Internal Medicine

08 November 2025 10:39

💢 Sarcopenia and MASLD

Effective management of metabolic dysfunction–associated steatotic liver disease (MASLD) and sarcopenia requires an integrated approach combining diet and physical activity.

The Mediterranean diet is recommended for MASLD due to its benefits on liver and metabolic health. Traditional calorie-restricted diets (low-carb, high-carb, or low-fat) show inconsistent results, while time-restricted eating, alternate-day fasting, and the 5:2 diet show promise but need stronger evidence.

For sarcopenia, increased protein intake and a structured exercise regimen—combining aerobic and resistance training—are crucial for muscle preservation, metabolic improvement, and reducing liver fat.

Currently, no pharmacological treatments target both MASLD and sarcopenia. Bariatric surgery may help patients with MASLD and severe metabolic dysfunction but lacks robust data confirming safety and efficacy in sarcopenia.

📎 Link


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Internal Medicine

07 November 2025 08:43

💢 Major observational study for Type 2 DM management

A systematic review of 1.1M+ patients

Combining SGLT2 inhibitors + GLP-1 RAs may cut risk of death, heart failure & kidney events more than either drug alone 💊💉

📉 MACE ↓ 44%
⚰️ CV death ↓ 74%
🏥 HF hospitalisation ↓ 33%
🧠 All-cause death ↓ 50%
🧬 Kidney events ↓ 52%

👀 Studies were observational, so RCTs needed!

No ⬆️ differences of severe hypoglycaemia, diabetic ketoacidosis, genitourinary infections or gastrointestinal side effects


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Internal Medicine

03 November 2025 18:42

💢 GLP-1 receptor agonists and cancer


Many clinical studies have shown reduced cancer risk in people with diabetes of obesity taking GLP-1 family of drugs. A new paper makes the case these drugs should be studied to reduce cancer in people without metabolic disease.


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Internal Medicine

02 November 2025 19:57

💢 PSC


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Internal Medicine

30 October 2025 14:08

💢 Ulcerated tophaceous gout


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Internal Medicine

19 October 2025 23:32

💢 Contraindications for approved blood pressure-lowering drug classes


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Internal Medicine

12 October 2025 22:42

💢 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.


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Internal Medicine

06 October 2025 13:04

AGA Clinical Practice Guideline on Management of
Gastroparesis

Internal Medicine

03 October 2025 12:39

💢 Hereditary hemorrhagic telangiectasia in a 68-year-old man


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Internal Medicine

28 September 2025 12:42

💢 Oral Semaglutide are a dose of 25mg in Adults with Overweight or Obesity


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Internal Medicine

26 September 2025 18:29

💢 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.


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Internal Medicine

25 September 2025 14:42

🎧 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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Internal Medicine

19 September 2025 21:34

💢 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.


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Internal Medicine

18 September 2025 18:31

💢 A primary care guide to the screening and pharmacologic management of
chronic kidney disease in people living with type 2 diabetes

Internal Medicine

15 September 2025 13:53

💢 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.


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Internal Medicine

07 November 2025 19:21

💢 Heart–liver co-management in MASLD

Traditionally, hypertension management has focused narrowly on cardiovascular endpoints, overlooking its direct hepatic effect.

Data from three international multicentre cohorts indicated that hypertension is associated with a 57% increased risk of liver stiffness progression (adjusted HR 1.57, 95% CI 1.30–1.90; P < 0.001), a 41% higher risk of fibrosis progression (adjusted HR 1.41, 95% CI 1.12–1.78; P < 0.001) and a 30% greater risk of long-term adverse clinical outcomes (adjusted HR 1.30, 95% CI 1.26–1.33; P < 0.001).


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Internal Medicine

05 November 2025 18:21

💢 Taking Melatonin Could Raise Your Risk of Heart Failure, Study Finds

https://www.healthline.com/health-news/long-term-melatonin-use-heart-failure-risk


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Internal Medicine

02 November 2025 20:02

💢 Steroid conversion chart


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Internal Medicine

31 October 2025 10:25

AGA Clinical Practice Update on the Management of Ascites,
Volume Overload, and Hyponatremia in Cirrhosis: Expert Review

Internal Medicine

23 October 2025 16:00

🔥

💢 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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Internal Medicine

13 October 2025 20:04

💢 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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Internal Medicine

10 October 2025 22:09

💢 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


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Internal Medicine

03 October 2025 12:45

💢 Monoclonal Gammopathy of Undetermined Significance

📎 Link


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Internal Medicine

30 September 2025 11:45

Pharmacodynamics,
pharmacokinetics, interactions
with other drugs, toxicity and
clinical effectiveness of proton
pump inhibitors

Internal Medicine

26 September 2025 19:41

💢 Primary care for recipients of kidney transplants


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Internal Medicine

25 September 2025 21:20

💢 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


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Internal Medicine

24 September 2025 17:55

💢 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.


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Internal Medicine

19 September 2025 17:28

💢 What is the current guidance for
exercise in the management of patients who have MASH?


🆔 @GIJournalClub
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Internal Medicine

15 September 2025 23:01

💢 Oral Hypoglycemics in CKD


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Internal Medicine

12 September 2025 21:56

💢 Want to loose weight? Sleep more.

https://open.substack.com/pub/brandonluumd/p/want-to-lose-weight-sleep-more?r=5p4qt&amp;utm_medium=ios


🆔 @InternalMed
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