During the Cleveland Clinic's Academic Awards Dinner, I received the "2023 Joseph Cash Memorial Award" for excellence in outcomes research.
A perfect end for my
@CleClinicHVTI
chapter under
@tavrkapadia
's mentorship & a nice memory as I start a new one
@YaleIMed
@MarkDSiegel1
My friends in healthcare, imagine this:
You get called to the ED. A mother of 3 with her children: 1 dead, 1 injured, and the 3rd in panic. But they're ur family.
Your wife asks to see the dead son one last time. A nurse signals she can only see his Rt 1/2 as the Lt 1/2 is...
Gaza |
The wife of the doctor, who lost his son in an Israeli airstrike that also injured their family, pleads to see her child. A nurse signals from a distance that they can only show her his right half.
God Will Avenge his Blood
#Match2024
I have reviewed many personal statements (PS) this year. While I cannot review more for now, here are the common issues that I highlighted to IM candidates:
🧵 1/
4 أخطاء ممكن تعملها و أنت بتكتب Personal Statement للماتش و ازاى تتجنبها؟ 🧵
1. البداية بالاكلشيهات المعتادة: و اللى عادة بتدور فى اطار 3 محاور:
- أولا: انا دخلت كلية الطب عشان طول عمرى كان نفسى أبقى دكتور يساعد الناس ... من لحظة Conception و أنا ناوى على الموضوع ده!
1/
#Match2024
For my colleagues applying IM,
Let me give 2 examples of personal statements:
- The 1st tells nothing about the applicant, his/her values, love for IM, or future plans ❌
- The 2nd is just the opposite of that ✅
You choose 👀
#MedTwitter
#IMGs
#internalmedicine
#Match2025
I have reviewed many personal statements (PS) this year. While I cannot review more for now, here are the common issues that I highlighted to IM candidates:
A repost from last year
🧵 1/
#Match2024
applicants
You just submitted ur app, but today you’ll see applicants tweeting they got their 1st interview.
Usually these are small programs that use filters/connections for interview decisions. Most good programs take time to FAIRLY review all apps.
Don’t worry!
Many people helped review my match personal statements last year.
To pay it forward, I can help review 10 personal statements for
#Match2024
IM applicants (for free, of course).
Just DM me.
My last rotation was MICU, a tough one!
At its end & before going on vacation, I received this email from one of my patient's families.
To me, those words are a reminder of why we are in medicine; to make a positive difference in the lives of our patients & their loved ones.
I wish I had half the luck of GLP1 agonists 😂😂
To be ignored for years, and then all of sudden become important for DM 2 (recent ADA guidelines suggests trying them before insulin), and show benefits for weight loss, HFpEF, and now Parkinson’s 😂🔥🔥
In a placebo-controlled LIXIPARK trial involving persons with Parkinson’s disease, the subcutaneous GLP-1 receptor agonist lixisenatide was associated with reduced motor disability over a period of 12 months.
Full trial results and Research Summary:
It is very important that you understand the difference between:
- Something you enjoy doing because you are really passionate about it.
And
- Something you enjoy doing because you are just good at it.
هل عمرك مشيت فى طريق و حسيت أنه مش مناسب بس قررت تكمل كده كده لأنك بذلت مجهود فيه و مستخسر ترجع؟
💡 مقالة قد تغير تفكيرك 💡
فى ظاهرة تعرف فى علم النفس ب "مغالطة التكلفة الغارقة Sunk cost fallacy" ... خلينى الأول أحكيلك عن كام تجربة علمية اتعملت على الموضوع ده:
🧵🧵 1/
Translation from a civilian in
#Gaza
"How can we quench our thirst with no water supply?
When we put anything on the stove, the vapor that condenses on the pot cover becomes water droplets. We keep collecting it in a cup. This is the only solution we've come up with".
Applicants write in their PS that they "can work under pressure". Not sure how much this is valued in today's world with the growing focus on wellness. Better say that you can maintain physical & mental wellbeing under pressure. It reflects a more +ve & mature mindset.
#Match2024
When you arrive at most US airports, there will be 2 lines:
- One for Citizens and Green card holders &
- One for all other Visa holders.
I have stood in both lines, and I can tell you that the treatment you get in each line is VERY different.
Just got my green card and used Global Entry for the first time. 2 sec interaction after the kiosk: “Mr. Hsu, anything to declare? No? Welcome home!”
