Episodes
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Kaue e Joanne convidam Caio Bastos para discutir 4 clinicagens sobre doença celíaca:
1. Quando suspeitar?
2. Doenças associadas
3. Como fazer o diagnóstico?
4. Manejo terapêutico
Referências
1. AL-TOMA, Abdulbaqi et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European gastroenterology journal, v. 7, n. 5, p. 583-613, 2019.
2. LEBWOHL, Benjamin; RUBIO-TAPIA, Alberto. Epidemiology, presentation, and diagnosis of celiac disease. Gastroenterology, v. 160, n. 1, p. 63-75, 2021.
3. LINDFORS, Katri et al. Coeliac disease. Nature reviews Disease primers, v. 5, n. 1, p. 1-18, 2019.
4. MAKHARIA, Govind K. et al. The global burden of coeliac disease: opportunities and challenges. Nature Reviews Gastroenterology & Hepatology, p. 1-15, 2022.
5. PINTO-SANCHEZ, M. Ines et al. Society for the Study of Celiac Disease position statement on gaps and opportunities in coeliac disease. Nature Reviews Gastroenterology & Hepatology, v. 18, n. 12, p. 875-884, 2021.
6. RAITERI, Alberto et al. Current guidelines for the management of celiac disease: A systematic review with comparative analysis. World Journal of Gastroenterology, v. 28, n. 1, p. 154, 2022.
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Rapha, José Marcos e Marcela discutem um caso de Demência em um paciente idoso!
Minutagem em breve!
Referências:
1- Uptodate 2022. Evaluation of Cognitive Impairment and Dementia.
2- TANG-WAI, David F.; FREEDMAN, Morris. Bedside approach to the mental status assessment. Continuum: Lifelong Learning in Neurology, v. 24, n. 3, p. 672-703, 2018.
3- Avaliação Cognitiva a Beira do Leito - Capítulo 3 - Neurologia Cognitiva e do Envelhecimento - 1ª Edição ABN - Nitrini - 2016
4- Comprometimento Cognitivo Vascular - Capitulo 14 - Neurologia Cognitiva e do Envelhecimento - 1ª Edição ABN - Nitrini - 2016
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Pedro Magno, Luísa Sousa e Guilherme Moura discutem 7 armadilhas de hipertensão no pronto-socorro! Um tema cheio de nuances! Hipertensão e cefaleia, qual a relação? Como diferenciar urgência de emergência? Precisa pedir exames? Isso e muito mais nesse episódio!
Referências
Peixoto, A. J. (2019). Acute severe hypertension. New England Journal of Medicine, 381(19), 1843-1852.
Miller, J., McNaughton, C., Joyce, K., Binz, S., & Levy, P. (2020). Hypertension management in emergency departments. American journal of hypertension, 33(10), 927-934.
Campos, C. L., Herring, C. T., Ali, A. N., Jones, D. N., Wofford, J. L., Caine, A. L., ... & Oles, K. S. (2018). Pharmacologic treatment of hypertensive urgency in the outpatient setting: a systematic review. Journal of general internal medicine, 33(4), 539-550.
Astarita, A., Covella, M., Vallelonga, F., Cesareo, M., Totaro, S., Ventre, L., ... & Milan, A. (2020). Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. Journal of hypertension, 38(7), 1203-1210.
2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)
Cremer, A., Amraoui, F., Lip, G. Y. H., Morales, E., Rubin, S., Segura, J., ... & Gosse, P. (2016). From malignant hypertension to hypertension-MOD: a modern definition for an old but still dangerous emergency. Journal of human hypertension, 30(8), 463-466.
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Fred, Pedro e Raíza discutem sobre Nódulo Pulmonar!
Confira o Resumo Visual do episódio no nosso canal no YouTube: https://youtu.be/m0wuZIq00GE
Referências e Minutagem em breve!
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João, Joanne e Rapha discutem 3 clinicagens na insulinoterapia: 1. Quando indicar? 2. Como começar e titular a dose? 3. Não alcancei o alvo, como ajustar? Referências:
1. DRAZNIN, Boris et al. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2022. Diabetes care, v. 45, n. Supplement_1, p. S125-S143, 2022.
2. Uptodate Fev/2022. General principles of insulin therapy in diabetes mellitus.Ruth S Weinstock, David M Nathan, Jean E Mulder.
