The Medical Joyworks Monthly


Connect to MJ's thriving community

Issue #2 (November 2019)


The latest from MJ

  • The MJ International Medical Board is seeking specialists to join as peer-reviewers for the following specialties: child and adolescent psychiatry, endocrinology, general surgery, geriatric medicine, obstetrics and gynecology, orthopedic surgery, pulmonary critical care medicine, pulmonary disease, psychiatry, and trauma surgery. Join the program at


Q&As from our user community

Clinical Sense: Thumping (Atrial Fibrillation)

Q: If the patient has a HASBLED score >3, shouldn't we use Non-vitamin K Antagonist Oral Anticoagulants (NOAC) despite their high cost?
A: Thank you for the excellent question. You are probably referring to the fact that there is now evidence pointing towards reduced bleeding events with some of the direct oral anticoagulants (DOACs) or even NOACs, as compared to warfarin, e.g., reduced intracranial bleeding with apixaban versus warfarin.

Here though, a HASBLED score ≥3 reflects a greater risk of bleeding with all forms of anticoagulation including DOACs. In these patients, the first goal should be to treat or mitigate any modifiable bleeding risk factors. Note also that the lower major bleeding rate of DOACs must be balanced against the lack/cost/inaccessibility of agents that can reverse their effects.

More details:
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: Lumped (Pott's Puffy Tumour)

Q: Since the CT brain results show subperiosteal and frontal epidural abscesses, is there any use in doing CSF analysis?
A: Whilst CT is the modality of choice for the diagnosis of Pott’s Puffy Tumor, CSF analysis is valuable in this case to exclude meningitis as a complication, particularly given the finding of an epidural abscess. I have attached an open access case report detailing the possible complications of this condition. 

More details:
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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