I didn’t realize how much this could mean to me. And what it still feels like to be an immigrant even after so many years here
"The Science of Deprescription"
A Thread 🧵
Medical students often learn how to prescribe medications, but rarely do they learn how to deprescribe them. The result: Millions of pts (esp older pts) exposed to polypharmacy and side effects of drugs with questionable benefits.
1/
Here is the VA QI event winner: The Coleman team 🎉🎊
Abdelrahman, Sneha, and
@SPlacideMD
We assembled Mr. Potato head 🥔 in a record 13.6 seconds, beating the surgery and ENT teams by a good margin 😅.
1. As a PI who LOVES to give advice I think the question that I get asked the most is one the goes something like “how do I choose & apply for a postdoc”. I have a set answer & I have seen parts of it many times on twitter, but I wanted to write a thread that collates my thoughts
Yesterday was a rough day in the hospital.
But then the palliative care attending was stopping by our room, and he thanked me for keeping a close eye on pain in my patients and working closely with him.
And it is small things like these that make the rough days go by.
- My wife: I crashed someone else's car.
= Me: What?
- My wife: No, I did not, but I just scratched our car.
= Me: Ok, thank God.
The art of breaking bad news 😂😂
An amazing grand rounds by my mentor
@tavrkapadia
at
@YaleCardiology
on the management of valvular heart disease.
The Cleveland Clinic has an amazing structural program and I am glad Dr. Kapadia got to share his expertise with us.
@CleClinicHVTI
Starting 2023 with another powerful PD note by
@MarkDSiegel1
celebrating open doors, diversity, and opportunities for all!
"Since 2011, the year I became PD, we’ve matched IMGs from 🇮🇳🇮🇷🇮🇱🇸🇦🇹🇷🇬🇷🇮🇹🇦🇹🇩🇪🇩🇰🇷🇺🇨🇴🇵🇪🇧🇷🇲🇽🇨🇦. This year, we’re trying for more."
👉
Some tips to improve your scientific writing (a thread)
1. Scientific writing has two purposes: First, to inform (not impress the reader) about your work and findings.
2. To strike a balance between authors who want to write more and readers who want to read less.
1/
A quote from working with a brilliant diagnostician today:
"I see the patient complained of dizziness before and her provider just gave her a meclizine. But the patient does not need a drug, she needs a diagnosis".
Had a blast today at
#ACC23
connecting with colleagues & presenting our poster on cardiology clinical research in Africa & how to address such disparity.
I will present tomorrow in a moderated session abt TAVR outcomes in small annuli (Hall F, Theatre 3 @ 10:30AM)
@tavrkapadia
Translation: A chest X-ray of a patient with dyspnea. Doctors considered a cancer diagnosis, but with further questioning, it turned out the patient was hiding a sweet potato in her clothes (believing it drives disease away).
حالة جدل: مريضه راجعت المستشفى تشتكي من صعوبة تنفس.بعد عمل الاشعه وجود اشتباه ورم وبعد اجتماع الاطباء لم يتوصلون لتشخيص.بعد مراجعة المريضه للعيادة اتضح انها كانت تخبي بطاطة 🥔صغيرة تحت ملابسها اعتقاد انها تبعد منها التعب
Personal belief that potatoes protects against disease
The American Geriatrics Society has updated its Beer's criteria (the list of potentially inappropriate medications) in older adults.
A highly recommended read 👇👇
@HilzFuld
If you understand Arabic, you hear the person in the video saying this is “Haret Abo-elkas” >> Abo-elkas alley.
Not sure where you come from, but people living in alleys do not often have palaces.
But if you read most comments, most people see you are lying anyway.
ABGs are aggressive and extremely painful procedures if the pt is awake. Yet, in 2024, we do not have a good alternative.
So, we should order them judiciously and only when they will influence management.
❌❌ ACEIs are the anti-HTN class of choice in pts w DM.
✅✅ ACEIs are the anti-HTN class of choice in pts w DM "and urinary albumin-to-Cr ratio >30 mg/g Cr".
>> Also, the term "microalbuminuria" has fallen out of favor for lack of precision & diagnostic inconsistency.
Refractory Hypokalemia 💊🩼
1) Check Serum Mg & replete if needed.
2) Check ABGs: Met alkalosis is a common cause; Urine Cl- can help specify the cause.
3) Check if the pt is receiving K-lowering meds (diuretics, B2 agonists, etc.)
An interesting case 👇
How does predicted patient-prosthesis mismatch (PPM) compare to measured PPM in TAVI and SAVR patients?
