Core IM | Internal Medicine Podcast

MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?

In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.

Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.

This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.

🔹Sponsor: Oakstone CME

Use the code "CORE325" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes:  

01:57 | Understanding MASLD as a Systemic Disease 

05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease 

08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan) 

16:15 | Lifestyle Treatment & Weight Loss Targets 

19:00 | ESSENCE Trial: Semaglutide for MASH 

21:58 | MAESTRO-NASH Trial: Resmetirom 

27:27 | Future Treatments for MASH 

30:51 | Key Takeaways for Clinicians 

Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis

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What blood pressure should we target in patients on hemodialysis? Why volume control remains the foundation of treatment? How blood pressure targets differ from the general population. Learn practical pearls on medication timing around dialysis, drug dialyzability, antihypertensive selection, and strategies to prevent intradialytic complications while optimizing long-term outcomes. 

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here. 

🔹Transcript and Shownotes:  

02: 19 | Pearl 1: Blood Pressure Targets 

09: 40 | Pearl 2: Timing Medications and Dialyzability 

15: 31 | Pearl 3 - Pharmacologic Management Nuances in Dialysis Patients 

22: 57 | Putting It All Together: The Medication Hierarchy 

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, ESRD, End-Stage Kidney Disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com
* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Quince for high-quality clothes with affordable pricing and use code quince.com/coreim
* Get 15% off Branch Basics with the code COREIM at https://branchbasics.com/COREIM #branchbasicspod



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Why is fluid management the most important part of dialysis care? This episode explores the fundamentals of hemodialysis, why ESKD patients have unique physiology, and how volume overload, not just hypertension, drives many complications. Learn practical pearls on dry weight, sodium restriction, diuretics, and the strategies that can reduce hospitalizations and improve patient outcomes. 

🔹Sponsor: Oakstone CME

Use the code "CORE325" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes:  

02:49 | Pearl 1: Foundations of Dialysis

09:21 | Pearl 2: Distinct Physiology

11:42 | Pearl 3: Why is fluid management so important?

19:43 | Pearl 4: Fluid Management Pro-tips

25:31 | Pearl 5: Diuretics in Patients with Residual Kidney Function

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, Dialysis, End-stage kidney disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com
* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Quince for high-quality clothes with affordable pricing and use code quince.com/coreim
* Get 15% off Branch Basics with the code COREIM at https://branchbasics.com/COREIM #branchbasicspod



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Can AI manage post-op atrial fibrillation or does medicine still require human judgment? Using post-op AFib as a case study, we explore where algorithms help, where evidence falls short, and why clinical context still matters. When evidence is incomplete, and every patient is different, can AI truly practice medicine or only assist the clinicians who do? This episode explores the space between algorithms, uncertainty, and human judgment in modern medical care. 

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.

🔹Transcript and Shownotes:  

02:51 | Broad workup for reversible causes and other etiologies of AFib that may occur post-op

05:10 | Considerations for management of post-op atrial fibrillation

13:00 | Stroke risk in atrial fibrillation

20:49 | Outpatient management of atrial fibrillation 

25:54 | The role of AI in medical decision-making

Tags: CoreIM, Internal Medicine, Medical Education, Atrial Fibrillation, Cardiology, Open Evidence

Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com
* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Quince for high-quality clothes with affordable pricing and use code quince.com/coreim
* Get 15% off Branch Basics with the code COREIM at https://branchbasics.com/COREIM #branchbasicspod



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We start with a gripping story of seizures and use it as a jumping-off point to unpack practical pearls for in-flight emergencies. Along the way: what’s actually in the emergency medical kit, when planes divert, how ground medical support works, altitude physiology, legal protections, and how to stay calm when medicine suddenly happens at 35,000 feet. By the end, you may still sweat a little…but hopefully less than before.

🔹Sponsor: Oakstone CME

Use the code "CORE325" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes:  

04:40 | Emergency Medical Kit (EMK) Standard Contents

08:50 | Role of Ground-Based Medical Support & Flight Diversion Decision-Making

19:35 | Interpreting Hypoxia at Altitude

22:06 | In-Flight Liability

23:35 | Common Chief Concerns & Useful Additional Medications

24:53 | How to Be Resourceful in an Austere Environment

Tags: CoreIM, Internal Medicine, Medical Education, In-flight Care, Medical Emergencies, Clinical Reasoning, Seizure Management, Hypoxia, Airway Management, Cardiac Emergency, Syncope, Respiratory Distress

Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com
* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Quince for high-quality clothes with affordable pricing and use code quince.com/coreim
* Get 15% off Branch Basics with the code COREIM at https://branchbasics.com/COREIM #branchbasicspod



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