March 2014
Student Who pg 4
Strange Cases pg 6
MMSA goes Candid pg 20
CONTENTS
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Student Who by Jade Zammit
6 Strange Cases by Leonard Callus and Kyle Cilia 10 Big Brother .... is Watching by The Sphygmo Team 12 Game of Medicine by Stefano Corso 14 The AppendiX Factor by Melise Mifsud and Abigail Mula 16 10 Movies you should watch by Shana Marie Buttigieg
19 Medschool + by Gabriel J. Ellul and Melise Mifsud
20 MMSA Candid by The Sphygmo Team 22 The Doctor ... the desolation of the Foundation Years by Gregory Apap Bologna 24 MythBusters ... the Medical Edition by Daniela Zammit 26 Did you know? by Gregory Apap Bologna 26 Funny ... or not by Daniela Tonna
DESIGNED AND COMPILED BY: Kurt Apap Malcolm Falzon
EDITOR’S NOTE Hi! My first words are thank you! Thanks to all those who helped in assembling this magazine, to all the medical students’ amusement. I’m proud of all the work and time which this year’s publications team put into making this Sphygmo edition possible. Coordinating the work on this year’s Sphygmo wasn’t simply a challenge: it was an experience within itself. We truly enjoyed doing it. We enjoyed pranking our fellow classmates, as you’ll read later on. We enjoyed taking photos of our friends while they’re asleep during lectures. We enjoyed asking other students what they think about us medical students and seeing their bewildered faces when we asked them whether we are party-goers or snobs! But don’t take it from me! Skim through the pages and see for yourself. I hope that what has been a memorable experience for us will surely be an interesting read for you fellow MMSA members All the best for the coming year! Very best regards Gabriel J. Ellul MMSA Public Relations Officer ‘13-’14
THEME COORDINATOR: Abigail Mula CONTRIBUTORS: Gregory Apap Bologna Kurt Apap Shana Marie Buttigieg Leonard Callus Kyle Cilia Stefano Corso Maria Croucher Theresia Dalli Gabriel J. Ellul Melise Mifsud Abigail Mula Daniela Tonna Daniela Zammit Jade Zammit Whilst every effort has been made to ensure that information contained within this magazine is accurate and up to date, MMSA and its members cannot take responsibility for any errors. Malta Medical Students’ Association MMSA Office University of Malta, Medical School Mater Dei General Hospital B’Kara Bypass Msida MSD 2090 Malta, Europe
www.mmsa.org.mt
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Student Who THE PAINF ENTHUSIAULLY STIC “Today w
as a good d ay! I got to examine s putum sam ples and th consultant e let me hold t h e patient’s fi le!”
THE GUNNER
op et me a t st g t ’ n o w A e. Mu “A mere the futur r!” in t s o p t e consultan ! Must work hard + A n a get
The Houdini
“Haven’t b ee week. May n to ward rounds in a be I should go tomorr ow. Or maybe not.”
Mind The One Tratocbkook a place
ber “Have to remem conference and gy ad for the cardiolo elective and re y g lo io rd ca y plan m ilure. up on heart fa io...” God I love card
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by Jade Zammit ionable t s e u Q e h T dmission A es “What do
”
MI mean?
THE QUIET ONE “....”
