Internal Medicine

31 August 2025 20:53

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These findings are consistent with pernicious anemia complicated by anemia-induced heart failure. However, the differential diagnosis also included myelodysplastic syndrome due to the patient’s weight loss and pancytopenia.

To confirm the diagnosis, upper gastrointestinal endoscopy was performed after admission, revealing atrophic gastritis.

Further testing showed a markedly reduced vitamin B12 level (72 pg/mL) and positive anti-intrinsic factor antibodies, establishing the diagnosis of pernicious anemia.

He received blood transfusions, oral furosemide, and intramuscular vitamin B12, which improved symptoms and normalized hemoglobin within 2 months.

Pernicious anemia, a type of macrocytic anemia, results from vitamin B12 deficiency caused by intrinsic factor deficiency.

This condition is associated with atrophic gastritis mediated by autoantibodies against parietal cells or intrinsic factor. Pancytopenia due to vitamin B12 deficiency may be misdiagnosed as myelodysplastic syndrome.

Both pernicious anemia and myelodysplastic syndrome, as illustrated in this case, are characterized by ineffective hematopoiesis, which may lead to fragmented red blood cells, elevated LDH, and increased indirect bilirubin levels.

Glossitis and other oral findings, which are present in up to 25% of patients with vitamin B12 deficiency, can serve as valuable clues for diagnosing vitamin B12 deficiency, particularly in the early stages before vitamin B12 test results are available.

Recognizing these signs may help clinicians prioritize vitamin B12 deficiency over other hematological disorders, potentially avoiding unnecessary invasive procedures such as bone marrow examination.


🆔 @InternalMed
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Internal Medicine

30 August 2025 18:38

Antithrombotic therapy after coronary artery bypass graft surgery ESC EACTS 2025

Internal Medicine

29 August 2025 16:46

💢 Musculoskeletal Disorders of the Elderly


▫️ Twenty-five percent of those ≥65 years of age have injurious falls annually.

▫️ Bone mineral density shows osteoporosis by 50 years of age in ≥50%.


🆔 @InternalMed
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Internal Medicine

29 August 2025 13:57

🎙 A 28-Year-Old Pregnant Woman with an Abnormal Urinalysis

In this episode, we discuss asymptomatic bacteriuria in a pregnant woman.


https://podcasts.apple.com/us/podcast/harrisons-podclass-internal-medicine-cases-and-board-prep/id1453765092?i=1000723908413


🆔 @InternalMed
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Internal Medicine

29 August 2025 08:44

2025 ESC Guidelines for the management of cardiovascular disease and pregnancy

Internal Medicine

29 August 2025 08:44

2025 ESC/EACTS Guidelines for the management of valvular heart disease

Internal Medicine

28 August 2025 21:15

Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology

Internal Medicine

27 August 2025 16:48

💢 Pharmacotherapy for obesity management in adults: 2025 clinical practice guideline update


🆔 @InternalMed
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Internal Medicine

24 August 2025 15:02

💢 Diverticulitis: Diagnosis and Management

https://podcasts.apple.com/us/podcast/jama-clinical-reviews/id1027430378?i=1000718860155


🆔 @InternalMed
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Internal Medicine

22 August 2025 18:21

💢 Hemorrhoidal Disease


🆔 @InternalMed
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Internal Medicine

18 August 2025 22:29

💢 Three FDA-Approved Obesity Drugs That Aren’t GLP-1s

https://www.medscape.com/viewarticle/three-fda-approved-obesity-drugs-arent-glp-1s-2025a1000k4a


🆔 @InternalMed
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Internal Medicine

17 August 2025 20:04

💢 Most GLP-1 Prescriptions Miss the Mark: Are Yours?

https://www.medscape.com/viewarticle/most-glp-1-prescriptions-miss-mark-are-yours-2025a1000jts

GLP-1 receptor agonists, including semaglutide, are now widely used for weight loss, offering substantial weight reduction, improved metabolic health, and reduced cardiovascular risk. However, effective treatment involves more than simply prescribing drugs, and ongoing clinical oversight is crucial. Based on recommendations published in JAMA Internal Medicine, the following five tips can help physicians avoid common pitfalls and deliver optimal patient care.

