Saturday 20 December 2014

13 Things Mature Men Don’t Do (By: Ivan Dimitrijevic)

Mature Man 
It seems that we as a society have forgotten some important values, and are generally becoming more immature as a result. There doesn’t seem to be a differentiation between manliness and egocentric chauvinist behavior in a lot of people’s minds, which is truly sad. You have people saying things like 30 is the new 20, and grown men acting like entitled spoiled children. The truth is that once you’ve stepped into your mid-20s you should have gained enough life experience to be able to behave like a mature adult.
The thing is, few young people –

Monday 8 December 2014

Unlock the Treasures of Tranquility (By: Hiba Khan)

I am easily distracted. This trait was a hindrance throughout my academic studies, but no doubt the area in which it is most detrimental is my worship. My daily prayers are plagued by thoughts that creep into my consciousness and silently grip my mind and heart, steering them away from Allah subhanahu wa ta`ala (exalted is He). Be it the pattern on my prayer mat or a task I have to do, there is always something diverting me from the most important moments of my day.

I write this as a reminder to myself, on attempting to rescue my salah (ritual prayers), a most exquisite and sublime gift from Allah (swt). A nourishment, rejuvenation and refocusing for our souls, and the first thing we will be asked about on the Day of Judgement. These windows of tranquillity have the potential to adorn our days and sustain, protect and fill our hearts amidst the transient whirlwind that is this world. We hear of people finishing one salah only to look forward to the next one, so why does prayer feel so heavy, ritualised and burdensome for so many of us? With each rising sun we witness comes a new God-given opportunity to reform our existence, to attain that contentment that every soul in this world is yearning. Don’t let another golden moment slip by. I pray He allows us to rescue our salah and fall in love with it until we enter Jannah (eternal Paradise).
The first step to take is to correct our mindset. A simple realignment of perspective is all it takes. You are not in control of anything. Your job, your happiness, your health, your family, your movements—you are not even in control of the simplest of bodily functions. He is. The beating of your heart, how people behave towards you, what you achieve—everything is from Him. He knows what is in your past and what is in your future. All honour, respect and sustenance are from Him. You are deaf, dumb and blind without Him and His provision and guidance. Everything around you is temporary, flawed and changing, but your soul is eternal, and does not belong here. One day it will all crumble and perish; only He will remain. Turn yourself away from the world and towards Him, close your eyes to the creation and open your heart to the Creator.  He has ordered us to prostrate to Him as a mercy only to us; each prayer is an opportunity to be forgiven.
Abu Dharr radi Allahu `anhu (may God be pleased with him) reported that the Prophet ﷺ
said: “Allah faces the slave while he is in the salah and keeps facing him as long as he does not turn. If [the slave] turns, [Allah] turns away from him.” – Abu Dawud [Saheeh Hadith]
Reflect on the sheer weight of this hadith. The Lord of the Worlds, who is aware of and sustaining every cell in every human, animal and bacteria, from the beginning of time to the end, is facing YOU. Listening to you, waiting for you to call, looking to forgive and to grant you more. You have His full attention until YOU lose focus.
The light in your life is proportional to the light that Allah (swt) bestows on you. You will only be content and at peace if He illuminates your existence. Your circumstances may appear perfect, but you will be restless and unhappy if He withholds His light. Once we truly comprehend this principle and realise we are nothing, while He is everything, insha’Allah (God willing) we can worship like we were made to.
Doing the following may help increase khushu` (a state of humility and reverence):
  • Remember death. Imagine the angel of death ready to take your soul. Pray like it is your last.
  • Picture yourself standing before Allah (swt), and know that He is facing you, hearing and seeing you.
  • Understand what you are saying by understand the Arabic and studying the tafseer (exegesis) of whatever you recite.
  • Speak and move at a measured pace. Try to recite melodiously.
  • Pray on time, and make the sincere intention to never miss a prayer.
  • Minimise internal distractions by building your connection with Him throughout the day and taking a few moments before each prayer to regain perspective.
  • Minimise external distractions by finding a suitable setting when possible.
  • Make du`a’ (supplication) in your own language while in sujood (prostration) and after each salah. What better time to beg Allah (swt) for what you are in need of?
Make the intention right now to rescue your salah and unlock the treasures of tranquillity, nearness and purpose. Embellish your path with prayer, and know that you will thank yourself on the Last Day, when there will be no doubt that a mere two rak`ahs (units) of prayer are worth more than the entire world and all it contains.
The Lord of the Heavens and the Earth awaits you.

“Come to prayer; come to success.” – Adhan (call to prayer)

Monday 18 August 2014

Mnemonic: How Beta and Alpha Receptors effect on Insulin and Renin

Mnemonic: How Beta and Alpha Receptors effect on Insulin and Renin Release

Always think Beta = Booster; which means stimulation of:
  • Beta 1 receptors -> increase renin secretion
  • Beta 2 receptors -> increase insulin secretion
And for Alpha receptors it’s the reverse, which means stimulation of:
  • Alpha 1 receptors -> decrease renin secretion
  • Alpha 2 receptors -> decrease insulin secretion

Beta & Alpha 1 for renin
Beta & Alpha 2 for insulin


Wednesday 30 July 2014

Muscle Weakness, Fatiguability, Tiredness



Muscle Weakness, Fatiguability, Tiredness

This Article looks at types of muscle weakness and discusses the wide range of problems which may cause them. These range from the very common to the very rare. Some are mild and reversible; others are not. However, most can be improved by exercise and physiotherapy.
Muscle weakness is a common complaint, but the word weakness has a wide range of meanings, including tiredness, reduced power and failure to work at all. There is an even wider range of possible causes.
The term muscle weakness can be used to describe several different things.

Primary or true muscle weakness
This shows itself as an inability to perform what you want to do with a muscle, even the first time you try. There is a reduction in the force which the muscle can exert, however hard you try. The muscle is not working properly - it has become abnormal.
When this kind of

Wednesday 23 July 2014

Digital Clubbing: A sign of underlying disease

The term digital clubbing is used to describe an enlargement of the distal segments of the fingers. The toes also may be affected by clubbing. Clubbing may be hereditary, but more often it is a sign of underlying disease. Clubbing is associated with a variety of pulmonary diseases, including idiopathic pulmonary fibrosis, lung cancer, bronchiectasis,lung abscess, and cystic fibrosis. Nonpulmonary conditions that may be accompanied by clubbing include cyanotic congenital heart disease, infective endocarditis, inflammatory bowel disease, and cirrhosis. Clubbing also may be idiopathic.

