Internal Medicine

06 April 2026 21:17

Discontinuation of Levothyroxine in Adults Aged 60 Years or Older

Internal Medicine

23 March 2026 19:13

Sepsis guideline 2026

Internal Medicine

20 March 2026 12:28

Treatment of Helicobacter pylori Infection

Internal Medicine

27 February 2026 22:10

این مقاله درباره کنترل شدید قند خون در سالمندان مبتلا به دیابت نوع ۲ هشدار می‌دهد و نشان می‌دهد که رساندن HbA1C به مقادیر بسیار پایین (مثلاً زیر ۷٪) در افراد مسن نه‌تنها سود قطعی در کاهش مرگ‌ومیر یا عوارض قلبی‌عروقی ندارد، بلکه می‌تواند خطراتی مانند افت قند خون علامت‌دار، سقوط، کاهش عملکرد جسمی و ذهنی، بستری شدن و حتی مرگ را افزایش دهد. بسیاری از مطالعات تصادفی‌سازی‌شده نشان داده‌اند که کنترل تهاجمی در این گروه سنی بهبود معناداری در پیامدهای مهم ایجاد نمی‌کند و حتی ممکن است مضر باشد، به‌ویژه با داروهایی مانند انسولین و سولفونیل‌اوره‌ها. همچنین سودمندی دستگاه‌های پایش مداوم قند خون در سالمندان به‌خوبی ثابت نشده است. در نتیجه، توصیه می‌شود درمان دیابت در سالمندان بر اساس شرایط فرد، بیماری‌های همراه و کیفیت زندگی تنظیم شود و اهداف ملایم‌تر (مثلاً HbA1C حدود ۷٫۵٪) در نظر گرفته شود تا از عوارض ناشی از درمان بیش‌ازحد جلوگیری گردد.


🆔 @InternalMed
.

Internal Medicine

27 February 2026 00:07

💢 Cochrane for Clinicians


1️⃣ PPIs to Prevent NSAID-Induced Ulcers and Dyspepsia

2️⃣ Interventions for Smokeless Tobacco Cessation


🆔 @InternalMed
.

Internal Medicine

26 February 2026 23:48

💢 Blood Pressure Target Recommendations


🆔 @InternalMed
.

Internal Medicine

25 February 2026 18:04

💢 Muscular Strength and Mortality in Women Aged 63 to 99 Years

A study of 5,472 women aged 63-99 years from SUNY Buffalo, published in JAMA Network Open, found that muscle strength, measured by grip strength and chair-stand times, independently predicts survival, even after accounting for physical activity and cardiorespiratory fitness.

Women with higher grip strength were 35% less likely to die, and those with faster chair-stand times were 34% less likely to die. These findings highlight the importance of muscle strength as a resilience marker in aging, suggesting that building muscle mass and quality should be a focus alongside cardiorespiratory fitness in older adults.

The Takeaway: Higher muscle strength was associated with lower all‑cause mortality after adjustment for physical activity and other measured confounders.


🆔 @InternalMed
.

Internal Medicine

03 January 2026 18:49

🔥

💢 Is resmetirom indicated in liver fibrosis associated with etiologies other than MASLD (i.e. AIH or hepatitis C)?
🔅 Amir Ali Sohrabpour


❌ Short answer: No.
Resmetirom is NOT currently indicated for liver fibrosis due to causes other than MASLD/MASH, such as autoimmune hepatitis (AIH) or hepatitis C–associated fibrosis.


Here’s the detailed breakdown:

⸻

• Resmetirom (Rezdiffra™) is FDA-approved (2024) only for adults with non-cirrhotic MASH/MASLD with moderate to advanced fibrosis (F2–F3).
• The approval is etiology-specific, not a general anti-fibrotic indication.

⸻

Evidence by disease category

1. MASLD / MASH

✅ Yes – indicated
• Studied extensively in MAESTRO-NASH and related trials
• Demonstrated:
• Resolution of steatohepatitis
• Improvement in fibrosis stage
• Mechanism (THR-β agonism) directly targets lipid metabolism and hepatic steatosis, which is central to MASLD pathophysiology

⸻

2. Autoimmune hepatitis (AIH)

❌ No – not indicated
• AIH patients were excluded from pivotal trials
• No clinical trial evidence supporting efficacy in:
• Immune-mediated inflammation
• AIH-related fibrogenesis
• Fibrosis in AIH is driven by adaptive immune dysregulation, not primarily metabolic dysfunction
• Current standard remains immunosuppression (steroids ± azathioprine/MMF)