We just got a research letter accepted in
@JACCJournals
that tries to answer the question 🔥🔥
Eternally grateful to Dr.
@tavrkapadia
for the incredible support and guidance
9/
Final tips:
- Don't reiterate your ERAS CV achievements; you can put them in context
- Don't go >700 words
- Don't overuse literary expressions & complex vocab (The purpose is to deliver a message, not to showcase linguistic ability).
- Always stay humble & true to yourself.
Known as the city of 1000 minarets, Cairo in Egypt is one of the world's oldest Islamic cities. With its famous mosques, madrasas, hammams & fountains, the beauty and charm of Cairo is in its exquisite use of Islamic architecture.
A thread on the beautiful heritage of Cairo…
Brilliant advice from my great
@YaleIMed
advisor Dr. Paul Bernstein, and Dr. Benjamin Doolittle on writing Personal Statements.
Full Paper with more golden pieces here 👉
I just found this masterpiece by Dr.
@AnkurKalraMD
, highlighting the struggles of IMGs with the annual J1 visa renewal process.
Really enlightening if you want to understand what IMGs go through on a regular basis.
A Swedish nationwide twin study in
@eClinicalMed
found that obesity predicted by genetics was less harmful than obesity influenced by environmental factors.
I do mot mind memorizing new drugs for HF as they are clinically relevant.
But step 1 is full of too much irrelevant stuff; for ex, most diseases we study in Biochemistry are so rare that most of us will never see them in our career.
When I took Step 1 the treatment for heart failure was beta blocker and ACEi. Now it’s BB-ACEi-ARB-ARNI-SGLT2-Ivabradine-ICD-BiV pacer. Students today have to MEMORIZE it all for the test plus the outdated stuff like digoxin. And that’s just one disease. Result=burnout.
I will definitely do this rotation again.
A seasoned senior
@ASanchez_PS
, a fantastic colleague
@amishadavemd
, and a brilliant medical student. Couldn’t ask for more ❤️🙏
The number of patients on Gabapentin in the US is scary.
Some patients don’t even know what they are taking it for. When I ask, a common answer is “I don’t know, my PCP prescribed it a few years ago” and they kept refilling it since.
The results of the ONWARDS 1 phase 3a trial are out in
@NEJM
, showing that "glycemic control was significantly better with once-weekly insulin Icodec than with once-daily insulin Glargine U100" in patients with type II DM.
A game-changer for patients with DM 2.
Our analysis on Cardiology clinical trials in Africa and the limitations facing them is featured by the Yale Department of Internal Medicine.
Hope this opens the door for more discussions and efforts to further engage Africa in cardiology clinical research.
In order to understand the limitations faced by African investigators in modern cardiology research, a group of researchers analyzed 30 years of African-led clinical trials in cardiovascular medicine.
Learn more about the study led by
@AbushoukMD
.
Tip of the Day:
One should suspect Euglycemic DKA "EDKA" in any ill-feeling Diabetic pt with symptoms such as malaise, dyspnea, nausea, or vomiting.
Because EDKA is often missed, always screen these patients with serum pH & blood/urine ketone testing.
Image Credit:
@EMNote
A new simplified way to diff VT & SVT with aberrancy:
The 2 mc methods are the Brugada & Vereckei.
In 2022, the "Basel criteria" was published "Fig". It has similar accuracy to the previous 2 but is way easier & ⬇️ the time to Dx at every experience level (attending>>resident).
So happy for our
@TradIMYale
residents who matched into fellowship today! Here's our list of Traditional
@YaleIMed
residents who are entering fellowship and GIM fields. Congratulations to all!
Pleased to share that 2 abstracts I submitted for
#ACC23
were accepted, including 1 in a moderated session.
Join me on March 5th & 6th to learn about TAVI outcomes in small annuli & engaging Africa in CV clinical trials.
@tavrkapadia
@EssaHariri
@AnkitAgrawalMD
@ahmed_sayed_98
Just out in
@NEJM
A Yale-led phase 2A trial of S.C. Retatrutide (a triple agonist of glucagon, GLP1, and GIP) for 48 wks showed substantial reductions in body wt.
@AniaJastreboff
This year has witnessed some interesting developments in Obesity Medicine.
3/
The PS should answer at least 3 basic questions:
A. Why IM? Not medicine in general; you are not applying for medical school.
B. Why You? Do not write "I am hard-working, enthusiastic, .... etc.). Mention one or two examples that show these qualities.
