Maio 22 - A Guerra pelo Trono Valvular

Devido a férias e afins, não tive tempo de elaborar como gostaria. Mas mais vale este na mão do que nenhum a voar, pelo que aqui vai.

ECA - Ensaio clínico aleatorizado | MBE - Medicina baseada na evidência | RS - Revisão Sistemática

Revisões Sistemáticas:

- Em doentes com elevado risco cardiovascular

> Ezetimibe e inibidores PCSK9 reduziram apenas eventos não-fatais (ao contrário das estatinas)

> Vacina anti-influenza reduziu consistentemente os eventos cardiovasculares (e ainda reduz numericamente a mortalidade!)

- Bloqueio neuro-muscular reduziu intensidade da cefaleia primária no SU (Nervos Grande Occipital e Esfenopalatino)

- Laparoscopia aumentou sobrevida geral! (sem aumentar sobrevida livre de doença...o que prova mais uma vez a desarticulação entre estes 2 outcomes)

ECAs:

CARDIOVASCULAR

- Dieta Mediterrânica melhor que Dieta pobre em gorduras na redução de "MACE alargado"

- TAVI não-inferior a SAVR a 1-ano...cautela, pois nos ECA que mediram outcomes a 2-3 anos a TAVI perdeu eficácia. Mais, em termos de EA a TAVI só tem a vantagem na menor hemorragia local, já que a SAVR se associa a menos pacemaker, complicações vasculares e insuficiência aórtica.

AVC

- Tenecteplase 0.4mg/kd definitivamente NÃO

- Tenecteplase 0.25mg/kg talvez! Peca por outcome muito pouco orientado para o doente...

Nefropatia IgA com Proteinúria

- Metilprednisolona oral foi eficaz na protecção renal (MAKE) aos 4 anos, com maior segurança e semelhante eficácia com menores doses

D. Dupuytren

- Adalimumab (4 injecções de 40mg a cada 3 meses) associado a melhoria da rigidez nodular (medido com durómetro)

Doente Crítico

- Traqueostomia precoce (primeiros 5 dias) sem vantagem e com mais efeitos adversos face à já habitual tardia (depois de 10 dias, caso necessário)

Diabetes / Obesidade

- Tirzepatide com inúmeras vantagens funcionais face ao semaglutide (...mas variáveis de substituição ou surrogates)

Asma

- LABA/CI mais uma vezes superior a SABA nas exacerbações agudas da asma

Entre outros, a ler (sempre ler!) abaixo.

Depois, guidelines, revisões, estudos observacionais e a sempre presente FOAMed.

Atentai!

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RS de ECA

• Cardiovascular

  • PCSK9i and ezetimibe with/without statin for cardiovascular risk reduction | The BMJ

• Cirurgia, Ortopedia & MFR

  • Topical imiquimod versus surgery for vulvar intraepithelial neoplasia | Lancet

  • Survival Among Rectal Cancer with Laparoscopic vs Open Surgery | JAMA NetOpen

• Geral, Geriatria & Paliativos

  • Peripheral Nerve Blocks for the Treatment of Primary Headache | AEM JF

• Infecciologia, Microbiologia & Antimicrobianos

  • Association of Influenza Vaccination With Cardiovascular Risk | JAMA Network Open

• Meta-investigação & MBE

  • Reporting of Patient-reported Outcomes in RCTs on alcohol use disorder | BMJ EBM

ECA

• Cardiovascular

  • Mediterranean vs low-fat diet on CVD 2nd Prevention - CORDIOPREV | The Lancet

  • TAVI vs SAVR on Total Mortality in >70y Severe Symptomatic Aortic Stenosis | JAMA

  • Balloon- vs Self-Expanding TAVI for Small Failed Bioprosthetic SAVR - LYTEN | JACC

