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*Announcement for Online Session No 64* *21 August 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 1 station 4 ( Communication skills )* regarding our preparation for MRCP PACES ( UK ) TIMINGS : Saudia Arabia: 8 30 pm Pakistan : 10 30 pm Bangladesh : 11 30 pm India : 11 00 pm Singapore : 1 30 am Hong Kong : 1 30 am Malaysia : 1 30 am Egypt : 7 30 pm Libya : 7 30 pm Bahrain : 8 30 pm Burma ( Myanmar ) : 12 00 am Sudan : 7 30 pm UAE : 9 30 pm UK : 6 30 pm Ireland ( Dublin ) : 6 30 pm Afghanistan : 10 00 pm Kenya : 8 30 pm Germany ( Berlin ) : 7 30 pm Nigeria : 6 30 pm Japan ( Tokyo ) : 2 30 am Denmark : 7 30 pm Qatar : 8 30 pm Oman : 9 30 pm Italy : 7 30 pm ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. Interested candidate may send a personal message to take the case. GOOD LUCK.

ANNOUNCEMENT Hello n salam everyone Regarding our *Aug-Sep 2022 online course for PACES MRCP (UK) ( duration 15 days ).* starting from *22 Aug* till *7 Sep* All slots for active participation are completely booked, *However Listener slot are still available.* Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*Announcement for Online Session No 64* *21 August 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Tomorrow we will have an online session on Zoom discussing 1 station 4 ( Communication skills )* regarding our preparation for MRCP PACES ( UK ) TIMINGS : Saudia Arabia: 8 30 pm Pakistan : 10 30 pm Bangladesh : 11 30 pm India : 11 00 pm Singapore : 1 30 am Hong Kong : 1 30 am Malaysia : 1 30 am Egypt : 7 30 pm Libya : 7 30 pm Bahrain : 8 30 pm Burma ( Myanmar ) : 12 00 am Sudan : 7 30 pm UAE : 9 30 pm UK : 6 30 pm Ireland ( Dublin ) : 6 30 pm Afghanistan : 10 00 pm Kenya : 8 30 pm Germany ( Berlin ) : 7 30 pm Nigeria : 6 30 pm Japan ( Tokyo ) : 2 30 am Denmark : 7 30 pm Qatar : 8 30 pm Oman : 9 30 pm Italy : 7 30 pm ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. Interested candidate may send a personal message to take the case. GOOD LUCK.

*Some info about clinical presentation of idiopathic thrombocytopenic purpara ( ITP ) by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* Approximately 1/3 of patients are asymptomatic and have incidental discovery on blood test. Approximately 2/3 of patients have bleeding. Commonly patients with ITP present to their doctors with petechiae , small red dots on the skin. Purpura , formed by petechiae joined together, can also occur. Mild epistaxis is common. Continuous epistaxis requiring nasal packing or cauterisation may pose greater risks of bleeding. In women, patients with ITP may have prolonged and heavy menstrual cycles. Very rarely, nonetheless the most importantly, ITP can present with intracranial bleeding; this occurs in 1.4% of the cases. Severe non-intracranial bleeds such as large gastrointestinal bleed occur in 9.6% of the cases. Patients with ITP can present as generally unwell, i.e. feeling lethargic. Occasionally, patients with ITP may present with strokes and TIA, often referred to as paradoxical thrombotic events in ITP. Good Luck

*Some info about pathophysiology of idiopathic thrombocytopenic purpara ( ITP ) by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* ITP is an autoimmune disorder. In ITP abnormal immune system leads to destruction of own platelets . Although the precise mechanism for ITP is not completely understood, there have been several widely accepted theories: In ITP, autoantibodies are produced by the patient's B cells, principally of IgG. These target against platelet membrane glycoproteins GPIIb/IIIa. These platelets with autoantibodies are then engulfed by macrophages and degraded in the spleen. The bone marrow compensates by producing megakaryocytes (precursor to platelets). Purpura occurs as a result of increased permeability in capillary due to low platelets. In some cases, it is thought that viral infections can precede development of ITP. Antibodies against viral antigens cross react with normal antigens on platelet surfaces thus producing molecular mimicry. Good Luck

