Dr Muhammad Sajjad

02/02/2026

01/02/2026

Purple Urine Bag Syndrome. Due to bacterial tryptophan metabolism to indoxyl, and subsequently producing indigo and indirubin metabolites, likely due to bacterial infection /UTI. Increased risk in elderly, dehydrated, low renal function, constipation, and female patients. Think Proteus, klebsiella, e coli, morganella and pseudomonas. What I love most about this is that purple is previously a regal colour, reserved for Kings and Queens and this was first seen or described in 1812, when King III had PUBS, probably due to an alternative diagnosis.

29/01/2026

Here’s a clear, exam-oriented + practical approach to the management of ovarian cysts, the way we usually think about it clinically 👇
1. First step: Assess the cyst
Management depends on 4 key factors:
Age: premenopausal vs postmenopausal
Size of cyst
USG features: simple vs complex
Symptoms: pain, pressure, torsion, rupture
2. Premenopausal woman
🔹 Simple ovarian cyst
< 5 cm
Reassurance
No treatment
Repeat USG in 6–8 weeks
5–7 cm
Follow-up USG
Observation if asymptomatic
> 7 cm
Further evaluation (MRI / surgery)
➡️ COCP:
Do not shrink existing cysts
Can be used to prevent new functional cysts
🔹 Functional cysts
(Follicular / Corpus luteum)
Usually resolve in 6–8 weeks
Analgesics if pain
Observation
🔹 Symptomatic cyst
Analgesics
If persistent or severe → surgery
3. Postmenopausal woman ⚠️
Higher suspicion for malignancy.
🔹 Simple cyst < 5 cm + CA-125 normal
Conservative
Repeat USG + CA-125 in 4–6 months
🔹 Complex cyst / CA-125 raised
Surgical evaluation
Refer to gynae-oncology
4. Indications for Surgery
✔ Persistent cyst (>3 months)
✔ Size > 7–8 cm
✔ Complex / solid / septations / papillary projections
✔ Suspected malignancy
✔ Complications:
Torsion
Rupture
Hemorrhage
5. Surgical options
Cystectomy → young, fertility preservation
Oophorectomy → completed family / malignancy risk
Laparoscopy → preferred if benign
Laparotomy → suspected malignancy
6. Emergency management 🚨
Ovarian torsion
Acute pain + vomiting
Urgent surgery
Detorsion ± cystectomy
Ruptured cyst
Stable → conservative + analgesia
Unstable → surgery
7. Red flags for malignancy (USG)
Solid areas
Thick septations
Papillary projections
Bilateral cysts
Ascites
📌 One-line exam summary:
Simple ovarian cysts in reproductive age are usually managed conservatively; surgery is reserved for persistent, large, symptomatic, complex, or suspicious cysts.

29/01/2026

Gynacomastia

29/01/2026

Management of Dhat syndrome (common in South Asia) focuses on reassurance, psycho-education, and treating comorbid anxiety/depression, not on “semen loss.” A simple, exam-oriented outline 👇
1. Psycho-education & Reassurance (core treatment)
Explain that semen loss in urine/nightfall is normal and not harmful
Clarify myths about weakness, infertility, or “vital fluid loss”
Use simple biological explanations; avoid confrontation
Involve family if beliefs are strongly reinforced at home
2. Psychological Interventions
Supportive psychotherapy: address stress, guilt, sexual misconceptions
Cognitive Behavioral Therapy (CBT)
Correct distorted beliefs
Reduce health anxiety and somatic focus
Relaxation techniques, stress management
3. Treat Associated Psychiatric Conditions
Dhat syndrome often overlaps with:
Anxiety disorders
Depression
Somatoform disorders
Medications (if indicated):
SSRIs (e.g., fluoxetine, sertraline) for anxiety/depression
Short-term anxiolytics only if severe anxiety (avoid long-term BZDs)
4. Sexual Counseling
Normal sexual physiology
No restriction on ma********on or in*******se unless culturally required
Address erectile dysfunction or premature ej*******on if present
5. Lifestyle & General Measures
Adequate sleep
Regular exercise
Healthy diet
Avoid excessive focus on ge***al symptoms
6. What NOT to do
❌ No unnecessary tests
❌ No tonics, aphrodisiacs, or “semen-boosting” medicines
❌ No reinforcing cultural myths
Key exam takeaway 📝
Dhat syndrome is managed primarily by reassurance, psychoeducation, and treatment of comorbid anxiety/depression.

29/01/2026

Left sided pneumothorax

17/01/2026

Cholelithiasis

09/01/2026

IV complications

09/01/2026

Cholecystitis