Just awarded the "Fellow of the European Society of Cardiology/FESC" title through the Scientific Excellence track. Thanks to my mentors
@tavrkapadia
,
@mo_gad_md
as well as Dr.
@VDelgadoGarcia
for supporting my application.
Officially: Abdelrahman Abushouk, MD, FESC 💪
أمال اعمل ايه؟ ممكن تبدأ بقصة و لو بسيطة برا الطب تبين فيها ازاى اكتسبت خصائص أو مهارات معينة فى شخصيتك و تربطها فى الباراجراف اللى بعده بازاى الخصائص و المهارات دى وجهتك للتخصص ده و هتخليك مميز فيه ... دى هتكون حقيقية أكثر و Unique أكتر و مهمة اكتر.
4/
This paper in
@JACCJournals
created a computational algorithm to help clinicians optimize the management of heart failure.
@umichCVC
I tried it and I think it is good. Check it out 👇
- ثانيا: أنا قررت أدخل طب لما حد قريبى تعب بمرض معين و شفته بيعانى فقررت أدخل طب عشان أحارب هذا المرض اللعين (مع موسيقى أرطغرل فى الخلفية) ... و النوع ده من القصص بيصنف من Tear Shedders (القصص المثيرة للدموع) و اللى حتى لو حقيقى فى حالتك فمن كتر استعماله التعاطف معاه ضعف.
2/
Most melatonin gummies in the market do not contain the amount of melatonin labeled on the product. One actually did not contain any melatonin, but contained CBD; a new research letter in
@JAMA_current
shows.
Thrilled to open 2024 with a case just published in
@BrownJHM
: "Pulmonary Infarction Due to Direct-acting Oral Anticoagulant Malabsorption" 🥂
We hope this 📄 will be considered a "must-read" for clinicians who diagnose & treat PEs!
الخلاصة أنت محتاج تكتب مقالة قوية و صادقة و تبين الجوانب المختلفة فى شخصيتك. و ده مش هيتحقق الا لو خدت وقتك و قعدت مع نفسك تتأمل فى الرحلة اللى وصلتك للنقطة دى و بعدين استعنت بمن حولك عشان يأكدولك أن اللى كتبته بيعكس شخصيتك. لو التزمت بالنصايح دى باذن الله هتكتب حاجة مميزة.
14/
had a blast at
#SCAI2024
! I shared my work comparing invasive and non invasive measures used in the dx of microvascular dysfunction🫀 we found high diagnostic agreement across 82Rb PET based MFR and thermodilution CFR with a modest positive correlation as well!
#WIN
@samitshahmd
#HeartFailure2024
#JACCHF
LBCT SimPub: First randomized, cross-over study examining the effectiveness of 3 diuretic regimens in the setting of an in-hospital HF day-care unit
🔹IV furosemide
🔹IV furosemide+oral metolazone
🔹IV furosemide+IV acetazolamide
9/ Final tips:
- Don't reiterate your ERAS CV achievements; you can put them in context.
- Don't go >700 words - Don't overuse literary expressions & complex vocab (The purpose is to deliver a message, not to showcase linguistic ability).
- Always stay humble & true to yourself.
6/
Please stay away from cliche stories: I chose IM when I saw a relative suffer from disease X. I am sorry you experienced this, but it isn't enough to justify an entire career. You may even come across as immature, making lifelong decisions based only on emotional experiences.
Ammonia levels corollate with neither severity of hepatic encephalopathy nor time to resolution of encephalopathy in this randomized controlled trial
From:
@JasmohanBajaj
In:
@AGA_CGH
#livertwitter
We just got a new study accepted in
@NatureMedicine
about the double burden of child malnutrition in 105 low and middle-income countries.
Thanks to our massive team for this magnanimous effort that reveals nutritional challenges, faced by 120 M children < 5y old all over LMICs.
The benefits of Beta Blockers are being re-examined across different cardiac indications (e.g., secondary prevention after MI, HF, etc). Most of the guidelines we have are based on historical trials (e.g., pre-reperfusion therapy).
Not all patients with “heart failure” need or benefit from beta blockers. Our analysis showing the potential for an increased risk for HF hospitalization with BB in patients with higher EFs (particularly over 60%).
In Sweden, blood donors receive a text message whenever their blood is used to save someone's life.
The program is designed to encourage donations and show the personal impact individual donors can have.
🇸🇪 ❤️