🆔 @InternalMed
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Internal Medicine

15 August 2025 10:05

💢 روند چشمگیر کاهش مصرف الکل در امریکا

مصرف الکل در ایالات متحده به پایین‌ترین میزان در تاریخ اخیر این کشور رسیده است؛ و جمهوری‌خواهان در این عرصه پیشتاز هستند.


🆔 @hr1ghadam
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Internal Medicine

14 August 2025 12:17

💢 MASLD NEJM2025


🆔 @InternalMed
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Internal Medicine

11 August 2025 22:36

💢 Prophylactic Antibiotics May Be of No Use in Cirrhosis With Upper GI Bleeding

https://www.medpagetoday.com/gastroenterology/generalhepatology/116933


🆔 @GIJournalClub
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Internal Medicine

31 August 2025 20:52

💢 Glossitis as a Diagnostic Clue for Pernicious Anemia

62-year-old man presented with a 7-month history of generalized fatigue and exertional dyspnea, along with bilateral lower limb edema that had developed 1 week prior to admission. Despite a well-balanced diet, he experienced unintentional 10kg weight loss over the past year. He had no significant medical history and used no regular medications except vitamin supplements.

On physical examination, pallor of the palpebral conjunctiva and jaundice of the bulbar conjunctiva were observed. A smooth tongue with atrophy of lingual papillae was noted (Figure). Pitting edema was present in both lower legs. Laboratory investigations revealed macrocytic anemia (Hb 4.1 g/dL, MCV 113.5 fL) and thrombocytopenia (platelet count 36,000/μL). LDH levels were elevated at 1431 U/L, with increased indirect bilirubin (1.2 mg/dL). Peripheral blood smear showed fragmented red blood cells. Chest computed tomography demonstrated evidence of pulmonary congestion.


@InternalMed
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Internal Medicine

29 August 2025 19:13

2025 ACC Scientific Statement on the Management of Obesity in Adults With Heart Failure

Internal Medicine

29 August 2025 16:27

💢 Effects of Collagen Supplements on Skin Aging: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Collagen supplements have not proven effective for aging skin when only high-quality and independently funded studies are considered; observed benefits are mostly limited to studies funded by pharmaceutical companies and those of lower quality.


Key Findings

- Collagen supplements were associated with improved skin hydration, elasticity, and wrinkles when analyzing all 23 RCTs together.

- However, in studies not funded by pharmaceutical companies, collagen supplements showed no significant benefits for hydration, elasticity, or wrinkle improvement.

- In studies of high methodological quality, no significant effect was observed in any category.

- Low-quality studies showed a small improvement in skin elasticity, but not in other skin parameters.


Funding and Bias

- Studies funded by pharmaceutical companies consistently reported significant improvements in skin parameters.

- This suggests potential bias in commercially funded studies.


Clinical Implications

- No solid clinical evidence currently supports the use of collagen supplements for preventing or treating skin aging.

- Recommendations for collagen supplementation for skin health should be made cautiously, especially considering study quality and funding bias.

📎 Link


🆔 @InternalMed
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Internal Medicine

29 August 2025 08:44

2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease

Internal Medicine

29 August 2025 08:44

2025 ESC Guidelines for the management of myocarditis and pericarditis

Internal Medicine

29 August 2025 08:44

2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias

Internal Medicine

27 August 2025 17:27

💢 Updated Guidelines From the Society of Critical Care Medicine Strongly Recommend Steroids for Hospitalized Adults With Severe CAP


🆔 @InternalMed
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Internal Medicine

26 August 2025 22:39

💢 Rapidly Progressing Facial Rash


🆔 @InternalMed
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Internal Medicine

23 August 2025 10:52

💢 Snowman Sign in Pituitary Macroadenoma


🆔 @InternalMed
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Internal Medicine

22 August 2025 18:03

💢 Good News on GLP-1s and Cancer Risk, With One Exception


A large retrospective study found that GLP-1 receptor agonist (GLP-1RA) use for weight loss is linked to a 17% lower overall cancer risk compared to non-users, with follow-up ranging from 1 to 11 years.

