@rokeefemd.bsky.social
MD/MBA PennMedicine/Wharton | Hospitalist | Onc, Pall Care, MedEd | Creator Point of Care Medicine | Clinical threads and pearls
New Substack post!
IM and Hospital Medicine Recap - Clinical Reviews (October, Part 2)
The best lessons and pearls from clinical reviews featuring Chronic CAD, syphilis, lung cancer in non-smokers, non-celiac gluten sensitivity, and evaluation of jaundice!
rokeefemd.substack.com/p/im-and-ho...
Check out our new spin-off podcast, IM + Hospital Medicine Recaps.
open.spotify.com/episode/5q9...
MGUS is common - it’s present in 5% of the adult population over 50!
Learn more about this topic in the most recent Substack post!
x.com/ROKeefeMD/s...
Check out our new spin-off podcast, IM + Hospital Medicine Recaps.
Audio notes for busy internists and hospitalists, built from our favorite clinical reviews, cases, trials, and more!
open.spotify.com/show/0gBboJ...
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
I hope you've found this helpful!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls.
Read the full September Recap on Substack!
Subscribe for more monthly recap posts like this!
open.substack.com/pub/rokeefe...
Before treating, send baseline labs and check for interactions
When treatment is complete, check HCV RNA quant 12 weeks after the last dose to document sustained virologic response which means there is a cure
There is no post-exposure prophylaxis for HCV
Genotyping is no longer routinely required for treatment naive patient
For most treatment-naïve adults without decompensated cirrhosis, two regimens cover nearly everyone:
glecaprevir/pibrentasvir for eight weeks (extend to 12 weeks in compensated cirrhosis)
sofosbuvir/velpatasvir for 12 weeks.
If you consistently reflex-confirm viremia, stage fibrosis noninvasively, pick a pan-genotypic DAA with interactions in mind, and ensure SVR12 (sustained virologic response at 12 weeks) plus cirrhosis-appropriate surveillance, you’ll cure the vast majority of your patients and prevent complications.
30.10.2025 20:58 — 👍 0 🔁 0 💬 1 📌 0Goal is to find it, confirm active viremia, stage liver disease, treat with pan-genotypic direct-acting antiviral (DAA), and keep people from getting reinfected
30.10.2025 20:58 — 👍 0 🔁 0 💬 1 📌 0FDA recently approved a point-of-care hepatitis C RNA finger-stick test that gets results within an hour.
Future treatments may include long-acting injectables to bypass issues of adherence and follow up. True elimination will likely require a vaccine.
New models bring care to these patients rather than expecting them to come to the clinic. Examples including treating patients at opioid treatment programs.
30.10.2025 20:58 — 👍 0 🔁 0 💬 1 📌 0Those with HepC are those least likely to engage meaningfully with the outpatient healthcare system and include those who are homeless, incarcerated, or who use injection drugs.
30.10.2025 20:58 — 👍 0 🔁 0 💬 1 📌 0While we have a cure, we are far from elimination. Rates of new infections are actually increasing due to the opioid epidemic. 2.4-4 million people in the US are estimated to be living with HepC. Only 1 in 3 of those diagnosed have actually been cured.
30.10.2025 20:58 — 👍 0 🔁 0 💬 1 📌 0Treatments are now pan-genotypic, all oral regimens like Mayvret (8 weeks), or Epclusa (12 weeks).
30.10.2025 20:58 — 👍 0 🔁 0 💬 1 📌 0In 2013, sobosbuvir, a direct-acting antiviral (DAA) was approved. These oral medications were well tolerated and achieved cure rates in 95% of cases.
DAA medications prevent cirrhosis, cancer, and improve all-case mortality.
In the late 1980’s, interferon monotherapy was standard of care and it was grueling for patients.
By 2011, standard management was a year long course of pegylated interferon and ribavirin - this course has debilitating side effects and only 50% chance of cure. Many patients were never even treated.
In the 1970’s hepatitis C was just known as “non-A, non-B” hepatitis.
In 1989, the Hepatitis C virus was identified via molecular cloning.
This meant it could be screened for in the blood supply - this essentially eliminated post-transfusion hepatitis in the U.S by the early 1990’s.
⚕️September IM and Hospitalist Recap!⚕️
Hepatitis C: Are We There Yet? (UCSF Grand Rounds)
Such a fascinating history - we've come a long way, and yet there is so much to be done!
My favorite lessons below.
www.youtube.com/watch?v=XrJ...
I hope you've found this helpful!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls for this topic and many more!
Thread Source:
thecurbsiders.com/curbsiders-...
Check out the @pointofcaremed page to learn more about ADHF and inpatient diuresis!
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
STEP-HFpEF trial demonstrated that Glucagon-like peptide-1 (GLP-1) receptor agonists significantly improve symptoms, physical function, and weight in patients with obesity-related HFpEF
29.10.2025 21:00 — 👍 0 🔁 0 💬 1 📌 0
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) - Entresto - also have a class 2b recommendation, having missed the primary endpoint in the PARAGON-HF trial, episode suggests it may be considered, particularly for patients with lower-range ejection fractions or persistent hypertension.
29.10.2025 21:00 — 👍 0 🔁 0 💬 1 📌 0
Mineralocorticoid Receptor Antagonists (MRAs) like spironolactone hold a class 2b recommendation; TOPCAT trial was neutral but subgroup analyses of patients from the Americas showed a benefit in reducing hospitalizations; the Jury is still out though
29.10.2025 21:00 — 👍 0 🔁 0 💬 1 📌 0
Sodium-glucose cotransporter-2 (SGLT2) inhibitors were the first drug class to meet primary endpoints in RCTs, reducing the composite of cardiovascular death and heart failure hospitalizations. (EMPEROR-Preserved Trial)
29.10.2025 21:00 — 👍 0 🔁 0 💬 1 📌 0The cornerstone of management of HFpEF involves addressing the comorbidities that are associated with it, including HTN, AFib, CKD, obesity, and sleep apnea.
I've started to see more HFpEF patients on "GDMT" medications
An average E/e′ ≥ 14–15 at rest is generally considered abnormal and supports elevated LV filling pressure; an average ≤ 8 suggests normal pressure; and 9–14 is a gray zone that needs additional data.
29.10.2025 21:00 — 👍 0 🔁 0 💬 1 📌 0Because E rises with higher left atrial (LA) pressure while e′ falls with impaired relaxation, a higher E/e′ implies higher LV filling pressures, the hemodynamic signature of HFpEF.
29.10.2025 21:00 — 👍 0 🔁 0 💬 1 📌 0
