Episodes

  • Fred, Kaue e Luísa conversam um pouco sobre Infecção de Corrente Sanguínea Associada ao Cateter - Como diagnosticar? Como fazer antibioticoterapia? Quando investigar complicações? Como manejar Cateter de Longa Permanência?

    EcoTT vs EcoTE:
    Em pacientes com os seguintes achados talvez EcoTT seja suficiente:
    1. Bacteremia nosocomial
    2. Culturas de controle negativas dentro de 4 dias do início do tratamento.
    3. Ausência de dispositivo intracardíaco
    4. Sem hemodiálise
    5. Sem sinais clínicos de endocardite ou infecção secundária
    - Holland, Thomas L., Christopher Arnold, and Vance G. Fowler. "Clinical management of Staphylococcus aureus bacteremia: a review." Jama 312.13 (2014): 1330-1341.

    Ecocardiograma em enterococco
    - Berge, Andreas, et al. "The DENOVA score efficiently identifies patients with monomicrobial Enterococcus faecalis bacteremia where echocardiography is not necessary." Infection 47.1 (2019): 45-50.


    Referências: Diretrizes: Manian FA. IDSA guidelines for the diagnosis and management of intravascular catheter-related bloodstream infection. Clin Infect Dis. 2009 Dec 1;49(11):1770-1; author reply 1771-2. doi: 10.1086/648113. PMID: 19891568. Chaves F. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva (Engl Ed). 2018 Jan-Feb;42(1):5-36. Cultura de Sangue do Cateter: Orihuela-Martín J, Rodríguez-Núñez O, Morata L, et al. Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience. Clin Microbiol Infect 2020; 26:383.e1. Bouzidi H, Emirian A, Marty A, et al. Differential time to positivity of central and peripheral blood cultures is inaccurate for the diagnosis of Staphylococcus aureus long-term catheter-related sepsis. J Hosp Infect 2018; 99:192. Freeman JT, Elinder-Camburn A, McClymont C, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013; 34:89. Diagnóstico pela Ponta do Cateter: Peterson LR, Smith BA. Nonutility of catheter tip cultures for the diagnosis of central line-associated bloodstream infection. Clin Infect Dis. 2015 Feb 1;60(3):492-3. doi: 10.1093/cid/ciu845. Epub 2014 Oct 29. PMID: 25355902. Peterson LR, Smith BA. Nonutility of catheter tip cultures for the diagnosis of central line-associated bloodstream infection. Clin Infect Dis 2015; 60:492. Cateter Arterial e Cateter Periférico: Mermel LA. Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review. Clin Infect Dis. 2017 Oct 30;65(10):1757-1762. Chopra V, O'Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):908-18. doi: 10.1086/671737. O'Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med. 2014 Jun;42(6):1334-9. Sítios e Risco Infeccioso: Parienti JJ, du Cheyron D, Timsit JF, et al. 

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  • Síncope no pronto-socorro é sempre um bom tema, já que pode ser algo simples até algo grave, e a decisão de internar ou não é um dos pilares da discussão dessa síndrome. Pedro e Fred discutem nesse bolus, quais os pontos principais a serem considerados nesse cenário!

    Referências em breve

  • Pedro, Guilherme e João se reunem novamente com o dr. José Carlos para falar de infarto sem supradesnivelamento de segmento ST! Um tema com mudanças recentes e cheio de dúvidas! Qual o melhor antiplaquetário depois do AAS? Fazer na sala de emergência ou na hemodinâmica? E o restante da prescrição? Qual a melhor hora pra fazer o cateterismo? Isso e muito mais nesse episódio!

    REFERÊNCIAS
    1. COLLET, Jean-Philippe et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European heart journal, v. 42, n. 14, p. 1289-1367, 2021.
    2. NICOLAU, José Carlos et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST–2021. Arquivos Brasileiros de Cardiologia, v. 117, p. 181-264, 2021.
    3. SCHÜPKE, Stefanie et al. Ticagrelor or prasugrel in patients with acute coronary syndromes. New England Journal of Medicine, v. 381, n. 16, p. 1524-1534, 2019.
    4. COMMIT (CLOPIDOGREL AND METOPROLOL IN MYOCARDIAL INFARCTION TRIAL) COLLABORATIVE GROUP et al. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. The Lancet, v. 366, n. 9497, p. 1622-1632, 2005.
    5. KUBICA, Jacek et al. Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial. European heart journal, v. 37, n. 3, p. 245-252, 2016.
    6. HOBL, Eva-Luise et al. Morphine decreases clopidogrel concentrations and effects: a randomized, double-blind, placebo-controlled trial. Journal of the American College of Cardiology, v. 63, n. 7, p. 630-635, 2014.
    7. MEINE, Trip J. et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. American heart journal, v. 149, n. 6, p. 1043-1049, 2005.
    8. ANDERSON, H. Vernon et al. One-year results of the Thrombolysis in Myocardial Infarction (TIMI) IIIB clinical trial: a randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. Journal of the American College of Cardiology, v. 26, n. 7, p. 1643-1650, 1995.
    9. ABUZAID, Ahmed et al. Oxygen therapy in patients with acute myocardial infarction: a systemic review and meta-analysis. The American journal of medicine, v. 131, n. 6, p. 693-701, 2018.