  • Management of ACS in Rural Australia - MORACS | JAMA Cardiology

• Cirurgia, Ortopedia & MFR

  • Algorithm-care vs UC for management after pancreatic resection | Lancet

  • Robot-Assisted w/ intracorp urinary diversion vs Open Radical Cystectomy | JAMA

• COVID-19

  • Surgical mask and cardiorespiratory responses | SAGE

  • Safety of 4 dose | Lancet ID

  • Awake Prone Positioning on Endotracheal Intubation | JAMA

  • Remdesivir and three other drugs for hospitalised patients - WHO Solidarity | Lancet

• Doente crítico/urgente

  • Early vs Standard Late Tracheostomy after Severe Stroke SETPOINT2 | JAMA

• Endocrinologia

  • SC tirzepatide vs placebo or semaglutide in function/safety (phase 1) | Lancet D&E

  • Intervention Targeting Appetitive Traits on among Overweight or Obesity| JAMA NO

• Gastroenterologia & Hepatologia

  • Pickle Juice Intervention for Cirrhotic Cramps Reduction - PICCLES | AJG

  • Reloxaliase in Enteric Hyperoxaluria | NEJM Evidence

  • TIPS w/ vs wo/ gastro-oesophageal variceal embolisation | Lancet G&H

• Geral, Geriatria & Paliativos

  • US guided IA Steroid and Local anaesthetic for hip osteoarthritis (HIT trial) | The BMJ

  • Duloxetine in Chronic Pain due to Hip or Knee Osteoarthritis | A&R - JW

  • Power vs Traditional Strength Training on Physical Function in Older Adults |JAMANO

  • Abbreviations and Acronyms on Patient Comprehension | JAMA Network Open

  • Multicomponent intervention to prevent mobility disability in frailty - SPRINTT | BMJ

• Imuno-mediado

  • Elsubrutinib or upadacitinib alone vs combination (ABBV-599) in RA | Lancet Rheuma

  • Anti-TNF (adalimumab) for early-stage Dupuytren's disease (RIDD) | Lancet Rheumat

• Infecciologia, Microbiologia & Antimicrobianos

  • 8 vs 15 days of antibiotic therapy for Pseudomonas aeruginosa VAP in adults | ICM

  • Doxy vs azi for anorectal C. trachomatis in vaginal infection - CHLAZIDOXY | Lancet ID

  • Capsid Inhibition with Lenacapavir in Multidrug-Resistant HIV-1 Infection | NEJM

  • Ivermectin + diethylcarbamazine and albendazole for lymphatic filariasis | Lancet ID

• Meta-investigação & MBE

  • Machine Learning–Assisted Risk-of-Bias Assessments in Systematic Reviews | AIM

• Nefrologia

  • Oral MPDN on Kidney Function in IgA Nephropathy - TESTING | JAMA

  • Difelikefalin in Mod-Severe Pruritus from Hemodialysis | JAMA Network Open

• Neurologia

  • Tenecteplase vs alteplase for acute ischaemic stroke (NOR-TEST 2) | Lancet Neuro

  • Tenecteplase vs alteplase for acute ischaemic stroke in MSU (TASTE-A) Lancet Neuro

  • Direct Transportation to Thrombectomy vs Local Stroke Center RACECAT | JAMA

  • Ultrahigh-Dose Methylcobalamin in Early Amyotrophic Lateral Sclerosis | JAMANeuro

  • ACI-24 Vaccine in Adults With Down Syndrome | Lancet Neurology

• Pneumologia

  • Smartphone-Based Financial Incentives on Peripartum Smoking | JAMA Net Open

  • Albuterol–Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma | NEJM

  • Phosphodiesterase 4B Inhibitor for Idiopathic Pulmonary Fibrosis | NEM

NORMAS DE ORIENTAÇÃO CLÍNICAS (GUIDELINES):

• Cardiovascular

  • Acute PE: a position paper of the ESC

• Infecciologia, Microbiologia & Antimicrobianos

  • Management of Pyogenic Osteomyelitis in Adults - WikiGuidelines | JAMA Net Open

