The Medical Joyworks Monthly


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Issue #20 (May 2021)


Dear Reader,

There’s no question that we’re in a period of multiple transitions. In many parts of the world, including the one I used to live in, spring is a 2-week period in May or sometimes early June where one transitions from sweaters to shirtsleeves.
People lucky enough to live in a place where COVID-19 has come under control may be moving toward a somewhat more normal life. And soon we’ll be at July 1st—the date when, in the U.S. at least, the new residency year begins in most places.
If you’ve been following our monthly newsletter, you may be aware that the MJ staff has undergone some changes as well. And as MJ's new line editor, I’m happy to be a part of our growing group.

A little background on me: I had a full career as a primary care pediatrician, retiring 3 years ago from practice. I’ve been involved in various writing projects for 5 years, including writing MJ learning modules. At this writing, however, I still practice one day a week; doing this, I feel, helps me see things from the perspective of people “in the trenches,” both physicians and patients. Similarly, our writers can’t help but be driven by their clinical experiences. We want to go beyond what the research articles say and do our best to put you in the middle of the “real-world” patient care experience. 

The MJ team strives to give you material that is relevant, informative, and, at times, even fun to play out.  And we’re working on giving you more of it. One very important part of that, of course, is your feedback. Come to us with your questions (many of which will come to me!), your concerns, and even suggestions for material you’d like us to cover. 

All the best as you experience the inevitable transitions brought by this time of year—and these times.

Dr. Stanley Sack,
Line Editor,
Medical Joyworks


The latest from MJ

  • In this month's edition of Meet Your IMB, Dr. Habib Shams shares with us his experiences and perspectives as a physician.
  • The new and massive update to Clinical Odyssey is nearly ready! Except to see it come out very soon.


International Medical Board Members

Name: Prof. Dr. Habib Shams
Speciality: Internal Medicine , Gastroenterology , Acupuncture 
Designation: Associate Clinical Professor, Consultant Internist, Head of Special Diseases Department 
Work institute: Madani Hospital, University of Medical Sciences, Khoy, Iran and Ultramed Tibb Merkezi, Baku, Azerbaijan
Graduated from: University of Shiraz Medical Sciences, Shiraz, Iran
What attracted you to your specialty?
I loved reading books since childhood, and with them, discovered that I could learn a lot. What is more, I discovered that if we are learning on a daily basis, our personalities change on a daily basis too. As a boy, I loved detective stories–especially Sherlock Holmes. From him I learned that we should use our senses with precision and focus in order to find the truth. This is the scientific method, in essence. But here is the thing: over time this approach allows for science to become art, and that is the final goal of science learning (in my opinion). Internal medicine is a speciality that offers all this, and more.

What have you learned about your specialty solely from experience?
I have learned that humans are a mystery that we can never solve entirely. The classical study of a disease is only one of many pieces needed to solve the puzzle that is a patient’s problem.Every patient is unique, and the approach toward diagnosing and treating a patient should always be personalized.

Attributes that are key toward success as an internist include being prepared to learn new things every day, empathy towards your patients, thinking carefully, making precise deductions, and taking immediate and appropriate action where necessary. Most of all, one must make sure they have a clear conscience at the end of the day.

What is a common misconception associated with your field of study?
Internal medicine is very broad and is always overlapping with other specialties. Here is where misconceptions occur, especially for a patient. When a patient experiences confusion because of this, one has to explain things carefully and in detail to them–even more so when the patient must be referred to another specialist.

What is your biggest research interest today?
Naturally, COVID-19 is the world’s main problem today. There are numerous research projects covering different aspects of the disease, from etiology and prevention, to treatment and vaccination. Given my clinical preferences, my team and I are conducting a survey exploring a number of old drugs and their effects on outpatients with COVID-19.