The Sane Oneer”
““Should have
become a farm
The Snob
“I probably should hav e told the cashier at the shop I’ m a medic student. H al e would ha pleased to v e b e e n know that it’s not jus commone t the rs who sho p at his sto re.” 5
by Leonard Callus and Kyle Cilia Corkscrew Oesphagus Abdominal pain and cramps, a common feeling that sometimes drives us crazy and lead to many sleepless nights. But have you ever thought how serious it could be? An 87-year-old Swiss woman suffered painful spasms in her chest and went to hospital where the doctors performed endoscopy to diagnose her problem. The test showed that her oesophagus was twisting itself into a corkscrew shape whenever she swallowed. Normally when a person swallows, the muscle fibers that encircle the top of the esophagus contract first, and then as they relax, the muscles just below them contract, and this wave of contraction continues all the way down to the stomach. Also, the muscles fibres at the distal end
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of the oesophagus tend to relax to help the food move slowly down to the stomach, a technique known as receptive relaxation. But in a person with this condition, all the muscles contract simultaneously. As a result, rather than moving food downward toward the stomach, the muscles pull the esophagus itself into a spiral shape. Why this happens, however, is still unknown. Some speculate that gastroesophageal reflux (GERD) could be playing a role. While there is no cure for the condition, therefore the doctors tried to treat the patient’s symptoms by giving her high-dose proton-pump inhibitor drugs, which are typically used to treat gastroesophageal reflux disease, and long-acting calcium channel-blockers in order to try to reduce the contractions of the oesophagus.
Geographic Tongue migratory glossitis
or
Benign
If you thought that this case was going to be on Miley Cyrus licking sledgehammer and sticking her tongue out in an uncontrolled fashion, I’m sorry to inform you that this has nothing to do with it. The tongue contains many small holes known as papillae that are covered by epithelium and contain the taste buds. These papillae change on different parts of the tongue and they have different taste buds according to the taste they sense. Around two to three percent of the general population has map-like shapes that form on the tongue, hence the name of the condition. Because
parts of the tongue are missing papillae, patches appear that look like smooth islands. The loss of papillae is due to an inflammatory reaction known as glottitis (infection of the tongue) that destroys the papillae on different regions of the tongue. Because of this, the flat pattern on the tongue also changes quickly from day to day, depending on where the papillae have healed and which have been destroyed by the inflammatory reaction. Geographic tongue is a harmless condition, with very few to no symptoms, though some people experience tongue discomfort or sensitivity to spicy foods. And the cause itself is a mystery. Several 7
studies provide conflicting data on the link between geographical tongue and other diseases such as diabetes. However, there is the possibility of a genetic link, as it tends to run in families.
their palms up while keeping their elbows straight. The elbows may also be angled outward (cubitus valgus) or have abnormal webbing. Many individuals with nail-patella syndrome have horn-like outgrowths of the iliac bones of the pelvis (iliac horns). These abnormal projections may be felt through the skin, but they do not cause any symptoms and are usually detected on a pelvic x-ray. Iliac horns are very common in people with nailpatella syndrome and are rarely, if ever, seen in people without this condition.
Nail-patella Syndrome This is an autosomal dominant genetic disorder. Such syndrome is characterized by abnormalities of the nails, knees, elbows, and pelvis. Patients with this disorder have absence or poorly developed nails. Individuals with nail-patella syndrome also commonly have skeletal abnormalities involving the knees, elbows, and hips. The kneecaps (patellae) are small, irregularly shaped, or absent, and dislocation of the patella is common. Some people with this condition may not be able to fully extend their arms or turn
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Other areas of the body may also be affected in nail-patella syndrome, particularly the eyes and kidneys. Individuals with this condition are at risk of developing increased pressure within the eyes (glucoma) at an early age. Some people develop kidney disease, which can progress to kidney failure.
after the eye takes a hit; Punches and the balls used in sports are most often the cause, but bumps from air bags and steering wheels have also created cataracts. When the eyeball is struck, the energy of the blow sends shock waves through the eye that can disrupt the nature of the eye’s lens, causing it to become opaque in regions. In most cases, cataracts look more like a vaguely shaped cloud, and can be white or yellowish. Star Shaped Catarct “Nature has made a beautiful cataract,” said Dr. Mark Fromer, an ophthalmologist at Lenox Hill Hospital in New York City. This statement was said after the ophthalmologist saw a star shaped cataract in a 55 year old man from Austria. It’s very common for cataracts to form
The only effective treatment for cataracts is surgery. Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens. The artificial lens, called an intraocular lens, is positioned in the same place as your natural lens. During cataract surgery, the ophthalmologist uses local anesthesia to numb the area around your eye, but the patient usually stays awake during the procedure.
