Abril 22 - Em Abril, evidência a mil

Pois é, em Abril, evidência a mil. Este mês fomos brindados com um infindável número de ECA e revisões sistemáticos de ECA.

Sem tempo este mês para uma análise mais profunda, deixo abaixo a lista habitual.

Nas RS:

- Destaco a difícil discussão em torno das estatinas e da teoria lipídica (ou seja, será a magnitude de redução de colesterol relevante para os outcomes clínicos?)

Nos ECA:

- Destaco o número sem fim de ECA na Cardiologia, muito em parte graças ao congresso americano da ACC. Se querem um analista sério e que perceba algo disto (não eu, portanto), aconselho espreitar/escutar o semanal This week in cardiology. Já eu, aconselho principalmente espreitar com olhos de ler os SODIUM-HF, RAFT-AF e PACIFIC-AF

- Na Neurologia, o relevante ECA da Trombectomia em AVCs de área isquémica volumosa (ou seja, ASPECTS 3-5), com boas notícias mas exigente de cautela na iatrogenia

- Na Endocrinologia/Cardiologia, o ECA que comparou jejum intermitente e restrição calórica com restrição calórica apenas (por mais defeitos que tenham, já são 2 ECA na restrição calórica negativos...)

- Na Pneumologia parece que temos o 1º fármaco com aplicação na tosse crónica, o Gefaxipant (inibidor P2X3, seja lá o que isso seja)

- Na Infecciologia, o muito relevante ECA do 1º carbapenem oral, o Tebipenem. Fico dividido, pois se já se fazem tantos carbapanemes endovenosos sem necessidade, quanto mais se farão havendo opção oral.

- Na Imuno-mediada, cada vez mais convicção que Tacrolimus PO é melhor que Ciclofosfamida IV na Nefrite Lúpica (sim, calma, foi ECA de não-inferioridade...ainda assim!)

Tudo e isto, e muito mais.

É ler, e crer.

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

RS de ECA

• Cardiovascular

• LDL Reduction and Relative and Absolute Effects of Statin Treatment | JAMA IM

• COVID-19

• Fluvoxamine for Outpatient to Prevent Hospitalization | JAMA Network Open

• Doente crítico

• IV Vitamin C in Critically Ill Patients | CCM - JournalFeed

• Endocrinologia

• Motivational Interviewing in Managing Overweight and Obesity | AIM

• GLP1a and Gallbladder and Biliary Diseases | JAMA Internal Medicine

• Gastroenterologia & Hepatologia

• Aldafermin in NASH (ALPINE 2/3) - Neutral | Lancet Gastroenterology & Hepatology

• Geral, Geriatria & Paliativos

• Psychological interventions for chronic, non-specific low back pain | The BMJ - JW

• Efficacy and safety of Osteopathic manipulative treatment | BMJ Open

• Imuno-mediado

• bDMARDs on quality of life in patients with psoriatic arthritis | BMJ Open

• Meta-investigação & MBE

• Quality of reporting among SR from ESC/ACC guidelines on VA and SCD | BMJ EBM

• Nefrologia

• Evaluation of RCTs in the haemodialysis population | BMJ Open

• Plasma exchange (PLEX) in ANCA-associated vasculitis | BMJ

• Neurologia

• IV thrombolytic treatment and EVT for ischaemic wake‐up stroke | Cochrane

• Oncologia

• Association of Immune Checkpoint Inhibitors With Neurologic AEs| JAMA Net Open

ECA

• Cardiovascular

• Long-term efficacy and safety of Renal denervation (SPYRAL HTN-ON MED) | Lancet

• Treatment for Mild Chronic Hypertension during Pregnancy | NEJM

• Text-Based Gamification to Improve Physical Activity | JAMA Cardiology

• Alirocumab plus High-Intensity Statin on non-culprit Atheroma after AMI | JAMA

• Diltiazem to improve coronary vasomotor dysfunction in ANOCA | JACC

• Home-based Exercise Intervention vs Usual Care on PAD (MOSAIC) | JAMA

• Reduction of dietary sodium to <100 mmol (<1.5g) in HF (SODIUM-HF) | Lancet

• Influenza Vaccine to Prevent Adverse Vascular Events (IVVE) | ACC

• Safety of the oral XIa inhibitor asundexian vs apixaban in AF (PACIFIC-AF) | Lancet