What publication/research are you most proud of?
I conducted several surveys on pulmonary hypertension and mitral valve prolapse some years back, all quite interesting. Lately, I have been conducting a study to understand the relationships between coated tongue (a physical finding) and peptic ulcer disease. However, because of the pandemic, my study is temporarily on hold. The study aims to: a) provide a new–improved–definition of “coated tongue” terminology, b) grade “coated tongue,“and c) determine the sensitivity and specificity of every grade with regard to peptic ulcer disease and helicobacter pylori infection. I hope to finish this study after the pandemic. It may offer a simple clinical tool to diagnose and treat this disease.

In your opinion, what is the greatest challenge in your field today?
Currently, the greatest challenge in my field is the pandemic. Internal medicine has been one of the medical specialties most directly involved in saving lives, with many physicians having given their lives to this battle. Unfortunately, vaccination is far from where it needs to be in many countries due to serious socio-economic and political barriers. There is also an urgent need to develop an effective and safe treatment modality, safe vaccines for children (currently in the works), and more.

What will be a game-changer innovation in your field?
Genetics and molecular biology are rapidly progressing fields. Nanotechnology and nanomedicine also are offering new insights and capabilities to my field. These are game changing innovations that are redefining our abilities to predict, prevent, diagnosis, and treat diseases earlier, better, and with less side effects. I believe that this will also expand the responsibilities of a physician, from disease prevention to eventual therapy (where needed).

How has MJ helped advance your professional objectives (in terms of teaching, research, management, personal development, etc.)?
Medical Joyworks’s evidence-based case studies and scenarios help develop students’ clinical skills easily. Your physician-moderated discussion boards and reference articles are also very valuable learning tools. Having these many publication types and learning options allows students to choose a learning method that works for them. Not surprisingly, I have learned a lot from Medical Joyworks, and I recommend your publications to my colleagues and students all the time. Solving medical cases that are fun, and then understanding the reasoning after the gameplay experience serves as a valuable opportunity to perfect one’s clinical and learning skills. I can only thank you all for coming up with this concept for doctors everywhere.



Q&As from our user community

Clinical Sense: Complicated (Statin Myopathy)

Q: This person has atorvastatin induced myositis. Why is CK normal?
A: Traditionally, one would have expected to see elevated serum creatinine kinase (CK) levels in a patient with statin induced myopathy. However, recent research has uncovered a subset of patients with normal CK levels, despite symptoms and tissue biopsies confirming statin associated myopathy.

Current guidelines discuss statin associated myopathies along a spectrum of severity. Patients with muscle pain or weakness associated with commencement of statins, but without elevated CK levels are at the milder end of this spectrum. Hence it is important not to discredit this possibility merely because serum CK levels are within the normal range.

Please see the following review article for more information:
If you would like to play this scenario or join the conversation, go to the Clinical Sense app in your mobile device.

Prognosis: Your Diagnosis: Persistent (Concussion, Sports related)

Q: This patient has persistent symptoms. Even though a concussion is the probable diagnosis, why not order a repeat CT? It's always better to be safe than sorry with potential neurological injury.
A: While these symptoms seem concerning, there are many reassuring features in this girl’s presentation. She has no focal neurological deficits. She has no clinical signs of raised intracranial pressure. The time-course does not fit a subarachnoid hemorrhage. Her age makes a subdural hemorrhage less likely. Last but not least, her symptoms fall within the ambit of standard post-concussive symptoms.

It is important to remember that no medical test is without risk. One should think twice before giving a second dose of radiation to a 15 year old girl, just two days after a previous CT. You could argue that an MRI could be performed instead—but you'd just be adding to her bill.
If you would like to play this scenario or join the conversation, go to the Prognosis: Your Diagnosis app in your mobile device.


Recently released stories

Ibrah I: Pregnancy Problems - Play it free online
Examined II - Play it in Clinical Odyssey
Unheard - Play it in Clinical Odyssey
Contracted - Play it free online
Submerged - Play it in Clinical Odyssey
More Chronicity - Play it in Clinical Odyssey
Schizophrenia - Read it free online
... and more.
That's all for now!

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