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BIG BROTHER.....
Z. Z Z Z
...
#happy
eee e h c #
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se
! G N I H C T A W ...IS
#eco
frien
dly
o #lo
ol
yh # ve r
appy
#s w ag 11
by Stefano Corso
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APPENDI
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Collected by: Melise Mifsud and Abigail Mula
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moVIES you should WATCH by Shana Marie Buttigieg
The Doctor (1991) Based on the memoir A Taste of My Own Medicine by Ed Rosenbaum, The Doctor is the story of a successful and arrogant surgeon who has it all. His arrogance causes him to treat his patients like machines instead of people. When he is diagnosed with throat cancer, Dr. MacKee is forced to see life from a patient’s perspective. He develops a relationship with another cancer patient and he learns that there is more to being a doctor than doing procedures and prescribing the right medicines. Wit (2001) Based on a Pulitzer-prize-winning play by Margaret Edson and directed by Mike Nichols, Emma Thompson plays a rigid and very intelligent English professor, Vivian Bearing, who is diagnosed with terminal metastatic stage IV ovarian cancer. She agrees to aggressive and experimental chemotherapy, even though she realizes the doctors treating her, including former student Jason Posner and her oncologist Harvey Kelekian,
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see her less as someone to save and more as a guinea pig for their treatments. The only person who seems to care for her is nurse Susie. Through flashbacks, she reflects on the illness, treatment, and the people who care for her. The movie portrays the humility of tests and being prodded by doctors, interns and students. Something (2004)
the
Lord
made
This film centres around the relationship between white, wealthy heart surgeon Alfred Blalock, played by Alan Rickman, and black, poor carpenter Vivien Thomas, played by Mos Def. Working in Baltimore in the 1940s. They work together to invent a new technique for performing heart surgery on babies with Tetralogy of Fallot. This film depicts how the socially privileged were gradually forced to acknowledge the contributions of talented people who had been excluded. And the (1993)
band
played
on
This movie is about the discovery
of the AIDS virus. It stars Matthew Modine, who plays Don Francis, a researcher at the Centers for Disease Control. Battling apathy in the public, government, and health care system, Francis seeks the cause behind a mysterious series of deaths in the gay community in San Francisco starting around 1978.
Awakenings (1990) Based on a memoir, Robin Williams plays a researcher who uses a then-experimental drug (L-dopa) to “awaken” patients who have been catatonic for decades due to an encephalitis epidemic. The movie focuses on the experience of the first patient, played by Robert de Niro, as he awakens and becomes aware of life in a new time and place, but eventually retreats into his catatonic state. It portrays the excitement and the heartbreak of clinical research.
Gifted Hands: The Ben Carson Story (2009) It’s based on the true life story of an African American neurosurgeon, who had to overcome difficulties in school and temperament to reach his goals and make a difference in others’ lives. Article 99 (1992) Ray Liotta and Kiefer Sutherland star as doctors whose devotion to healing the sick goes way beyond the call of duty. When Dr. Peter Morgan (Sutherland) begins his medical internship at a Veteran’s Administration hospital, he expects to breeze through on his way to a cushy practice. Instead, he’s thrust into a bizarre bureaucratic maze where the health of patients is secondary to politics. And the temperature really rises when he teams up with some freewheeling physicians, led by Dr. Richard Sturgess (Liotta), who think they’ve learned how to break the rules-and save lives-without getting
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caught. Lorenzo’s oil (1992). This movie directed by George Miller is based on a true story of two parents Augusto and Michaela Odone (Nick Nolte and Susan Sarandon) relentlessly fighting for a cure for their son Lorenzo’s rare genetic disease called adrenoleukodystrophy (ALD). They clash with skeptical doctors, scientists, and support groups but they persist. This ultimately leads to the first treatment for the disease. The real Lorenzo Odone lived two decades longer than originally predicted by doctors. You don’t Know Jack (2010) Directed by Barry Levinson and
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starring Al Pacino as Jack Kevorkian, this film deals with the questionable topic of euthanasia and a doctor’s fight to help his terminally ill patients who want nothing more than to rest in peace. ... First do no harm (1997) This movie directed by Jim Abrahams, stars Meryl Streep as a mother of boy with severe epilepsy who is unresponsive to medications, and fights to use the ketogenic diet to treat him. Jim Abrahams was inspired to make the film as a result of his own experiences with his epileptic son Charlie. He created the Charlie Foundation to promote the diet and funded research studies to demonstrate its effectiveness.