DETECTING THE PRESENCE OF CLUBBING:
Digital clubbing is defined by structural changes at the base of the nails that results in a convex distal phalanx (Figure 1). The Schamroth sign can be used in the detection of clubbing. This sign is elicited by placing the dorsal surfaces of the terminal phalanges on opposing fingers together (Figure 2). Normally, a diamond shaped window appears in a patient without clubbing, whereas in a patient with clubbing (Figure 1B) this window is obliterated. Identification of advanced clubbing poses little challenge when the so-called "drumstick fingers” are obvious; however, identification of the early stages of clubbing can prove difficult. Two objective measures for determining the presence of clubbing have been proposed. The first, known as the digital index, measures 2 separate circumferences on each of the 10 fingers at the nail bed (NB) and the distal interphalangeal joint (DIP) (Figure 3).4 The sum of the 10 ratios (NB:DIP) determines the digital index. A digital index of 10.2 or higher signifies the presence of clubbing. Although a NB:DIP ratio of 1.0 or greater at any single digit is suggestive of clubbing, the sum of the 10 ratios is more specific for clubbing.
The second objective method for the detection of clubbing is calculation of the phalangeal depth ratio. In the normal finger, the distal phalangeal depth (DPD) is smaller than the depth of the interphalangeal joint (IPD). To perform this test, calipers should be used. The calipers should touch but not compress the skin. For clubbing to be present, the DPD:IPD ratio should exceed 1.0 (Figure 4). The index finger is the suggested digit used for measurement.



SUMMARY OF ASSESSMENT OF DIGITAL CLUBBING :

Schamroth sign—Diamond-shaped window is absent
when dorsal surfaces of terminal phalanges on oppo-
site fingers are apposed. 
Digital index—Sum of NB:DIP ratios for all 10 fingers
(ratio of circumference at nail bed to circumference
at distal interphalangeal joint). Index ≥10.2 indi-
cates clubbing.
Phalangeal depth ratio—ratio of distal phalangeal
depth to interphalangeal joint depth of index finger.
Ratio > 1.0 indicates clubbing


Figure 1

 
Figure 2

Figure 3
 
Figure 4



CLINICAL CORRELATIONS/PATHOGENESIS:
Digital clubbing is a clinical syndrome with an unknown pathogenesis. Possible mechanisms include
dilation of peripheral vessels and stimulation of connective tissue growth by platelet-derived growth factor (PDGF) or hepatocyte growth factor (HGF). Digital clubbing typically is a sign of underlying disease, usually of pulmonary or cardiovascular origin .Pulmonary conditions often accompanied by clubbing include chronic lung infections, malignancy, and chronic interstitial lung diseases. Idiopathic pulmonary fibrosis is one of the most common underlying causes of digital clubbing. Digital clubbing does not usually occur in chronic obstructive pulmonary disease or asthma. If clubbing is seen in a patient with chronic obstructive pulmonary disease, a work-up for underlying malignancy should be undertaken. Clubbing in patients with pulmonary diseases is usually accompanied by cyanosis. Clubbing is not specific to pulmonary disorders and
also can be seen in cyanotic congenital heart disease,infective endocarditis, cirrhosis of the liver, and inflammatory bowel disease. In fact, one study found that the highest incidence of clubbing occurred in patients with chronic liver disease.  Clubbing without cyanosis is common in patients with infective endocarditis, inflammatory bowel disease, and cirrhosis. Clubbing can be associated with hypertrophic osteoarthropathy. Unlike other forms of clubbing, clubbing associated with hypertrophic osteoarthropathy is a painful process. Hypertrophic osteoarthropathy results from subperiosteal formation of new bone in the distal long bones, and it occurs in patients with lung cancer, bronchiectasis, and cirrhosis. Clubbing in patients with hypertrophic osteoarthropathy is believed to be stimulated by PDGF leading to proliferation of connective tissue and periosteum. 6 Several mechanisms have been proposed by which platelet clumps accumulate in the finger tips and release PDGF. HGF is another potential stimulator of clubbing. One study found higher levels of HGF in lung cancer patients with clubbing than in those without clubbing, suggesting that HGF may play a role in the formation of digital clubbing. Clubbing has been reported in 29% of patients with lung cancer and is more common in patients with non–small-cell lung cancer than those with small-cell lung cancer. 9 Another study found higher levels of HGF in patients with idiopathic pulmonary fibrosis as compared to normal age-matched controls, suggesting that HGF may play a role in the pathogenesis of idiopathic pulmonary fibrosis in addition to the development of clubbing.