3. Uptodate 2022. Insulin therapy in type 2 diabetes mellitus. Deborah J Wexler, David M Nathan, Jean E Mulder.
4. COWART, Kevin. Overbasalization: addressing hesitancy in treatment intensification beyond basal insulin. Clinical Diabetes, v. 38, n. 3, p. 304-310, 2020.
5. NATHAN, David M. et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, v. 29, n. 8, p. 1963-1972, 2006.
6. TAYLOR, Roy et al. Appropriate insulin regimes for type 2 diabetes: a multicenter randomized crossover study. Diabetes Care, v. 23, n. 11, p. 1612-1618, 2000.
7. UK PROSPECTIVE DIABETES STUDY (UKPDS) GROUP et al. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The lancet, v. 352, n. 9131, p. 837-853, 1998.
8. MADENIDOU, Anastasia-Vasiliki et al. Comparative benefits and harms of basal insulin analogues for type 2 diabetes: a systematic review and network meta-analysis. Annals of internal medicine, v. 169, n. 3, p. 165-174, 2018.
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Iago apresenta um caso de tontura para o Pedro e Kaue, com um foco na investigação da tontura e no exame físico direcionado (HINTS).
Vídeo do HINTS comentado por Kaue e Pedro: https://youtu.be/keqwC-36HmM
Referências:
1. Newman-Toker DE, Edlow JA. TiTrATE: a novel approach to diagnosing acute dizziness and vertigo. Neurol Clin 2015;33(3):577-599. doi:10.1016/j.ncl.2015.04.011
2. Edlow JA, Gurley KL, Newman-Toker DE. A new diagnostic approach to the adult patient with acute dizziness. J EmergMed 2018;54(4):469-483. doi:10.1016/j.jemermed.2017.12.024
3. Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the international classification of vestibular disorders. Neurol Clin 2015;33:541-550. doi:10.1016/j.ncl.2015.04.010
4. Kerber KA. Episodic positional dizziness. Continuum (Minneap Minn) 2021; 27(2, Neuro-otology):348-368.
5. Newman-Toker DE, Cannon LM, Stofferahn ME, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007;82(11):1329-1340. doi:10.4065/82.11.1329
6. Steenerson KK. Acute vestibular syndrome. Continuum (Minneap Minn) 2021; 27(2, Neuro-otology):402-419.
7. Wasay M, Dubey N, Bakshi R. Dizziness and yield of emergency head CT scan: is it cost effective? Emerg Med J 2005;22(4):312. doi:10.1136/ emj.2003.012765
8. Huang CY, Yu YL. Small cerebellar strokes may mimic labyrinthine lesions. J Neurol Neurosurg Psychiatry. 1985; 48(3):263–5.
9. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007; 369(9558):293–8.
10. Oppenheim C, Stanescu R, Dormont D, Crozier S, Marro B, Samson Y, Rancurel G, Marsault C. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol. 2000; 21(8):1434–40.
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João, Rapha e Joca discutem 7 armadilhas sobre Vitamina B12! 1. Nem toda anemia macrocítica é deficiência de B12 2. B12 pode causar manifestações além da anemia 3. Qual é o valor de corte normal de B12? 4. Não é apenas baixa ingestão de B12 que causa deficiência de B12 5. Como repor B12, via oral ou IM/EV? 6. Qual é a dose ideal de B12? 7. O que causa B12 alta? Referências: 1. Uptodate. Fevereiro 2022.Causes and pathophysiology of vitamin B12 and folate deficiencies. Robert T Means, Kathleen M Fairfield, Kathleen J Motil, Jennifer S Tirnauer. 2. UPTODATE Fev 2022. Macrocytosis/Macrocytic anemia. Robert A Brodsky, William C Mentzer, Jennifer S Tirnauer. 3. Uptodate Fev 2022. Clinical manifestations and diagnosis of vitamin B12 and folate deficiency. Robert T Means, Kathleen M Fairfield, William C Mentzer, Jennifer S Tirnauer, Lisa Kunins. 4. KAPTAN, Kürşad et al. Helicobacter pylori—is it a novel causative agent in vitamin B12 deficiency?. Archives of Internal Medicine, v. 160, n. 9, p. 1349-1353, 2000. 5. HU, Yanfeng et al. Vitamin B12 deficiency after gastrectomy for gastric cancer: an analysis of clinical patterns and risk factors. Annals of surgery, v. 258, n. 6, p. 970-975, 2013. 7. Devalia, V., Hamilton, M. S., & Molloy, A. M. (2014). Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British Journal of Haematology, 166(4), 496–513. 8. Parks NE. Metabolic and Toxic Myelopathies. Continuum (Minneap Minn). 2021 Feb 1;27(1):143-162.