  • Fred e Pedro discutem um caso do João de Dor Abdominal! Uma das principais queixas do PS! Comenta com a gente o que achou e o que ficou de fora lá nas nossas redes sociais @tadeclinicagem!

    Referências

    CARTWRIGHT, Sarah L.; KNUDSON, Mark P. Evaluation of acute abdominal pain in adults. American family physician, v. 77, n. 7, p. 971-9778, 2008.

    LYON, Corey; CLARK, Dwayne C. Diagnosis of acute abdominal pain in older patients. American family physician, v. 74, n. 9, p. 1537-1544, 2006.

    CLAIR, Daniel G.; BEACH, Jocelyn M. Mesenteric ischemia. New England Journal of Medicine, v. 374, n. 10, p. 959-968, 2016.

    http://getthediagnosis.org/diagnosis/Appendicitis.htm

    http://getthediagnosis.org/diagnosis/Cholecystitis.htm

    ROSS, James T.; MATTHAY, Michael A.; HARRIS, Hobart W. Secondary peritonitis: principles of diagnosis and intervention. Bmj, v. 361, 2018.

    SRINIVASAN, Radhika; GREENBAUM, David S. Chronic abdominal wall pain: a frequently overlooked problem: practical approach to diagnosis and management. The American journal of gastroenterology, v. 97, n. 4, p. 824-830, 2002.

    MANTEROLA, Carlos et al. Analgesia in patients with acute abdominal pain. Cochrane Database of Systematic Reviews, n. 3, 2007.

  • João e Pedro trazem no bolus dessa semana uma revisão rápida sobre Síndrome de Realimentação!

    - Como é feito o diagnóstico

    - Em quem suspeitar

    - Quais os cuidados

    - Como tratar 

    REFERÊNCIAS

    1. DA SILVA, Joshua SV et al. ASPEN consensus recommendations for refeeding syndrome. Nutrition in Clinical Practice, v. 35, n. 2, p. 178-195, 2020.

    2. SCHNITKER, MAURICE A.; MATTMAN, PAUL E.; BLISS, THEODORE L. A clinical study of malnutrition in Japanese prisoners of war. Annals of internal medicine, v. 35, n. 1, p. 69-96, 1951.

    3. AHMED, Sameh; TRAVIS, Jane; MEHANNA, Hisham. Re-feeding syndrome in head and neck–Prevention and management. Oral oncology, v. 47, n. 9, p. 792-796, 2011.

    4. KHAN, Laeeq UR et al. Refeeding syndrome: a literature review. Gastroenterology research and practice, v. 2011, 2010.

    5. GARBER, Andrea K. et al. Short-term outcomes of the study of refeeding to optimize inpatient gains for patients with anorexia nervosa: a multicenter randomized clinical trial. JAMA pediatrics, v. 175, n. 1, p. 19-27, 2021.

    6. REBER, Emilie et al. Management of refeeding syndrome in medical inpatients. Journal of clinical medicine, v. 8, n. 12, p. 2202, 2019.

    7. MEHANNA, Hisham M.; MOLEDINA, Jamil; TRAVIS, Jane. Refeeding syndrome: what it is, and how to prevent and treat it. Bmj, v. 336, n. 7659, p. 1495-1498, 2008.

    8. ORNSTEIN, Rollyn M. et al. Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring. Journal of adolescent health, v. 32, n. 1, p. 83-88, 2003.

  • - Quem deve fazer?

    - Até quando?

    - Como fazer?

    - O que fazer quando o resultado vem alterado?

    Rapha, Joanne e Iago respondem essas e outras perguntas! E ainda dão um bônus sobre as síndromes familiares, Polipose Adenomatosa Familiar (PAF) e Síndrome de Lynch

    Referências:

    1- Screening for colorectal cancer: Strategies in patients at average risk. Uptodate Agosto 2021. Author:Chyke Doubeni, MD, FRCS, MPHSection Editors:Joann G Elmore, MD, MPHJ Thomas Lamont, MDDeputy Editor:Jane Givens, MD

    2- USPSTF Recommendation: Screening for Colorectal Cancer. Entrevista do Jama, disponível em https://edhub.ama-assn.org/jn-learning/audio-player/18612046

    3- DAVIDSON, Karina W. et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, v. 325, n. 19, p. 1965-1977, 2021.

    4- NEE, Judy; CHIPPENDALE, Ryan Z.; FEUERSTEIN, Joseph D. Screening for colon cancer in older adults: risks, benefits, and when to stop. In: Mayo Clinic Proceedings. Elsevier, 2020. p. 184-196.

    5- http://cancerscreening.eprognosis.org/

    6- Shaukat et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021, The American Journal of Gastroenterology, vol. 116, n. 3 - p. 458-479, March 2021.

    7- SYNGAL, Sapna et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. The American journal of gastroenterology, v. 110, n. 2, p. 223, 2015.

