Maio 22 - A Guerra pelo Trono Valvular

Devido a férias e afins, não tive tempo de elaborar como gostaria. Mas mais vale este na mão do que nenhum a voar, pelo que aqui vai.
ECA - Ensaio clínico aleatorizado | MBE - Medicina baseada na evidência | RS - Revisão Sistemática
Revisões Sistemáticas:
- Em doentes com elevado risco cardiovascular
> Ezetimibe e inibidores PCSK9 reduziram apenas eventos não-fatais (ao contrário das estatinas)
> Vacina anti-influenza reduziu consistentemente os eventos cardiovasculares (e ainda reduz numericamente a mortalidade!)
- Bloqueio neuro-muscular reduziu intensidade da cefaleia primária no SU (Nervos Grande Occipital e Esfenopalatino)
- Laparoscopia aumentou sobrevida geral! (sem aumentar sobrevida livre de doença...o que prova mais uma vez a desarticulação entre estes 2 outcomes)
ECAs:
CARDIOVASCULAR
- Dieta Mediterrânica melhor que Dieta pobre em gorduras na redução de "MACE alargado"
- TAVI não-inferior a SAVR a 1-ano...cautela, pois nos ECA que mediram outcomes a 2-3 anos a TAVI perdeu eficácia. Mais, em termos de EA a TAVI só tem a vantagem na menor hemorragia local, já que a SAVR se associa a menos pacemaker, complicações vasculares e insuficiência aórtica.
AVC
- Tenecteplase 0.4mg/kd definitivamente NÃO
- Tenecteplase 0.25mg/kg talvez! Peca por outcome muito pouco orientado para o doente...
Nefropatia IgA com Proteinúria
- Metilprednisolona oral foi eficaz na protecção renal (MAKE) aos 4 anos, com maior segurança e semelhante eficácia com menores doses
D. Dupuytren
- Adalimumab (4 injecções de 40mg a cada 3 meses) associado a melhoria da rigidez nodular (medido com durómetro)
Doente Crítico
- Traqueostomia precoce (primeiros 5 dias) sem vantagem e com mais efeitos adversos face à já habitual tardia (depois de 10 dias, caso necessário)
Diabetes / Obesidade
- Tirzepatide com inúmeras vantagens funcionais face ao semaglutide (...mas variáveis de substituição ou surrogates)
Asma
- LABA/CI mais uma vezes superior a SABA nas exacerbações agudas da asma
Entre outros, a ler (sempre ler!) abaixo.
Depois, guidelines, revisões, estudos observacionais e a sempre presente FOAMed.
Atentai!
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RS de ECA
Cardiovascular
PCSK9i and ezetimibe with/without statin for cardiovascular risk reduction | The BMJ
Cirurgia, Ortopedia & MFR
Topical imiquimod versus surgery for vulvar intraepithelial neoplasia | Lancet
Survival Among Rectal Cancer with Laparoscopic vs Open Surgery | JAMA NetOpen
Geral, Geriatria & Paliativos
Peripheral Nerve Blocks for the Treatment of Primary Headache | AEM JF
Infecciologia, Microbiologia & Antimicrobianos
Association of Influenza Vaccination With Cardiovascular Risk | JAMA Network Open
Meta-investigação & MBE
Reporting of Patient-reported Outcomes in RCTs on alcohol use disorder | BMJ EBM
ECA
Cardiovascular
Mediterranean vs low-fat diet on CVD 2nd Prevention - CORDIOPREV | The Lancet
TAVI vs SAVR on Total Mortality in >70y Severe Symptomatic Aortic Stenosis | JAMA
Balloon- vs Self-Expanding TAVI for Small Failed Bioprosthetic SAVR - LYTEN | JACC
Management of ACS in Rural Australia - MORACS | JAMA Cardiology
Cirurgia, Ortopedia & MFR
Algorithm-care vs UC for management after pancreatic resection | Lancet
Robot-Assisted w/ intracorp urinary diversion vs Open Radical Cystectomy | JAMA
COVID-19
Remdesivir and three other drugs for hospitalised patients - WHO Solidarity | Lancet
Doente crítico/urgente
Early vs Standard Late Tracheostomy after Severe Stroke SETPOINT2 | JAMA
Endocrinologia
SC tirzepatide vs placebo or semaglutide in function/safety (phase 1) | Lancet D&E
Intervention Targeting Appetitive Traits on among Overweight or Obesity| JAMA NO
Gastroenterologia & Hepatologia
Pickle Juice Intervention for Cirrhotic Cramps Reduction - PICCLES | AJG
TIPS w/ vs wo/ gastro-oesophageal variceal embolisation | Lancet G&H
