Internal medicine

🚨 Beta Blockers After Heart Attack? New Evidence Says Think Again. For decades, beta blockers have been prescribed almost automatically to people recovering from a heart attack — a practice once thought to be life-saving. But a landmark clinical trial is now challenging that long-standing belief. The REBOOT trial, conducted across Spain and Italy and published in the New England Journal of Medicine, followed more than 8,500 heart attack survivors with normal heart function. Half received beta blockers, half did not. After nearly four years of follow-up, researchers found no difference between the groups in overall survival, repeat heart attacks, or hospitalizations for heart failure. Even more striking, the data hinted at a troubling pattern among female patients — those with normal heart function who took beta blockers actually faced worse outcomes, including higher rates of death and repeat heart attacks. Experts believe the findings reflect how cardiology has evolved: decades ago, beta blockers were crucial when treatments were limited. Today, with advanced stents, statins, and targeted therapies, their benefit for patients with preserved heart function may have vanished — or even turned harmful for some. This is the largest study of its kind, and it may reshape global post-heart-attack treatment guidelines. For patients and doctors alike, it’s a reminder that even well-established medical habits must evolve as evidence does. Source: “Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction,” New England Journal of Medicine, August 29, 2025.

A 2-year-old girl in China tragically passed away after being born with a rare condition called fetus in fetu, where a fetus was found inside her skull. This condition, which affects approximately 1 in 500,000 births, led to severe head swelling and developmental delays in the child. Despite undergoing neurosurgery to address the issue, the girl succumbed to her condition within two weeks due to extensive brain damage. Only 18 similar cases have been documented worldwide,

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2025 Harrison’s Principles of Internal Medicine, 22th Edition فایل #اصلی ویرایش جدید 2025 کتاب اصول طب داخلی هریسون ، مطرح ترین منبع طب داخلی. #Internal_Medicine #Harrison @khu_medical

Ankylosing spondylitis (AS) is a type of chronic inflammatory arthritis that primarily affects the spine, though it can also impact other joints and organs. It is a form of spondyloarthritis, a group of rheumatic diseases that cause inflammation in the joints and ligaments. Here are some key points about AS: ### Symptoms - Back Pain and Stiffness: The hallmark symptom is chronic pain and stiffness in the lower back and hips, especially in the morning or after periods of inactivity. - Reduced Flexibility: Over time, the spine may become less flexible, leading to a hunched-forward posture. - Peripheral Joint Pain: Pain and swelling can occur in other joints, such as the shoulders, knees, or ankles. - Enthesitis: Inflammation where ligaments and tendons attach to bones, commonly affecting the heels or the bottom of the feet. - Fatigue: Many people with AS experience significant fatigue. - Extra-articular Manifestations: AS can affect other organs, such as the eyes (uveitis), heart, lungs, and gastrointestinal tract. ### Causes - Genetics: The HLA-B27 gene is strongly associated with AS, though not everyone with the gene develops the condition. - Immune System Dysregulation: AS is an autoimmune disease where the immune system mistakenly attacks healthy tissues. - Environmental Factors: Infections or other environmental triggers may play a role in triggering the disease in genetically predisposed individuals. ### Diagnosis - Clinical Evaluation: Based on symptoms, physical examination, and family history. - Imaging: X-rays or MRIs can show changes in the spine and sacroiliac joints. - Blood Tests: HLA-B27 testing and markers of inflammation (e.g., CRP, ESR) may support the diagnosis. ### Treatment - Medications: - NSAIDs: Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) to reduce pain and inflammation. - DMARDs: Disease-modifying antirheumatic drugs (e.g., sulfasalazine) for peripheral joint involvement. - Biologics: TNF inhibitors (e.g., adalimumab, infliximab) or IL-17 inhibitors (e.g., secukinumab) for severe cases. - Physical Therapy: Exercises to improve posture, flexibility, and strength. - Lifestyle Modifications: Regular exercise, good posture, and avoiding smoking. - Surgery: In rare cases, joint replacement or spinal surgery may be needed. ### Prognosis - AS is a progressive disease, but early diagnosis and treatment can slow its progression and improve quality of life. - Complications may include spinal fusion, osteoporosis, and cardiovascular issues. If you suspect you have AS or are experiencing symptoms, consult a rheumatologist for proper evaluation and management.

Ankylosing spondylitis (Bamboo spine)

When you give methotrexate to RA patients Use these drugs with caution. Reference current 2025

Management of DMT2 ADA 2025 guidelines