• Ablation-Based Rhythm-Control vs Rate-Control in HF and AF (RAFT-AF) | Circulation

• Ventricular Tachycardia Ablation in patients with ICD (PARTITA) | Circulation

• Edoxaban vs DAT after TAVR: The ADAPT-TAVR | Circulation

• Left Atrial Appendage Occlusion,2 RCT: SWISS-APERO & AmuletIDE | JW - Circulation

• Cirurgia, Ortopedia & MFR

• Aggressive intraOP warming during non-cardiac surgery (PROTECT) | Lancet

• Tranexamic Acid in Patients Undergoing Noncardiac Surgery | NEJM - JW

• Exercise to prevent shoulder problems after breast cancer surgery (PROSPER) | NIHR

• 3 Different Minimally Invasive Surgeries for Lumbar Spinal Stenosis | JAMA NetO

• Bariatric Surgery on Risk of Complications After Total Knee Arthroplasty | JAMA NO

• Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture | NEJM

• Sinus Surgery for Nasal Polyps

• COVID-19

• Pulse Oximetry for Monitoring Patients with Covid-19 at Home | NEJM

• Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19 | NEJM

• Gimsilumab (a-GM-CSF) for COVID-19 Pneumonia | AJR and CCM

• Ruxolitinib for hospitalized COVID-19 (RUXCOVID) | Lancet Rheumatology

• Doente crítico/urgente

• Blood vs Saline in trauma-related haemorrhagic shock (RePHILL) - Lancet Haemat

• Scalpel-Finger-Cannula vs Scalpel-Finger-Bougie Front-of-Neck Access | A&A - JFeed

• Endocrinologia

• Calorie Restriction with or without Time-Restricted Eating in Weight Loss | NEJM

• Sleep Restriction on Energy Intake, Expenditure, and Visceral Obesity | JACC

• Gastroenterologia

• 12M antiTNF vs surgery + 4M antiTNF in perianal fistulas in CD (PISA-II) | Lancet G&H

• Geral, Geriatria & Paliativos

• Deprescribing Education vs Usual Care in PC for Cognitive Impairment | JAMA IM

• Communication-Priming Intervention on Documented GoC | JAMA Network Open

• Efficiency of EHR Assessment of PRO After Cancer Immunotherapy | JAMA Net Open

• Effect of Patient-Directed Messaging on Colorectal Cancer Screening | JAMA NetO

• IM vs IA Glucocorticoid Injection Among Knee Osteoarthritis | JAMA Network Open

• Empowerment-Based Self-care Education in Heart Failure | JAMA Network Open

• Plasma/Blood Donations on serum PFASs in Firefighters in Australia | JAMA NetOpen

• Exercise and Education for Knee Osteoarthritis — An Unusual Randomized Trial

• Hematologia

• Rilzabrutinib, an Oral BTK Inhibitor, in Immune Thrombocytopenia | NEJM

• Mitapivat versus Placebo for Pyruvate Kinase Deficiency | NEJM

• Ivosidenib and Azacitidine in IDH1-Mutated Acute Myeloid Leukemia | NEJM

• Imuno-mediado

• Two Phase 3 Trials of Baricitinib for Alopecia Areata | NEJM

• Tacrolimus vs IV Cyclophosphamide in Lupus Nephritis response - NIT | JAMA NO

• Infecciologia, Microbiologia & Antimicrobianos

• Tebipenem Pivoxil Hydrobromide (Oral Carbapenem) in Complicated UTI | NEJM

• Antimicrobial Prophylaxis After Clean Orthopedic Surgery | JAMA Network Open

• Multifaceted intervention to reduce HD catheter related BSI (REDUCCTION) |BMJ

• Gram Stain–Guided Initial Antibiotic Therapy in VAP (GRACE-VAP) | JAMA Net Open

