Outubro de 2025 - Inventário do mês

Vide também no Substack

Versão esquemática de Mariana Barosa:

What multimorbidity shows us about guideline-driven evidence based medicine ou Sensible Medicine

TABELA DE CONTÉUDOS:

1. REVISÕES SISTEMÁTICAS DE ENSAIOS CONTROLADOS E ALEATORIZADOS (ECAs)

2. ENSAIOS CONTROLADOS E ALEATORIZADOS (ECAs)

3. NORMAS DE ORIENTAÇÃO CLÍNICA

4. OBSERVACIONAIS

   1. Primários

   2. Casos clínicos e séries

5. OPINIÃO

   1. Revisões narrativas

   2. Perspectiva

6. FOAMed

Glossário:

✔✔✔ --> Muito relevante

✔ --> Relevante

✗ --> Não eficaz mas relevante (contraria hipóteses, práticas, etc.)

(sem símbolo) --> Pouco relevante (mas eventualmente interessante)

(sem símbolo) --> Não eficaz e pouco relevante (mas eventualmente interessante)

classificação pessoal, nem todos concordarão

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REVISÕES SISTEMÁTICAS de ECAs

tabela de conteúdos ↟

Cardiovascular

✔✔✔ Outcomes in Older Patients After Switching to a NOAC or Remaining on Warfarin: COMBINE‑AF | JACC

✔✔✔ Blood pressure‑lowering efficacy of antihypertensive drugs and their combinations | Lancet

Doente crítico/urgente

✔✔✔ Automated vs non‑automated weaning for reducing the duration of mechanical ventilation | Cochrane Database

✔✔✔ Preoxygenation strategies for intubation of patients who are critically ill | Lancet Respiratory Medicine

Meta-investigação & MBE

! ! ! Nonregistration, Discontinuation, and Nonpublication of Randomized Trials | JAMA Network Open 

Neurologia

✔ Cognitive Behavioral Therapy for Insomnia in People With Chronic Disease | JAMA Internal Medicine

(✔ Mechanical Thrombectomy for Large Ischemic Stroke: A Critical Appraisal of Evidence From 6 RCTs| Stroke)

Oncologia

✔ Age and Treatment Intensification in Metastatic Hormone‑Sensitive Prostate Cancer | NEJM Evidence

Psiquiatria

The effects of antidepressants on cardiometabolic and other physiological parameters | Lancet

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ENSAIOS CONTROLADOS E ALEATORIZADOS

tabela de conteúdos ↟

Anestesiologia

✔ Liposomal bupivacaine vs ropivacaine perianal infiltration for postop analgesia of haemorrhoidectomy | BMJ Op

Cardiovascular

✔✔✔ Immediate or Deferred Nonculprit‑Lesion PCI in Myocardial Infarction — iMODERN | NEJM

✔✔✔ Intracardiac vs Transesophageal Echocardiography in Atrial Fibrillation Ablation - ICE vs TEE | JAMA Cardiology

✔ Multidomain Rehabilitation for Older Patients with Myocardial Infarction – PIpELINe | NEJM

✔ Reduction of Antihypertensive Treatment in Nursing Home Residents – RETREAT‑FRAIL | NEJM

- Early Discontinuation of Aspirin after PCI in Low‑Risk Acute Myocardial Infarction – TARGET‑FIRST | NEJM ; Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome – TACSI | NEJM ; Early Withdrawal of Aspirin after PCI in Acute Coronary Syndromes – NEO‑MINDSET | NEJM

? ? ? Sotatercept for Pulmonary Arterial Hypertension within the First Year after Diagnosis – HYPERION | NEJM

Cirurgia, Ortopedia & MFR

✔ Single‑anastomosis duodeno‑ileal bypass w/ sleeve gastrectomy vs Roux‑en‑Y gastric bypass – SADISLEEVE | Lancet

Thoracoscopic vs open oesophagectomy for oesophageal cancer – JCOG1409 MONET | Lancet Gastro & Hepatology

✗ Paclitaxel-coated vs uncoated devices for infrainguinal endovascular revascularisation in chronic limb-threatening ischaemia - SWEDEPAD 1 | Lancet ; Paclitaxel-coated vs uncoated devices for infrainguinal endovascular revascularisation in patients with intermittent claudication - SWEDEPAD 2 | Lancet

Doente crítico/urgente

✔ ✔ ✔ Deferring Arterial Catheterization in Critically Ill Patients with Shock - EVERDAC | NEJM

✔ ✔ ✔ Respiratory Gas Shifts to Delay Asphyxiation in Critical Avalanche Burial — SAFEBACK | JAMA

? ? ? Selective Decontamination of the Digestive Tract during Ventilation in the ICU — SuDDICU | NEJM

Geral, Geriatria & Paliativos

✔ ✔ ✔ Suzetrigine, a Nonopioid NaV1.8 Inhibitor for Treatment of Moderate‑to‑severe Acute Pain – NAVIGATE‑1 & NAVIGATE‑2 | Anesthesiology