Pathophysiology Explained in detail:
The specific pathophysiologic mechanism of digital clubbing remains unknown. Many theories have been proposed, yet none have received widespread acceptance as a comprehensive explanation for the phenomenon of digital clubbing. As stated best by Samuel West in 1897, "Clubbing is one of those phenomena with which we are all so familiar that we appear to know more about it than we really do."
Alterations in size and configuration of the clubbed digit result from changes in the nail bed, beginning with increased interstitial edema early in the process. As clubbing progresses, the volume of the terminal portion of the digit may increase because of an increase in the vascular connective tissue and change in quality of the vascular connective tissue, although some cases have been associated with spurs of bone on the terminal phalanx.
Although clubbing is a common physical finding in many underlying pathological processes, surprisingly, the mechanism of clubbing remains unclear. Different pathological processes may follow different pathways to a common end. Many studies have shown increased blood flow in the clubbed portion of the finger.
High-resolution magnetic resonance imaging uisng a contrast agent in 4 patients with finger clubbing and 4 healthy volunteers documented nail bed hypervascularization as linked with clubbed nails.[5] Most researchers agree that this results from an increase in distal digital vasodilation, the cause of which is unknown. Also unknown is the exact mechanism by which increased blood flow results in changes in the vascular connective tissue under the nail bed.
Many researchers agree that the common factor in most types of clubbing is distal digital vasodilation, which results in increased blood flow to the distal portion of the digits. Whether the vasodilation results from a circulating or local vasodilator, neural mechanism, response to hypoxemia, genetic predisposition, or a combination of these or other mediators is not agreed on currently.
Evidence that favors the presence of a circulating vasodilator derives from the association of clubbing with cyanotic congenital heart disease. Many potential vasodilators, which usually are inactivated as blood passes through the lungs, bypass the inactivation process in patients with right-to-left shunts. Patients with tetralogy of Fallot with substantial shunting have a high incidence of clubbing. After surgical correction diminishes the shunt, the clubbing improves. Also previously observed is clubbing confined to the feet in patients with late untreated patent ductus arteriosus in whom blood from the pulmonary artery bypasses the lungs and is shunted into the descending aorta. In the absence of a shunt, the circulating vasodilator may be produced by the lung tissue, or, possibly, it passes through the pulmonary circulation without becoming inactivated. Proposed vasodilatory factors include ferritin, prostaglandins, bradykinin, adenine nucleotides, and 5-hydroxytryptamine.
A neural mechanism has been proposed with particular consideration of the vagal system. An increased incidence of digital clubbing has been associated with the pathology and disease of vagally innervated organs. Furthermore, regression of clubbing after vagotomy has been reported. Although some factor related to the vagal system is a possible contributor to the development of clubbing, especially clubbing occurring with hypertrophic osteoarthropathy, the hypothesis of a neural mechanism has decreased in popularity because of the lack of evidence of clubbing in neurologic disorders and the presence of clubbing in diseases of organs not innervated by the vagal system.
Hypoxia has been proposed as an alternative explanation for clubbing in cyanotic heart disease and pulmonary diseases. An increase in hypoxia may activate local vasodilators, consequently increasing blood flow to the distal portion of the digits; however, in most cases, hypoxia is absent in the presence of clubbing, and many diseases with noted hypoxia are not associated with clubbing.
Genetic inheritance and predisposition also may play a role in digital clubbing. Hereditary clubbing is observed in 2 forms, including idiopathic hereditary clubbing and clubbing associated with pachydermoperiostosis. The 2 forms are believed to be separate entities. Both demonstrate autosomal dominant inheritance with incomplete penetrance.
More recently, platelet-derived growth factor released from fragments of platelet clumps or megakaryocytes has been proposed as the mechanism by which digital clubbing occurs.[6] The fragments are large enough to lodge in the vascular beds of the fingertips, and, subsequently, they release platelet-derived growth factor. This factor has been shown to have general growth-promoting activity and causes increased capillary permeability and connective tissue hypertrophy.

Diseases Commonly Associated with Digital Clubbing :

Pulmonary
Bronchiectasis
Chronic interstitial lung diseases
Chronic lung infection
Cystic fibrosis
Lung abscess
Lung cancer
Cardiovascular
Cyanotic congenital heart disease
Infective endocarditis
Other causes
Cirrhosis of liver
Inflammatory bowel disease


Mnemonic:
the mnemonic is C.L.U.B.B.I.N.G, while the L has an extension of A.B.C.D.E.F

Cyanotic heart disease
Lung disease
Abscess
Bronchiectasis
Cystic Fibrosis
Dont say COPD or Asthma
Empyema
Fibrosis

Ulcerative Collitis + Inflammatory Bowel Disease(Crohn's Disease)
Biliary cirrhosis
Birth Defects
Infective Endocarditis
Neoplasm(eg. Lung cancer or mesothelioma)
Gastrointestinal malabsorption syndrome(Coeliac disease)



Good Luck ;-)

Saturday 19 July 2014

In Pursuit Of Happyness: Never Giving Up



”Hey. Don’t ever let somebody tell you… You can’t do something. Not even me. All right? You got a dream… You gotta protect it. People can’t do something’ themselves, they wanna tell you you can’t do it. If you want something’, go get it. Period.” – In Pursuit Of Happyness

Internal Medicine multiple choice questions scenario based with answers explained (FCPS, MRCP, USMLE, PLAB practice quetions)

Question 1.A 31-year-old homosexual man presents complaining of pain with defecation. He denies any symptoms of diarrhea, abdominal pain, or fevers. Six months earlier, he developed traveler's diarrhea while vacationing in Mexico. On physical examination, he is afebrile and has an unremarkable abdominal examination. On examination of the perianal area, there is a group of five clustered ulcers adjacent to the anal orifice and extending into the anal canal. A sigmoidoscopy reveals normal rectosigmoid mucosa. Which of the following is the most likely diagnosis?

Friday 18 July 2014

STAND UP FOR GAZA AND #LiftTheSiege (page shared from suhaibwebb.com)

STAND UP FOR GAZA AND #LiftTheSiege

We are participating in an online blackout to show support for the people of Gaza. As people of conscience, we protest the international response (or lack thereof!) to the injustice committed against the civilian population of Gaza.

This is a humanitarian crisis that should pain every soul witnessing it. We unequivocally condemn, in strongest terms, the attacks on civilians from both sides, and more specifically the indiscriminate bombardment and collective punishment of the people of Gaza.

We are asking you to join us and make your voice heard. Here is what you can do:

(1) Make du`a' (pray) to Allah to defend the defenseless.

(2) Take it to Twitter.
-- Educate your network about the situation in Gaza using the hashtag #LiftTheSiege.
-- Tweet at anybody of influence (e.g. news personnel, elected officials, etc.) using the hashtag #LiftTheSiege.

(3) Contact your elected representatives and do the following:
--- Express your concern about the situation in Gaza.
--- Encourage them to support Palestinian human rights.
--- Remind them of your democratic right to vote out those who support injustice.

Talking Points:
-- Tell your elected representatives to push for an immediate end of the Israeli assault on Gaza.
-- Object to your government's unconditional support of Israel despite their illegal actions (settlements, etc.)
-- In light of recent human rights violations, demand a review of political and financial aid given to Israel by your government.