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Pedro, Fred e Amyr discutem sobre a punção do líquido pleural e os exames de análise do líquido pleural.
ReferênciasFeller-Kopman, D., & Light, R. (2018). Pleural disease. New England Journal of Medicine, 378(8), 740-751.
Bhatnagar, R., & Maskell, N. (2015). The modern diagnosis and management of pleural effusions. bmj, 351.
Tian, P., Qiu, R., Wang, M., Xu, S., Cao, L., Yang, P., & Li, W. (2021). Prevalence, Causes, and Health Care Burden of Pleural Effusions Among Hospitalized Adults in China. JAMA Network Open, 4(8), e2120306-e2120306.
Maskell, N. (2010). British thoracic society pleural disease guidelines-2010 update. Thorax, 65(8), 667-669.
Light, R. W. (1995). A new classification of parapneumonic effusions and empyema. Chest, 108(2), 299-301.
Jany, B., & Welte, T. (2019). Pleural effusion in adults—etiology, diagnosis, and treatment. Deutsches Ärzteblatt International, 116(21), 377.
Rooper, L. M., Ali, S. Z., & Olson, M. T. (2014). A minimum fluid volume of 75 mL is needed to ensure adequacy in a pleural effusion: a retrospective analysis of 2540 cases. Cancer cytopathology, 122(9), 657-665.
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Formato novo no TdC! E nesse episódio especial, as vozes ganharam rostos canal no nosso canal no YouTube hahaha Confere aqui no link! https://youtu.be/iBxrbGse9Kg
Seleção dos 7 melhores artigos de 2021 na opinião da equipe TdC! Seguem os links pros estudos citados episósio:
Estudo 01 (Antler): https://www.nejm.org/doi/full/10.1056
Estudo 02 (Step 1): https://www.nejm.org/doi/full/10.1056
Estudo 03 (TC para febre aguda no PS): https://www.sciencedirect.com/science
Estudo 04 (TOMAHAWK): https://www.nejm.org/doi/full/10.1056
Estudo 05 (SANAD 2): https://www.thelancet.com/journals/la
Estudo 06 (Controle glicêmico no paciente internado): https://shmpublications.onlinelibrary
Estudo 07 (Emperor preserved): https://www.nejm.org/doi/full/10.1056
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Marcela, Pedro e Fred discutem 7 armadilhas sobre a crise de gota. Pode usar alopurinol na crise? Precisa puncionar toda monoartrite? Colchicina, AINEs ou corticoide, qual é o melhor? Essas armadilhas e mais algumas são discutidas nesse episódio.
Referências:
Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016. Hill EM, et al. Does Starting Allopurinol Prolong Acute Treated Gout? A Randomized Clinical Trial. JCR - Journal of Clinical Rheumatology Apr 2015. Vol21 Issue 3. Taylor TH. Initiation of Allopurinol at First Medical Contact for Acute Attacks of Gout: A Randomized Clinical Trial. The American Journal of Medicine. Vol 125, Issue 11. Nov 2012. Xin Feng, Yao Li, Wei Gao. Significance of the initiation time of urate-lowering therapy in gout patients: A retrospective research. Joint Bone Spine Volume 82, Issue 6, December 2015. Park Y, Park Y, Lee S, et al. Clinical analysis of gouty patients with normouricaemia at diagnosisAnnals of the Rheumatic Diseases 2003;62:90-92. LOGAN JA, MORRISON E, McGILL PE. Serum uric acid in acute goutAnnals of the Rheumatic Diseases 1997;56:696-697. FitzGerald, J. D., Dalbeth, N., Mikuls, T., Brignardello‐Petersen, R., Guyatt, G., Abeles, A. M., ... & Neogi, T. (2020). 2020 American College of Rheumatology guideline for the management of gout. Arthritis care & research, 72(6), 744-760. Ragab, Gaafar, Mohsen Elshahaly, and Thomas Bardin. "Gout: An old disease in new perspective–A review." Journal of advanced research 8.5 (2017): 495-511. Janssens, H. J., Janssen, M., Van de Lisdonk, E. H., van Riel, P. L., & van Weel, C. (2008). Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. The Lancet, 371(9627), 1854-1860. Parperis, K. (2021). Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care. Annals of the Rheumatic Diseases, 80(12), e202-e202. Barthélémy, I., Karanas, Y., Sannajust, J. P., Emering, C., & Mondié, J. M. (2001). Gout of the temporomandibular joint: pitfalls in diagnosis. Journal of Cranio-Maxillofacial Surgery, 29(5), 307-310. Terkeltaub, R. A., Furst, D. E., Bennett, K., Kook, K. A., Crockett, R. S., & Davis, M. W. (2010). High versus low dosing of oral colchicine for early acute gout flare: twenty‐four–hour outcome of the first multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group, dose‐comparison colchicine study. Arthritis & Rheumatism, 62(4), 1060-1068. Lumezanu, E., Konatalapalli, R., & Weinstein, A. (2012). Axial (spinal) gout. Current rheumatology reports, 14(2), 161-164. Kienhorst, Laura BE, et al. "The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study." Rheumatology 54.4 (2015): 609-614. Clebak, Karl T., Ashley Morrison, and Jason R. Croad. "Gout: Rapid evidence review." American family physician 102.9 (2020): 533-538. Robin, F., et al. "External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients." Clinical Rheumatology 40.5 (2021): 1983-1988. Ma, Lingling, Ann Cranney, and Jayna M. Holroyd-Leduc. "Acute monoarthritis: what is the cause of my patient's painful swollen joint?." Cmaj 180.1 (2009): 59-65. Yu, K. H., et al. "Concomitant septic and gouty arthritis—an analysis of 30 cases." Rheumatology 42.9 (2003): 1062-1066. NBR 6023Janssens, Hein JEM, et al. "A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis.Archives of Internal Medicine170.13 (2010): 1120-1126
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Joanne apresenta um caso de AVC Hemorrágico para o Kaue e José Marcos, com um foco mais em abordagem, falamos um pouco sobre manifestações clínicas, etiologias, qual imagem pedir para o diagnóstico e como manejar.
Referências:
1. Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2032.
2. Gross BA, Jankowitz BT, Friedlander RM. Cerebral Intraparenchymal Hemorrhage: A Review. JAMA 2019; 321:1295.
3. Baharoglu MI, Cordonnier C, Al-Shahi Salman R, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016; 387:2605.
4. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28:1.
5. Manning L, Hirakawa Y, Arima H, et al. Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial. Lancet Neurol 2014; 13:364.
6. Qureshi AI, Palesch YY, Foster LD, et al. Blood Pressure-Attained Analysis of ATACH 2 Trial. Stroke 2018; 49:1412.
7. Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet 2018; 392:1257.
8. Kuramatsu JB, Biffi A, Gerner ST, et al. Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage. JAMA 2019; 322:1392.
9. Hanley DF, Thompson RE, Rosenblum M, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 2019; 393:1021.
10. Mendelow AD, Gregson BA, Rowan EN, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013; 382:397.
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Episódio curtinho! Em pouco mais de 30 minutos Iago apresenta um caso de hipocalemia para Luísa e Pedro, que destrincham a abordagem desse distúrbio tão comum na prática diária.
Referências
Gumz ML, Rabinowitz L, Wingo CS. An integrated view of potassium homeostasis. N Engl J Med. 2015;373:60-72.
Palmer BF. Regulation of potassium homeostasis. Clin J Am Soc Nephrol. 2015; 10: 1050-1060
Palmer BF, Clegg DJ. Physiology and Pathophysiology of Potassium Homeostasis: Core Curriculum 2019. Am J Kidney Dis. Novembro de 2019; 74 (5): 682-695. doi: 10.1053 / j.ajkd.2019.03.427. Epub 2019, 19 de junho.
VIERA, Anthony J.; WOUK, Noah. Potassium disorders: hypokalemia and hyperkalemia. American family physician, v. 92, n. 6, p. 487-495, 2015.
GRAMS, Morgan E.; HOENIG, Melanie P.; HOORN, Ewout J. Evaluation of hypokalemia. Jama, v. 325, n. 12, p. 1216-1217, 2021.
PALMER, Biff F.; CLEGG, Deborah Joy. The use of selected urine chemistries in the diagnosis of kidney disorders. Clinical Journal of the American Society of Nephrology, v. 14, n. 2, p. 306-316, 2019.