⸻

3. Chronic hepatitis C (HCV)–associated fibrosis

❌ No – not indicated
• Patients with active viral hepatitis were excluded from trials
• No data supporting:
• Fibrosis regression in virally mediated liver injury
• In HCV:
• Primary antifibrotic strategy is viral eradication with DAAs
• Fibrosis regression often follows sustained virologic response (SVR) without adjunct antifibrotic drugs

⸻

4. Other liver diseases (briefly)

Alcoholic liver disease ❌ Not indicated
PBC / PSC ❌ Not indicated
Cryptogenic cirrhosis ❌ Not indicated
Congestive hepatopathy ❌ Not indicated

⸻

Mechanistic consideration (why it doesn’t generalize)

Resmetirom:
• Selectively activates thyroid hormone receptor-β

• Improves:
• Hepatic fat metabolism
• Lipotoxicity
• Downstream inflammation and fibrosis in metabolic liver disease

• It does not:
• Suppress immune-mediated inflammation
• Target viral injury
• Directly inhibit stellate cell activation across etiologies

So fibrosis improvement is context-dependent, not universal.

⸻

Off-label use?
• No strong rationale at present
• Would be difficult to justify outside a clinical trial
• Not recommended in guidelines for non-MASLD fibrosis

⸻

Bottom line

Resmetirom should be used only for MASLD/MASH-related fibrosis (F2–F3). There is currently no evidence or indication for its use in AIH-, HCV-, or other non-metabolic causes of liver fibrosis.


🆔 @GIJournalClub
.

Internal Medicine

01 January 2026 15:16

💢 32-Year-Old Woman Presenting With
Hemoptysis


Granulomatosis with polyangiitis (GPA) is a necrotizing small- to medium-vessel vasculitis classically involving the upper and lower respiratory tracts and kidneys.

High-yield clinical features include hemoptysis, pulmonary nodules or cavitary lesions, rapidly progressive glomerulonephritis, and systemic symptoms.

The diagnosis is strongly supported by the presence of cytoplasmic ANCA directed against proteinase-3 (PR3-ANCA) and confirmed by tissue biopsy demonstrating necrotizing granulomatous inflammation with pauci-immune vasculitis.

First-line treatment for severe, generalized disease consists of high-dose corticosteroids combined with rituximab or cyclophosphamide for remission induction, followed by maintenance immunosuppression.

Infection is the leading cause of mortality in GPA, particularly due to immunosuppressive therapy, making early diagnosis and careful monitoring essential for improving outcomes.


🆔 @InternalMed
.

Internal Medicine

26 December 2025 07:17

💢 Cardiovascular Outcomes with Tirzepatide in Type 2 Diabetes


🆔 @GIJournalClub
.

Internal Medicine

24 December 2025 18:12

Management of glucagon-like peptide-1 receptor agonist (GLP-1 RA)-induced gastrointestinal side effects

Internal Medicine

24 December 2025 18:12

Practical use of glucagon-like peptide-1 receptor agonists in patients with heart failure.

Internal Medicine

19 December 2025 08:36

*اساتید محترم دانشگاه ها و مراکز آموزش عالی و پژوهشگران گرامی و دانشجوپژوهشگران عزیز*
با تقدیم سلام و احترام
در حال انجام یک پژوهش دانشگاهی با عنوان  “بررسی دانش، نگرش و عملکرد پژوهشگران ایرانی درباره کاربرد هوش مصنوعی در پژوهش” هستیم و خواهش می کنیم با صرف حدود ده دقیقه از وقت ارزشمند خود، *با پاسخ به سوالات پرسشنامه موجود در لینک، در این تحقیق شرکت فرمایید و در صورت امکان، لینک را سخاوتمندانه با سایر اساتید و پژوهشگرانی که می شناسید به اشتراک بگذارید.*
پیشاپیش از همکاری صمیمانه جنابعالی/سرکار سپاسگزاریم.
*تیم پژوهشگران دانشگاههای علوم پزشکی شیراز و کرمان*
📌 لینک پرسشنامه:

https://survey.porsline.ir/s/wTBlIhhT

Internal Medicine

02 December 2025 19:38

💢 Colorectal Cancer Screening and Prevention


Adults with average risk of CRC, but no signs or symptoms of the condition, should undergo periodic screening from 45 to 75 years of age.

Adults 76 to 85 years of age with average risk of CRC may undergo screening based on overall health status, prior screening history, and patient preferences.

