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Symptoms of Heart Attack

Symptoms of Heart Attack
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Heart Attack, also called Myocardial Infarction (MI), is a life threatening clinical condition when blood flow to the heart stops. Blockage happens due to fat, cholesterol or other substances. Mostly heart attacks are caused by coronary heart diseases.

There are various symptoms of heart attack and may vary from one person or gender to another person or gender. Following are the most common symptoms.

  1. Discomfort or tingling in arms, back, neck, shoulder or jaw
  2. Chest pain
  3. Shortness of breath
  4. Nausea or vomiting
  5. Unusual tiredness
  6. Sudden dizziness
  7. Cold sweat
  8. Heart-burn like feeling

Patient can experience one of these symptoms or a combination.

If you notice any of these symptoms in yourself or anyone else around you, call 1122 immediately for ambulance help.


Haemovigilance – Blood Safety

Kulsum International Hospital offers NAT Screened blood for all transfusions


Blood transfusion is one of the historical achievements of mankind. History of efforts to transfuse blood dates back to early 17th century. Finally a successful human to human blood transfusion was first performed by James Blundell in 1818, since then the history of blood transfusion is full of the success stories. Discovery of blood groups, blood typing, cross match, establishment of blood banks, blood plasma transfusion, harvesting platelet concentrates, blood screening for viruses, and other live organisms are the major milestones. With the advancement in blood preservation and cross match techniques blood was thought safe till medical scientists discovered that if blood of a disease carrier is transfused to another person it can transmit disease to the recipient. A number of viruses, bacteria and other organisms can be transmitted through blood transfusion. Globally the surety of a blood clean of all harmful viruses, bacteria and other organisms was urged and a blood screening strategy was implemented to prevent the disease transmission.


In Pakistan, donor blood screening for Hepatitis B, Hepatitis C, AIDS, malaria, and syphilis is mandatory. Blood screening through a sensitive and reliable method must be ensured and preferred due to seriousness of the diseases transmitted. It is a fact that a person acquiring Hepatitis B, C or AIDS virus remains silent carrier for a long time and gradually falls sick. Just after the entry of a virus in body it is engulfed by the body’s defense mechanisms. The virus is either eliminated by defense system or it escapes and thrives in body. In case if it thrives  it can be detected either by appearance of its surface particles in blood called as antigens or by a protein produced against this antigen called as viral antibody.  Blood screening methods detect either antigen or antibodies (the method is called as immunological assay) which are produced after few weeks of infection, during this period the virus is present in body, the host is unaware and apparently without any sick feeling.  During this period the virus can be transmitted through blood to another person even if it is tested and found negative for these diseases and it is known as dark period or window period. These silent carriers transmit disease if they donate blood in this window period.


As it takes few weeks for antigens or antibodies to be detectable in blood by immunological methods, more sensitive strategies to detect viral genome in blood at very early stage (during window period) of infection were explored. Currently, the immunological methods are regarded as inadequate to ensure blood safety. The viral genome can be detected in blood within first week of infection with a sensitive method. The genome is made up of nucleic acids distinct for each species; this genomic detection in blood is called as nucleic acid testing (NAT). Globally the screening by NAT is regarded as most sensitive and appropriate for blood screening. It has been imposed mandatory for blood screening in USA, UK and other developed countries. In Pakistan it is at early stage and only few blood bank facilities screen blood by NAT methodology. This strategy almost eliminates the possibility of viral transmission through blood, fresh frozen plasma or platelet concentrate.


In Pakistan, Hepatitis B and Hepatitis C are endemic and danger of spread of AIDS is lurking. The true incidence of these diseases is not known due to non-availability of authenticated data, however most of the studies conclude 3-5% Hepatitis B and Hepatitis C each in general population and 1-3% each in apparently healthy blood donors. Past studies conducted in well reputed institutes of Pakistan show that a significant number of apparently healthy blood donors declared safe by screening with immunological methods may show evidence of viral genome when screened by NAT methodology. People receiving multiple transfusions as in case of cardiac surgery, major surgery, complicated child birth, Hematological disorders, accidental injuries and patients on dialysis are more at risk. Countries where the incidence of these viruses is < 1 in 100,000 consider NAT as a mandatory measure why we should not in Pakistan?  Kulsum International Hospital consider patient safety as its Core value and to meet its Corporate Social responsibility(CSR) has now decided that patients receiving blood which in addition to normal legal testing is also NAT tested to eliminate any chance of spread of these diseases through blood transfusion or its products.