Geral, Geriatria & Paliativos
US guided IA Steroid and Local anaesthetic for hip osteoarthritis (HIT trial) | The BMJ
Duloxetine in Chronic Pain due to Hip or Knee Osteoarthritis | A&R - JW
Power vs Traditional Strength Training on Physical Function in Older Adults |JAMANO
Abbreviations and Acronyms on Patient Comprehension | JAMA Network Open
Multicomponent intervention to prevent mobility disability in frailty - SPRINTT | BMJ
Imuno-mediado
Elsubrutinib or upadacitinib alone vs combination (ABBV-599) in RA | Lancet Rheuma
Anti-TNF (adalimumab) for early-stage Dupuytren's disease (RIDD) | Lancet Rheumat
Infecciologia, Microbiologia & Antimicrobianos
8 vs 15 days of antibiotic therapy for Pseudomonas aeruginosa VAP in adults | ICM
Doxy vs azi for anorectal C. trachomatis in vaginal infection - CHLAZIDOXY | Lancet ID
Capsid Inhibition with Lenacapavir in Multidrug-Resistant HIV-1 Infection | NEJM
Ivermectin + diethylcarbamazine and albendazole for lymphatic filariasis | Lancet ID
Meta-investigação & MBE
Machine Learning–Assisted Risk-of-Bias Assessments in Systematic Reviews | AIM
Nefrologia
Oral MPDN on Kidney Function in IgA Nephropathy - TESTING | JAMA
Difelikefalin in Mod-Severe Pruritus from Hemodialysis | JAMA Network Open
Neurologia
Tenecteplase vs alteplase for acute ischaemic stroke (NOR-TEST 2) | Lancet Neuro
Tenecteplase vs alteplase for acute ischaemic stroke in MSU (TASTE-A) Lancet Neuro
Direct Transportation to Thrombectomy vs Local Stroke Center RACECAT | JAMA
Ultrahigh-Dose Methylcobalamin in Early Amyotrophic Lateral Sclerosis | JAMANeuro
ACI-24 Vaccine in Adults With Down Syndrome | Lancet Neurology
Pneumologia
Smartphone-Based Financial Incentives on Peripartum Smoking | JAMA Net Open
Albuterol–Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma | NEJM
Phosphodiesterase 4B Inhibitor for Idiopathic Pulmonary Fibrosis | NEM
NORMAS DE ORIENTAÇÃO CLÍNICAS (GUIDELINES):
Cardiovascular
Infecciologia, Microbiologia & Antimicrobianos
Management of Pyogenic Osteomyelitis in Adults - WikiGuidelines | JAMA Net Open
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RS COM ESTUDOS OBSERVACIONAIS (com ou sem ECA)
Doente crítico/urgente
Long-term Survival After Out-of-Hospital Cardiac Arrest | JAMA Cardiology
Airway US as Predictor of Difficult Direct Laryngoscopy | AA - JF
Endocrinologia
Gastroenterologia & Hepatologia
Worldwide prevalence of HBV and HCV among patients with cirrhosis | Lancet G&H
Risk Scores for Lower Gastrointestinal Bleeding | JAMA Network Open
Meta-investigação & MBE
Good practice statements in Covid-19 guidelines | BMJ Evidence-Based Medicine
Assessing the magnitude of reporting bias in trials of homeopathy | BMJ EBM
PROSPECTIVOS
Cardiovascular
HDL and Adverse Cardiovascular Outcomes in High-risk Populations | JAMA C
Cirurgia, Ortopedia & MFR
Surgery vs conservative treatment for traumatic subdural haematoma | Lancet N
Awake vs asleep craniotomy in glioblastoma in eloquent areas - GLIOMAP | Lancet O
COVID-19
Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline Findings | AIM
Doente crítico/urgente
Score for Poor Neurocognitive Outcomes in Acute CM Poisoning | JAMA Net Open
Endocrinologia
Long-term Metformin and Lifestyle on CVE in the DPPO study | Circulation
Gastroenterologia & Hepatologia
Serrated polyp detection and interval post-colonoscopy CRC | Lancet G&H
Geral, Geriatria & Paliativos
Patient and Proxy Recall Written or Oral Informed Consent | JAMA Network Open
Gabapentin, Pain Control and Feeding Tube Placement in HNC with CRT | JAMA NetO
Hematologia
Ruxolitinib vs best therapy in refractory PV (after HXU) wo/ splenomegaly | Lancet H
Infecciologia, Microbiologia & Antimicrobianos
Bayesian vs Frequentist Adaptive Trial Design | JAMA Network Open
Pharmacist-Driven Intervention for Oral Antimicrobials at Discharge | JAMA NetOpen