Patients with one or more first-degree relatives with CRC or adenomatous polyps should start screening at 40 years of age or 10 years before age of youngest relative at time of their diagnosis.

Physicians should counsel patients about behaviors that may reduce the risk of CRC, which include staying at a healthy weight; performing moderate to vigorous physical activity; eating a diet high in fruits, vegetables, and whole grains and low in red and processed meats; not drinking alcohol; and not smoking.


🆔 @InternalMed
.

Internal Medicine

30 November 2025 19:19

💢 Vitamin B12 Deficiency: Common Questions and Answers


In a multicenter open-label randomized controlled trial comparing metformin with placebo, a low or borderline vitamin B12 level (less than 298 pg/mL [220 pmol/L]) was seen in 19.1% of the metformin group vs 9.5% of the placebo group. Another randomized controlled trial showed metformin use was associated with vitamin B12 deficiency with a number needed to harm of 14.

A 2023 meta-analysis showed that proton pump inhibitor use was associated with vitamin B12 deficiency (odds ratio = 1.42).

A 2018 Cochrane review showed no difference in disease-oriented outcomes in those treated with oral vs intramuscular vitamin B12 supplementation. Even in those with pernicious anemia or Roux-en-Y gastric bypass, 1,000 mcg daily of oral vitamin B12 was non-inferior to intramuscular vitamin B12.


🆔 @InternalMed
.

Internal Medicine

06 April 2026 21:17

jama_ravensberg_2026_oi_260011_1775150650.73756.pdf

Internal Medicine

23 March 2026 19:13

s00134-026-08361-1.pdf

Internal Medicine

28 February 2026 21:34

💢 Neutropenia: Evaluation and Management in the Primary Care Setting

Internal Medicine

27 February 2026 19:01

A large prospective cohort study in the UK Biobank (88,905 adults, mean age 62) found that higher personal nighttime light exposure (measured via wrist sensors for 1 week) was linked to increased risk of cardiovascular diseases over ~9.5 years of follow-up.

Compared to those with the darkest nights (≤50th percentile), individuals in the brightest group (>90th percentile) showed significantly higher adjusted risks: coronary artery disease (+32%), myocardial infarction (+47%), heart failure (+56%), atrial fibrillation (+32%), and stroke (+28%). These associations held after extensive adjustments for confounders like age, sex, BMI, lifestyle factors, sleep duration/quality, shift work, chronotype, comorbidities, and genetic risk.

The findings support a dose-response pattern and align with known mechanisms of circadian disruption from nighttime light (e.g., impaired nocturnal blood pressure dipping, sympathetic overactivity, metabolic changes), independent of sleep duration.

While observational (with limitations like single-week measurement and lack of light source differentiation), the results highlight a potentially modifiable everyday risk factor—reducing unnecessary light at night (from screens, lamps, or urban leakage)—for better cardiovascular health.


🆔 @InternalMed
.

Internal Medicine

26 February 2026 23:53

بر اساس این مقاله جالب، تعیین هدف درمان فشار خون باید یک تصمیم‌گیری مشترک میان پزشک و بیمار با در نظر گرفتن تعادل بین فواید و مضرات باشد. اگرچه کارآزمایی‌های بالینی مانند SPRINT و BPROAD نشان داده‌اند که کنترل شدید فشار خون (رسیدن به اعداد کمتر از ۱۳۰/۸۰) می‌تواند پیامدهای قلبی‌عروقی را کاهش دهد، اما این رویکرد با افزایش قابل‌توجه عوارضی نظیر افت فشار خون، سنکوپ و آسیب‌های حاد کلیوی همراه است. نکته حیاتی این است که در این تحقیقات، فشار خون با پروتکل‌های بسیار دقیق و زمان‌بری اندازه‌گیری شده است که اجرای آن‌ها در مطب‌های شلوغ معمولاً غیرعملی است؛ بنابراین، تلاش برای دستیابی به اهداف سخت‌گیرانه بر اساس اندازه‌گیری‌های شتاب‌زده و معمول در مطب‌ها، خطر «درمان بیش از حد» (Overtreatment) و عوارض دارویی را به شدت افزایش می‌دهد. در نهایت، نویسندگان توصیه می‌کنند که پیگیری اهداف پایین‌تر فشار خون نباید یک رویه همگانی باشد و در صورت توافق پزشک و بیمار برای کنترل شدیدتر، اندازه‌گیری فشار خون باید حتماً با رعایت کامل پروتکل‌های استاندارد و زمان‌بر انجام شود تا سلامت بیمار به خطر نیفتد.