Find your representatives: US, UK and Canada.

(4) Share this page and spread the word.

We ask Allah the All-Mighty to protect the people of Gaza, ameen.

Contact Us:
- Want to blackout your site? Contact Us.
- Media professionals, see our Press Release here.


Sunday 13 July 2014

14 short stories worth reading, feeling (taken from the blog by Ashish Dadhwal)

1. Fall and Rise
Today, when I slipped on the wet tile floor a boy in a wheelchair caught me before I slammed my head on the ground.  He said, “Believe it or not, that’s almost exactly how I injured my back 3 years ago .

2. A father’s advice
Today, my father told me, “Just go for it and give it a try!  You don’t have to be a professional to build a successful product.  Amateurs started Google and Apple.  Professionals built the Titanic

3. The power of uniqueness.
Today, I asked my mentor – a very successful business man in his 70’s – what his top 3 tips are for success.  He smiled and said, “Read something no one else is reading, think something no one else is thinking, and do something no one else is doing.

4. Looking Back
Today, I interviewed my grandmother for part of a research paper I’m working on for my Psychology class.  When I asked her to define success in her own words, she said, “Success is when you look back at your life and the memories make you smile.

5. Try and U shall know
I am blind by birth. When I was 8 years old, I wanted to play baseball. I asked my father- “Dad, can I play baseball?” He said “You’ll never know until you try.” When I was a teenager, I asked him, – “Dad Can I become a surgeon?”. He replied “Son, you’ll never know until you try.” Today I am a Surgeon, just because I tried!

6. GOODNESS & GRATITUDE
Today, after a 72 hour shift at the fire station, a woman ran up to me at the grocery store and gave me a hug.  When I tensed up, she realized I didn’t recognize her.  She let go with tears of joy in her eyes and the most sincere smile and said, “On 9-11-2001, you carried me out of the World Trade Center.”

7. LOVE CONQUERS PAIN
Today, after I watched my dog get run over by a car, I sat on the side of the road holding him and crying.  And just before he died, he licked the tears off my face.

8. A DOOR CLOSES TO OPEN ANOTHER
Today at 7AM, I woke up feeling ill, but decided I needed the money, so I went into work. At 3PM I got laid off. On my drive home I got a flat tire. When I went into the trunk for the spare, it was flat too. A man in a BMW pulled over, gave me a ride, we chatted, and then he offered me a job.  I start tomorrow.

9. LOOKING BACK
Today, as my father, three brothers, and two sisters stood around my mother’s hospital bed, my mother uttered her last coherent words before she died. She simply said, “I feel so loved right now. We should have gotten together like this more often.”

10. AFFECTION
Today, I kissed my dad on the forehead as he passed away in a small hospital bed.  About 5 seconds after he passed, I realized it was the first time I had given him a kiss since I was a little boy.

11. INNOCENCE
Today, in the cutest voice, my 8-year-old daughter asked me to start recycling. I chuckled and asked, “Why?” She replied, “So you can help me save the planet.”  I chuckled again and asked, “And why do you want to save the planet?” “Because that’s where I keep all my stuff,” she said.

12. JOY
Today, when I witnessed a 27-year-old breast cancer patient laughing hysterically at her 2-year-old daughter’s antics, I suddenly realized that I need to stop complaining about my life and start celebrating it again.

13. KINDNESS
Today, a boy in a wheelchair saw me desperately struggling on crutches with my broken leg and offered to carry my backpack and books for me.  He helped me all the way across campus to my class and as he was leaving he said, “I hope you feel better soon.”.

14. SHARING
Today, I was traveling in Kenya and I met a refugee from Zimbabwe.  He said he hadn’t eaten anything in over 3 days and looked extremely skinny and unhealthy.  Then my friend offered him the rest of the sandwich he was eating.  The first thing the man said was, “We can share it.”

Saturday 12 July 2014

To live is the rarest thing

“To live is the rarest thing in the world. Most people exist, that is all.” — Oscar Wilde

Friday 11 July 2014

Staying Physically Energized During Ramadan..By Noor Hani Salem

While we focus on our spiritual upbringing, we also need to focus on our physical well-being. Instead of praying Maghrib and rushing to eat, set your intention to eat to nourish your body so that you can stand and pray. In this case, you make eating an act of worship and get rewarded for it, Allah (swt) willing. Set your intention to eat suhoor (the meal before sunrise) to worship and have energy all day. Set your intention to eat iftar (the meal after sunset) to worship and pray during the night. Now, let me share a few tips on what to eat to stay hydrated, energized, and motivated all day long.
With Ramadan in the midst of summer this year, we need nothing more than hydration and good eating habits to keep us going. However, Ramadan is not only about omitting food and drink from sunrise to sunset. It’s not about sleeping all day and waking up an hour before sunset to prepare a meal. It’s not about indulging all night and sleeping all day. No, Ramadan is a spiritual car wash for our souls. It’s a time to check in on ourselves, omitting desires, and focusing on what we were initially created for: worshipping Allah subhanahu wa ta`ala (exalted is He).

