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Internal Medicine
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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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+224 soatlar
+217 kunlar
+10730 kunlar
Postlar arxiv
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💢 Polycystic ovary syndrome: An update on diagnosis and management
https://www.ccjm.org/content/ccjom/93/3/176.full.pdf
🆔 @InternalMed
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💢 Management of Nausea
and Vomiting in a Cannabis User
Cannabis can reduce nausea in some disorders (e.g., cyclic vomiting syndrome, gastroparesis) but can also cause recurrent severe vomiting in cannabinoid hyperemesis syndrome (CHS).
CHS is most associated with long-term, frequent, high-dose cannabis use; diagnosis depends on cannabis-use history and improvement after sustained abstinence.
The main treatment is cannabis cessation, though many patients struggle with abstinence because of withdrawal symptoms, perceived benefit from cannabis, and stigma.
For acute CHS episodes, haloperidol and droperidol appear more effective than traditional antiemetics such as ondansetron or metoclopramide.
Other options include topical capsaicin, lorazepam, and aprepitant; IV fluids and electrolyte replacement are important.
Clinicians should avoid assuming that every cannabis user with vomiting has CHS and should use a nonjudgmental, individualized approach.
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Hypertension is responsible for more than 10 million deaths each year. 5-6 million of those are with 'mild to moderate' hypertension.
We're close to a world where those deaths can be prevented with a shot every six months.
That's what Alnylam is making, and it seems to work!
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💢 Multiple grey–white plaques on the oropharynx of a 35-year-old man
🆔 @InternalMed
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Combined therapy with nebulized and intravenous colistin for the
treatment of multidrug resistance pneumonia in burn patients:
experience from a third referral burn care center in Mexico City
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Answer:
Late-onset systemic lupus erythematosus (SLE).
The patient was treated with intravenous steroids and hydroxychloroquine, resulting in rapid clinical improvement.
The article emphasizes that late-onset SLE (onset after age 50) accounts for 10–20% of lupus cases and often presents with nonspecific symptoms such as fatigue, fever, and weight loss, which may delay diagnosis.
Compared with younger patients, elderly patients are more likely to have serositis, cardiac involvement, thrombosis, and higher mortality, while severe kidney disease is less common.
The main message is that clinicians should consider SLE even in older adults with vague systemic symptoms and oral ulcers to avoid delayed diagnosis and treatment.
🆔 @InternalMed
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Question:
A 73-year-old woman presents with painful oral ulcers, fever, weight loss, rash, chest pain, and polyarthritis. Laboratory tests reveal positive ANA and anti-dsDNA antibodies with low complement levels. Imaging shows pleural and pericardial effusions. What is the most likely diagnosis?
🆔 @InternalMed
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👇
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Eli Lilly just released Phase 3 data for retatrutide, their next-generation obesity drug. 2,339 patients. 80 weeks. The biggest trial in the field.
8 things worth knowing:
1️⃣ It beats every obesity drug on the market. Wegovy (semaglutide): 15% Zepbound (tirzepatide): 22% Retatrutide: 25%
2️⃣ You don’t need the highest dose. The lowest (4mg) already outperforms Wegovy. 18% weight loss with one dose increase. Fewer people quit than on the sugar pill.
3️⃣ At two years, weight was still dropping. No plateau. Patients with BMI over 35 lost 84 pounds. 30% of their body weight.
4️⃣ Some patients stopped taking it because they lost too much weight. That’s never happened with an obesity drug.
5️⃣ It works differently. Ozempic and Zepbound suppress appetite. Retatrutide does that too, but its third receptor (glucagon) flips your metabolism toward burning stored fat. In Phase 2, ketone bodies rose 2-3x, confirming the body was switching fuel sources.
6️⃣ It causes a side effect no other obesity drug does: tingling and numbness (12.5%). New receptor, new trade-off. Worth watching.
7️⃣ In a separate study, it cleared 86% of liver fat. 93% of patients reached normal levels. 1 in 3 adults have fatty liver disease. No approved drug comes close.
8️⃣ Two-thirds of patients on the highest dose were reclassified out of obesity entirely. They started at BMI 40. They finished under 30. That’s not just weight loss. That’s a medical reclassification.
US FDA filing expected late 2026.
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Supplementation with Vitamin D or calcium, or both does not help prevent fractures or falls. From a new systematic review of 69 randomized trials and >150,000 participants.
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SOUL trial post-hoc secondary analysis in JAMA Cardiology. Oral semaglutide improved HbA1c, BP, weight, inflammation & lipids early & sustained over 4 years in 9,650 high-risk T2DM patients on top of standard of care. Multiple CV risk factor benefits likely explain the 14% MACE reduction.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847041
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Sources (all DOIs clickable):
Primary source for rankings 1, 2, 4, 5, 6:
Gupta AK et al. Comparative efficacy of minoxidil and 5-alpha reductase inhibitors monotherapy for male pattern hair loss. J Cosmet Dermatol. 2025.
(Bayesian NMA, 33 RCTs, 18 interventions, SUCRA rankings)
Ranking 3 (finasteride+minoxidil combo):
Relative efficacy of minoxidil in combination with other treatments. Front Med. 2025.
(18 studies, Bayesian NMA, SUCRA 80.18% in males for combo)
Caveats:
- Dutasteride is NOT FDA-approved for hair loss (approved for BPH). Used off-label.
- Oral minoxidil for hair loss is off-label. Cardiac monitoring recommended at 5mg.
- Sublingual minoxidil availability is limited. Route is still emerging.
- SUCRA rankings reflect probability of being best, not absolute efficacy difference.
- Side effects not ranked here. Dutasteride has longer half-life (sexual side effects may persist longer if they occur).
- Women excluded from these rankings (different treatment hierarchy).
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2025 meta-analysis of 33 RCTs finally ranked every hair loss treatment. Dutasteride crushed finasteride with a 96.3% probability of being #1.
6 treatments ranked by hair density at 24 weeks:
1. Oral dutasteride 0.5mg
SUCRA 96.3% for total hair density. Significantly more effective than every other monotherapy except sublingual minoxidil. It blocks both types of the enzyme finasteride only partially inhibits.
2. Oral minoxidil 5mg
SUCRA 93.2% for terminal hair density. The oral version of the topical most men already use. Growing evidence, off-label but increasingly prescribed.
3. Finasteride + minoxidil combo
SUCRA 80.2% in males. The only combination that showed statistically significant improvement over minoxidil alone. +29.7 hairs/cm2 at 24 weeks.
4. Topical minoxidil 5%
Most effective topical monotherapy. FDA-approved. Decades of safety data. Still the baseline treatment most dermatologists start with.
5. Oral finasteride 1mg
Most prescribed FDA-approved oral treatment. Effective, but the NMA ranked it well below dutasteride and oral minoxidil for density gains.
6. Sublingual minoxidil 5mg
SUCRA 92.2% for terminal hair density. Emerging route that avoids topical mess and first-pass liver metabolism. Limited availability.
The ranking nobody expected: a $0.50/day generic (dutasteride) outperformed everything.