🆔 @InternalMed
.

Internal Medicine

25 February 2026 18:07

رهنمودهای جدید رژیم غذایی برای آمریکا، محدوده پروتئین مصرفی را از 1.2 تا 1.6 گرم به ازای هر کیلوگرم وزن بدن توصیه می‌کنند که نسبت به توصیه قبلی 0.8 گرم به ازای هر کیلوگرم افزایش یافته است. این افزایش برای بهینه‌سازی سلامت فراتر از جلوگیری از کمبود پروتئین صورت می‌گیرد. این افزایش به ویژه برای بزرگسالان مسن، کودکان، زنان باردار و کسانی که در حال بهبودی از بیماری هستند یا از داروهای GLP-1 استفاده می‌کنند یا کسانی که فعالیت بدنی بسیار زیادی دارند، مهم است. بیماران باید مصرف پروتئین خود را در طول روز توزیع کنند و برای جلوگیری از مصرف بیش از حد چربی‌های اشباع‌شده، منابع گیاهی را نیز در رژیم غذایی خود بگنجانند. در حالی که مصرف زیاد پروتئین به طور کلی بی‌خطر است، اما نباید جایگزین سایر مواد مغذی ضروری شود. این مقاله بر اهمیت مصرف متعادل پروتئین برای سلامت کلی بدن و حفظ عضلات تاکید می‌کند.


🆔 @InternalMed
.

Internal Medicine

30 January 2026 10:29

💢 Cancer Incidence and Mortality With Aspirin in Older Adults - Follow-Up of the ASPREE Trial


From JAMA Oncology: Low-dose aspirin in older adults was not associated with lower cancer incidence over 8.6 years, and cancer mortality risk did not persist beyond the exposure period.


🆔 @InternalMed
.

Internal Medicine

01 January 2026 16:42

💢 Lipoprotein(a) in clinical practice:
What clinicians need to know


🆔 @InternalMed
.

Internal Medicine

26 December 2025 16:02

💢 Managing obesity in older adults

Obesity should be managed in older adults. However, challenges in this age group include multimorbidity, polypharmacy, limited mobility and sensation, and, in particular, sarcopenia, a natural consequence of aging exacerbated by weight loss. Lifestyle recommendations should emphasize adequate protein intake and exercise, particularly strength training, adapted to mobility. Antiobesity medications and metabolic-bariatric surgery are useful in select patients.


🆔 @InternalMed
.

Internal Medicine

24 December 2025 18:12

Pharmacological treatment for patients
with obesity and heart failure: Focus on
glucagon-like peptide-1 receptor agonists

Internal Medicine

24 December 2025 18:12

Role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) across the Universal Definition of Heart Failure stages

Internal Medicine

23 December 2025 12:50

🔥

💢 FDA Okays Oral Semaglutide 25 mg for Weight Management

https://www.medscape.com/viewarticle/fda-okays-oral-semaglutide-25-mg-weight-management-2025a100104g?src=rss


🆔 @GIJournalClub
.

Internal Medicine

03 December 2025 21:05

💢 NEJM Case

A 76‑year‑old man with coronary artery disease and heart failure with reduced ejection fraction presented with 8 months of progressive bilateral breast enlargement and tenderness.

He had been on spironolactone for 4 years, increased to 100 mg daily 1 year earlier, then reduced to 25 mg 2 months prior due to hyperkalemia.

Exam showed symmetric glandular tissue with tenderness but no nodules, discharge, or skin changes; labs revealed normal renal and hepatic function, low‑normal testosterone, and otherwise normal hormone levels.

The diagnosis was spironolactone‑induced gynecomastia, a dose‑related adverse effect more common above 100 mg daily.

Mechanisms include androgen‑receptor blockade and increased peripheral conversion of testosterone to estradiol.

Spironolactone was discontinued and replaced with eplerenone. At 3‑month follow‑up, breast tenderness resolved, though gynecomastia persisted, reflecting irreversible glandular changes.


🆔 @InternalMed
.

Internal Medicine

01 December 2025 22:06

💢 Acromegaly — NEJM2025


🆔 @InternalMed
.

Internal Medicine

29 November 2025 18:19

💢 Hidden in Plain Sight: When Adrenal Insufficiency Looks Like Hypothyroidism

معرفی یک کیس جالب و کلاسیک توسط اساتید شیراز


🆔 @InternalMed
.