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Cupom de desconto de 200 reais ===> SpfVoyBUPX (https://checkout.medway.com.br/vzW8JjIipE/SpfVoyBUPX) Link para o extensivo R3 de clínica médica da medway: https://r3.medway.com.br/clinica-medica/?utm_source=Social&utm_medium=BrandedContent&utm_campaign=ta-de-clinicagem Rapha, João e Fred discutem sobre a variante Omicron. O episódio é dividido em 3 partes: primeiro a discussão sobre as mudanças nas orientações de isolamento do Ministério da Saúde, segundo sobre a vacinação de reforço e a resposta vacinal com a nova variante, terceiro sobe os novos tratamentos de COVID-19 ambulatorial e atualizações sobre o tratamento hospitalar.Dá uma olhada nas "show notes" no nosso site tadeclinicagem.com.brReferências:Guia de Vigilância Epidemiológica Emergência de Saúde Pública de Importância Nacional pela Doença pelo Coronavírus 2019 (Ministério da Saúde, janeiro de 2022)Uptodate Jan 2022. COVID-19: Vaccines. Kathryn M Edwards,Walter A Orenstein, Martin S Hirsch, Allyson Bloom, MD.ACCORSI, Emma K. et al. Association Between 3 Doses of mRNA COVID-19 Vaccine and Symptomatic Infection Caused by the SARS-CoV-2 Omicron and Delta Variants. JAMA, 2022.OMER, Saad B.; MALANI, Preeti N. Booster Vaccination to Prevent COVID-19 in the Era of Omicron: An Effective Part of a Layered Public Health Approach. JAMA, 2022.JOHNSON, Amelia G. COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence—25 US Jurisdictions, April 4–December 25, 2021. MMWR. Morbidity and Mortality Weekly Report, v. 71, 2022.THOMPSON, Mark G. Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance—VISION Network, 10 States, August 2021–January 2022. MMWR. Morbidity and Mortality Weekly Report, v. 71, 2022.NEMET, Ital et al. Third BNT162b2 vaccination neutralization of SARS-CoV-2 Omicron infection. New England Journal of Medicine, 2021.SIGAL, Alex. Milder disease with Omicron: is it the virus or the pre-existing immunity?. Nature Reviews Immunology, p. 1-3, 2022.CLEMENS, Sue Ann Costa et al. Heterologous versus homologous COVID-19 booster vaccination in previous recipients of two doses of CoronaVac COVID-19 vaccine in Brazil (RHH-001): a phase 4, non-inferiority, single blind, randomised study. The Lancet, 2022.GOTTLIEB, Robert L. et al. Early remdesivir to prevent progression to severe Covid-19 in outpatients. New England Journal of Medicine, 2021.KAWANO-DOURADO, Leticia; ROCHWERG, Bram. Therapeutics and COVID-19: living guideline. 2021.https://www.gov.br/anvisa/pt-br/assuntos/paf/coronavirus/medicamentos (acesso em 27/01/2022)CAO, Yunlong Richard et al. B. 1.1. 529 escapes the majority of SARS-CoV-2 neutralizing antibodies of diverse epitopes. BioRxiv, 2021.RAMACCIOTTI, Eduardo et al. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. The Lancet, 2021.GUPTA, Anil et al. Early treatment for Covid-19 with SARS-CoV-2 neutralizing antibody sotrovimab. New England Journal of Medicine, v. 385, n. 21, p. 1941-1950, 2021.JAYK BERNAL, Angélica et al. Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients. New England Journal of Medicine, 2021.https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-additional-phase-23-study-resultsRhee, C., et al. "Duration of SARS-CoV-2 infectivity: when is it safe to discontinue isolation?[manuscript published online ahead of print August 25 2020]." Clin Infect Dis (2020).Owusu, Daniel, et al. "Persistent SARS-CoV-2 RNA Shedding without Evidence of Infectiousness: A Cohort Study of Individuals with COVID-19." The Journal of Infectious Diseases (2021).
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Cupom de desconto de 200 reais para o extensivo R3 de clínica médica da medway: SpfVoyBUPX (https://checkout.medway.com.br/vzW8JjIipE/SpfVoyBUPX)
Link para o extensivo R3 de clínica médica da medway: https://r3.medway.com.br/clinica-medica/?utm_source=Social&utm_medium=BrandedContent&utm_campaign=ta-de-clinicagem.