1)     Eat dates.
  • I personally don’t question any food that was eaten by the Prophet Muhammad ﷺ (peace be upon him) or recommended by him.
    • Anas Ibn Malik radi Allahu `anhu (may God be pleased with him) narrated: “The messenger of Allah ﷺ  used to break his fast before praying with some fresh dates, but if there were no fresh dates, he had a few dry dates, and if there were no dry dates, he took some mouthfuls of water.” [Sunan Abu Dawud]
  • Fasting all day means facing difficulties reaching the required daily value for many essential vitamins and nutrients. Dates are known to provide many of these nutrients with just a few pieces:
    • Dates have immense health benefits, including high fiber, potassium, magnesium, copper, and B vitamins.
    • Dates are known to regulate blood sugar, weight loss, blood pressure, cancer, and arthritis. Dates also aid in facilitating oxygen to the brain and the formation of healthy skin.
  • Tip: Eat three or more dates at suhoor to give you energy all day. Break your fast on dates and pray Maghrib. This regulates your blood sugar and causes you to not overeat at iftar.
2)     DON’T skip out on suhoor.
  • Yes, it’s 4 a.m. and yes it’s going to be difficult, but my number one piece of advice is don’t skip out on suhoor. The Prophet ﷺ advised us to eat suhoor and promised barakah (blessings) in it. Abu Hurairah (ra) narrated: “The Messenger of Allah ﷺ said: ‘Eat suhoor, for in suhoor there is blessing.’” [Sunan Al- Nasa’i]
  • Eating a meal before sunrise will give you energy to keep going during the long day ahead of you.
  • If you skip out on suhoor, you are putting your body in starvation mode and actually only going to cause yourself to overindulge at iftar.
  • So, EAT SUHOOR!
  • Tip: Eat a light but nutritious, breakfast-like meal:
    • Try a zatar  or cheese pie with some cucumbers. Tomatoes and a cup of fresh-squeezed orange juice are also excellent sources of vitamins and nutrients.
    • Have nutrient-dense whole-grain toast with almond butter, cashew butter, or all-natural peanut butter. Top with berries or banana slices.
    • Try some quinoa with almond milk, raisins, cinnamon, raw honey, and bananas. It will definitely give you fuel for the day.
    • A bowl of steel cut oats or whole grain cereal and organic milk/almond milk are also great.
    • Don’t forget the dates. ;)
salad
3)     Eat hydrating foods like watermelon, cucumbers, citrus fruit, and tomatoes.
  • It’s not only summer time, but we are fasting 17+ hours. Many of us have work and others are taking summer courses. We are going to lack energy and need as much nutrients as we can get from the food we eat. Hydrating ourselves with water-dense foods will keep our bodies from dehydrating in the heat.
  • Tip: Other foods with high water content include: lettuce, pineapple, berries, citrus fruit, and spinach.
4)     Drink plenty of water between iftar and suhoor
  • Water is the most purifying drink;  it cleans out toxins from your body and prevents you from getting headaches (especially when you’re not drinking or eating all day).
  • Tip: Skip the soda! Drinking soda with your iftar will only make you thirstier, and dehydrate your body more than it already is. Drink water with your meal and keep it at hand throughout the night.  Break your coffee and tea addiction.
  • If possible, regulate your body to get rid of your caffeine addiction before Ramadan starts. If you are drinking 3-4 cups of coffee daily, and on the first day of Ramadan you don’t drink any, you may get headaches and lack energy.
  • Tip: If you really need energy, opt for dates instead. Coffee and tea are known to dehydrate the body even more.
I hope that you find these eating tips helpful! I assure you that making these small changes in your Ramadan and even regular diet, will substantially improve your overall health and fitness.

Monday 7 July 2014

Internal medicine multiple choice question with explanation (FCPS, MRCP, USMLE, PLAB)

A 53-year-old woman presents complaining of fatigue over the past 6 months. During this time, she has also developed pruritus and lost 4 pounds. She is not sexually active, and her past medical history is significant only for Sjögren syndrome.
On physical examination, she is afebrile and has mildly icteric sclera. There are excoriations noted on all four extremities and trunk and back. The liver edge is smooth and non-tender and measures 9 cm at the midclavicular line. There is no ascites, splenomegaly, or peripheral edema.
Laboratory results reveal a normal complete blood count, normal electrolytes, and liver function tests with an alkaline phosphatase of 260 U/L (normal, <110 U/L), total bilirubin of 3.1 mg/dL, and normal transaminase levels. Which of the following is the most likely diagnosis?
a) Acute cholecystitis
b)Acute hepatitis A infection
c)Bacterial cholangitis
d)Primary biliary cirrhosis
e)Primary sclerosing cholangitis 


Explanation:
The correct answer is D.

This woman has a classic presentation of primary biliary cirrhosis. It typically affects middle-aged women and will progress gradually to the point of end-stage liver disease over a number of years. The disease is due to an autoimmune destruction of intrahepatic bile ductules, and the diagnosis is made by liver biopsy. The serology that should be checked is the antimitochondrial antibody. Primary biliary cirrhosis is often seen in individuals with other autoimmune diseases, such as Sjögren syndrome, pernicious anemia, and Hashimoto thyroiditis.
Acute cholecystitis (choice A) presents acutely with right upper quadrant pain and fever and not with chronic fatigue and pruritus.

Acute hepatitis A (choice B) may cause jaundice and fatigue, but it is a self-limiting infection and does not last 6 months.

Cholangitis (choice C) is due to acute obstruction of the common bile duct and presents urgently with fever, right upper quadrant pain, and jaundice (Charcot's triad).

Primary sclerosing cholangitis (choice E) is a sclerosing process of the extra- and intrahepatic ducts, which usually presents in young males with underlying inflammatory bowel disease.