✔ Improving Hospital Sleep Beyond the ICU — WEsleep | Eur J Intern Med

Endoscopic vs surgical gastroenterostomy for palliation of malignant gastric outlet obstruction–ENDURO | Lancet G&H

Pain Relief by Targeting Nonrestorative Sleep in Fibromyalgia | Pain Medicine​ ; A Phase 3 Study To Evaluate The Efficacy And Safety Of TNX-102 SL (Sublingual Cyclobenzaprine HCl) Taken Daily At Bedtime In Patients With Fibromyalgia - RALLY |_ClinicalTrials.gov

✗ Efficacy and Safety of Sublingual Cyclobenzaprine for the Treatment of Fibromyalgia | Arthritis Care & Research ​;

✗✗✗ Morphine for chronic breathlessness (MABEL) in the UK | The Lancet Respiratory Medicine 

Imuno-mediadas

✔ Continuation vs temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases | Clin Infect Dis

✔ A Phase 3 Trial of Telitacicept for Systemic Lupus Erythematosus – 18C010 | NEJM

Infecciologia, Microbiologia & Antimicrobianos

✔ ✔ ✔ Cloxacillin versus cefazolin for meticillin‑susceptible Staphylococcus aureus bacteraemia – CloCeBa | The Lancet

✔ ✔ ✔ Dalbavancin for Treatment of Staphylococcus aureus Bacteremia – DOTS | JAMA

✔ ✔ ✔ A Pragmatic Trial of Glucocorticoids for Community‑Acquired Pneumonia - SONIA | NEJM

✗✗✗Cefiderocol vs standard for nosocomial Gram-neg bacterial bloodstream infection – GAME CHANGER | Lancet ID

Nefrologia

✗ Spironolactone vs placebo in patients undergoing maintenance dialysis – ACHIEVE | Lancet

Neurologia

Sedation vs General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke — SEGA | JAMA Neurology

? ? ? Intra‑Arterial Alteplase After Successful Endovascular Reperfusion in Acute Stroke — PEARL | JAMA

Oncologia

✔ Methylcobalamin on capecitabine‑induced hand‑foot syndrome in early HER2‑neg breast cancer – MEC-HFS | BMJ

Pneumologia

✔ Dupilumab versus omalizumab in patients with chronic rhinosinusitis with nasal polyps and coexisting asthma (EVEREST) | The Lancet Respiratory Medicine

✗✗✗ Hypertonic Saline or Carbocisteine in Bronchiectasis – CLEAR | (NEJM)

POCUS

✔ Cardiopulmonar POCUS for Hospitalist Management of Undifferentiated Dyspnea | JAMA NO

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NORMAS DE ORIENTAÇÃO CLÍNICAS - GUIDELINES

tabela de conteúdos ↟

Endocrinologia

Primary Aldosteronism — Endocrine Society Clinical Practice Guideline | JCEM

Infecciologia, Microbiologia & Antimicrobianos

✔ Diagnosis and Management of Community-acquired Pneumonia. An Official ATS Clinical Practice Guideline

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ESTUDOS OBSERVACIONAIS

PRIMÁRIOS - SUB-ANÁLISE / COORTE / CASO-CONTROLO / INQUÉRITOS / A. ECONÓMICAS

tabela de conteúdos ↟

Cardiovascular

✔✔✔ Bayesian diagnosis of Occlusion Myocardial Infarction: transforming the STEMI paradigm | Diagnostics

✔✔✔ Long-Term Continuous Monitoring of New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting | JAMA

✔ Atrial amyloidosis identified by biopsy in atrial fibrillation: Prevalence and clinical presentation | Eur Heart J ; Cardiac amyloidosis in a Swiss autopsy cohort — distribution and clinical relevance | SMW

Diagnóstico e Raciocínio Clínico

✔ Rapid pan-microbial metagenomics for pathogen detection and personalised therapy in the ICU | Lancet Microbe

Biparametric vs Multiparametric MRI for Prostate Cancer Diagnosis – PRIME | JAMA

Doente crítico/urgente

✔✔✔ Validation of the Sudbury Vertigo Risk Score to risk stratify for a serious cause of vertigo | Acad Emerg Medicine

✔✔✔ Global simplified strategy for suspected pulmonary embolism | Lancet RespMed

✔ Phenobarbital for Alcohol Withdrawal | JAMA Network Open

Endocrinologia

✔ Association of selective serotonin reuptake inhibitors and venlafaxine with profound hyponatremia | EJofEndocrin

Cycle characterisation and clinical complications in patients with cyclic Cushing’s syndrome | Lancet Diab& Endo

Geral, Geriatria & Paliativos

✔ ✔ ✔ Patient-Centered Priorities for Older Adults in Ambulatory Care | JAMA Network Open

Imuno-mediadas

✔ Machine learning to classify the focus score and Sjögren's disease using digitalised salivary gland biopsies: a retrospective cohort study | The Lancet Rheumatology

