Internal Medicine

29 November 2025 18:15

💢 Herpes zoster after ground-level fall


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Internal Medicine

24 November 2025 19:21

💢 management of anaphylaxis


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Internal Medicine

21 November 2025 22:23

💢 Comparison of recent guidelines for MASLD and MASH

3/3

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Internal Medicine

21 November 2025 22:23

💢 Comparison of recent guidelines for MASLD and MASH

1/3

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Internal Medicine

18 November 2025 23:03

A 74-year-old woman is evaluated for 3 weeks of fatigue, low-grade fevers, and right-sided headache and scalp tenderness. During this time, she has also had recurrence of shoulder achiness and hand stiffness that lasts about 30 minutes and is worse in the morning. Polymyalgia rheumatica diagnosed 4 months ago had dramatically improved after initiation of prednisone, 15 mg/d, followed by a taper, with no symptoms until 3 weeks ago. Apart from low-dose prednisone, she takes no other medications.

On physical examination, vital signs are normal. Tenderness over the right scalp is noted. Eye examination is unremarkable. Pain occurs with abduction of both arms and in the hip girdle area and persists with and without movement. There are bony prominences over the proximal interphalangeal joints. No rash, synovitis, or bruits are observed.

Laboratory studies at follow-up:

Erythrocyte sedimentation rate 88 mm/h High
C-reactive protein 4.0 mg/dL (40 mg/L) High
The prednisone dose is increased.

Which of the following is the most appropriate diagnostic test to perform next?

A. CT angiography of the chest, abdomen, and pelvis
B. MRI of the brain
C. Rheumatoid factor and anti–cyclic citrullinated peptide antibodies
D. Temporal artery biopsy


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Internal Medicine

14 November 2025 16:59

💢 Acute upper gastrointestinal bleeding: state-of-the-art review


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Internal Medicine

12 November 2025 19:03

Question  Does consumption of caffeinated coffee have a beneficial, detrimental, or neutral effect on the risk of recurrent atrial fibrillation (AF) episodes?

Findings  In this multicenter randomized clinical trial including 200 patients with persistent AF undergoing cardioversion, the risk of recurrent AF was significantly lower in the group allocated to coffee consumption (47%) compared with the abstinence group (64%).

Meaning  Consumption of coffee and other caffeinated products may be reasonably considered in patients with AF.


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Internal Medicine

08 November 2025 19:34

New meta-analysis of 55 RCTs shows GLP-1RAs increase the risk of gallstones and acid reflux—but not other serious GI or biliary events.

👇
https://ow.ly/zwew50XlXqc


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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


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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.


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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

29 November 2025 18:05

💢 A practical approach to the diagnosis and management of hepatic encephalopathy


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Internal Medicine

21 November 2025 22:23

💢 MASLD — BMJ Review 2025


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Internal Medicine

21 November 2025 22:23

💢 Comparison of recent guidelines for MASLD and MASH

2/3

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Internal Medicine

18 November 2025 23:03

The most appropriate diagnostic test to perform next is temporal artery biopsy (Option D). Giant cell arteritis (GCA) can develop in up to 20% of patients with polymyalgia rheumatica (PMR). Symptoms of GCA may include headache; jaw claudication; visual changes; hip and shoulder girdle pain (which are also symptoms of PMR); and constitutional symptoms, such as fever and fatigue. Findings may include tenderness over the temporal artery, reduced peripheral pulses, bruits, and significantly elevated inflammatory markers.

A complication of GCA is ischemic optic neuropathy, which can cause irreversible blindness; early recognition and treatment of GCA are critical. PMR classically presents with pain and stiffness of the shoulder and hip girdles, but in approximately 20% of cases, patients may also have peripheral inflammatory arthritis affecting the small joints of the hand. Because of the relationship between PMR and GCA, all patients with PMR should be regularly asked about GCA symptoms.

GCA may develop soon after the onset of PMR, but it may also occur while glucocorticoids for PMR are being tapered. If symptoms of GCA develop, high-dose glucocorticoid therapy should be started to avoid complications, such as vision loss, and should not be delayed for biopsy.

A temporal artery biopsy should be performed on the affected side. Ideally, this would be performed urgently (within 2 weeks) to increase the likelihood of a positive pathologic result. This patient with a recurrence of PMR symptoms and findings suggestive of GCA should begin receiving high-dose glucocorticoids and should undergo temporal artery biopsy for diagnostic confirmation.

All patients with GCA should be screened for large-vessel involvement using noninvasive imaging, such as CT angiography (Option A), to assess for extracranial disease. This patient does not yet have a diagnosis of GCA and does not have audible bruits or signs of limb claudication. Although CT angiography should be considered in the future, it would not be the next diagnostic test in this patient suspected of having GCA.

Although MRI of the brain (Option B) may be useful in patients with unexplained persistent headaches (especially if concerning neurologic deficits or systemic symptoms are present), this patient's right-sided headache with associated scalp tenderness on a background of PMR suggests GCA. MRI of the brain is not recommended to diagnose GCA.

Rheumatoid factor and anti–cyclic citrullinated peptide antibodies (Option C) are useful in evaluating rheumatoid arthritis. Although this patient has hand stiffness, she does not have features of rheumatoid arthritis on examination (e.g., synovitis, prolonged morning stiffness). Additionally, symptoms have been present for only 3 weeks. GCA better explains her symptoms and significantly elevated inflammatory markers.


Key Points

Symptoms of giant cell arteritis may include headache, jaw claudication, visual changes, and constitutional symptoms.

Giant cell arteritis is suspected on the basis of clinical presentation, and temporal artery biopsy can confirm the diagnosis.


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Internal Medicine

16 November 2025 17:57

💢 Penile ulcers in a 35-year-old man


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Internal Medicine

12 November 2025 20:05

💢 The Influence of GLP-1 Receptor Agonists on Five-Year Mortality in Colon Cancer Patients

This scientific article reports on an observational study from UC San Diego suggesting that GLP-1 receptor agonists, commonly sold as Ozempic and Wegovy, may dramatically improve survival rates for colon cancer patients.

The research analyzed medical records and found that colon cancer patients using these drugs, originally developed for diabetes and weight loss, had less than half the mortality rate of non-users.

Researchers speculate that the drugs' anti-inflammatory and metabolic effects, particularly in patients with obesity, may contribute to this benefit.

However, the authors caution that these are only observational findings and emphasize the need for randomized clinical trials to definitively prove that GLP-1 medications directly enhance cancer survival.


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Internal Medicine

09 November 2025 12:23

💢 Eating breakfast later in the day is linked to higher risks of illness and death in older adults.

A recent study found that *delaying breakfast until after 9 a.m.* was associated with a significantly increased risk of cardiovascular disease and all-cause mortality among adults aged 65 and older. Key findings include:

- Early breakfast eaters (before 8 a.m.) had the *lowest risk* of developing heart disease and dying from any cause.
- Those who ate breakfast after 9 a.m. had a 44% higher risk of cardiovascular disease and a 28% higher risk of all-cause mortality.
- The study adjusted for lifestyle factors such as sleep duration, physical activity, and diet quality, suggesting that *meal timing itself* may play a role in health outcomes.

Researchers hypothesize that earlier eating may better align with circadian rhythms, improving metabolic health and reducing inflammation. This adds to growing evidence that meal timing—not just meal content—matters for longevity and disease prevention.


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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