---------------------------------------------------------- OBSERVACIONAIS --------------------------------------------------

RS COM ESTUDOS OBSERVACIONAIS (com ou sem ECA)

• Doente crítico/urgente

  • Long-term Survival After Out-of-Hospital Cardiac Arrest | JAMA Cardiology

  • Airway US as Predictor of Difficult Direct Laryngoscopy | AA - JF

• Endocrinologia

• Gastroenterologia & Hepatologia

  • Worldwide prevalence of HBV and HCV among patients with cirrhosis | Lancet G&H

  • Risk Scores for Lower Gastrointestinal Bleeding | JAMA Network Open

• Meta-investigação & MBE

  • Good practice statements in Covid-19 guidelines | BMJ Evidence-Based Medicine

  • Assessing the magnitude of reporting bias in trials of homeopathy | BMJ EBM

PROSPECTIVOS

• Cardiovascular

  • HDL and Adverse Cardiovascular Outcomes in High-risk Populations | JAMA C

• Cirurgia, Ortopedia & MFR

  • Surgery vs conservative treatment for traumatic subdural haematoma | Lancet N

  • Awake vs asleep craniotomy in glioblastoma in eloquent areas - GLIOMAP | Lancet O

• COVID-19

  • Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline Findings | AIM

• Doente crítico/urgente

  • Score for Poor Neurocognitive Outcomes in Acute CM Poisoning | JAMA Net Open

• Endocrinologia

  • Long-term Metformin and Lifestyle on CVE in the DPPO study | Circulation

• Gastroenterologia & Hepatologia

  • Serrated polyp detection and interval post-colonoscopy CRC | Lancet G&H

• Geral, Geriatria & Paliativos

  • Patient and Proxy Recall Written or Oral Informed Consent | JAMA Network Open

  • Gabapentin, Pain Control and Feeding Tube Placement in HNC with CRT | JAMA NetO

• Hematologia

  • Ruxolitinib vs best therapy in refractory PV (after HXU) wo/ splenomegaly | Lancet H

• Infecciologia, Microbiologia & Antimicrobianos

• Bayesian vs Frequentist Adaptive Trial Design | JAMA Network Open

• Pharmacist-Driven Intervention for Oral Antimicrobials at Discharge | JAMA NetOpen

• Household Transmission of Clostridioides difficile Infection | EID - JW

• Meta-investigação& MBE

  • Visualising harms in publications of randomised controlled trials | The BMJ

• Neurologia

  • Flying Intervention Team to Endovascular Thrombectomy | JAMA Neurology

RETROSPECTIVOS

• Cardiovascular

  • Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee | AIM

  • Low-Dose Triple AntiHT vs Usual Care With Time at Target BP | JAMA Cardiology

  • Time to Benefit of Intensive BP Lowering in > 60Y | JAMA IM

  • High-Intensity Statin Use Among Atherosclerosis in the US | JACC

  • Association between symptoms and risk of NSTEMI | BMJ Open

  • AT After Complex PCI In Patients at High Bleeding Risk from MASTER DAPT | EHJ

  • Post-hoc analysis of AUGUSTUS trial of the TIA/Stroke/TE subgroup - JAMACardiology

  • Outcomes in the ISCHEMIA Trial Based on CAD and Ischemia Severity | Circulation

  • Alcohol Septal Ablation or Septal Myectomy for Obstructive Hypertrophic CMP |JACC

• Cirurgia, Ortopedia & MFR

  • Abdominal Wall Reconstruction by Surgical Fellows vs Faculty | JAMA Network Open