Infecciologia, Microbiologia & Antimicrobianos

✔ Peri–Covid-19 Antibiotic Use and Antimicrobial Resistance in Older Adults | NEJM Evidence

Neurologia

✔Risk of Future Hemorrhage From Unruptured Brain Arteriovenous Malformations-MulticenterAVM(MARS) | JAMANeur

Risk of Parkinson Disease Among Patients With Restless Leg Syndrome | JAMA Network Open

Oncologia

✔ The Rise in Early-Onset Cancer in the US Population—More Apparent Than Real | JAMA Internal Medicine

POCUS

✔✔✔ Developing Point-of-Care Ultrasound Curricula for Internal Medicine Residency | Annals of Internal Medicine

✔ Increased lumbar puncture success using a paramedian ultrasound-assisted approach | Journal of Hospital Medicine

✔Novel 4-Stage Classification to Estimate Right Atrial Pressure by Point-of-Care Ultrasound of Neck Vasculature | JACC

? Incidence and Clinical Relevance of Echocardiographic Visualization of Occult Ventricular Fibrillation | AEM

Feasibility and clinical value of nurse‑led POCUS screening for prethrombotic state in postop cardiac ICU patients | USJ

Perspectives on Point-of-Care Ultrasonography Credentialing and Privileging | JAMA Network Open

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CASOS CLÍNICOS e SÉRIES DE CASOS

tabela de conteúdos ↟

Cardiovascular

Aortic Valve Papillary Fibroelastoma | AIM

Uncovering Dysphagia Lusoria: Late-Onset Symptoms in the 60s Following Percutaneous Coronary Intervention | AIM 

Dermatologia

A Case of Cutaneous and Systemic Plasmacytosis Treated With Tocilizumab | AIM

Endocrinologia

When Supplements Turn Dangerous: Glucocorticoid-Induced Adrenal Insufficiency From Hidden Steroids | AIM

Geral, Geriatria & Paliativos

Combination Immunotherapy (Relatlimab/Nivolumab)–Associated Capillary Leak Syndrome: A Case Report | AIM

Imuno-mediadas

Idiopathic Granulomatous Mastitis: A Rare Disorder to Consider in the Differential Diagnosis of a Breast Mass | AIM 

Infecciologia, Microbiologia & Antimicrobianos

An Atypical Case of Whipple Disease With Mesenteric Lymphadenopathy and an Exudative Pleural Effusion | AIM

Neurologia

Elsberg Syndrome: Sudden Cauda Equina Syndrome After Aseptic Meningitis | AIM

“Mantis Eyes Sign” for Brain Manganese Accumulation | AIM

Clonidine Withdrawal to Posterior Reversible Encephalopathy Syndrome: Imaging and CSF Clues | AIM 

Oncologia

Squamous Cell Carcinoma Arising in Chronic Hidradenitis Suppurativa | AIM 

Pneumologia

Point-of-Care Ultrasound Diagnosis of Diffuse Pulmonary Metastases: The Cannonball Sign | AIM

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OPINIÃO

REVISÃO NÃO-SISTEMÁTICA / NARRATIVA

tabela de conteúdos ↟

Diagnóstico e Raciocínio Clínico

✔ Managing Clinical Uncertainty: Formalizing Management Reasoning in Emergency Care Delivery | AEM

Gastroenterologia & Hepatologia

✔ Guidance for timely referral to liver transplantation - AST | Clin Gastroenterol Hepatol

Infecciologia, Microbiologia & Antimicrobianos

✔ Turning the Tide Against Carbapenem-resistant Acinetobacter baumannii: Sulbactam–Durlobactam | Open Forum ID

Navigating the Muddled Middle:CaseBased Exploration of Oral βLactams for Systemic Gram‑Negative Infection | OFID

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PERSPECTIVA

tabela de conteúdos ↟

Cardiovascular

✔✔✔ The problem with hospitalization endpoints in heart failure trials | European Journal of Heart Failure

✔ Bayesian diagnosis of Occlusion Myocardial Infarction: transforming the STEMI paradigm | Diagnostics

Diagnóstico e Raciocínio Clínico

✔✔✔ Educational Strategies to Prepare Trainees for Clinical Uncertainty | New England Journal of Medicine 

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✔✔✔ FOAMed

tabela de conteúdos ↟

Cardiovascular

25 AHA/ACC/... Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure

Geral, Geriatria & Paliativos

#397 Meds for Essential Tremor: Steady solution or shaky science? | TFP

Turn Down the Heat, Part II! Can fezolinetant improve vasomotor symptoms in menopause? | TFP

Hematologia

490: Update! Anticoagulation for Venous Thromboembolism with Dr. Tara Lech, PharmD | Curbsiders

Infecciologia, Microbiologia & Antimicrobianos

Are We Doing It For No Reason? – 4 Tests At The Crossroads of Diagnostic Stewardship and Antimicrobial Stewardship

Neurologia

Mortalidade e institucionalização de doentes com demência | NL 346

Psiquiatria

Ammonia Rising - Curious Clinicians

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