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