Abril 2026 - Inventário do mês

Vide também no Substack

Versão esquemática de Mariana Barosa:

What multimorbidity shows us about guideline-driven evidence based medicine ou Sensible Medicine

TABELA DE CONTEÚDOS:

1. META-REVISÃO

2. REVISÕES SISTEMÁTICAS DE ENSAIOS CONTROLADOS E ALEATORIZADOS (ECAs)

3. ENSAIOS CONTROLADOS E ALEATORIZADOS (ECAs)

4. NORMAS DE ORIENTAÇÃO CLÍNICA

5. OBSERVACIONAIS

   1. Revisões Sistemáticas

   2. Primários

   3. Casos clínicos e séries

6. OPINIÃO

   1. Revisões narrativas

   2. Perspectiva

   3. Notícias

7. FOAMed

Glossário:

✔ ✔ ✔ --> Muito relevante e reforça ou pode mudar a prática

? ? ? --> Muito relevante mas dúvidas

✗ ✗ ✗ --> Não eficaz mas muito relevante (contraria hipóteses e práticas ; valor didáctico ; etc.)

c --> Relevante e a favor da prática

? --> Relevante mas dúvidas

✗ --> Não eficaz mas relevante (contraria hipóteses e práticas ; valor didáctico ; etc.)

(sem símbolo) --> Pouco relevante (eventualmente interessante)

(sem símbolo) --> Não eficaz e pouco relevante (eventualmente interessante)

classificação pessoal, nem todos concordarão

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REVISÕES SISTEMÁTICAS de ECAs

tabela de conteúdos ↟

Cardiovascular

✔ ✔ ✔ Systemic Embolic Events in Atrial Fibrillation: An Individual Patient Data Meta-analysis | Circulation

✗ ✗ ✗ Fluid restriction in patients with heart failure: a systematic review | Heart

Gastroenterologia & Hepatologia

✔ ✔ ✔ Indocyanine green fluorescence angiography, anastomotic perfusion assessment, colorectal surgery|LancetG&H

Oncologia

✔ First-Line Chemotherapy for Unresectable Locally Advanced or Metastatic Biliary Tract Cancer | JAMA Network Open

Pneumologia

✔ ✔ ✔ Non-invasive respiratory and criteria for intubation in RCTs of acute hypoxaemic resp. failure | Lancet RespMed

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ENSAIOS CONTROLADOS E ALEATORIZADOS

tabela de conteúdos ↟

Cardiovascular

✔ ✔ ✔ Deferral of PCI in patients undergoing transcatheter aortic valve implantation - PRO-TAVI | Lancet

✔ ✔ ✔ Randomized, Placebo-Controlled Trial of Chronic Total Occlusion PCI in Stable Angina - ORBITA CTO | JACC

✔ ✔ ✔ Sirolimus-Coated Balloon Angioplasty for Infrainguinal Artery Disease - SirPAD | NEJM

✔ ✔ ✔ Ultrasound-guided vs conventional venous puncture for atrial fibrillation ablation - ULYSSES | EHJ

✔ ✔ ✔ Discontinuation of Beta-Blocker Therapy after Myocardial Infarction - SMART-DECISION | NEJM

✔ ? ✗ Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease - Ez-PAVE | NEJM

✔ ? ✔ Asundexian for Secondary Stroke Prevention – OCEANIC-STROKE | NEJM

✗ ✗ ✗ Left Ventricular Unloading in High-Risk Percutaneous Coronary Intervention - CHIP-BCIS3 | NEJM

✗ ✗ ✗ Encerramento do apêndice auricular

• Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation – CLOSURE-AF | NEJM

• Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation – CHAMPION-AF | NEJM

✔ ICP guiada por ecografia em ICP de "altíssimo-risco"

• IVUS or Angiography Guidance for PCI in Complex Coronary Bifurcation Lesions - DKCRUSH VIII | JACC

✗ ICP guiado por ecografia em ICP de alto-risco

• IVUS-Guided versus Angiography-Guided PCI in Unprotected Left Main Coronary Disease - OPTIMAL | NEJM

• Intravascular Ultrasound–Guided or Angiography-Guided Complex High-Risk ICP – IVUS-CHIP | NEJM

Cirurgia, Ortopedia & MFR

✔ ✔ ✔ Transanal total mesorectal excision vs laparoscopic for mid and low rectal cancer - COLOR III | Lancet Gastro&H

Doente crítico/urgente

✗ ? ✗ Restrictive vs Liberal Physical Restraint Strategies in Critically Ill Patients – R2D2-ICU | JAMA