Saturday 5 July 2014

"Giving Life to a Dead Heart: Al-Muhyi " ... By: Jinan Bastaki

Alhamdulillah (all praise be to God), we have entered into Ramadan. While this is the most beautiful time of the year—a time in which the doors to Paradise are open, the gates of hell are closed, and the devils are chained—some of us may be coming into it carrying a heavy burden. Some of us might be broken. And still others might not really feel anymore. No one knows our internal state, the fact that all those months have done something to us, that our hearts are numb and we are not even really sure what it is like to feel that energy or that love anymore.
If you are that person, and if you feel that something in your heart has died, don’t give up just yet. This Name of Allah, subhanahu wa ta`ala (exalted is He), is for you. Allah tells us:
“And is one who was dead and We gave him life and made for him light by which to walk among the people like one who is in darkness, never to emerge therefrom?” (Qur’an, 6:122)
In the last article, we briefly mentioned Allah’s Name al-Muhyi—the Giver of Life. We see manifestations of His Name all around us. Life and death are two sides of the same coin; He who causes death, also brings life out of death. In Surat al-Baqara, Allah (swt) tells us the story of the Prophet ‘Uzayr, `alayhi as salaam (peace be upon him), when he came to Jerusalem and found it to be burnt to the ground, with no traces of life whatsoever. ‘Uzayr (as) exclaimed:
“’How will Allah bring this to life after its death?’ So Allah caused him to die for a hundred years; then He revived him […]” (Qur’an, 2:259).
Just as Allah (swt) brought back to life ‘Uzayr—and indeed the whole of Jerusalem—and just like He created a sturdy 400-year-old Redwood tree from a tiny seed—a seed that seems dead, a seed that had you stepped on it would have been crushed—know that He can bring alive your beautiful heart. The same heart that He created to know Him.
If we fail to use our hearts for what they were created for, that is when they become rusty. A person who never exercises finds it much harder to run a marathon, and cannot take it. Even more than that, a person who is bedridden for months probably won’t be able to walk straightaway when he is better, because his legs were out of use for so long. Similarly, when we fail to use our hearts by directing them to Allah (swt), slowly they die and we forget how to exercise them in what they were created for.
It does not really matter how we got here. We may think, “But I am different. I am so beyond help.” That is Shaytan (Satan) or your nafs (base self). Remember Malik bin Dinar, who most people know as a great scholar. But it was not always so. He was a person who went to the extremes in what was prohibited—whether it was through illicit relationships, alcohol or gambling. There wasn’t anything he did not try. But God blessed him and tested him in ways that brought him back. And his heart came alive, even though you would not have believed it if you had met him before.
Some of us may have had a very difficult year, or a very difficult couple of years, and these things take their toll. Others of us may have slowly slipped, such that everything has become more important than our relationship with Allah (swt). But whatever the journey, the result is the same. And for each and every one of us, Allah al-Muhyi, the Giver of Life, calls us to bring us back to life. So don’t think that there is no hope for you, and that there is no point in trying. The only way to truly bring us back is by mending our relationship with Him and making Him our center again.
Just remember your part. Make the intention. Intend to bring back your heart. And remember that you will get what you intend. This Ramadan, intend tawba—a return to Him. And know with full conviction that He will accept you, as He tells us:
“Allah wants to accept your repentance, but those who follow [their] passions want you to digress [into] a great deviation.” (Qur’an, 4:27)
When your heart comes alive—truly alive—you will be light and fulfilled, because your heart is full of what it is meant to be full of—love for Allah. And you will be a living manifestation of Allah’s Name al-Muhyi.
Because our hearts are rusty, it may take a while. But Allah is al-Muhyi, so the result is guaranteed insha’Allah (God willing). So what can we do to aid in the journey?
Qur’an
“O mankind, there has to come to you instruction from your Lord and healing for what is in the breasts and guidance and mercy for the believers.” (Qur’an, 10:57)
The Qur’an was sent as a healing for our hearts, and this is the month of the Qur’an. So reflect on the Qur’an this month in addition to reciting it. If you feel you do not have the tools to do so, then make it a goal to listen to tafseer every night (Nouman Ali Khan is great for this, and I believe he has a Ramadan Qur’an series). Also, make it a point and a goal to choose 5 lessons from the Qur’an that you will implement by the end of Ramadan. This way you are of the people who not only listen to and reflect on the Qur’an, but you are of those who implement it. You will be what the Prophet ﷺ (peace and blessings be upon him) describes as a “citron – its scent is fragrant and its taste is good,” (agreed upon) because of your recitation and implementation of the Qur’an.
Istighfaar—Seeking Forgiveness
Sometimes this numbness is as a result of the wrongs that we do that have become so numerous we do not even notice them anymore. But as the Prophet ﷺ taught us:
“When a slave commits a sin, a black spot appears on his heart. But if he gives it up, seeks forgiveness and repents, his heart will be cleansed. But if he repeats it, (the blackness) will increase until it overwhelms his heart.” [Tirmidhi, Ibn Majah]
The essence of istighfaar is reflection. Our hearts become numb when we do not reflect. So cleanse your heart by seeking forgiveness from Allah (swt).
Du`a’—Supplication
This is key. Truly, no one knows of that emptiness that we feel except for Him, and only He can fill it. Du`a’ that comes from the heart represents our need for Him, and only Him. So call out to Him in the night. Ask Allah (swt) to bring alive your heart. Ask Him to fill it with love for Him. Take the steps, even the baby steps, to come closer to Allah, through your prayers, through remembering Him and through good company. Remember that He is Generous, Shy and He responds. Pour out your heart to Him this Ramadan. Ask for what you need to give your heart life.

Internal Medicine practice Mcqs (FCPS, USMLE, PLAB, MRCP)



A 45 year old male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
A. Korsakoff’s psychosis
B. Wernicke encephalopathy
C. De Clerambault syndrome
D. Delirium tremens
Correct answer : B. Wernicke encephalopathy
Wernicke encephalopathy is characterised by a triad of confusion, ophthalmoplegia and ataxia in an alcoholic patient.

Internal Medicine Practice MCQs (FCPS, USMLE, PLAB, MRCP)

A 29-year-old man is brought to the emergency department in a comatose state a few hours after complaining of sudden onset of excruciating headache. Neurologic examination reveals dilated pupils poorly responsive to light. A CT scan of the head without contrast demonstrates hyperdensity within the suprasellar cistern, while MRI is unremarkable. Lumbar puncture shows hemorrhagic cerebrospinal fluid. Which of the following is the most likely diagnosis?
a)Amyloid angiopathy-related hemorrhage
b)Cavernous sinus thrombosis
c)Hemorrhagic infarction
d)Pituitary apoplexy
e)Ruptured berry aneurysm

Explanation:
The correct answer is E.
Headache of sudden onset ("thunderclap" headache), rapid deterioration of mental status and blood in the CSF are virtually diagnostic of ruptured berry aneurysms. Note the characteristic hyperdensity on CT of the suprasellar cistern, indicating blood in the subarachnoid space. Rupture of a berry aneurysm is the most common cause of subarachnoid bleeding. Berry aneurysms develop as a result of congenital weakness at branching points of the arteries in the circle of Willis. These outpouchings tend to expand progressively, but in most cases they remain asymptomatic. Hypertension facilitates development and rupture of berry aneurysm. One third of patients recover, one third die, and one third develop re-bleeding. Rapid onset of coma is an ominous sign.

Amyloid angiopathy-related hemorrhage (choice A) would manifest as a cortical-based hematoma in a lobar distribution. It is due to accumulation of Aβ amyloid in blood vessel walls.