  1. WHO, 2017, Blood transfusion safety. [Online] Available at <> [Accessed at 01-Jan-2017].
  2. Stainsby D, Faber JC, Jorgensen J. Overview of hemovigilance. In: Simon TL, Solheim BG, Straus RG, Snyder EL, Stowell CP, Petrides M, editors. Rossi’s Principles of Transfusion Medicine. 4 th ed. West Sussex: Blackwell Publishing; 2009. p. 694.

Dr. Brig . Nadir Ali (Retd.)


Hold Yourself with a Good Posture

What is a good posture?

Posture is the position in which you hold your body upright against gravity while standing, sitting or lying down. Good posture involves training your body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities. Proper posture,

  1. Keeps bones and joints in the correct alignment so that muscles are being used properly.
  2. Helps decrease the abnormal wearing of joint surfaces that could result in arthritis.
  3. Decreases the stress on the ligaments holding the joints of the spine together.
  4. Prevents the spine from becoming fixed in abnormal positions.
  5. Prevents fatigue because muscles are being used more efficiently, allowing the body to use less energy.
  6. Prevents strain or overuse problems.
  7. Prevents backache and muscular pain.
  8. Contributes to a good appearance.

What is a poor posture?

It is the posture that results from certain muscles tightening up or shortening while others lengthen and become weak which often occurs as a result of one’s daily activities. There are different factors which can impact on posture and they include occupational activities and biomechanical factors such as force and repetition. Risk factors for poor posture also include psychosocial factors such as job stress and strain. Workers who have higher job stress are more likely to develop neck and shoulder symptoms.

Studies have implicated poor sitting posture in the development and perpetuation of neck pain syndromes. Sitting for long periods without interruption with poor posture has been shown to cause postural backache. Poor posture can result in spinal and joint dysfunction as a result of muscle changes. Poor posture can result in short term but more likely long term pain or damage

Poor posture can present in several ways:

  • It can present with rounded and elevated shoulders and a pushed-forward head position. This position places stress on the spine between the top of the neck and skull and the base of the neck and upper shoulders. There is a reduction in the stability of the shoulder blades resulting in changes to the movement pattern of the upper extremities.
  • It can present with a forward tilting of the hips, an increase in the curve of the lumbar spine, and a protruding stomach. This position places stress over both the hip joints and lower back.

Identifying Incorrect Posture

The first step in improving posture is to identify what needs improvement by examining one’s own posture throughout the day, such as sitting in an office chair, carrying objects, or standing in line. At regular intervals during the day, take a moment to make a mental note of posture and back support. This should be done through the normal course of a day to best identify which times and positions tend to result in poor posture. Some people find it easier to ask someone else to observe their posture and make comments or suggestions.

Correct sitting position

Sit up with your back straight and your shoulders back. Your buttocks should touch the back of your chair. All three normal back curves should be present while sitting. A small, rolled-up towel or a lumbar roll can be used to help you maintain the normal curves in your back. Here’s how to find a good sitting position when you’re not using a back support or lumbar roll:

  • Sit at the end of your chair and slouch completely.
  • Draw yourself up and accentuate the curve of your back as far as possible. Hold for a few seconds.
  • Release the position slightly (about 10 degrees). This is a good sitting posture.
  • Distribute your body weight evenly on both hips.
  • Bend your knees at a right angle. Keep your knees even with or slightly higher than your hips. (use a foot rest or stool if necessary). Your legs should not be crossed.
  • Keep your feet flat on the floor.
  • Try to avoid sitting in the same position for more than 30 minutes.
  • At work, adjust your chair height and work station so you can sit up close to your work and tilt it up at you. Rest your elbows and arms on your chair or desk, keeping your shoulders relaxed.
  • When sitting in a chair that rolls and pivots, don’t twist at the waist while sitting. Instead, turn your whole body.
  • When standing up from the sitting position, move to the front of the seat of your chair. Stand up by straightening your legs. Avoid bending forward at your waist. Immediately stretch your back by doing 10 standing backbends.