? ✔ ? Transesophageal Echocardiography During CPR in OHCA – EXECT-CPR | JAMA IM

✗ ✔ ✗ Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism - HI-PEITHO | NEJM

✗ ✔ ✗ Catheter-Directed vs Peripheral Lysis for PE - STRATIFY | Cardiovasc Research

✗ ✔ ✗ Mechanical Thrombectomy vs Anticoagulation Alone for Intermediate-High Risk PE - STORM-PE | Circulation

✔ Efficacy of Ultrasound-Guided PENG Block for Acute Pain Relief in Adult Hip Fracture Patients| Acad Emerg Med

Geral, Geriatria & Paliativos

✔ Palliative Care Intervention for Patients With End-Stage Liver Disease – PAL LIVER | JAMA Internal Medicine

✔ Deprescribing Intervention and Reduction of Proton Pump Inhibitor Use in Primary Care | JAMA Internal Medicine

? ✔ ? POCT by acute community nurses in home assessment of elderly w/ potential acute respiratory conditions | Lancet HL

Imuno-mediadas

✔ ✔ ✔ A Phase 3 Trial of Brepocitinib in Dermatomyositis - VALOR | NEJM

✔ Treat-to-target vs symptom-driven management of gout – GO TEST Overture | Lancet Rheumatology

Infecciologia, Microbiologia & Antimicrobianos

✔ ✔ ✔ Dengue Suppression by Male Wolbachia-Infected Mosquitoes | NEJM

✔ ✔ ✔ Using Probability of Community-Acquired Pneumonia to Tailor Antimicrobials Among Inpatients | CID

? ✔ ? FAST Antimicrobial Susceptibility Testing for Gram-Negative Bacteremia - FAST | JAMA

? ✔ ? Polymyxin B haemoadsorption in endotoxic septic shock – Tigris | Lancet Respiratory Medicine

✗ ✗ ✗ Oral Nirmatrelvir–Ritonavir for Covid-19 in Higher-Risk Outpatients – PANORAMIC & CanTreatCOVID | NEJM

Neurologia

✔ ✔ ✔ Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage - TRIDENT | NEJM

Early vs Delayed Extubation After Thrombectomy for Acute Ischemic Stroke - EDESTROKE | JAMA Neurology

Oncologia

✔ ✔ ✔ Pembrolizumab plus paclitaxel in platinum-resistant recurrent ovarian cancer - ENGOT-ov65/KEYNOTE-B96 | Lancet

✔ ✔ ✔ Overall survival w/ relacorilant + nab-paclitaxel in patients with platinum-resistant ovarian cancer - ROSELLA|Lancet

? ✔ ? Timing of Pegfilgrastim Administration and Pegfilgrastim-Induced Bone Pain | Ann Intern Med

Pneumologia

✔ Proximal Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in the OSPREY Study | AIM

Rilzabrutinib for patients with moderate-to-severe asthma with uncontrolled symptoms | Lancet Respir Med

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NORMAS DE ORIENTAÇÃO CLÍNICAS - GUIDELINES

tabela de conteúdos ↟

Gastroenterologia & Hepatologia

AGA Clinical Practice Update on Inpatient Management of Adults With Inflammatory Bowel Disease: Expert Review | Gastroenterology

Neurologia

2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: AHA/ASA | Stroke

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ESTUDOS OBSERVACIONAIS

REVISÕES SISTEMÁTICAS COM ESTUDOS OBSERVACIONAIS (com ou sem ECA)

tabela de conteúdos ↟

Doente crítico/urgente

✔ ✔ ✔ Incidence of Adverse Events in Peripheral Intravenous Vasopressor Use | JAMA Network Open

Infecciologia, Microbiologia & Antimicrobianos

✔ ✔ ✔ Methicillin-Resistant Staph Aureus Nasal Swab Utilization as a Predictor for Skin & Soft Tissue Infections | OFID

✔GastricAspirate Isolate Demonstrates Strain-Level Concordance with Sputum Isolate in NMTbPulmonaryDisease|OFID

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PRIMÁRIOS - SUB-ANÁLISE / COORTE / CASO-CONTROLO / INQUÉRITOS / A. ECONÓMICAS

tabela de conteúdos ↟

Cardiovascular

✔ ✔ ✔ Aspirin vs clopidogrel for chronic maintenance monotherapy after PCI: 10-year follow-up of HOST-EXAM| Lancet

✗ ✔ ✗ Invasive vs Conservative Strategy for Frail Older Patients With Myocardial Infarction | JAMA Network Open

? Six-Month Outcomes of a Trial of Potassium Supplementation Thresholds After Cardiac Surgery | JAMA

✗ Hypertension With High-Risk Features in Cryptogenic Stroke | JAMA Neurology

Diagnóstico e Raciocínio Clínico

✔ 18F-FDG-PET/CT leads to improved source control of extra-cardiac complications in infective endocarditis | OFID