• Tafenoquine plus DH-P to reduce P. falciparum transmission | Lancet Microbe

• Higher-Dose Primaquine to Prevent Relapse of Plasmodium vivax Malaria | NEJM

• Meta-investigação & MBE

• Supported Self-management in gout (GoutSMART) l Lancet Rheumatology

• Web-Based Management Guide on Risk Factors in T2D and DKD | JAMA NO

• Influence of statistical significance and spin on readers' interpretation | BMJ Open

• Nefrologia

• Daprodustat for Anemia of CKD in Incident Dialysis Patients | JAMA IM

• Neurologia

• EVT for Acute Stroke with a Large Ischemic Region | NEJM

• Gamification With Social Incentives on Daily Steps After Stroke | JAMA Neurology

• Ravulizumab (terminal C5 inhibitor) in Generalized Myasthenia Gravis | NEJM

• Oncologia

• Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer | NEJM

• Nivolumab, nivo–ipilimumab and VEGFR-TKI for metRCC (BIONIKK) | Lancet Onco

• NA Pertuzu+trastuzumab: w/ or wo/ paclitaxel in HER2+ breast cancer | Lancet Onc

• Bevacizumab: + Paclitaxel vs + EndocrineT in adv/met ER+ breast cancer | Lancet Onc

• Pembrolizumab as adjuvant in resected IIB/C melanoma (KEYNOTE-716) | Lancet

• Abiraterone(+PDN) +- ADT/docetaxel in metast CS prostate cancer (PEACE-1) | Lancet

• Pneumologia

• HFNO alone or alternating wit NIV in ARF of immunocompromised | Lancer RM

• Tezepelumab (anti-TSL) in steroid-dependent Asthma (SOURCE) | Lancet RespM

• Astegolimab, an anti-ST2, in moderate-severe COPD (COPD-ST2OP) | Lancet RespM

• Weight Loss / Lifestyle Intervention on OSA Severity (INTERAPNEA) | JAMA NO

• Gefapixant (P2X3i) in chronic cough (COUGH-1 and COUGH-2) | The Lancet

• Psiquiatria

• Automated virtual reality therapy to treat agoraphobic (gameChange) | Lancet Psy

• Suicide Prevention Module for Adults in SUD Treatment | JAMA Network Open

NORMAS DE ORIENTAÇÃO CLÍNICAS (GUIDELINES):

• Cardiovascular

• 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

• Aspirin to Prevent Cardiovascular Disease USPSTF Statement | JAMA

• Gastroenterologia

• AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors

• Neurologia

• Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis | AAN

• Aducanumab Use in Symptomatic Alzheimer Disease Evidence in Focus | AAN

RS (com ou sem ECA)

• Cardiovascular

• Nurse-led care on CV risk factors for patients with type 2 diabetes | BMJ Open

• SGLTi in Patients With Heart Failure | Annals of Internal Medicine

• Evaluation of the Incremental Value of a CACS | JAMA Internal Medicine

• COVID-19

• Poor Humoral Response in Recipients of Solid Organ Transplant | JAMANetworkOpen

• Myopericarditis following COVID-19 non-COVID-19 vaccination | Lancet Resp Med

• Update Alert 7: Masks for Prevention of Respiratory Virus Infections | AIM

• Anticoagulants for people hospitalised with COVID‐19 | Cochrane

• Doente crítico/urgente

• How Accurate Are hs-cTn Accelerated Diagnostic Protocols? – JournalFeed

• Can You Spot a Ruptured AAA? Symptoms, Signs, CTA, and POCUS | AEM - Journal F

• Employing primary healthcare professionals in ED triage on patient flow | BMJ Open

• Geral, Geriatria & Paliativos

• How the reduction of working hours could influence health outcomes | BMJ Open

• Interventions to reduce long term opioid for chronic non-cancer pain | BMJ Open