  • Perioperative Outcome Among Surgeons Who Operated the Night Before | JAMA IM

  • Overdiagnosis and Overtreatment of Low-Risk PTC in the US | JAMA Network Open

  • Knee Arthroscopy from 2004 to 2019 in Ontario, Canada | NEJM Evidence

• COVID-19

  • AUD–Mortality in the US Before and During the COVID-19 Pandemic | JAMANetOpen

  • VV-ECMO in acute covid-19 associated respiratory failure | The BMJ

  • Antibody and T-Cell Responses to Omicron in Unvaccinated | JAMA Network Open

  • Trajectory of long covid symptoms after covid-19 vaccination | The BMJ

  • Protection and Waning of Natural and Hybrid Immunity to SARS-CoV-2 | NEJM

• Doente crítico/urgente

  • Patient disposition using the Emergency Severity Index | BMJ Open

  • Utility of Biomarkers for Sepsis-Associated Acute Kidney Injury Staging | JAMA NetO

• Endocrinologia

  • Weekly tirzepatide vs insulin degludec on fat (substudy SURPASS-3MRI) | Lancet D&E

  • Weekly tirzepatide vs daily insulin degludec (substudy SURPASS-3CGM) | Lancet D&E

  • Cardiovascular Outcomes in Patients Initiating First-Line Treatment of Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors vs Metformin | AIM

• Geral, Geriatria & Paliativos

  • Preferences for EoL Care Among Terminal Cancer in China | JAMA Network Open

  • Multimodal Intervention to Decreased Opioid Prescribing after surgery | JAMA OHNS

  • HPV Impact and Effectiveness Through 12Y After Vaccine in the US, 2003-2018 | AIM

• Hematologia

  • Prevalence of monoclonal gammopathies by mass spectrometry | Lancet Haemat

• Infecciologia, Microbiologia & Antimicrobianos

  • Meningococcal Vaccination Rates Among HIV in the US | JAMA Network Open

  • PC Clinician Attitudes on Treating Asymptomatic Bacteriuria | JAMA Network Open

• Meta-investigação & MBE

  • Supportive Evidence for US FDA Approvals of Novel Drugs in 2020 | JAMA Net Open

  • Medicare Spending on Drugs w/ Accelerated Approval | Annals of Internal Medicine

• Neurologia

  • Diagnostic Accuracy of MRI on Brain Atrophy in PSP and CBD | JAMA Network Open

  • Depression in Survivors of Stroke in the United States, 2004–2017 | Neurology - JW

  • Ischemic Stroke in Asymptomatic Severe Carotid Stenosis | JAMA IM

  • Prion protein monoclonal antibody (PRN100) for Creutzfeldt–Jakob disease | JAMA N

• Oncologia

  • HRQL in aRCC w/ lenvatinib + pembrolizumab/everolimus vs sunitinib | Lancet

  • QoL and Survival Outcomes in Cancer Drug Trials from 2019 | JAMA Oncology

  • 2020 NICE criteria vs MRI for NeoA RT in operated rectal cancer | Lancet Oncology

  • 5α-Reductase Inhibitors and Prostate Cancer Mortality | JAMA Oncology

  • Underrecognition of Symptoms Caused by Breast Radiation Therapy | JAMA O

• Pneumologia

  • Characterization of Eosinophilic Bronchiectasis: A European Multicohort | AJRCCM

  • Neuropsychiatric Diagnoses After Montelukast Initiation | JAMA Network Open

• Psiquiatria

  • Risk of suicide death following ECT for depression (Propensity Score W) | Lancter Psy

  • Medical Treatment for Opioid Use Disorder With Suicide Mortality | AJP - JW

CASO CLÍNICO / IMAGEM CLÍNICA

• Pele e partes moles

  • Ulcerated Plaques on the Scalp and Dorsal Hands of an Older Man

  • Recurrent ear and eye pain in an Older patient

FOAMed

• Geral, Geriatria & Paliativos

  • ACP IM 2022 Recap | The Curbsiders

• Infecciologia, Microbiologia & Antimicrobianos

  • Episode 48 – Urine the Lung | Curious Clinicians