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Internal Medicine

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Despite extensive clinical experience, evidence of competence, and willingness to practice in underserved communities, IMGs experience multiple barriers to entry in the US, including the immigration process, the pathways available for certification and licensing, and institutional reluctance to consider non–US-trained candidates. International medical graduates applying to postgraduate training programs compare favorably with US-trained candidates in terms of clinical experience, prior formal postgraduate training, and research, but have higher application withdrawal rates and significantly lower residency and fellowship match rates, a disparity that may be exacerbated by the recent elimination of objective performance metrics, such as the US Medical Licensing Examination Step 1 score. Once legally in the US, IMGs encounter additional obstacles to board eligibility, research funding, and career progression.


https://jamanetwork.com/journals/jama/article-abstract/2821148

Oral Sebetralstat for On-Demand Treatment of Hereditary Angioedema Attacks


Population:

  • Patients with type 1 or type 2 hereditary angioedema (HAE) aged 12 years or older.

  • Total of 136 participants were enrolled, with 110 participants included in the full analysis population.

Intervention:

  • Oral administration of sebetralstat at doses of 300 mg or 600 mg.



Harsh Sura
Noor Shah
Manar  Ismail

This would be so beneficial for all the HAE patients, one of the few instances where you fall in love with how medicine is progressing. Hopefully it will be covered by insurance.

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Importance  Youth (those aged <18 years) parental death has been associated with negative health outcomes. Understanding the burden of parental death due to drug poisoning (herein, drugs) and firearms is essential for informing interventions.


Objective  To estimate the incidence of youth parental death due to drugs, firearms, and all other causes.


Design, Setting, and Participants  This cross-sectional observational study was conducted using vital registration, including all US decedents, and census data from January 1990 through December 2020. Data were analyzed from May 30, 2023, to March 28, 2024.

Exposures  Parental death due to drug poisoning or firearms.


Main Outcomes and Measures  A demographic matrix projection model was used to estimate the number and incidence of youth experiencing parental death, defined as the death of 1 or more parents, per 1000 population aged less than 18 years. Analyses evaluated parental deaths by drugs, firearms, and all other causes from 1999 through…


Harsh Sura
Nader Guma

This population-based cohort study in Denmark, examining individuals born between 1977-2018 and followed up to 40 years, found tooth agenesis associated with increased risks of several cancers before 40 years, notably neuroblastoma, nephroblastoma, hepatoblastoma, osteosarcoma, colorectal carcinomas, and bladder carcinomas, with HRs ranging from 2.19 to 7.10. The study highlights the need for further research on the clinical implications of these findings.


Congenital Tooth Agenesis and Risk of Early-Onset Cancer | Oncology | JAMA Network Open | JAMA Network

A nice summary of appetite stimulant therapies in patients with Cachexia


Mazen Kherallah
Abbas Farooqui
Desmond Boakye Tanoh
Nader Guma

Sadia Usmani
Mazen Kherallah
Nader Guma

Ayham Alagha
Seif Hayek
Sadia Usmani
Mazen Kherallah

Polypharmacy, which is defined as regular use of five or more medications, increases the risk of adverse medical outcomes.


Patients who take five or more medications can find it difficult to understand and adhere to the complicated regimens.

Risk factors for polypharmacy include having multiple medical conditions that are managed by multiple specialist or subspecialist physicians, residing in a long-term care facility, having poorly updated medical records, and using automated refill services. Inappropriate prescribing of drugs that are not discontinued after their usual effective or recommended period is known as legacy prescribing and can contribute to inappropriate polypharmacy.

According to the Choosing Wisely campaign, any prescriptions beyond a threshold of five medications should trigger a thorough review of the patient’s complete regimen, including over-the- counter medications and dietary supplements, to determine if any of the medications can be discontinued. Tools such as the Beers criteria list and the Medication

Appropriateness…

Ayham Alagha
Mazen Kherallah
Seif Hayek
Manar  Ismail

Thank you for posting, as I do not work in an outpatient setting, I am not familiar with BEERS criteria, would anyone enlighten me on it? @Everyone

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What are the indications for starting Allopurinol in patients with gout?

Nader Guma
Mazen Kherallah

Thank you for your answers.


The primary indications for pharmacologic urate-lowering therapy in gout include frequent or disabling flares, often defined as two or more annually, with the threshold for treatment potentially lower for patients experiencing severe, prolonged, or activity-interfering flares. Additionally, the presence of tophi and structural joint damage, evidenced by clinical or radiographic signs such as gouty bone erosion, polyarticular disease, and tophaceous deposits, necessitates this therapy. Furthermore, treatment should be individualized for patients at high risk of severe gout, considering factors such as high baseline serum urate levels, early onset of symptoms, genetic predisposition, medication intolerance, and ultrasound evidence of monosodium urate deposits or inflammation.

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