Iago apresenta um caso repleto de reviravoltas para Rapha e nosso convidado especial Layon Campagnaro que destrincham o raciocínio clínico por trás da síndrome nefrótica e muito mais. Gostou do episódio? Quer se aprofundar mais nos temas de nefro com qualidade e muita didática? Confere o conteúdo do @nefropapers nas redes sociais! Referências - ROVIN, Brad H. et al. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney International, v. 100, n. 4, p. S1-S276, 2021.
- Uptodate 2022. Evaluation of proteinuria in pregnancy and management of nephrotic syndrome. Ravi I Thadhani, Sharon E Maynard, Richard J Glassock, Vanessa A Barss, Albert Q Lam
- Uptodate 2021. Glomerular disease: Evaluation and differential diagnosis in adults. Jai Radhakrishnan, Richard J Glassock, Brad H Rovin, Albert Q Lam. -
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Joanne, Marcela e Fred discutem sobre doença hepática gordurosa não alcoólica. Comentam sobre a confusão das nomenclaturas (NASH? NAFLD? Esteatose?), sobre os diagnósticos diferenciais, sobre os exames auxiliares (biópsia, elastografia) e sobre o tratamento.
Referências
1. Chalassani N, et al. The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases. HEPATOLOGY, VOL. 67, NO. 1, 2018
2. Diehl AM, Day C. Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis. N Engl J Med. 2017. 377;21
3. EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease, Journal of Hepatology, Volume 64, Issue 6, 2016, Pages 1388-1402.
4. Glen J, Floros L, Day C, Pryke R. Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance BMJ 2016; 354 :i4428.
5. Roeb E. Diagnostic and Therapy of Nonalcoholic Fatty Liver Disease: A Narrative Review. 2021. Visc Med.
6. Pandyarajan, Vijay et al. “Screening for Nonalcoholic Fatty Liver Disease in the Primary Care Clinic.” Gastroenterology & hepatology vol. 15,7 (2019): 357-365.
7. Sheka AC, et al. Nonalcoholic Steatohepatitis. A Review. JAMA. 2020. vol 323 N 12.
8. Sheth SG, et al. Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults. UpToDate. Acesso em Jan/2022.
9. Vuppalanchi, R., Gould, R.J., Wilson, L.A. et al. Clinical significance of serum autoantibodies in patients with NAFLD: results from the nonalcoholic steatohepatitis clinical research network. Hepatol Int 6, 379–385 (2012).
10. Hernaez, Ruben, et al. "Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta‐analysis." Hepatology 54.3 (2011): 1082-1090.11. de Moura Almeida, Alessandro, et al. "Fatty liver disease in severe obese patients: diagnostic value of abdominal ultrasound." World journal of gastroenterology: WJG 14.9 (2008): 1415.
12. Mottin, Cláudio C., et al. "The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients." Obesity surgery 14.5 (2004): 635-637.
13. Cho C.S., et al. Preoperative radiographic assessment of hepatic steatosis with histologic correlation. J Am Coll Surg. 2008 Mar;206(3):480-8.
14. Crossan, Catriona, et al. "Referral pathways for patients with NAFLD based on non‐invasive fibrosis tests: Diagnostic accuracy and cost analysis." Liver International 39.11 (2019): 2052-2060.
15. Boursier, Jerome, and Emmanuel A. Tsochatzis. "Case-finding strategies in non-alcoholic fatty liver disease." JHEP Reports 3.2 (2021): 100219.
16. Shah, Amy G., et al. "Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease." Clinical gastroenterology and hepatology 7.10 (2009): 1104-1112.
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Pedro, João e Kauê trazem 7 armadilhas da cetoacidose diabética! Assunto muito comum e que precisa ficar atento! Do diagnóstico ao tratamento, tem tudo aqui!
Referências em breve
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Faça sua pré-inscrição na turma 2 do Curso de Pronto-Atendimento e receba BÔNUS exclusivos: https://cursotdc.com.br/
João e Pedro discutem um caso apresentado pelo Kaue de hemorragia digestiva alta! O que fazer inicialmente? Quais as causas principais? Como realizar o tratamento inicial? Tudo isso nesse episódio!
Referências em breve.
