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Stay up-to-date on topics of Internal Medicine including educational cases, guidelines, important research findings. Admin: Amir Ali Sohrabpour MD Former Provost & Assoc Prof of Gastro/Hepato @ TUMS 🇮🇷 Https://zil.ink/aasohrabpour
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💢 SELECT trial surprise
💉 Semaglutide ⤵️cardiovascular events 20% regardless of wt loss.
🔸👫losing <5% had same CV benefit as those losing >5%.
🔹Only 33% of benefit explained by waist circ. changes.
👉Reframes GLP-1s from weight loss drugs to CV disease modifiers.
🔗 Link
🆔 @InternalMed
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💢 Colorectal Cancer Screening in the Older Adult
Discussions about CRC screening for older patients are complex, highlighting the role of shared decision making that addresses several important factors.
Case A is a healthy 80-year-old person with no co-morbidities, active lifestyle; advanced adenoma 3 years ago; brother with
colorectal cancer at age 67.
Case B is a 71-year-old with chronic kidney disease, coronary artery disease, and heart failure; screening colonoscopy 5 years ago with one 3 mm adenoma complicated by difficulty prepping (nausea, vomiting) and recovery (delayed return to activities); patient wants to focus on prioritizing function and quality of life, not worried about colorectal cancer.
🆔 @GIJournalClub
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💢 Obesity Management Algorithm Summary
EASO Algorithm for the pharmacological treatment of obesity and its complications in Nature Medicine. Obesity is an adiposity-based chronic disease (ABCD); assess severity and complications to guide treatment
🔗 Link
🆔 @GIJournalClub
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💢 Monoclonal Gammopathy of Undetermined Significance
📎 Link
🆔 @InternalMed
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Pharmacodynamics,
pharmacokinetics, interactions
with other drugs, toxicity and
clinical effectiveness of proton
pump inhibitors
💢 Primary care for recipients of kidney transplants
🆔 @InternalMed
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💢 Too Little Sleep Can Lead to Too Much Weight: What to Do?
https://www.medscape.com/viewarticle/too-little-sleep-can-lead-too-much-weight-what-do-2025a1000pp9?src=rss
🆔 @InternalMed
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💢 NEJM Case
A 65-year-old man presented with a 4-month rash, 2-month diarrhea, and weight loss. Exam showed a maculopapular eruption on trunk, arms, and legs [A]. Labs revealed normocytic anemia and elevated serum tryptase (>200 μg/L; normal <11). CT abdomen/pelvis showed thoracic vertebral osteosclerosis and end-plate erosions, without hepatosplenomegaly [B]. Skin biopsy demonstrated mast-cell infiltration; bone marrow biopsy showed cohesive groups of round and spindle-shaped mast cells with dense chromatin, eosinophilic cytoplasm, and marked fibrosis [C].
Immunohistochemistry was positive for CD25 and CD117 (c-Kit). Molecular testing detected the KIT D816V gain-of-function mutation. Findings established systemic mastocytosis, a disorder with mast-cell infiltration of organs including bone marrow, GI tract, and bone. Patient was treated with antihistamines and midostaurin, a c-Kit inhibitor. At 1-year follow-up, symptoms had resolved.
🆔 @InternalMed
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💢 What is the current guidance for
exercise in the management of patients who have MASH?
🆔 @GIJournalClub
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💢 Oral Hypoglycemics in CKD
🆔 @InternalMed
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💢 Want to loose weight? Sleep more.
https://open.substack.com/pub/brandonluumd/p/want-to-lose-weight-sleep-more?r=5p4qt&utm_medium=ios
🆔 @InternalMed
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💢 Sugar Substitutes Not So Sweet for Brain Health
https://www.medscape.com/viewarticle/sugar-substitutes-not-so-sweet-brain-health-2025a1000nes?src=rss
🆔 @InternalMed
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💢 Does Eating Red Meat Actually Raise Your Cancer Risk?
https://www.medscape.com/s/viewarticle/does-eating-red-meat-actually-raise-your-cancer-risk-2025a1000nj6?src=rss
🆔 @InternalMed
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💢 Once-Monthly Maridebart Cafraglutide for the Treatment of Obesity
🆔 @InternalMed
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▫️New real-world data from #ESC2025:
• Semaglutide 2.4 mg cuts risk of heart attack, stroke or death by 57% vs. tirzepatide in people with obesity & CVD.
• Benefits appear specific to semaglutide.
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https://www.prnewswire.com/news-releases/novo-nordisks-wegovy-cuts-risk-of-heart-attack-stroke-or-death-by-57-compared-to-tirzepatide-in-real-world-study-of-people-with-obesity-and-cardiovascular-disease-302542590.html
🆔 @InternalMed
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💢 Contraindications for approved blood pressure-lowering drug classes
🆔 @InternalMed
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💢 GLP-1 agonists pose emerging challenge for PET-CT imaging
New research presented this week at the 38th Annual Congress of the European Association of Nuclear Medicine (EANM'25) has revealed that GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) may alter FDG PET-CT scan results by increasing tracer uptake in the stomach and pancreas, potentially mimicking pathology.
