McMaster Textbook of Internal Medicine

19/08/2025

💡 : high-dose vitamin D (cholecalciferol) therapy in reducing disease activity in patients with clinically isolated syndrome typical for multiple sclerosis (the D-Lay MS trial).

17/04/2025

🧬 Familial Mediterranean fever (FMF) is the most common autoinflammatory syndrome. Historically, it affected populations in the Mediterranean region but now is a borderless disease due to the frequency of global migration. The underlying pathophysiology of FMF is mediated by MEFV gene mutations. Manifestation of the disease is characterized by recurrent episodes of fever and systemic inflammation, that spontaneously resolve. Our patient illustrates a case of FMF that is atypical in presentation in comparison to known literature.

🩺🧩 A 31-year-old Emirati woman presented with recurrent fever associated with a sore throat. She was initially diagnosed with tonsilitis and treated with antibiotics. Two days later, she developed epigastric abdominal pain, which became diffuse and increased in severity. It was associated with recurrent fever. The patient had a history of episodes of recurrent tonsilitis that would spontaneously resolve since her late twenties. She had no previous surgical history, personal history of arterial/venous thromboses or miscarriages.

▶️ Watch Dr Sarah Al Qassimi review the diagnosis and treatment of this patient at Best Case Report Contest 2024. ⬇️

14/04/2025

Dr Gordon Guyatt (McMaster Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact) explains how to use a network meta-analysis to compare all medications and evaluate patient-important outcomes by synthesizing high-quality evidence.

Join us in the second part of the talk to review different treatment strategies recommended for patients with diabetes, including the advantages and adverse effects of SGLT2 inhibitors and GLP-1 receptor agonists. 👇

🗨️ “We had a long time when we were treating diabetes where nothing—except for maybe ACE inhibitors in proteinuria—nothing influenced the major outcomes, the major cardiovascular outcomes or renal outcomes. So we were giving these things out to lower blood glucose without any impact on the major cardiovascular or renal events, and that’s what these results show. When we put it all together, there’s still no benefit from these things. …

The reason for lowering blood glucose is not to prevent these major events. Lowering blood glucose, as far as we can tell, does not prevent the major events. On the other hand, we do see people coming in with hyperosmolarity, very sick, they may be extremely sick, they’re at risk of dying, and that’s because they’ve got glycosuria, they get volume-depleted, and they end up in these hyperosmolar states. It may be that the glycosuria also predisposes to urinary tract infections.

So there are reasons for lowering the blood glucose and the SGLT2 inhibitors in particular are not very good. They’re about the worst we have of the things we give out in terms of lowering blood glucose. So you’re certainly not going to give these drugs out, the other drugs out for lowering for major events, but you may be thinking of giving them for lowering the blood glucose. And pick somebody, take somebody who is young, relatively young, type 2 diabetic, say, they’re 50 years old and they don’t have hypertension and they have no other risk factors, but they don’t like that they’re subject to urinary tract infections and they don’t like running to the washroom every 15 minutes because of their glycosuria. Metformin might be the right drug to start with in such individuals.”

Full video 👇

09/04/2025

💡 : reduced-dose vs full-dose direct anticoagulant (DOAC) therapy in patients requiring extended anticoagulation.

(Yes, it’s still the —new name, same content)

04/04/2025

🤔▶️ Aspirin: when to use, when to avoid, when to replace with P2Y12 inhibitors?

In the latest Dr Anthony Sandre (McMaster Faculty of Health Sciences) shares practical insights for clinicians managing patients receiving . Join us to explore:
💠 Current indications for aspirin use
💠 Key situations when aspirin should be avoided
💠 Comparison between aspirin and P2Y12 inhibitors
Full video 👇

31/03/2025

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14/03/2025

🫀 Gerbode defect is a rare form of atrioventricular septal defect that creates direct communication between the left ventricle and right atrium. While most cases are congenital, and therefore diagnosed in childhood, in some rare cases Gerbode defect has been described in adults following a cardiac surgery, infective endocarditis, or blunt chest trauma.

🩺🧩 A 48-year-old man was transported to the emergency department following a high-velocity, single-passenger traffic accident. Initial examination showed multiple long bone and rib fractures, bilateral pneumothorax, pulmonary contusions, pericardial effusion, and a complex fracture of the right acetabulum. The patient underwent emergency surgical fixation of his long bone fractures and was admitted to the intensive care unit with a plan for interval complex pelvic surgery. Despite intravenous diuretic therapy, over the following days he developed a severe acute kidney injury, markedly deranged liver function tests, and significant peripheral edema.

▶️ Watch Dr John McCormick discuss the complications and management of this patient at Best Case Report Contest 2024. ⬇️

12/03/2025

10/03/2025

💡 : GLP-1 drugs (semaglutide, liraglutide, tirzepatide) and in patients without diabetes.

(Psst! Yes, these are still our —new name, same content, but now with extra sparkle 🦋✨)

28/02/2025

🤔▶️ Are benefits of SGLT2 inhibitors limited to patients with ?

The latest features Dr Gordon Guyatt (McMaster Faculty of Health Sciences) discussing the latest evidence on SGLT2 inhibitors for renal dysfunction. Join us to learn how these medications are changing treatment approaches and benefiting high-risk patients. 👇

🗨️ “There is an evolving perspective. If you were a nephrologist, you were very unhappy for many years because there was nothing in diabetes you could do—except perhaps angiotensin-converting enzyme (ACE) inhibitors—to prevent progression of renal disease to renal failure.

Now the situation has changed. The nephrologists in general are delighted that they now have other medication that can prevent progression, and the SGLT inhibitors are perhaps the best of those.

So clearly we wanted to get the message out to people. We wanted to summarize, and we believe of course that we need systematic reviews of the highest quality evidence available to give the best summaries and our clinicians and patients deserve such summaries.”

20/02/2025

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