Correct driving position

  • Use a back support (lumbar roll) at the curve of your back. Your knees should be at the same level or higher than your hips.
  • Move the seat close to the steering wheel to support the curve of your back. The seat should be close enough to allow
  •  Your knees to bend and your feet to reach the pedals.

Correct lifting position

  • If you must lift objects, do not try to lift objects that are awkward or are heavier than 30 pounds.
  • Before you lift a heavy object, make sure you have firm footing.
  • To pick up an object that is lower than the level of your waist, keep your back straight and bend at your knees and hips. Do not bend forward at the waist with your knees straight.
  • Stand with a wide stance close to the object you are trying to pick up and keep your feet firm on the ground. Tighten your stomach muscles and lift the object using your leg muscles. Straighten your knees in a steady motion. Don’t jerk the object up to your body.
  • Stand completely upright without twisting. Always move your feet forward when lifting an object.
  • If you are lifting an object from a table, slide it to the edge to the table so that you can hold it close to your body. Bend your knees so that you are close to the object. Use your legs to lift the object and come to a standing position.
  • Avoid lifting heavy objects above waist level.
  • Hold packages close to your body with your arms bent. Keep your stomach muscles tight. Take small steps and go slowly.
  • To lower the object, place your feet as you did to lift, tighten stomach muscles and bend your hips and knees.

Correct sleeping position

Approximately 1/3 of our life is spent lying in bed, on the couch, and on the floor. Like other positions, there is a right way and a wrong way to lie. For individuals suffering from pain, modifications may be necessary to obtain a “pain-free” position or a position which does not aggravate the pain.

Try to sleep in a position which helps you maintain the curve in your back (such as on your back with a pillow under your knees or a lumbar roll under your lower back; or on your side with your knees slightly bent). Do not sleep on your side with your knees drawn up to your chest.


  1. Johnson , Jeremy. “Bad Posture.” NASM. National Academy of Sports Medicine CPT, Mar 2013
  2. John Schubbe, Identifying Incorrect Posture. [Online] Available at: <> [Accessed 28 December 2016]

Dr. Riafat Mehmood


Nailing the Diagnosis

Nail – A window to bone and joint health

Take a long hard look at your nail as they may be saying something about health of your joints and bones. A recent study show that a mineral deficiency in toe nails is linked to risk of Osteoarthritis and finger nails give doctors a clue about the condition that elevate the risk of Osteoarthritis.

Osteoarthritis (OA), sometimes called Degenerative Changes, is the most common chronic condition of the joints. It may affect different parts of body including

  1. Knees
  2. Fingers
  3. Feet
  4. Hip
  5. Cervical Spine
  6. Lumbar Spine
  7. Riz arthritis of the thumb (Suffered by Manual Professionals)

In 2005, a research was presented in American College of Rheumatology (Atlanta) which shows that people with lower level of mineral “Selenium” are more prone to develop OA of knees. To prove the presence of Selenium in toe nails, clippings from 1000 people were measured as toe nails grow slowly and they reflect selenium level in the body. From past several months up to a year ago, no one realized and investigated if Selenium might be related to OA. Studies suggest that deficiency of selenium is common in many parts of Asia as they are not rich in this mineral. People in these areas tend to develop Kashin Beck Disease known as Arthritis Big Joint Disease. Another study shows that abnormal formation of Disulfide bonds in cells causes problems in nails and bones. Disulfide bonds are needed for joining Protein Molecules such as Nail Protein Keratin and Bones Protein Collagen. Research of Dr. Mark Towler from University of Limerick (Ireland) depicts that weak nails among Osteoporosis delved in to nails and bone properties. Result of his work is a device called “Selectis Bone Quality Test”. This test diagnoses Osteoporosis by analyzing the Disulfide Bonds in nail clippings. Device used in the test in as accurate as Dexa Scan which is currently being used to diagnose Osteoporosis and it is less expensive. On top of it, this test doesn’t require the presence of patient as only patient’s nail is needed. Suggest

Reducing Risks

To avoid the risk of Osteoarthritis, eat plenty of food which contains selenium.

