The Medical Joyworks Monthly


Connect to MJ's thriving community

Issue #28 (January 2022)


Dear Reader,

We hope that 2022 turns out to be far better than 2021.

2021 was a terrific year for the Medical Joyworks community, with important milestones achieved, new colleagues having joined the company, healthy business growth, and many happy customers. 
So what does 2022 have in store?

For starters, new products and content will be going live in the coming weeks. We want to tell you all about it, but we have to wait. IMB members will also be getting more from the IMB Program, as it continues to expand in terms of membership and perks offered.

But for now, I'll focus on the most immediate change: the MJ Monthly is going to change into something different, with this edition being the last under the current format. Starting in the second quarter of the year, we'll be introducing a quarterly publication with an entirely design and feel.

So to you, dear reader: we truly appreciate your commitment to the MJ Monthly over the past two years. Thanks very much! 

Now, stay tuned for more soon.

That's it for now. Stay healthy and curious; and see you in the next quarter!

Miguel Angel Molina
Chief Operating Officer
Medical Joyworks


The latest from MJ

  • The MJ International Medical Board is seeking specialists to join as peer-reviewers for the following specialties: general surgery; orthopedic surgery; pediatrics; obstetrics and gynecology; neurosurgery; intensive care/critical care; psychiatry; urology; ear, nose and throat surgery; and dermatology. Join the program at or contact Julia Botija at
  • In this month's edition of Meet Your IMB, Dr. Ana Sofia Pessoa shares her views on the importance of internal medicine. 
  • Finally, we're excited to share a recent interview given by Miguel, our COO, to the Medical Mnemonist Show, a podcast hosted by medical studies specialist and enthusiast Dr. Chase DiMarco. In this 40 min talk, Miguel shares insights into where medical education stands today, and how Medical Joyworks goes about producing its content. The podcast is free, and available at


International Medical Board Members

Name: Dr. Ana Pessoa
Speciality: Internal Medicine
Designation:  Attending Physician
Work institute: Centro Hospitalar do Médio Ave, Portugal
Graduated from:  Faculty of Medicine, University of Porto, Portugal
What attracted you to your specialty?
I see Internal Medicine as the cornerstone of hospital care. An internist has broad knowledge on a myriad of pathologies and can integrate multi-organ care; but at the same time is capable of diving deep into a specific problem and make intricate diagnoses. This comprehensive understanding of the human biopsychosocial dimensions allows the internist to be able to care for both the patient and the disease, making Internal Medicine the holistic specialty par excellence.

What have you learned about your specialty solely from experience?
As much as we study during college, we only gain true clinical experience from practice with real life patients. People’s organisms are the same, but they are still very different from one another. Experiences, relationships, and day-to-day life make us all unique. This uniqueness transforms illnesses, making the same disease appear differently in different people. A good doctor, in my opinion, needs to understand this in order to be able to adapt to the person being treated and have the flexibility of thought to consider various (sometimes out of the box) explanations for a given complaint. And this can only come from practical experience.

What is a common misconception associated with your field of study?
The general population tends to think that internists are family physicians. Both internists and family physicians have knowledge of a broad range of diseases. However, family physicians focus on disease prevention in the community, both in adults and children. Internists are hospital doctors trained to diagnose, treat, and follow complex diseases in adult patients.

What is your biggest research interest today?
It would be a bit difficult for me to highlight one research interest, given that what I love most about Internal Medicine is the opportunity to study different fields. Geriatrics and Clinical Nutrition are still somewhat unknown and undervalued by both the healthcare community and population, although they are the foundation of a good and holistic (elderly) care. Continuing to study their impact in the health and morbimortality of the population is the pathway to raise awareness of these disciplines. That is what I am most currently focused on.

What publication / research are you most proud of?
In line with my Geriatrics and Clinical Nutrition interests, the publication I am most proud of is “Feeding in Advanced Dementia: Consensus Report from the Portuguese Society of Internal Medicine and Portuguese Enteral and Parenteral Nutrition Society” (available at There is a lack of knowledge regarding the best feeding approach for patients with advanced dementia, and so this publication was made in an effort to clarify existing guidelines on this matter, and to help healthcare professionals and caregivers make informed decisions that best suit their patients.

In your opinion, what is the greatest challenge in your field today?
The pandemic has taken a big toll on our healthcare system and on healthcare professionals. Good healthcare is very important, and should be truly and equally available to everyone. However, good universal healthcare is very expensive, and the lack of investment seen in some areas is very demoralizing. I hope this will change soon so that we can keep providing the best possible care to everyone who needs it.

What will be a game-changer innovation in your field?
I’m not sure Internal Medicine needs a real game-changer innovation to be the powerful and holistic specialty it is supposed to be. A solid theoretical knowledge of the human being, and good doctor-patient relationship are the foundation of a good practice. Other tools may be valuable adjuncts. But being fundamentally a medical specialty, the subjectivity and flexibility of the human intelligence can never be replaced.

How has MJ helped advance your professional objectives (in terms of teaching, research, management, personal development, etc.)?
I have been working with Medical Joyworks since I became a doctor. I love writing and I love my specialty; and being able to write about diseases and patients takes the boredom out of studying, making this a very fun and creative way for me to learn. This experience also allows me to include in the content that I write things such as: the subjective aspects of medicine, the difficulties of day-to-day practice, and unique elements of human interaction that cannot be taught through reading. Combined, all these things influence patient care, treatment, and prognosis so much. Working with Medical Joyworks has given me the opportunity to do this, all while broadening my medical knowledge in a fun and engaging way—and with the perk of meeting some great people along the way.


Q&As from our user community

Clinical Sense: Continuous (Childhood Cough)

Q: Could this patient have pneumonia, rather than bronchiolitis? Wouldn't it be better to be cautious and start empirical antibiotics anyway?
A: Distinguishing between bronchiolitis and (bacterial) pneumonia can be tricky, as both can have similar signs and symptoms. In this case, findings in favor of bronchiolitis include the gradual onset over two days, the widespread crackles on auscultation, and the low grade fever (37.8 C); in pneumonia, symptom onset is generally more abrupt, focal findings are often present on auscultation, and the fever tends to be higher. That being said, clinical findings can vary.

Since bronchiolitis is the probable diagnosis, antimicrobial therapy is not indicated. A Cochrane review was not able to find sufficient evidence supporting the use of antibiotics for patients under two years old with bronchiolitis. To re-iterate, bronchiolitis is usually caused by viral infection, and while some patients may develop a secondary bacterial infection, this is uncommon, and not a reason to routinely administer antibiotics to every child with bronchiolitis. I have linked the Cochrane review below for your review:
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: Invaded (Angiostrongyliasis)

Q: Why not administer albendazole immediately? There is evidence that this may reduce brain damage if given within 14 day after ingestion of an intermediate host. See: Parasitology (Cambridge) 148(2):227-233.
A: You are correct—there is evidence for the use of Albendazole in angiostrongyliasis, particularly in the early stages of infection. Anthelmintics should be administered as early as possible, and are most effective if administered before CNS infiltration. By three weeks, however, the majority of the worms will have died, or grown large enough to begin migrating out of the CNS. If anthemintics are administered at this point, death of the remaining worms may cause additional CNS inflammation and lesions.

In this case, the patient has had symptoms for two days before presenting; he returned from Thailand three days prior to this; and was in Thailand for two weeks. Exposure could have occurred anytime between five to 19 days prior. Eith such a broad window during which exposure could have occurred, it is hard to determine the safety of administering anthelmintics.
If you would like to play this scenario or join the conversation, go to the Prognosis: Your Diagnosis app in your mobile device.


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That's all for now!

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