• Extrapolation in New Drug Approvals by the US FDA | JAMA Network Open

• Neurologia

• Tenecteplase vs tPA for Acute Ischemic Stroke | JAMA Network Open

• Thrombectomy for Acute Stroke with Isolated M2 Occlusion - AN - Journal Watch

PROSPECTIVOS

• Cardiovascular

• Impact of medication management interventions | BMJ Open

• 15-mg Edoxaban in 3 Age Strata (ELDERCARE–AF prespecified) | JAMA Cardiology

• Septal Myectomy and QoL in LVOT Obstruction from HCM | Cardiology | JAMA NO

• Myocardial Fibrosis and SV by CMR in Severe AS After Valve Replacement | JAMA NO

• COVID-19

• Symptoms, duration, and risk of hospital admission in omicron (ZOE) - The Lancet

• T-cell responses 1 year after infection | Lancet Microbiology

• Protection after Covid-19 Vaccination and Previous Infection | NEJM

• Long-term Immunogenicity of BNT162b2 Vaccine in Solid Tumors | JAMA Oncology

• Doente crítico/urgente

• Epi vs norepi in cardiac arrest w/ post-resuscitation shock | ICM - JournalFeed

• Emergency Subglottic Airway Training w/ Simulation | AA - JF

• Can RV assessments improve triaging of low risk PE? | AEM - JF

• Endocrinologia

• Hospital-Wide Implementation of a SC Insulin Protocol for DKA | JAMANetworkOpen

• Progression to Diabetes in HbA1c–Defined Prediabetes in US Elderly | JAMANetOpen

• Mild Primary Hyperparathyroidism - Surgery vs Observation (10y follow-up) | AIM

• Geral, Geriatria & Paliativos

• Work ability and smoking on neck/back pain (Sweden) | BMJ Open

• Email Warning on Reducing Unauthorized Access to Health Information | JAMA NO

• Nefrologia

• Cumulative erythropoietin on bone mineral density in dialysis patients | BMJ Open

• Neurologia

• International Validation of the Canadian Syncope Risk Score | AIM

• EVT Time to Treatment and Outcomes in Basilar A. Occlusion | Circulation - JournalF

• Implanted System for Orthostatic Hypotension in Multiple-System Atrophy | NEJM

• Pneumologia

• Fine Particulate Matter Exposure From Secondhand Cannabis Smoking | JAMA NetO

RETROSPECTIVOS

• Cardiovascular

• Severe inpatient hypertension and antihypertensive treatment | JCH

• AEs w/ PD5i and Oral Organic Nitrates in Males With Ischemic Heart Disease | AIM

• TnI and severity of coronary stenosis w/ varied renal functions | BMJ Open

• Higher intensity of 72‐hour non‐invasive cardiac test referral | AEM - JournalFeed

• AI in Echocardiographic differentiation of Takotsubo from MI | JAMA Cardiology

• TET2-Driven Clonal Hematopoiesis and Response to Canakinumab | JAMA NO

• Sudden Cardiac Arrest 3M after ICD implantation (DREAM-ICD-II)| Circulation

• Postapproval Studies of CV Devices Before and After the 21st Century Cures Act

• Empagliflozin Improves Health Status at 90 Days in Acute HF | Circulation

• Efficacy and Safety of Dapagliflozin According to Frailty in HFrEF | AIM

• Ten-year trends of clinical outcomes after percutaneous coronary intervention: a Korean nationwide longitudinal cohort study | BMJ Open

• Cirurgia, Ortopedia & MFR

• 35-mm Rule to Guide Pneumothorax Management | JTACS - JournalFeed

• Challenging Traditional Paradigms in Posttraumatic PE | JAMA Surgery

• Rapidly Destructive Hip Disease Following IA Corticosteroid Injection | TJB&JS

• COVID-19

• Global, regional, and national daily/cumulative infections through Nov14 21 - Lancet

• Physical activity w/ significant protective effects from severe COVID-19 | BJSM

• Postmortem Assessment of Olfactory Tissue and Microvasculopathy | JAMA Neuro

• Effectiveness of the BNT162b2 Vaccine after Recovery from Covid-19 | NEJM

• 4 vaccines among previous SARS-CoV-2 in Brazil | Lancet Infectious Diseases

• Reinfection and hospitalisation in natural and hybrid immunity in Sweden | Lancet ID

