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
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
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
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
COVID-19
Pulse Oximetry for Monitoring Patients with Covid-19 at Home | NEJM
Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19 | NEJM
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
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
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
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
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
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
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
Olho
Macular Cystoid Edema Induced by Nab-Paclitaxel | Acta Médica Portuguesa
Pele e partes moles
Sistema nervoso central e periférico
Sleep Recording for the Diagnosis and Treatment of Paraplegia | 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
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
FOAMed
COVID-19
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
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
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
POCUS