Medschool+ by Gabriel Ellul and Melise Mifsud
We did a quick survey on a sample population of University students from other faculties. We gave them a list of characteristic and asked them to rank them from 1 to 5 according to whether they apply to us medical students. Word to the wise: don’t take this too seriously
The yay side of things ... We medical students were given an average score of 8/10 for our intelligence and ambition. We were given a score of 7/10 for being partygoers...
The dark side.... A score of 5/10 for our fitness So University students think that half of us are fat. I think it’s due to the Behavioural Seminars’ buffet menus...
So many students know of our parties #mmsaleisureftw
We’re bummers.....at least 9/20 of us are, according to other students.
Another score of 7/10 for our patience and care... go meds!
We were given a score of 7/10 for being opportunistic. A similar score for being nerds
Similar scores for our discipline, punctuality and helpful nature. Tell that to our lecturer when we come in late..... An average score of 5/10 for our smoking habits and 3/10 for our drinking Lol they have a mistake here....I’m sure of it! A score of 6/10 for our money
That’s quite ironic since we’re also seen as partygoers....maybe they think we only live to study and rave? 6/10 score that we practice what we preach. We didn’t know where to put this so we figured we’ll put it here with the other negative ones... We were given an average score of 3/10 for drug abuse, according to students from other faculties. We hope that’s not the case...
They think we’re rich...God bless them A score of 4/10 for being losers A score of almost 8/10 for our skills I knew we had it in us!
Just so you know....BSc. students strongly supported this statement. And to pick with our charismatic long-term rivals... Law students gave us a score of 9/10 for our intelligence but an average score of 7/10 for being money-seeking, binge-drinking, rich, opportunistic party-goers and an average score of 5/10 for being power-hungry, lazy, alcoholic snobs who smoke.
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MMSA Candid by Kurt Apap, Daniela Tonna and the others who stayed laughing in the background Imagine...
You’ve finished half a busy day’s work. You’re tired and on your way home to get some rest before continuing your studies. You’re listening to your favourite song while walking peacefully to the bus-stop. And then your phone rings.... This is the story of a number of unfortunate students who decided to pick up their phone and answer the call. On the other end of the line, Daniela Tonna conveys bad news. You’re dressed inappropriately in your ward rounds, says Daniela to a startled Kristina Bartolo, who happened to answer from just outside the library. Her voice had a serious tone to it, unlike Daniela’s, who had troubled keeping her giggling to herself. Kyle Cilia, who was sitting next to her while she was doing the
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prank call didn’t help. But Kurt Apap had the goodwill to leave the room and laugh alone in the corridor. After many questions and interjections, Daniela finally told Kristina to come to med school early next morning, so that a group of “well-qualified professionals” assess if her attire is appropriate for the day’s ward round. Kristina agreed, with Daniela making sure to stress that she had no choice other than agree. And then came the golden question: Kristina asked where she had to meet the professionals for her assessment. And Daniela burst out laughing, telling her she can come call at the MMSA office, where she is being made victim to our Sphygmo mood. A similar story is that of two other students, whom we called to make sure that they use appropriate language during their ward rounds.