Endocrinologia

✔ ✔ ✔ Discontinuation of Levothyroxine in Adults Aged 60 Years or Older | JAMA

Geral, Geriatria & Paliativos

✔ Patient Characteristics & Outcomes of Pyelonephritis Treated in Mayo Clinic's Hospital-at-Home Program | OFID

Infecciologia, Microbiologia & Antimicrobianos

✔ ✔ ✔ Early Antifungal Activity of Rezafungin for Shorter Treatment Duration for Candidemia | OFID

✔ Bridging the Gap: Optimizing OPAT Transitions to Skilled Nursing Facilities | OFID

✔ Low yield of blood cultures after end-of-therapy of an episode of infective endocarditis | OFID

Meta-investigação & MBE

✗ ✗ ✗ Retracted RCTs From Superretractors and Top-Cited Scientists w/ Multiple Retractions | JAMA Network Open

Psiquiatria

✔ Clozapine rechallenge after neutropenia: a retrospective cohort study in the UK

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CASOS CLÍNICOS e SÉRIES DE CASOS

tabela de conteúdos ↟

Endocrinologia

Severe Symptomatic Hypercalcemia Caused by Antibiotic Bead Placement | AIM 

Imuno-mediadas

When Sarcoidosis Looks Like Myeloma: A Diagnostic Pitfall | AIM

Common Variable Immunodeficiency Presenting With Bilateral Optic Nerve Edema: Case Report | AIM   

Infecciologia, Microbiologia & Antimicrobianos

Chronic Q Fever Masquerading as Granulomatous Disease: A Diagnostic Challenge | AIM

Atypical Skull Base Osteomyelitis From Streptococcus parasanguinis | AIM

Neurologia

A Case of Dacrystic Seizure in a 72-Year-Old Man | AIM

Oncologia

Persistent Nasal Cellulitis Revealing Extranodal Natural Killer/T-cell Lymphoma | AIM

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OPINIÃO

REVISÃO NÃO-SISTEMÁTICA / NARRATIVA

tabela de conteúdos ↟

Geral, Geriatria & Paliativos

✔ ✔ ✔ Things We Do for No Reason™: Prescribing gabapentinoids for pain | Journal of Hospital Medicine

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PERSPECTIVA

tabela de conteúdos ↟

Meta-investigação & MBE

✔ ✔ ✔ FDA approval of benzgalantamine - flaws in the 505(b)(2) pathway for innovations on existing drugs | BMJ EBM

✔ ✔ ✔ Identifying prior evidence for new trials (REVEAL): guidance for clinical researchers | BMJ

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NOTÍCIAS

tabela de conteúdos ↟

Endocrinologia

FDA Approves Weekly Basal Insulin for Adults With Type 2 Diabetes | JAMA

FDA Approves GLP-1 Obesity Pill Without Food or Water Restrictions | JAMA

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✔✔✔ FOAMed

tabela de conteúdos ↟

Cardiovascular

Orthostasis Part 1: Gray Matters + Orthostatic Hypotension Part 2: Gray Matters Segment | CoreIM

O Maior Efeito Mandela da Cardiologia | MBE Descomplicada

S1Q3T3: a especificidade de 97% que não muda quase nada | MBE Descomplicada

The Problem of Incidental Coronary Artery Calcium on a CT Scan | Sensible Medicine

Doente crítico/urgente

Dynamic left ventricular outflow tract obstruction | First10EM

Endocrinologia

Proactive vs Reactive DDAVP: The Clamp Finally Faces an RCT | PBF

Saline Doesn’t Ruin Hyponatremia Labs (It Might Help) | PBF

Gastroenterologia & Hepatologia

Geral, Geriatria & Paliativos

#505 Demystifying Dizziness with Dr. David Hale | Curbsiders

Meta-investigação & MBE

Técnicos em Medicina ou Cientistas da Profissão Médica? | MBE Descomplicada

Incentives and Noninferiority Designs | Sensible Medicine

What Makes a Good Journal? | Sensible Medicine

Guidelines, Evidence-based Medicine, and the Practice of Medicine | Sensible Medicine

EMU articles of the year 2026

Nefrologia

2025 IgAN KDIGO guidelines: fresh out of press, already aging gracefully | NephJC

Neurologia

Hypertension With High-Risk Features in Cryptogenic Stroke | JAMA Neurology

Oncologia

Fit to quit? The trial evidence for smoking cessation interventions in ED | St. Emlyn´s

Psiquiatria

Mirtazipine for methamphetamine? (McKetin 2026) | First10EM

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