• T-cell Reactivity to Omicron by Immunized Individuals | JAMA Network Open

• Pfizer-Biotech Uptake and Intentions Following FDA Approval | JAMA IM

• Risks of DVT, PE, and bleeding after covid-19 | The BMJ

• Doente crítico/urgente

• Safety of Electrocautery of Subungual Hematomas with Acrylic Nails | WJEM - JF

• Heart Rate and Mortality in Acute Symptomatic Pulmonary Embolism - CHEST

• US IVC More Sensitive Than Vital Sign for Moderate and Severe Hemorrhage - JEM

• Fluid Received Prior to Enrollment, Type of Admission (BASICS subanalysis) - AJRCCM

• Early norepinephrine (<3h, independent of preload) in septic shock (PSB) - AJEM

• Number of PGY w/ Patient Intubation Outcomes in the ED | JAMA Network Open

• Delays to ED patient admission and all-cause 30-day mortality - BMJ EMJ - St Emlyn's

• A new axilar ultrasound-guided (in-plane, extra-thoracic) access | ICM

• Endocrinologia

• T2D in Adults/Children Treated w/ Anticonvulsant Mood Stabilizers | JAMA NetOpen

• 5 vs 10 Units of IV Insulin for Hyperkalemia in Moderate Renal Dysfunction - JEM

• Geral, Geriatria & Paliativos

• Medical Documentation Burden Among US | JAMA Internal Medicine

• Impact of the hospitalist system on inpatient mortality and length of stay | BMJ

• Traditional Advance Directives Undermine Advance Care Planning | JAMA IM

• CT screening with lung cancer stage shift and survival in the United States | The BMJ

• Hematologia

• Risks for Anaphylaxis With Intravenous Iron Formulations | AIM

• AE and IV Iron Infusion With and Without prior Reactions | JAMA Network Open

• Infecciologia, Microbiologia & Antimicrobianos

• Pneumonia w/ culture-indep. metatranscriptomics in HIV+ in Uganda | Lancet Micro

• Topical Estradiol on the Vaginal Microbiota in Postmenopausal Women | JAMA NO

• Bacteremia in Subsequent Blood Cultures in a Tertiary Care Hospital | JAMANetOpen

• Ocular Complications in Candidemic Patients and Routine Eye Exams | OFID

• Meta-investigação & MBE

• Downstream activities after laboratory testing in primary care | BMJ Open

• Dermatopathologist Perceptions of Overdiagnosis and Diagnostic Behaviors | JAMA

• Neurologia

• DAT for Secondary Prevention in US Patients With AIS | JAMA Neurology

• Potentially Modifiable Dementia Risk Factors in the US | JAMA Neurology

• Alzheimer Disease and Related Dementia in RA Treated With TDMA | JAMA Neuro

• Long-term Survival After Status Epilepticus Using the ACD Score | JAMA Neurology

• Oncologia

• Global, regional, and national burden of CRC and its RF, 1990–2019 | Lancet G&H

• FP After Screening w/ Digital Breast Tomosynthesis vs Digital Mammography | JAMA

• Guideline-Concordant Surgery/Chemotherapy in Early-Stage Lung Cancer - JAMA O

• Downstream Cascade Services after Breast MR vs Mammography | JAMA Net Open

• Optimal Threshold of NLR Among Patients With Head and Neck Cancer | JAMA O

• Pneumologia

• Trends in Cigarette Smoking Among US Adults w/ MDD or SUD, 2006-19 | JAMA NO

• Association of self-reported snoring and hyperuricaemia | BMJ Open

• Treatment persistence and exacerbations in asthma w/ IC&BA | BMJ Open

• POCUS

• Not so FAST! POCUS vs CXR – A Rebuttal Letter | JTACS - JF

• DUS vs manual palpation for pulse femoral detection in cardiac arrest | Resus - JF