You know, we asked them a couple of questions, made them feel guilty that they use rude words during some morning rounds (even though that was not the case) and then asked them to come by “the office” the next morning. Daniela keenly asked them if they had a blazer, because the morning assessment session will involve “a panel of highly-qualified individuals who will be giving you a lecture on patient ethics”. They obviously condescended to it all, only to realise that they are being pranked....and the rest is history. And the last prank call was that of Rebecca Stoner....who happened to be organising her SCOME Career’s Convention at the time. So we called her, using the Daniela Tonna voice which pranked the others, and convinced her that she was being considered as a potential English Language teacher. You know, Rebecca speaks good English. It seemed appropriate at the time. And she fell for it headfirst. Pity she was in a hurry and kept on asking to call us back.
hang up and we cancel your name from the list. Unfortunately, Sarah Catania, her smart SCOME Secretary, gave her the headsup halfway through the conversation. And Stoner uttered her fury by telling us: “Oh it’s that Sphygmo prank...you had me guys!” Believe me, doing these prank calls was fun. And we want to share them with you. Just visit the MMSA channel on youtube and look out for the video “The Sphymo Prank”. Alternatively, just scan the following code using your smartphone or tablet.
But, being considerate classmates, we obviously insisted that this is a “now-or-never” opportunity. You 21
The Doctor... by Gregory Apap Bologna
the Desolat ion of Foundat ion Years
I was doing a procedure on for this proce a frail, elderly dure often?’ patient and And she goes trying to put h ‘h e’s not my im at ease by father, he’s m making small y husband!’ talk. At one As it turns ou point I turned t, he has this to his relative, procedure eve who was a re ry 2 weeks.. latively young meaning I have woman, and to see him asked her ‘so every 2 weeks does your fa for 3 months ther come in after that foul!!
Alexia Farrugia - FY1
During induction week after I got my pager, I got my first ever page. I called back, pretty someone because excited
E H T T C EXPE ECTED! P UNEX ud - FY1 Maria
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Mifs
needed my help. 1 minute into the call I realise they actually wanted a radiologist with the same name as myself!
It was one of my busiest duties and I was called by a nurse to assess a patient as his voice SUDDENLY sounded ‘somewhat funny.’ I found the patient comfortably propped up in bed, fully alert, no complaints. As I was going to sign for his dissmissal, the patient’s wife randomly mentioned that her husband was missing his upper denture. The
ture ard entailed. I can still pic One of my most awkw look ing with vivid detail the us am t, igh ds hin in t, ye and e of absolute horror moments as a hous at twisted disgust th of e on g rin du s wa er offic face nts appeared on her my pre-ops for patie end y. when I told her which undergoing endoscop would are the colonoscope s nt tie pa , lly ua Us ters at enter. To make mat somewhat aware of wh o worse, she was als d an ils ta en e ur ed oc pr the OGD es scheduled for an my job usually involv and ar in the same session giving them a cle aw er e her question ‘Nisp th ing er sw an d an re tu pic bel e li tnaddfuh it-tubu qa questions that follow. Th lqi’ e ma tittawlu minn ha on en wh e os ar lem prob and o still makes me cringe patient came along wh ly to ss smile simultaneous was absolutely cluele ure this day! about what the proced
David Pisani - FY1
nurses and I assured her that it was close to impossible for her husband to have swallowed it and remained so stable but the wife was not amused. After a whole ‘treasure hunt’ I passively decided to look into the patient’s mouth and voila... a full set of teeth were spotted, sitting just over the trachea, ready to block it any second. All were left in awe. 23
THE MEDICAL S R E T S U B H MYT EDITION common medical m yths.......
1. Cardio is one of the best types of exercise
Jogging at a regular pace only works on the slow-twitch muscle fibers, completely ignoring your white muscle super-fast twitch fibers. Sprinting for 20-30 seconds, followed by a 90-second recovery period produces a unique metabolic response that is responsible for its superior benefits. It produces high levels of catecholamines, which allow more fat to be burned from under your skin and within your muscles.