Household Transmission of Clostridioides difficile Infection | EID - JW
Meta-investigação& MBE
Visualising harms in publications of randomised controlled trials | The BMJ
Neurologia
Flying Intervention Team to Endovascular Thrombectomy | JAMA Neurology
RETROSPECTIVOS
Cardiovascular
Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee | AIM
Low-Dose Triple AntiHT vs Usual Care With Time at Target BP | JAMA Cardiology
High-Intensity Statin Use Among Atherosclerosis in the US | JACC
AT After Complex PCI In Patients at High Bleeding Risk from MASTER DAPT | EHJ
Post-hoc analysis of AUGUSTUS trial of the TIA/Stroke/TE subgroup - JAMACardiology
Outcomes in the ISCHEMIA Trial Based on CAD and Ischemia Severity | Circulation
Alcohol Septal Ablation or Septal Myectomy for Obstructive Hypertrophic CMP |JACC
Cirurgia, Ortopedia & MFR
Abdominal Wall Reconstruction by Surgical Fellows vs Faculty | JAMA Network Open
Perioperative Outcome Among Surgeons Who Operated the Night Before | JAMA IM
Overdiagnosis and Overtreatment of Low-Risk PTC in the US | JAMA Network Open
Knee Arthroscopy from 2004 to 2019 in Ontario, Canada | NEJM Evidence
COVID-19
AUD–Mortality in the US Before and During the COVID-19 Pandemic | JAMANetOpen
VV-ECMO in acute covid-19 associated respiratory failure | The BMJ
Antibody and T-Cell Responses to Omicron in Unvaccinated | JAMA Network Open
Trajectory of long covid symptoms after covid-19 vaccination | The BMJ
Protection and Waning of Natural and Hybrid Immunity to SARS-CoV-2 | NEJM
Doente crítico/urgente
Patient disposition using the Emergency Severity Index | BMJ Open
Utility of Biomarkers for Sepsis-Associated Acute Kidney Injury Staging | JAMA NetO
Endocrinologia
Weekly tirzepatide vs insulin degludec on fat (substudy SURPASS-3MRI) | Lancet D&E
Weekly tirzepatide vs daily insulin degludec (substudy SURPASS-3CGM) | Lancet D&E
Geral, Geriatria & Paliativos
Preferences for EoL Care Among Terminal Cancer in China | JAMA Network Open
Multimodal Intervention to Decreased Opioid Prescribing after surgery | JAMA OHNS
HPV Impact and Effectiveness Through 12Y After Vaccine in the US, 2003-2018 | AIM
Hematologia
Prevalence of monoclonal gammopathies by mass spectrometry | Lancet Haemat
Infecciologia, Microbiologia & Antimicrobianos
Meningococcal Vaccination Rates Among HIV in the US | JAMA Network Open
PC Clinician Attitudes on Treating Asymptomatic Bacteriuria | JAMA Network Open
Meta-investigação & MBE
Supportive Evidence for US FDA Approvals of Novel Drugs in 2020 | JAMA Net Open
Medicare Spending on Drugs w/ Accelerated Approval | Annals of Internal Medicine
Neurologia
Diagnostic Accuracy of MRI on Brain Atrophy in PSP and CBD | JAMA Network Open
Depression in Survivors of Stroke in the United States, 2004–2017 | Neurology - JW
Ischemic Stroke in Asymptomatic Severe Carotid Stenosis | JAMA IM
Prion protein monoclonal antibody (PRN100) for Creutzfeldt–Jakob disease | JAMA N
Oncologia
HRQL in aRCC w/ lenvatinib + pembrolizumab/everolimus vs sunitinib | Lancet
QoL and Survival Outcomes in Cancer Drug Trials from 2019 | JAMA Oncology
2020 NICE criteria vs MRI for NeoA RT in operated rectal cancer | Lancet Oncology
5α-Reductase Inhibitors and Prostate Cancer Mortality | JAMA Oncology
Underrecognition of Symptoms Caused by Breast Radiation Therapy | JAMA O
Pneumologia
Characterization of Eosinophilic Bronchiectasis: A European Multicohort | AJRCCM
Neuropsychiatric Diagnoses After Montelukast Initiation | JAMA Network Open
Psiquiatria
Risk of suicide death following ECT for depression (Propensity Score W) | Lancter Psy
Medical Treatment for Opioid Use Disorder With Suicide Mortality | AJP - JW
CASO CLÍNICO / IMAGEM CLÍNICA
Pele e partes moles
Ulcerated Plaques on the Scalp and Dorsal Hands of an Older Man
FOAMed
Geral, Geriatria & Paliativos
Infecciologia, Microbiologia & Antimicrobianos