• Psiquiatria

• Long-term clozapine and haematological malignancies in schizophrenia | Lancet Psy

• Alcohol Drinking in Higher Education Students from Coimbra | AMP

• Use of Cognitive Enhancers by Portuguese Medical Students | AMP

CASO CLÍNICO / IMAGEM CLÍNICA

• ECG

• Wide Complex Tachycardia Gone Wrong – JournalFeed

• Apparent Atrial Dissociation and Electrical Alternans | JAMA IM

• Unusual Electrocardiographic Findings in an Elderly Patient With Syncope | JAMA IM

• An Unusual Cause of ST-Segment Elevation in Lead aVR | JAMA IM

• Acute Myocardial Infarction or Not? | JAMA Internal Medicine

• Electrocardiographic Abnormalities in Hepatocellular Carcinoma | JAMA InternalMed

• Músculo-esquelético

• An Intramedullary Enigma | JAMA

• Olho

• Macular Cystoid Edema Induced by Nab-Paclitaxel | Acta Médica Portuguesa

• Pele e partes moles

• A Woman With Painful Digital Ulcers | JAMA

• Sistema nervoso central e periférico

• Sleep Recording for the Diagnosis and Treatment of Paraplegia | JAMA Neurology

• Pulsatile Superficial Temporal Artery | JAMA Neurology

• Reversal of Idiopathic ICHypertension After Lumbar Puncture | JAMA Neurology

REVISÃO NARRATIVA

• COVID-19

• COVID-19 associated pulmonary mucormycosis | Lancet Infectious Diseases

• Doente crítico/urgente

• High risk and low prevalence diseases: Traumatic arthrotomy | AJEM -JF

• Imuno-mediado

• Angioedema: Diagnostic / Therapeutic Approach in the ED | Acta Médica Portuguesa

• Prognostic Factors and Treatment Efficacy in Spinal Cord Sarcoidosis | Neurology - JW

• Neurologia

• Recent advances in the diagnosis and management of cluster headache | BMJ

• Psiquiatria

• Pharmacological Treatment of Alcohol Withdrawal | AMP

ANÁLISE ECONÓMICA

• Cardiovascular

• Cost-effectiveness of multicomponent interventions in DM2 - INDICA | BMJ Open

• Cirurgia, Ortopedia & MFR

• Cost-effectiveness of RARP for Localized Prostate Cancer in the UK | JAMA Net Open

ARTIGOS DE OPINIÃO

• Cardiovascular

• Emergency physicians should interpret every triage ECG | AJEM - JF

• Doente crítico/urgente

• Evidence of Fabricated Data in a Vitamin C trial by Marik et al - Letter to CHEST

• Geral, Geriatria & Paliativos

• Less is more

• The Harms of Postoperative Antibiotic Prophylaxis | JAMA Internal Medicine

• Meta-investigação & MBE

• The illusion of evidence based medicine | The BMJ

• Collider Bias | JAMA

FOAMed

• COVID-19

• EPIC-HR: Some underwhelming data on Paxlovid - First10EM

• Doente crítico/urgente

• The man who purposefully paralyzed himself | Curious Clinicians

• JC: The RePHILL trial. | St Emlyn's Is saline the fluid of choice in trauma? | First10EM

• Overdiagnosis in the emergency department | First10EM

• REBEL Core Cast 79.0 - Orthostatics in Volume Loss | REBEL EM

• Cardiac output as a metaphor for flow through an urgent care setting • St Emlyn's

• Endocrinologia

• Thirsty for weight loss ideas? Water for weight loss | Tools For Practice #312

• Gastroenterologia

• PPIs should not be prescribed for upper GI bleeds (pre-endoscopy)| First10EM

• Stercoral Colitis - CoreEM

• Geral, Geriatria & Paliativos

• SGIM22 Recap (Society of General Internal Medicine) | The Curbsiders

• Meta-investigação & MBE

• Empirical evidence of the availability bias in emergency medicine - First10EM

• Glossário MBE do ISBE

• POCUS

• Ultrasound Guided Lumbar Puncture – Core EM