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

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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

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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

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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

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Can you distinguish benign eosinophilia from a sign of serious disease, and know exactly when to act at the bedside?

In this high-yield episode, test your clinical reasoning as we tackle:

• When eosinophilia becomes dangerous and why it matters
• How to distinguish if its from atopy vs. systemic disease
• Which medications to stop (and which to watch)
• How travel, diet, and exposure history shape your workup
• When to suspect malignancy before giving steroids

🔹Transcript and Shownotes: 

02:34 | Why Do We Care About Eosinophilia? (Pearl 1)

10:24 | Atopy and Eosinophilia (Pearl 2)

18:57 | Drugs and Eosinophilia (Pearl 3)

27:29 | ID and Eosinophilia (Pearl 4)

33:54 | Pearl 5: Eosinophilia, Steroids, and Neoplasms (Pearl 5)

Tags: CoreIM, Internal Medicine, Medical Education, Eosinophilia, Hypereosinophilia, Allergy Immunology, Hematology, Pulmonology, Parasitic Infections, Atopy

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Is coffee helping or harming our patients’ hearts?

In this Beyond Journal Club, we unpack the CRAVE trial and use it as a lens to answer a bigger question:

How should clinicians interpret nutrition research, especially when it feels inconsistent or hard to trust?

Listen for a concise, practical framework you can use the next time a patient asks about coffee, diet, or lifestyle.

🔹Sponsor: Oakstone CME

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

🔹 Transcript and Show notes

00:00 | Challenges of interpreting nutritional research.

02:22 | Best practices for evaluating studies in nutrition. 

12:35 | Delve into the CRAVE trial as an example of critically appraising nutritional investigations.

26:41 | Applying this to clinical practice for your patients.

Tags: IMCore, Internal Medicine, Medical Education, Epidemiology, Diet and Lifestyle

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Why can these infections be tricky? How to diagnose osteomyelitis at the bedside? Do we always need IV vs oral antibiotics? And the best for last: Simple, practical wound care strategies for medical students, residents, and clinicians who want a clear, usable approach.

.🔹Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com

🔹Transcript and Shownotes:

02:15 | Pearl 1: Pathophysiology

08:20 | Pearl 2: Diagnosis

16:35 | Pearl 3: Treatment

20:35 | Pearl 4: Antibiotics

27:39 | Pearl 5: Wound Care

Tags: CoreIM, Internal Medicine, Medical Education, Diabetic Foot Infections, Osteomyelitis, Foot Ulcer, Wound Care

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A dialysis patient with a chronic cough: is it COPD, or are they still volume overloaded?

A patient with AKI and hyperkalemia says they’re still peeing — does that rule out post-obstructive AKI?

A patient arrives in the ED with uremic symptoms and a newly created AV fistula. Can you safely use it, or do you need to place a temporary dialysis catheter?

And the classic inpatient dilemma: your heart failure patient looks better after diuresis, but the creatinine is rising. Is it time to stop, or should you keep going?

🔹Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/

See here for Neph Madness details 

See here for the POCUS region of NephMaddness

VOTE here to build your bracket!

🔹Transcript and Shownotes:

00:52 | What is NephMadness?

02:19 | Detecting post-renal obstruction in a patient who reported normal urination

11:26 | POCUS for discharge or continue diurese

17:25 | Distinguishing COPD from volume overload in a dialysis patient using lung ultrasound

23:55 | Assessing AV fistula maturity at the bedside to potentially avoid placing a temporary dialysis line

Along the way, we discuss practical ways clinicians can use renal, lung, and venous ultrasound to clarify uncertain clinical situations and make faster decisions at the bedside.

If you’ve ever paused on rounds, wondering “what should we do next?” in a patient with kidney disease, this episode explores how POCUS can help answer that question.

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, AKI Management, POCUS

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Most clinicians see dementia medications on the med rec, but many of us aren’t sure how much they actually help. In this episode we break down donepezil, memantine, and the new anti-amyloid drugs, and when to stop them.

• Do cholinesterase inhibitors really work?

• What should clinicians know about lecanemab and donanemab before referring patients?

• How much benefit should we expect and for how long?

• When should you deprescribe dementia medications?

🔹Sponsor: Caraway’s cookware set is a favorite for a reason.

For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.

🔹Transcript and Shownotes

02:27 | Deep Dive 1: How do we deliver the news of a diagnosis of dementia?

09:41 | Deep Dive 2: Prescribing medications for cognitive decline

29:30 | Deep Dive 3: Patient-centered management for a patient with cognitive decline

35:46 | Deep Dive 4: Planning for an uncertain future

Tags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistant

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