Statistically significant cancer risk reductions were observed for endometrial cancer (HR 0.75), ovarian cancer (HR 0.53), and meningioma (HR 0.69), all hormone-sensitive or metabolism-related cancers.

Most other obesity-associated cancers, including colorectal, breast, prostate, and lung cancers, showed a trend toward reduced risk in GLP-1RA users, though these findings were not statistically significant.

The only exception was kidney cancer, which had a non-significant increased risk (HR 1.38) among GLP-1RA users, especially in patients under 65 and those who were overweight but not obese, requiring further investigation.

These results support existing evidence from bariatric surgery studies and prior research linking weight loss and cancer risk reduction, highlighting obesity management as a key cancer prevention strategy.

Limitations include the study’s retrospective observational design, lack of longitudinal BMI and glycemic control data, and reliance on electronic health records, meaning causality cannot be confirmed.

The findings underscore the need for prospective randomized trials to clarify whether GLP-1 agonists directly reduce cancer risk or if benefits stem from weight loss and metabolic improvements.

Given that over 137 million people in the U.S. are eligible for GLP-1RA therapy, even modest changes in cancer risk could have significant public health implications.


🆔 @InternalMed
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Internal Medicine

18 August 2025 22:02

💢 Managing the side effects of sodium-glucose cotransporter-2 inhibitors


🆔 @InternalMed
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Internal Medicine

16 August 2025 20:36

💢 Managing noninsulin glucose-lowering medications before surgery: A comparison of clinical practice guidelines


🆔 @InternalMed
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Internal Medicine

14 August 2025 18:23

💢 Small intestinal bacterial overgrowth as one of the diagnostic markers of hypertension

This study investigates the role of small intestinal bacterial overgrowth (SIBO) as a contributing factor in the diagnosis and understanding of certain health conditions, particularly those related to blood pressure abnormalities.

Through clinical and microbiological analyses, the study highlights that incorporating the assessment of gut microbiota and SIBO into diagnostic protocols could improve the detection and management of conditions associated with hypertension.

The data indicate that SIBO may influence vascular responses and systemic inflammation, making it an important diagnostic consideration.

This insight provides a broader understanding of the multifactorial nature of hypertension beyond traditional risk factors.

The findings underscore the potential clinical significance of targeting SIBO in treatment strategies. By recognizing bacterial overgrowth in the small intestine, healthcare providers may enhance therapeutic approaches to managing elevated blood pressure and related disorders.

This research opens pathways for further investigation into how modifying gut microbiota could contribute to improved patient outcomes in cardiovascular and possibly other systemic diseases.


🆔 @InternalMed
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Internal Medicine

14 August 2025 11:51

💢 Why Many Americans Are Rethinking Alcohol, According to a New Gallup Poll

https://www.medpagetoday.com/publichealthpolicy/publichealth/116979

A record high percentage of U.S. adults, 53%, now say moderate drinking is bad for their health, up from 28% in 2015.

The uptick in doubt about alcohol's benefits is largely driven by young adults -- the age group most likely to believe drinking "one or two drinks a day" can cause health hazards -- but older adults are also now increasingly likely to think moderate drinking carries risks.


🆔 @InternalMed
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Internal Medicine

11 August 2025 08:36

💢 Adding salt to foods increases the risk of MASLD


Many people add salt to their food at the table, but it is not clear whether this habit affects liver health.

We studied nearly 500,000 British adults for about 14 years to find out if people who frequently add salt to their meals are more likely to develop fatty liver disease, a condition in which fat builds up in the liver, which can cause serious health problems.

We find that people who always add salt to their food have a 35% higher chance of developing fatty liver disease compared to those who rarely or never add salt.

This risk is especially high in people with certain inherited traits, those who regularly drink alcohol, and people of normal weight.

Our findings suggest that reducing salt added at the table could help protect your liver and this should be recommended to people to reduce the risk of developing liver disease.


🆔 @GIJournalClub
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