2. Fluoride in your water lowers your risk of cavities Fluoride works from the outside of the tooth, not from the inside of your body, so why swallow it? Water fluoridation is ineffective for preventing caries; in fact, the health dangers of fluoride far outweigh any benefit to your teeth, such as thyroid disease and low IQ.
3. We use only 10% of our brain
Brain imaging shows that no area of the brain is completely silent or inactive. The many functions of the brain are highly localized, with different tasks allocated to different regions. Detailed probing of the brain has failed to identify the “nonfunctioning� 90%!
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4. One should drink 8 glasses of water a day.
There is lack of evidence supporting this and studies suggest that adequate fluid intake is usually met through typical daily consumption of juice, milk, and even caffeinated drinks. Drinking excess amounts of water can be dangerous, resulting in water intoxication, hyponatraemia, and even death.
5. Saturated fats are dangerous
Excess of saturated fat does cause health problems but saturated fat from animal and vegetable sources provides the building blocks for cell membranes and hormones. They also act as carriers for important fat-soluble vitamins A, D, E and K. Dietary fats are also needed for the conversion of carotene to vitamin A, and for mineral absorption.
6. Reading in dim light ruins your eyeseight
Suboptimal lighting can make it difficult to focus and decreases the rate of blinking, leading to discomfort from drying. The important counterpoint is that these effects do not persist, and
Compiled by: Daniela Zammit
it is unlikely to cause a permanent change on the function or structure of the eyes.
7. Shaving hair causes it to grow back faster, darker or coarser
Shaving removes the dead portion of hair, not the living section lying below the skin’s surface, so it is unlikely to affect the rate or type of growth. Shaved hair lacks the finer taper seen at the ends of unshaven hair, giving an impression of coarseness.
8. Medications improve health
When we take any medication, it is perceived as a “poison” by our immune system. This added “toxic load” places additional stress on the body. These chemicals must be detoxified and eliminated by the body, causing stress in the liver and kidneys and can damage these vital organs. Besides, all drugs have their own side-effects that can be potentially more disabling than the symptoms they are being used to treat and may require further medications to be alleviated.
9. Artificial sweeteners are safe, well tested and help promote weight loss. Studies have proven that people who use artificial sweeteners gain more weight than those who consume caloric sweeteners. It was shown that drinking diet soft drinks increased the likelihood of serious weight gain – far more so than regular soda. Moreover, aspartame was found to be damaging to our health. Such dangers include brain damage, cognitive skills disruption, retardation, neurochemical changes in the brain and behavioural and mood changes.
10. Soy is healthy.
Unfermented soy is linked to malnutrition, digestive distress, immune-system breakdown, kidney stones, thyroid dysfunction, cognitive decline, reproductive disorders, infant abnormalities, infertility, cancer and heart disease. One should opt for organic and most importantly, properly fermented soy for great health benefits. These include tempeh, miso and natto.
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DID YOU KNOW? by Gregory Apap Bologna Chocolate really can make you thinner. Researchers at the University of California have found that the majority of people who eat chocolate regularly have less body fat than those who do not. They studied the diet, calorie intake and body mass index of 1,000 people in the US. Consumed in moderation - and this is the key bit - they discovered that a small amount of chocolate eaten throughout the week can actually boost metabolism, making the body work harder to burn off fat. Sorry, guys. While females are the ones who carry the gene for Hemophilia (a disease where the blood doesn't clot), except in the rarest of cases, only males manifest the disease. Caffeine serves the function of a pesticide in a coffee plant.
Funny ... or not by Daniela Tonna
A lady went to a doctor’s office where she was seen by a Doctor. A few minutes into the examination, screeching could be heard from the room, and then the lady burst out of the room as if running for her life. After much effort a nurse finally managed to calm her down enough to tell her story. The nurse barged into the office of the Doctor and screamed, “shame on you, Mrs. Smith is 82 years old, and you told her she’s pregnant.” The Doctor continued writing calmly and barely looking up said, “does she still have the hiccups?”…
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Sphygmo has been published for medical students’ amusement for years!
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