*Some info about aetiology of idiopathic thrombocytopenic purpara ( ITP ) by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* It is thought that ITP is an autoimmune disorder resulting in antibodies produced to target against individual’s own platelets, leading to thrombocytopenia. This in turn results in petechiae and in rarer cases more severe bleeding. Furthermore, ITP can be primary or secondary. Primary ITP occurs when there is isolated thrombocytopenia is found with no co-existing conditions. Secondary ITP is associated with co-existing conditions. These include: Rheumatological diseases CLL Lymphoma Viral infections Various pharmacological agents Good Luck

*Important points in the management of sarcoidosis by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* *Indications for steroids* patients with chest x-ray stage 2 or 3 disease who have moderate to severe or progressive symptoms. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment hypercalcaemia eye, heart or neuro involvement Prognosis *Factors associated with poor prognosis* insidious onset, symptoms > 6 months absence of erythema nodosum extrapulmonary manifestations: e.g. lupus pernio, splenomegaly CXR: stage III-IV features black people Good Luck

*Important clinical features of sarcoidosis by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia insidious: dyspnoea, non-productive cough, malaise, weight loss skin: lupus pernio hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol) the Kveim test (where part of the spleen from a patient with known sarcoidosis is injected under the skin) is no longer performed due to concerns about cross-infection Good Luck

*Important investigations for sarcoidosis by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* There is no one diagnostic test for sarcoidosis and hence diagnosis is still largely clinical. ACE levels have a sensitivity of 60% and specificity of 70% and are therefore not reliable in the diagnosis of sarcoidosis although they may have a role in monitoring disease activity. Routine bloods may show hypercalcaemia (seen in 10% if patients) and a raised ESR A chest x-ray may show the following changes: stage 0 = normal stage 1 = bilateral hilar lymphadenopathy (BHL) stage 2 = BHL + interstitial infiltrates stage 3 = diffuse interstitial infiltrates only stage 4 = diffuse fibrosis spirometry: may show a restrictive defect tissue biopsy: non-caseating granulomas gallium-67 scan - not used routinely Good Luck

ANNOUNCEMENT Hello n salam everyone Regarding our *Aug-Sep 2022 online course for PACES MRCP (UK) ( duration 15 days ).* starting from *22 Aug* till *7 Sep* All slots for active participants are fully occupied however *Listener slots still available* Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*Few syndromes associates with Sarcoidosis by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas. It is more common in young adults and in people of African descent *Lofgren's syndrome* is an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis In *Mikulicz syndrome* there is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma this term is now considered outdated and unhelpful by many as there is a confusing overlap with Sjogren's syndrome *Heerfordt's syndrome (uveoparotid fever* ) there is parotid enlargement, fever and uveitis secondary to sarcoidosis Good Luck

*Important complications of Psoriasis by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* Psoriatic arthropathy (around 10%) Increased incidence of metabolic syndrome Increased incidence of cardiovascular disease Increased incidence of venous thromboembolism Psychological distress Good Luck

*Important points in the management of Psoriasis by courtesy of Dr Toqeer Bhatti. Thanks a lot dr* Regular emollients may help to reduce scale loss and reduce pruritus First-line: NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once daily for up to 4 weeks as initial treatment These should be applied separately, one in the morning and the other in the evening Second-line: if no improvement after 8 weeks then offer a vitamin D analogue twice daily Third-line: if no improvement after 8-12 weeks then offer either: A potent corticosteroid applied twice daily for up to 4 weeks or A coal tar preparation applied once or twice daily Short-acting dithranol can also be used Good Luck

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Raed Khan* For passing *MRCP ( Ireland ) Part 2* He has been a keen participant in our group for Part 2 prepration. We wish him the best for his future.