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.


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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.


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Internal Medicine

26 December 2025 07:17

💢 Cardiovascular Outcomes with Tirzepatide in Type 2 Diabetes


🆔 @GIJournalClub
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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.


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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.


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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

🆔 @GIJournalClub
👇

Internal Medicine

21 November 2025 22:23

💢 Comparison of recent guidelines for MASLD and MASH

1/3

🆔 @GIJournalClub
👇

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


🆔 @GIJournalClub
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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

01 January 2026 16:42

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


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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.


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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


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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.


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Internal Medicine

01 December 2025 22:06

💢 Acromegaly — NEJM2025


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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


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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


🆔 @GIJournalClub
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Internal Medicine

21 November 2025 22:23

💢 Comparison of recent guidelines for MASLD and MASH

2/3

🆔 @GIJournalClub
👇

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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