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Fred e Raphael trazem nesse bolus especial, muita informação essencial para essa nova onda de Influenza: quando pensar? E a diferença com COVID? Como diagnosticar e como tratar? Tudo isso aqui!
Referências:
Call, Stephanie A., et al. "Does this patient have influenza?." Jama 293.8 (2005): 987-997.World Health Organization. "Recommended composition of influenza virus vaccines for use in the 2022 southern hemisphere influenza season–Composition"
Punpanich, Warunee, and Tawee Chotpitayasunondh. "A review on the clinical spectrum and natural history of human influenza." International Journal of Infectious Diseases 16.10 (2012): e714-e723.
Uyeki, Timothy M., et al. "Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza." Clinical Infectious Diseases 68.6 (2019): e1-e47.
Gaitonde, David Y., Faith C. Moore, and Mackenzie K. Morgan. "Influenza: Diagnosis and treatment." American family physician 100.12 (2019): 751-758.
Rodrigo, Chamira, et al. "Corticosteroids as adjunctive therapy in the treatment of influenza." Cochrane database of systematic reviews 3 (2016).
Lansbury, Louise, et al. "Corticosteroids as adjunctive therapy in the treatment of influenza." Cochrane Database of Systematic Reviews 2 (2019).
Ni, YN., Chen, G., Sun, J. et al. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Crit Care 23, 99 (2019). -
Fred, Rapha e Iago comentam 3 casos de Asma no Pronto Socorro:
1. Uma paciente com exacerbação leve/moderada
2. Um paciente com exacerbação grave
3. Um paciente com risco iminente de vida
Minutagem em breve!
Referências:
1- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Available from: www.ginasthma.org
2- Uptodate 2021. Acute exacerbations of asthma in adults: Emergency department and inpatient management. Christopher H Fanta, Bruce S Bochner,Robert S Hockberger, Helen Hollingsworth.
3- JOKERST, Clinton et al. ACR Appropriateness Criteria® acute respiratory illness in immunocompetent patients. Journal of the American College of Radiology, v. 15, n. 11, p. S240-S251, 2018.
4- Chien, Jason W., et al. "Uncontrolled oxygen administration and respiratory failure in acute asthma." Chest 117.3 (2000): 728-733.
5- Perrin, Kyle, et al. "Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma." Thorax 66.11 (2011): 937-941.6- Rehrer, Matthew W., et al. "A randomized controlled noninferiority trial of single dose of oral dexamethasone versus 5 days of oral prednisone in acute adult asthma." Annals of emergency medicine 68.5 (2016): 608-613.
7- Kravitz, Joel, et al. "Two days of dexamethasone versus 5 days of prednisone in the treatment of acute asthma: a randomized controlled trial." Annals of emergency medicine 58.2 (2011): 200-204.
8- O'Driscoll, B. R., et al. "Double-blind trial of steroid tapering in acute asthma." The Lancet 341.8841 (1993): 324-327.
9- Jones, A. M., et al. "Prospective, placebo-controlled trial of 5 vs 10 days of oral prednisolone in acute adult asthma." Respiratory medicine 96.11 (2002): 950-954.
10- Kew, Kayleigh M., Liza Kirtchuk, and Clare I. Michell. "Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department." Cochrane Database of Systematic Reviews 5 (2014).
11- Kirkland, Scott W., et al. "Combined inhaled beta‐agonist and anticholinergic agents for emergency management in adults with asthma." Cochrane Database of Systematic Reviews 1 (2017). -
João e Kaue discutem um caso clínico do Pedro, trazendo os principais pontos na abordagem diagnóstico do paciente sangrando. O que é relevante na anamnese? Hereditário ou adquirido? Como interpretar o coagulograma? Tudo isso nesse episódio!
Referências:
1. Dilley A, Drews C, Miller C, et al. von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol. 2001;97(4):630–636.
2. Knol HM, Mulder AB, Bogchelman DH, Kluin-Nelemans HC, van der Zee AG, Meijer K. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities. Am J Obstet Gynecol. 2013;209(3):202.e1–202.e7.
3. Neutze D, Roque J. Clinical Evaluation of Bleeding and Bruising in Primary Care. Am Fam Physician. 2016;93(4):279-286.
4. Girolami A, Luzzatto G, Varvarikis C, et al. Main clinical manifestations of a bleeding diathesis: an often disregarded aspect of medical and surgical history taking. Haemophilia 2005; 11:193.
5. Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3:692. - Montre plus