A UK case series found atypical patterns in patients on GLP-1s, raising concerns about misinterpretation.
While stopping the drug a month prior could eliminate its impact due to its long half-life, researchers currently advise clinicians to account for medication history rather than discontinuing use. This underscores the importance of contextualizing imaging findings and staying alert to emerging postmarket drug effects.
🆔 @InternalMed
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AGA Clinical Practice Guideline on Management of
Gastroparesis
💢 Hereditary hemorrhagic telangiectasia in a 68-year-old man
🆔 @InternalMed
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💢 Oral Semaglutide are a dose of 25mg in Adults with Overweight or Obesity
🆔 @InternalMed
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💢 TUMS Case
A 15-year-old girl with acne vulgaris developed a painful, blistering rash on both hands after starting oral doxycycline. She had frequent sun exposure while playing outdoors without protection. Exam revealed erythematous plaques with vesicles on sun-exposed areas—especially the dorsal thumbs and dorsolateral index fingers—suggestive of doxycycline-induced phototoxicity, a dose-dependent reaction. These specific locations are commonly affected due to direct sun exposure, making them key diagnostic clues. Doxycycline was discontinued, and topical clobetasol initiated. The rash resolved within days, highlighting the importance of recognizing phototoxic patterns and managing with drug cessation and anti-inflammatory therapy.
🆔 @InternalMed
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🎧 Five Things to Do When Communicating Medical Numbers
https://podcasts.apple.com/us/podcast/jama-clinical-reviews/id1027430378?i=1000728245808
🆔 @GIJournalClub
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💢 NEJM Case
A 44-year-old previously healthy man presented with a 4-day history of pruritic rash and 2-day fever with malaise. The rash began on the scalp and spread rapidly over 24 hours to the trunk, extremities, face, and scalp. Examination showed pleomorphic lesions in different stages, including vesicles, pustules, and umbilicated lesions with central necrosis. He had no prior history of chickenpox or varicella vaccination. Laboratory tests revealed mild transaminase elevations. PCR of vesicle fluid confirmed varicella–zoster virus, establishing the diagnosis of primary varicella infection. Varicella in adults is often more severe than in children and carries an increased risk of complications such as pneumonia and encephalitis, even in immunocompetent patients. The patient was treated with oral valacyclovir, with resolution of systemic symptoms and skin lesions. At 4-week follow-up, he showed complete recovery with residual post-inflammatory hyperpigmentation only.
🆔 @InternalMed
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💢 A primary care guide to the screening and pharmacologic management of
chronic kidney disease in people living with type 2 diabetes
💢 NEJM Case
A 16-year-old girl presented with a 2-month cough and left lung base decreased breath sounds and dullness. Chest radiograph revealed a well-defined cystic lesion with a double-domed appearance, suggesting a ruptured pulmonary hydatid cyst, characterized by an outer pericyst and inner endocyst. She had exposure to sheep, cattle, and dogs. Despite a negative ELISA for Echinococcus granulosus IgG, chest CT confirmed the ruptured hydatid cyst; no other cysts were found in whole-body imaging. She underwent video-assisted thoracotomy with cystotomy and capitonnage, carefully avoiding cyst fluid spillage. Histopathology confirmed E. granulosus infection. Albendazole therapy was given postoperatively. At 9 months, there was no recurrence.
🆔 @InternalMed
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💢 Nice graphic on hemodialysis and peritoneal dialysis
🔗 JAMA 2024;332;(18):1559-1573.
🆔 @InternalMed
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🎧 Diagnosis and Management of Hypothyroidism
https://podcasts.apple.com/us/podcast/jama-clinical-reviews/id1027430378?i=1000724787007
🆔 @InternalMed
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💢 Get screened for colon cancer
Early screening for Colon Cancer has become more common in recent years. Joffrey Kopin, MD, joined Jon Hansen to discuss the importance of early screening and more. Listen now:
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http://wgnradio.com/health/dr-jeffrey-kopin-get-screened-for-colon-cancer
🆔 @InternalMed
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💢 Powerful new painkiller ADRIANA shows promise in ending opioid dependence
https://www.sciencedaily.com/releases/2025/09/250901104649.htm
🆔 @InternalMed
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💢 Rare Liver Damage Linked to Vinegar in 60-Year-Old Patient
عارضه کبدی سرکه سیب
https://www.medscape.com/viewarticle/rare-liver-damage-linked-vinegar-60-year-old-patient-2025a1000mzf
🆔 @GIJournalClub
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