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
COVID-19
Doente crítico
Endocrinologia
Gastroenterologia & Hepatologia
Geral, Geriatria & Paliativos
Imuno-mediado
Meta-investigação & MBE
Nefrologia
Neurologia
Oncologia
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
Doente crítico/urgente
Endocrinologia
Gastroenterologia
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
Imuno-mediado
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
Nefrologia
Neurologia
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
NORMAS DE ORIENTAÇÃO CLÍNICAS (GUIDELINES):
Cardiovascular
Gastroenterologia
Neurologia
RS (com ou sem ECA)
Cardiovascular
COVID-19
Doente crítico/urgente
Geral, Geriatria & Paliativos
Neurologia
PROSPECTIVOS
Cardiovascular
COVID-19
Doente crítico/urgente
Endocrinologia
Geral, Geriatria & Paliativos
Nefrologia
Neurologia
Pneumologia
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
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
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
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
Neurologia
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
POCUS
Psiquiatria
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
Pele e partes moles
Sistema nervoso central e periférico
REVISÃO NARRATIVA
COVID-19
Doente crítico/urgente
Imuno-mediado
Neurologia
Psiquiatria
ANÁLISE ECONÓMICA
Cardiovascular
Cirurgia, Ortopedia & MFR
ARTIGOS DE OPINIÃO
Cardiovascular
Doente crítico/urgente
Geral, Geriatria & Paliativos
Meta-investigação & MBE
FOAMed
COVID-19
Doente crítico/urgente
Endocrinologia
Gastroenterologia
Geral, Geriatria & Paliativos
Meta-investigação & MBE
Empirical evidence of the availability bias in emergency medicine - First10EM
POCUS
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