Cavernous sinus thrombosis (choice B) is a rare complication of conditions leading to coagulation abnormalities, such as sepsis, antiphospholipid antibody syndrome, and leukemias. It leads to hemorrhagic infarction of large areas of hemispheric gray and white matter.

Hemorrhagic infarction (choice C) usually develops as a result of embolic occlusion of an intraparenchymal artery. It gives rise to a hyperdense wedge-shaped area in a cortical field corresponding to a specific vascular territory.

Pituitary apoplexy (choice D) refers to hemorrhage in the pituitary gland. It may occur in the setting of a large pituitary adenoma or in pregnancy. It manifests with rapid onset of panhypopituitarism.





Thursday 3 July 2014

My Garden of Memories... By: Reehab Ramadan


https://www.flickr.com/photos/shandilee/4661066533
Photo: Shandi-lee Cox




In the field behind my house, there is a garden where my memories grow. Scattered by the wind, yet perfectly sorted by time. Some have yet to grow and blossom into their full potential, while others are so withered, it’s a wonder they are still alive. From time to time I go out and walk through my garden, trying to appreciate the beauty of the blessed landscape that my life has, over time, sown.
It is always the same, yet each time a little bit different. It begins as something joyous, something I look forward to. But then my heart gets entangled in the weeds, I see the flowers that have died, and my heart turns hard and cold. Gardens should be a source of pleasure, but mine has at times been a source of heart-gripping nostalgia and at other times a source of tears—from wounds that have never been healed.
This time was different. This time, I decided to take the gardener along with me on my stroll. Well, I didn’t really decide to take him with me; it had been decided for me. It was as if God was reminding me that I was never taught to be a gardener, yet I had relied upon my own gardening skills, which was a recipe for failure. So when he came to me, with his brimmed sun hat and garden tools in hand, I opened the gate and invited him in. At first I wanted him to take the stroll himself; if he had come to fix things, if he had come to make my garden beautiful, then he could do it on his own. But without a word he shook his head and handed me a tool as well.
I took the tool from him and stood behind him, hoping that he would shield me from the view of the garden that I was just too tired to look at any longer. He grabbed my hand and ran to the opposite side. I never started with this side of the garden, so usually by the time I got here I was too tired to see what was growing. He fell to his knees and pulled me down beside him. “These are the oldest of your flowers, yet they look the youngest. These are the flowers that started it all. These are the flowers you should cherish and take care of always. They don’t have any thorns; they don’t have any sharp edges. They are just flowers.” And as I looked at them, I began to smile, from molar to molar. Buttercups! Buttercups! I had never noticed that they were my childhood favorite, buttercups. And I began to laugh as I remembered how we would find the buttercups as children and pick off the stem. We would hold the flower to our lips and suck, ever so gently, finding the sweetness of the nectar dripping onto our tongues and invigorating our hearts. We’d then throw the flowers down and lay in the grass, talking about nothing and everything all at the same time. Buttercups. All this time they were right there, but I had always started at the wrong side of my garden, so I never noticed.
I had gotten lost in thought and forgotten the gardener was waiting for me. I looked up at him, ready to apologize for wasting his time, but I found him simply sitting. Sitting and smiling. He stood up and took my hand and walked me over to another part of my garden. He looked a little concerned, but not too much so. He sat down and gently tapped the ground so I could sit beside him. “These flowers look a bit rough. They are beautiful flowers, but they have begun to grow small thorns on the stems, so you must be careful when you touch them. There are many small weeds growing in this part of the garden, and they don’t need to be here. They are taking the nutrients from the flowers and taking away from their beauty. Together we will pull out these weeds. Be gentle—do not tear them. Pull them from the root, and put them in the bucket. I will show you what we will use them for later.” I nodded my head and watched as he showed me how to weed the garden. I had never before weeded anything, but he was so skilled that when I began to follow his lead, I learned quickly. Each time I pulled one of the small weeds, the garden seemed to radiate more and more, the beauty of the flowers finally emerging. After we finished, the bucket where the weeds lay looked dark and cold. Just looking at the weeds made my chest tighten and tears well up in my eyes. He put his hand on my heart. “Don’t worry, you will soon understand. We need these weeds for later.” I had no idea what he was saying, but I had come to trust him so much that I didn’t need to understand. I took another look at the now beautiful portion of my garden, and took in a deep breath, smelling the sweet aroma of flowers that had never before made it to my soul. He put his hand on my shoulder and urged me to move on.
I found myself standing in front of the last planted portion of my garden. This was the portion that I usually began with, the portion that was the ugliest, the most neglected. Just looking at this part made me sick to my stomach. I looked for a few seconds, hit the floor with my knees, and covered my face. This wasn’t even a garden; it was a garbage dump. I began to cry, not really understanding why, but when I looked at him, he nodded in recognition. He knew why I was crying, and it was okay. He waited until I was done, and gently sat next to me in front of the horrific scene before us. “Look closely. If you look past the entangled jumble of weeds, past the dead leaves and bugs, you will see tiny little flowers. They are there, but they haven’t been taken care of at all and the weeds have cut off their supply of nutrients. They get smaller every day and have never been given a chance. Look at the weeds. They have sharp thorns that can cut your hand if you touch them. Look at the dead leaves. All over them there are bugs that are eating away at the soul of the flowers. These too can bite you if you are not careful. For this garden, you must wear gloves. You will wear gloves and tear away all of the overgrown weeds, cut off all of the dead leaves, and spray them with food that will nourish the small flowers. Again, make sure not to cut the tiny flowers, and make sure to get the weeds at the root. These too will go into our bucket.”
He handed me the strongest leather gloves that I had ever seen. I put them on, and then I noticed that he didn’t put any on. I asked him why; wouldn’t he get hurt? He responded, “I am a gardener. I am experienced in the gardens of weeds, thorns, and bugs. My hands have built their own shields, and I feel no pain when I touch them. They can no longer affect me.” I nodded my head, not fully understanding, but hoping that one day I would. I began pulling at the weeds, revealing tiny flowers I had never seen before, which had sadly been deprived of nutrients for so long. This part of the garden took the longest. We spent hours and hours plucking away at the weeds, until finally we had finished. He then took out the nutrient water and sprayed the area. Before my eyes, I saw the flowers begin to strengthen and grow. “You must spray this garden every day for some time in order for the flowers to reach their full potential. If you forget, the weeds will return, and it will go back to being the ugly place it was before.” I nodded my head and promised that I would.
We finished all the planted areas of the garden. Now all that was left was a barren space that had never been sown. Before I had a chance to explain that this hadn’t been planted yet, I saw him reach for the bucket of weeds. He began to spray them with nutrient water and crush them with his hands. Under the pressure of his touch, they crumbled and became like powder. When he finished, he handed me the bucket of powder that his hands had produced. “Go to that barren area, and spread this dust all over the untouched soil. This will be the fertilizer by which new flowers will grow. You will see that the flowers that are produced in this area will be more beautiful and more fragrant than any other part of your garden. They will be stronger, and they will have fewer thorns. They will be the flowers that you admire most. They will be what makes your garden complete. And the only reason they will have been able to grow in such magnificent ways is because of the fertilizer that we made, together from the weeds that clouded your other flowers.” I took the bucket and did as he said. Before my eyes I saw small green plants begin to bud. I could not tell what color the flowers would be, or even what kind they would be. But I could tell that these flowers were not like anything I had ever dreamed of having in my garden.
The sun began to set, and the gardener handed me the tools that were in his hands. “I must go now, but I have given you exactly what you need to take care of your garden. If you need me, just call out and I will be at your door in a minute. You did a great job today. Don’t forget that.” He turned and walked away, leaving me sitting in my garden, this time with a joyous relief and gratitude I had never felt before. This was my garden of memories, and it was the most beautiful garden I had ever seen.

