@ahmedawan132 From I got into med school to I finished med school. The full circle moment we all needed today. Congratulations, Dr. Ahmed. The world needs more people who finish what they start.
¡Soy médico! Hoy recogí mi título.
Un recordatorio de que, aunque haya días cansados, cada esfuerzo cuenta y cada paso te acerca más a donde quieres estar. Lo estás haciendo bien.
P.D. Prometo volver en 4 años y voy a citar este tweet diciendo: ¡Soy Ginecólogo y Obstetra! 🤞🏻🤞🏻
To every medical intern about to complete internship,
The white coat you wear today carries dreams, sacrifices, sleepless nights, and countless battles that only you truly understand. You have survived exhausting calls, difficult patients, heartbreaking losses, and moments when you doubted whether you could make it through another shift. Yet here you are standing at the finish line of one chapter and the beginning of another.
But as internship comes to an end, a difficult truth awaits. The world outside is not always kind. Jobs may not come as quickly as you hope. Doors may not open immediately. Some of your classmates may seem to move ahead faster than you. There will be days when frustration, uncertainty, and fear will test your spirit.
When those moments come, do not allow your title to become your prison. Put pride aside. Put ego aside. If an opportunity presents itself, take it and give it your best. Never believe that any honest work within healthcare is beneath you. The person who remains teachable will always go further than the person who believes they already know enough.
Treat everyone with respect. The nurse, the cleaner, the laboratory technician, the pharmacist, the clinical officer, the consultant, and the patient all have lessons that no textbook can teach. Your character will open more doors than your qualifications ever will.
Most importantly, do not measure your journey against someone else's timeline. Life is not a race. Some will find success early, while others will struggle before they rise. What matters is that you keep moving, keep learning, and keep showing up even when the future seems uncertain.
One day, the struggles you are facing now will become the story that inspires another young medic not to give up. So hold on. Stay humble. Stay hungry. Stay faithful to your purpose.
The world may not owe you anything, but your perseverance can earn you everything.
Your internship is ending, but your true test and your true greatness..
I wish you the very best and a fruitful future ahead✅️✅️🔥🙏🫂
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SOME OF THE COLDEST BRO TO BRO CODE YOU NEED TO KNOW;
1) never eat where your mother is mocked
2. never judge your father until you become a man.
3. never mock a brother to entertain the table
4. we might eat late but I promise, we will eat
5. world is so cruel to a poor man
6. You are independent, only mom can love you without conditions
7. We are not behind, we just didn’t get it handed to us.
8. Show up everyday to fix your life. Do it alone, do it tired, do it scared, do it broke, do it anyway. Just find a way!
9. And when you become their type, Don’t date them!
10.Bro to bro: I want to see you win!🫵🏽
Share some bro code you know, for others to learn!
Treatment of Tuberculosis in a patient with chronic liver disease (CLD) is challenging because the major anti-TB drugs can cause hepatotoxicity.
The key principle is:-
> Treat TB effectively while minimizing liver injury.
Step 1: Assess severity of liver disease
Evaluate:
LFTs (AST/ALT, bilirubin)
Albumin, INR
Child-Pugh class
Presence of jaundice, ascites, encephalopathy
The worse the liver disease - the fewer hepatotoxic drugs you should use.
Hepatotoxic anti-TB drugs:-
Most hepatotoxic:
1. Pyrazinamide (Z) - most hepatotoxic
2. Isoniazid (H)
3. Rifampicin (R) - relatively less but still hepatotoxic
Relatively safe:
Ethambutol (E)
Streptomycin (S)
Fluoroquinolones (Levofloxacin/Moxifloxacin)
Drug selection in CLD
1. Stable CLD / mild liver disease
(Child A, mild enzyme elevation)
Can use:
H + R + E
Avoid or cautiously use:
Pyrazinamide
Common regimen:
2 HRE / 7 HR or
2 HRE + FQ / 7 HRE
Reason: Pyrazinamide is usually omitted first.
2. Moderate liver disease
Use only one hepatotoxic drug if possible.
Example:
Rifampicin + Ethambutol + Fluoroquinolone + Streptomycin
Avoid:
H and Z if liver dysfunction significant
3. Severe CLD / decompensated cirrhosis
Avoid all hepatotoxic drugs if possible.
Regimen may include:
Ethambutol
Streptomycin
Fluoroquinolone
Amikacin
Linezolid (selected cases)
Duration is usually prolonged (12–18 months).
Important principles - Monitoring
Monitor frequently:
LFTs
Jaundice
Nausea/vomiting
Encephalopathy
Stop hepatotoxic drugs if:
AST/ALT >5× normal without symptoms or
> 3× normal with symptoms
Stroke localization is one of the most powerful bedside skills in neurology and also one of the most favorite questions consultants ask during morning rounds.
So if you want to avoid getting embarrassed during rounds, you should definitely know these patterns.
Here are more high yield stroke localization pearls for residents and house officers 👇
➡️ Aphasia = dominant hemisphere lesion (usually left MCA) until proven otherwise.
➡️ Neglect = non-dominant parietal lobe stroke (usually right MCA).
➡️ Crossed signs (cranial nerve deficit on one side + body weakness on opposite side) = brainstem stroke.
➡️ Sudden vertigo + ataxia + diplopia = posterior circulation stroke unless proven otherwise.
➡️ Pure motor hemiparesis with no cortical signs = lacunar infarct.
➡️ Visual field defect without weakness = think PCA territory.
➡️ Locked-in syndrome is basilar artery thrombosis until proven otherwise.
➡️ Face and arm weakness worse than leg = MCA stroke.
➡️ Leg-predominant weakness = ACA stroke.
➡️ Dysphagia + hoarseness + ipsilateral facial sensory loss = lateral medullary syndrome.
➡️ A patient who “cannot speak” may still fully understand you → Broca aphasia.
➡️ Fluent but meaningless speech with poor comprehension → Wernicke aphasia.
➡️ Eye deviation usually points toward the side of hemispheric stroke.
➡️ Thalamic strokes commonly present with pure sensory deficits.
➡️ Sudden coma with pinpoint pupils should raise concern for pontine hemorrhage.
➡️ Severe headache + vomiting + decreased consciousness = think hemorrhagic stroke.
➡️ New atrial fibrillation in stroke patient = always suspect cardioembolic stroke.
➡️ Brainstem strokes can present subtly but deteriorate rapidly.
➡️ Bilateral weakness is never a typical MCA stroke pattern — think brainstem/basilar pathology.
➡️ If symptoms do not fit one vascular territory, reconsider the diagnosis.
➡️ Cortical signs = aphasia, neglect, gaze deviation, visual field defects, seizures.
➡️ Absence of cortical signs strongly favors lacunar stroke.
➡️ Sudden isolated ataxia in elderly hypertensive patient can still be a stroke.
➡️ Posterior circulation strokes are commonly missed in emergency settings.
➡️ Normal CT brain early in ischemic stroke does NOT exclude stroke.
I envy people who don't update anything about their lives. Nothing about their jobs, business, dinner, children, family or even their pictures
How did you get this disciplined?🤔
Once you realize that anything can happen—sickness, death, or loss of a job—literally anything can change in the blink of an eye, you become very humble. Tables turn, and that's how crazy life can be. Always pray, stay humble, and be thankful.
Once you're born in Africa, life is automatically leading 1-0. If you're not educated, 2-0. If your parents don't have money, 4-0. At that point, you're left with no option but to hustle every day just to equalize.