  1. Nuts
  2. Meats
  3. Poultry
  4. Fish
  5. Whole grains

Do not increase the intake of any Vitamin or Mineral (including Selenium) without the consultation of physician. It might lead to Selenium Toxicity and increased harm to bones & joints.



  1. Stanley Birge, “Should you Supplement Selenium?” 2006, Washington University, School of Medicine, St. Louis.
  2. , J.M., 2006. Selenium & OA Development, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill.
  3. , M . 2006. Weak Nails among Osteoporosis Patient, Arthritis Foundation, University of Limerick, Ireland.
  4. Osteoarthritis Foundation, 2015. [Online] Available at <> [Accessed 15 December 2015]



Dr. Shafi Muhammad Chawdhry



Shoulder Rehabilitation


Shoulder is one of the largest and most complex joints in the body. The shoulder joint is formed where the Humerus (upper arm bone) fits into the scapula (shoulder blade), like a ball and socket. Other important bones in the shoulder include:

  • The acromion, a bony projection off the scapula.
  • The clavicle (collarbone), meets the acromion in the acromioclavicular joint.
  • The coracoid process, a hook-like bony projection from the scapula.

The shoulder has several other important structures:

  • The rotator cuff is a collection of muscles and tendons that surround the shoulder, giving it support and allowing a wide range of motion.
  • The bursa is a small sac of fluid that cushions and protects the tendons of the rotator cuff.
  • A cuff of cartilage called the labrum forms a cup for the ball-like head of the humerus to fit into.
  • The humerus fits relatively loosely into the shoulder joint. This gives the shoulder a wide range of motion, but also makes it vulnerable to injury.

Shoulder Conditions:

  • Frozen shoulder: Inflammation develops in the shoulder that causes pain and stiffness. As a frozen shoulder progresses, movement in the shoulder can be severely limited.
  • Osteoarthritis: The common “wear-and-tear” arthritis that occurs with aging. The shoulder is less often affected by osteoarthritis than the knee.
  • Rheumatoid Arthritis: A form of arthritis in which the immune system attacks the joints, causing inflammation and pain. Rheumatoid Arthritis can affect any joint, including the shoulder.
  • Gout: A form of Arthritis in which crystals form in the joints, causing inflammation and pain. The shoulder is, however, an uncommon location for gout.
  • Rotator cuff tear: A tear in one of the muscles or tendons surrounding the top of the Humerus. A rotator cuff tear may be a sudden injury, or result from steady overuse.
  • Shoulder impingement: The acromion (edge of the scapula) presses on the rotator cuff as the arm is lifted. If inflammation or an injury in the rotator cuff is present, this impingement causes pain.
  • Shoulder dislocation: The Humerus or one of the other bones in the shoulder slips out of position. Raising the arm causes pain and a “popping” sensation if the shoulder is dislocated.
  • Shoulder tendonitis: Inflammation of one of the tendons in the shoulder’s rotator cuff.
  • Shoulder bursitis: Inflammation of the bursa; the small sac of fluid that rests over the rotator cuff tendons. Symptoms include pain with overhead activities or pressure on the upper, outer arm.
  • Labral tear: An accident or overuse can cause a tear in the labrum, the cuff of cartilage that overlies the head of the Humerus. Most labral tears heal without requiring surgery.

Shoulder Tests:

  • (MRI Scan): This scanner uses a high-powered magnet and a computer to create high-resolution images of the shoulder and surrounding structures.
  • (CT Scan): A CT scanner takes multiple X-rays, and a computer creates detailed images of the shoulder.
  • Shoulder X-ray: A plain X-ray film of the shoulder may show dislocation, Osteoarthritis or a fracture of the Humerus. X-ray films cannot diagnose muscle or tendon injuries.

Shoulder Treatments:

  • Shoulder surgery: Surgery is generally performed to help make the shoulder joint more stable. Shoulder surgery may be Arthroscopic (several small incisions) or open (large incision). In an Arthroscopic surgery, the surgeon makes small incisions in the shoulder and performs surgery through an endoscope (a flexible tube with a camera and tools on its end). Arthroscopic surgery requires less recovery time than open surgery.
  • Physical therapy: An exercise program can strengthen shoulder muscles and improve flexibility in the shoulder. Physical therapy is an effective, nonsurgical treatment for many shoulder conditions.


Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Keeping these muscles strong can relieve shoulder pain and prevent further injury.


Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.

Target Muscles:

The muscle groups targeted in this conditioning program include:

  • Deltoids (front, back and over the shoulder)
  • Trapezius muscles (upper back)
  • Rhomboid muscles (upper back)
  • Teres muscles (supporting the shoulder joint)
  • Supraspinatus (supporting the shoulder joint)
  • Infraspinatus (supporting the shoulder
  • Subscapular (front of shoulder)
  • Biceps (front of upper arm)
  • Triceps (back of upper arm)

Pain relievers:

  • RICE Therapy: RICE stands for Rest, Ice, Compression (not usually necessary), and Elevation. RICE can improve pain and swelling of many shoulder injuries.
  • Corticosteroid (cortisone) injection: A doctor injects cortisone into the shoulder, reducing the inflammation and pain caused by Bursitis or Arthritis. The effects of a cortisone injection can last several weeks.

Shoulder Replacement Indications: Severe Osteo or Rheumatoid Arthritis where the predominant feature is pain.

Post-Shoulder Replacement Treatment Protocol

In Patient
Day 0
  • Master sling with body belt or Cold Compression sling fitted in theatre
  • Finger, wrist and elbow movements
  • Occupational Therapy
Day 1Level 1 Exercises
  • Body belt removed
  • Axillary hygiene taught
  • Pendular exercises
  • Scapular setting
  • Passive flexion in the scapula plane as comfortable
  • External rotation to neutral
  • Discharge usually at day 1
Out Patient
Day 5 – 3 weeksLevel 2 exercises
  • No resisted internal rotation or forced passive external rotation (reattached subscapular is muscle is vulnerable)
  • Begin passive abduction (maintain shoulder in IR)
  • Passive external rotation to neutral only
  • Active assisted flexion in supine and progress to sitting position as soon as the patient is able.
  • Progress to active when possible
  • Begin isometric strengthening of all muscle groups (except IR)
  • Remove sling as able
  • Functional reaching activities below 90 degrees
3 weeks +Level 2 exercises
  • Encourage active movement into all ranges with some gentle self-stretching at the end of range.
  • Add isometric IR
  • Progress functional activities
6 Weeks +Progress to level 3 exercises
  • Progress strengthening through range
  • Regularly stretch the joint to the end of its available range
  • Soft tissue manipulation if required


Improvement continues for 18 months to 2 years and the patients should continue exercising until their maximum potential has been reached.

Return to functional activities

  • Driving           After 4 weeks
  • Swimming

Breaststroke:   6 weeks

Freestyle:        12 weeks

  • Golf                 3 Months
  • Lifting            Light lifting can begin at 3 weeks.
    Avoid lifting heavy items for 6 months.
  • Return           Sedentary job: 6 weeks
    to work          Manual job: Guided by Surgeon



  1. O’Sullivan. S. and Schmitz. T.,2011. Physical Rehabilitation. 5th Edition. F.A. Davis Company.
  2. ShoulderDoc, 2015, Shoulder Replacement. [Online] Available at <> [Accessed Dec 21, 2015]
  3. Healthwise, 2014, Shoulder Replacement Surgery. [Online] Available <> [Accessed Dec 21, 2015]
  4. Porter. S., .2008, Tidy’s Physiotherapy. 14th Edition. Elsevier Health Sciences.



Dr. Riafat Mehmood



Brain Aneurysm

Brain Aneurysm (Cerebral or Intracranial aneurysm) is the weak area of an artery in the brain which causes a localized blood filled balloon, like bulge, in the wall of blood vessel. Aneurysm is caused from wear and tear of the arteries, injury, infection and inherited tendency. It can occur to all age groups but incidence increases gradually after the age of 25. Most affected age group is 50 to 60 and women have more tendency of prevalence.
Large unruptured aneurysms lead to symptoms based on the pressure on the brain tissue, nerves and surrounding structures. Symptoms include weakness or paralysis on one side of the face, pain above and behind the eye, numbness, enlarged pupil or changes in vision. Unruptured Aneurysms require different assessment and treatment. When cerebral aneurysms rupture, bleeding is usually caused in to the brain and surrounding space known as “subarachnoid space”. Approximately 2% – 3% of people with brain aneurysm suffer from bleeding. It is an emergency situation and stiff neck, blurred vision, nausea and vomiting and loss of sensations are usual symptoms.