Monday 30 June 2014

Thats what FAITH can do


The Number that Never Changes...By: Omar Zarka

He was right; having a good friend for over fifty years is impressive. I was attending a dinner in which a well-respected scholar and professor was being recognized for his accomplishments. Instead of focusing on himself and his journey, he spent his entire speech thanking the numerous individuals that impacted his life. As he reflected on his experience, he said one of the most rewarding gestures he ever received had been from a former student going out of his way to find the professor’s contact information to contact him and thank him for the time and effort he put into his education. I found it peculiar that after several decades of many accomplishments, friends and family, one of the most rewarding gestures the professor received was a thank you.

It’s true though. Sometimes, after trying so hard and going out of our way to help someone, all it takes is two words—thank you—to start the rush of accomplishment and success. In fact, it happens all the time at work and school when we get a pat-on-the-back for the job-well-done on a project or a paper.


I used to ponder on the significance of giving “thanks” to Allah subhanahu wa ta`ala (exalted is He). Clearly there is no benefit to Him, al-Ghani (the One that is free of all needs). Slowly yet surely though, life comes to show that it truly is the thought that counts; at the core, it’s about the very process and not the details. The very act of giving thanks is a humbling comment; a recognition of benefit and respect or even awe. The professor didn’t reminisce on the contents of the thank you, but rather the fact that he was thanked. And notice – the value of the thank you increased because the student was so thankful that he was willing to thank his professor years later, even at the cost of the student’s time and effort. In other words, the fact that his student was so thankful that he thanked him again, was worth more.
We’re so blinded by our own heedlessness and the thick, murky fog of this dunya (the physical Universe) that we readily miss the blessings that surround us. But when we are so fortunate to see some of the things that keep us standing, we don’t have to search for Allah’s contact information. He’s the friend that we’ve known the longest and His number never changes wa alhamdulilLah (and praise be to Allah).

Checkpoints of Faith: Where do you Stand? By Accepted Whispers (Yasmin Mogahed)


https://www.flickr.com/photos/leon_77/2762842195




About six months ago, I had just finished praying Fajr (dawn prayer) and decided to recite some Qur’an. Craving attention and appreciation from the right place this time, I remembered reading somewhere that the angels witness morning recitation. I gently flipped through the pages of my Qur’an and started recitation from where I left off but it wasn’t long until I felt my voice crack and eyes blur. I was crying…again! I embraced the Qur’an open and wept silently till the dawn. Exhausted, I carefully placed The Holy Qur’an on the table in front of me, took a deep breath and began recitation again.
“And when the two companies saw one another, the companions of Moses said, ‘Indeed, we are to be overtaken!’ [Moses] said, ‘No! Indeed, with me is my Lord; He will guide me.’” (Qur’an 26:61-62)
I paused and reflected. It wasn’t the first time I had heard this story but like the new dawn, that day, it brought a whole new meaning into my life. Standing in front of the Red Sea, Musa `alayhi as-salam (peace be upon him) had nowhere to go; I too had nowhere to go. But Prophet Musa’s unwavering faith in the face of such great difficulty touched the depths of my heart and I finally realized why Allah subhanahu wa ta`ala (exalted is He) narrates His miracles to us. Prophets were people like us. Allah chose them to deliver His message and through them, the Almighty is enlightening us of how to believe in Him.
Allah (swt) has a plan for us, and sometimes what we are most afraid of is what happens. We find ourselves asking, “Why me?” These emotions of utter despair and hopelessness swamp all aspects of our lives and it becomes almost impossible to keep any hope. Take a moment and reflect. Don’t be afraid, for this is merely a test, a test of your faith. Prophet Musa (as) stood firm in front of the Red Sea and without a doubt believed Allah will make a way, and so He did.
These extraordinary stories from the Qur’an are checkpoints of faith: Where do you and I stand? Al-Mu’min (the Inspirer of faith) unfolds the story of Musa (as), so that we may be inspired and sow seeds of unflinching faith within our hearts. Faith produces miracles, and what was impossible becomes possible.
As I reflected upon the beautiful words of Prophet Musa (as), I wiped my tears and smiled. Humbled, I quickly took the Qur’an in my arms once again. I found peace and tranquility where I had never imagined. I found solace in Allah (swt).
“Don’t look at the Red Sea, look at the One who can split it in two.”—Yasmin Mogahed