IV bolus.

IV Bolus: 80 units/kg
(Maximum: often capped at 5,000–10,000 units)

Infusion: 18 units/kg/hour
Adjusted based on aPTT

Monitoring:
▪︎aPTT target: 1.5–2.5 × control (typically 50–70 seconds, but lab-specific)
▪︎Check aPTT every 6 hours after starting or adjusting infusion until therapeutic, then daily.
▪︎Some centers use anti-Xa levels (target: 0.3–0.7 IU/mL).

Example for 70 kg patient:

》Bolus: 80 × 70 = 5,600 units IV push

》Infusion: 18 × 70 = 1,260 units/hour IV

Do you always use heparin infusion or just IV bolus every 6 hrs? 🤔

30/11/2025

A heartfelt appreciation for Mr. Mubark Ali, Senior Receptionist and Naimat Ali at CPSP Regional Center Larkana.

With more than 27 years of dedicated service, he has been a true pillar of support for trainees, supervisors, faculty, and every visitor who walks through CPSP Larkana doors. His humility, gentle personality, and ever-helping attitude make him one of the most respected and beloved members of our CPSP family.

Thank you, Dear Mubark Ali & Naimalt Ali for your unmatched commitment, kindness, and professionalism. Your years of service are an inspiration to all of us.

Prayers and best wishes for your continued health, happiness, and success.

30/11/2025

TURNER SYNDROME (45,X) :

A chromosomal disorder affecting females, caused by partial or complete monosomy of the X chromosome.

ETIOLOGY
• Usually 45,X (complete monosomy).
• Mosaicism: 45,X/46,XX or 45,X/46,XY.
• Structural abnormalities: isochromosome, ring chromosome, deletions of Xp.

⸻

CLINICAL FEATURES

1. Physical Features
• Short stature (most common).
• Webbed neck (pterygium colli).
• Broad chest with widely spaced ni***es.
• Cubitus valgus (wide carrying angle).
• Low posterior hairline.
• Lymphedema of hands/feet in newborns.
• Shield chest.
• Short 4th metacarpal.

2. Gonadal / Reproductive
• Streak ovaries → ovarian failure.
• Primary amenorrhea.
• Infertility.
• Lack of secondary sexual characteristics (little breast development).

3. Cardiovascular
• Coarctation of aorta.
• Bicuspid aortic valve.
• Increased risk of aortic dissection.

4. Renal
• Horseshoe kidney.
• Duplicated collecting system.
• Abnormal renal vasculature.

5. Endocrine
• Hypothyroidism (Hashimoto).
• Glucose intolerance / Type 2 diabetes.
• Obesity.
• Osteoporosis due to estrogen deficiency.

6. Others
• Normal intelligence but learning difficulties, especially spatial and math skills.
• Hearing loss (sensorineural).
• Recurrent otitis media.
• Pigmented nevi.

⸻

DIAGNOSIS

Investigations
• Karyotype → confirms monosomy X / mosaicism.
• FSH, LH → elevated (hypergonadotropic hypogonadism).
• Estradiol → low.
• Echocardiogram → check for CV anomalies.
• Renal ultrasound.
• Thyroid function tests.

Prenatal diagnosis
• Nuchal translucency increased.
• Cystic hygroma.
• Confirmed by amniocentesis / CVS karyotype.

⸻

MANAGEMENT

1. Growth
• Growth hormone therapy early to improve final height.

2. Puberty induction
• Estrogen replacement at puberty age → breast development.
• Add progesterone later for menstruation.

3. Fertility
• Usually infertile.
• IVF with donor oocytes may be possible (cardiac evaluation required).

4. Cardiac & Renal care
• Annual cardiology follow-up.
• Regular renal monitoring.

5. Endocrine care
• Treat hypothyroidism, glucose issues.
• Bone density monitoring.

⸻

PROGNOSIS
• With proper management, normal life expectancy.
• Risks: aortic dissection, infertility, osteoporosis.

28/11/2025

28/11/2025

# jobs

28/11/2025

SLEEP APNEA IN CHILDREN:
(Obstructive Sleep Apnea – OSA)

Sleep apnea in children refers to repeated episodes of partial or complete upper airway obstruction during sleep, leading to disrupted sleep and intermittent hypoxia.
The most common type in children is Obstructive Sleep Apnea (OSA).

⸻

ETIOLOGY / RISK FACTORS
• Adenotonsillar hypertrophy (most common cause)
• Obesity
• Allergic rhinitis / nasal obstruction
• Craniofacial anomalies (micrognathia, midface hypoplasia)
• Neuromuscular disorders (Down syndrome, cerebral palsy)
• Prematurity
• Family history

⸻

CLINICAL FEATURES

Night-time symptoms
• Loud snoring (most common)
• Pauses in breathing / witnessed apnea
• Gasping / choking episodes
• Mouth breathing
• Restless sleep
• Night sweats
• Enuresis (bedwetting)

Daytime symptoms
• Morning headaches
• Excessive daytime sleepiness OR paradoxical hyperactivity
• Poor concentration / school performance
• Behavioral problems (ADHD-like symptoms)
• Irritability

⸻

COMPLICATIONS
• Failure to thrive / poor growth
• Learning difficulties
• Behavioral problems
• Pulmonary hypertension
• Cor pulmonale (rare but serious)
• Systemic hypertension

⸻

DIAGNOSIS

1. Polysomnography (Sleep Study) – GOLD STANDARD

Key parameters:
• Apnea-Hypopnea Index (AHI)
• Oxygen saturation
• Sleep stages

2. Clinical Evaluation
• History from parents
• Tonsil size (using Brodsky scale)
• Craniofacial structure
• BMI

3. Other Investigations
• Nocturnal oximetry (screening)
• Lateral neck X-ray (enlarged adenoids)

⸻

MANAGEMENT

1. First-line treatment

Adenotonsillectomy
• For children with adenotonsillar hypertrophy
• Very effective in most cases

2. Medical therapy
• Nasal corticosteroids (e.g., mometasone) for mild cases
• Leukotriene receptor antagonists (Montelukast)
• Weight loss in obese children

3. Continuous Positive Airway Pressure (CPAP)
• For moderate–severe OSA when surgery is contraindicated or ineffective

4. Orthodontic / Adjunctive options
• Rapid maxillary expansion
• Mandibular advancement devices (in selected cases)

⸻

WHEN TO REFER
• ENT specialist for possible adenotonsillectomy
• Sleep medicine / pulmonology for CPAP
• Urgent referral if: severe OSA, growth failure, pulmonary hypertension signs

⸻

PROGNOSIS
• Most children improve significantly after adenotonsillectomy
• Obesity and syndromic children may need long-term follow-up
• Early treatment prevents cognitive and behavioral complications

28/11/2025

mentors build strong clinicians & Mentorship is the heart of training. Grateful to be part of this journey .

productive week wrapped up. Our four-day workshop on research methodology, biostatistics, and medical writing brought supervisors together from 24 to 27 November 2025. Great conversations, practical learning, and plenty of new ideas to take back to our teams. Proud to be part of it.

27/11/2025

has this rare disorder. What’s the diagnosis?

26/11/2025

Opportunity in KMU

25/11/2025

is this diagnosis and treatment?

25/11/2025

Iron Replacement: Oral Vs IV

Dr. Kashif khaskheli