Ruptured aneurysms are diagnosed by finding signs of subarachnoid hemorrhage via CT scan (Computerized Tomography). Cerebral Angiogram, a test, is performed by neuro-interventional expert to determine the exact size, location and shape of an aneurysm. Cerebral angiography is a medical procedure when dye is injected in to the arterial system through a catheter. MRA (Magnetic Resonance Angiography) and CTA (Computed Tomographic Angiography) are non-invasive alternative procedures to the traditional methods. Contrast dye injected in to the vein which travels to the brain arteries and images are created using CT scan. These images show how blood flows in to the brain arteries.

There are two type treatment options available for brain aneurysm.
1. Aneurysm Clipping
2. Aneurysm Coiling

Aneurysm Coiling
Objective of Aneurysm Coiling is to isolate an aneurysm from the normal circulation without blocking off nearby arteries or contracting main vessel.
Microcatheter is inserted through initial catheter and the coil is attached with the microcatheter. Once the microcatheter reaches the aneurysm and gets inserted in to it, coil is separated from catheter with the use of electric current. This coil will cap the opening of the aneurysm and it is placed permanently in aneurysm. More than one coil may be needed depending upon the size of aneurysm. Coils used in this procedure are spring shaped and made of soft platinum metal. These coils are very thin and small, ranging from less than the width of human hair to twice to the width of a single hair. Fluoroscopy supports the whole procedure of Endovascular Coiling. It is a special type of X-ray movie. Physicians use Fluoroscopy in order to locate the aneurysm and guide catheter for all movements.
Patient can return to home spending one night in Intensive Care Unit after surgery and may be expected to resume normal life activities within 2 days. Exact details regarding procedure and discharge for a particular case could be obtained from the physician.


Umair Rashid Chaudhry


PCR for Clostridium Difficile

PCR test for Clostridium Difficile detection is now available at KIH. It gives rapid and accurate diagnosis of all toxigenic strains of Clostridium difficile causing diarrhea and Colitis.
Test Name : PCR for Clostridium Difficile
Reporting time: 6 hours


Kulsum International Hospital Successfully Achieves ISO 9001:2015

KIH Management takes pleasure to announce that Kulsum International Hospital had a successful transition to ISO 9001:2015 (Risk Based Thinking) from ISO 9001:2008. This achievement demonstrates our undeviating commitment to provide the highest quality services to our customers.

We are committed to provide high standards to attain customer satisfaction by ensuring services and practices which consistently meet customer’s requirements including quality, safety, cost and delivery.

We faithfully comply with all the requirements of ISO 9001:2015 and aim to consistently improve our quality management system.


Spine Clinic by Dr. Mohammed Akmal

Dr. Mohammed Akmal, a globally renowned Spinal Surgeon is visiting Kulsum International Hospital on December 12-13, 2017. He is working as a Consultant Orthopedics and Spinal Surgery with some of the prestigious institutions of United Kingdom. He will conduct Spine Clinic at Kulsum International Hospital and will perform related surgeries especially in chronic and trauma patients.

Profile of the Consultant: 

Dr. Mohammed Akmal

MBBS, MD, FRCS (Ortho), CCST (UK),

Fellowship Spinal Surgery (UK)


Consultant Trauma, Orthopedics and Spinal Surgery,

Hospital of St John and St Elizabeth & Imperial College Healthcare NHS Trust,

London, United Kingdom.


Visit of KIH Management to Cleveland Clinic Abu Dhabi

Dr. Iqbal Saifullah Khan (Director, Saif Healthcare Limited) and Dr. Muhmmad Saleem Khan (CEO, Saif Healthcare Limited) visited Cleveland Clinic Abu Dhabi. Aim of the visit was to learn the healthcare practices adopted by Cleveland Clinic and implementing them at Kulsum International Hospital.

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