    8- Daniel C Chung, Linda H Rodgers. Familial adenomatous polyposis: Screening andmanagement of patients and families; Acesso em uptodate.com em setembro/2021

    9- Michael J Hall. Lynch syndrome (hereditary nonpolyposis colorectalcancer): Cancer screening and management. Acesso em uptodate.com em setembro/2021

    10- Finlay A Macrae. Overview of colon polyps; Acesso em uptodate.com em setembro/2021

  • Joanne e João recebem o dr. Júlio César para falar sobre um tema super importante: racismo e saúde da população negra! Qual o impacto do racismo na população e no sistema de saúde? Por quais vetores o racismo se expressa? Quais estratégias para reduzir esse problema? Isso e muito mais nesse episódio!

    LINK PARA O TESTE DE ASSOCIAÇÃO IMPLÍCITA
    https://implicit.harvard.edu/implicit/takeatest.html

    REFERÊNCIAS:
    1. DEVINE, Patricia G. et al. Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. Journal of experimental social psychology, v. 48, n. 6, p. 1267-1278, 2012.
    2. CUNNINGHAM, William A.; PREACHER, Kristopher J.; BANAJI, Mahzarin R. Implicit attitude measures: Consistency, stability, and convergent validity. Psychological science, v. 12, n. 2, p. 163-170, 2001.
    3. GREEN, Alexander R. et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of general internal medicine, v. 22, n. 9, p. 1231-1238, 2007.
    4. COOPER, Lisa A. et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American journal of public health, v. 102, n. 5, p. 979-987, 2012.
    5. DASGUPTA, Nilanjana; GREENWALD, Anthony G. On the malleability of automatic attitudes: combating automatic prejudice with images of admired and disliked individuals. Journal of personality and social psychology, v. 81, n. 5, p. 800, 2001.
    6. Brasil. Ministério da Saúde (MS). Política Nacional de Saúde Integral da População Negra: Uma Politica do SUS. 3a edição. Brasília: MS; 2017
    7. EVANS, Michele K. et al. Diagnosing and treating systemic racism. 2020.
    8. BAILEY, Zinzi D.; FELDMAN, Justin M.; BASSETT, Mary T. How structural racism works—racist policies as a root cause of US racial health inequities. 2021.
    9. PALLOK, Kristen; DE MAIO, Fernando; ANSELL, David A. Structural racism—a 60-year-old black woman with breast cancer. New England Journal of Medicine, v. 380, n. 16, p. 1489-1493, 2019.
    10. MAIN, Elliott K. et al. Reduction in racial disparities in severe maternal morbidity from hemorrhage in a large-scale quality improvement collaborative. American journal of obstetrics and gynecology, v. 223, n. 1, p. 123. e1-123. e14, 2020.
    11. WHITTLE, Jeff et al. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. New England Journal of Medicine, v. 329, n. 9, p. 621-627, 1993.
    12. TEAL, Cayla R. et al. Helping medical learners recognise and manage unconscious bias toward certain patient groups. Medical education, v. 46, n. 1, p. 80-88, 2012.

  • Mais um bolus! Pedro e João vieram dessa vez para falar de como é feito o diagnóstico de artrite reumatoide e assim conhecendo um pouco mais sobre a doença. 

    Smolen, J. S. et al. Rheumatoid arthritis. Nat. Rev. Dis. Primers 4, 18001 (2018)

    AGGARWAL, Rohit et al. Distinctions between diagnostic and classification criteria?. Arthritis care & research, v. 67, n. 7, p. 891, 2015.

    Verpoort KN, van Dongen H, Allaart CF, et al. Undifferentiated arthritis—disease course assessed in several inception cohorts. Clin Exp Rheumatol 2004;22: S12–17.

    WEVERS-DE BOER, K. V. C. et al. Drug therapy in undifferentiated arthritis: a systematic literature review. Annals of the rheumatic diseases, v. 72, n. 9, p. 1436-1444, 2013.

    VENABLES, P.; MAINI, Ravinder N. Diagnosis and differential diagnosis of rheumatoid arthritis. UpToDate2012, 2014.

  • Iago e Pedro discutem um caso de Plaquetopenia apresentado pelo Fred! Como confirmar a plaquetopenia? O que pedir de exame? Tudo isso nesse episódio! 

    Referências 

    Thachil J, Fitzmaurice D. Thrombocytopenia in an adult. Bmj. 2013 Jun 10;346.

    Bradbury C, Murray J. Investigating an incidental finding of thrombocytopenia. BMJ. 2013 Jan 11;346.

    Stasi R. How to approach thrombocytopenia. Hematology 2010, the American Society of Hematology Education Program Book. 2012 Dec 8;2012(1):191-7.

    Swain F, Bird R. How I approach new onset thrombocytopenia. Platelets. 2020 Apr 2;31(3):285-90.

    Donald M Arnold, MD, MSc, Adam Cuker, MD, MS. Diagnostic approach to the adult with unexplained thrombocytopenia. uptodate.com acesso em agosto/2021

    GAUER, Robert; BRAUN, Michael M. Thrombocytopenia. American family physician, v. 85, n. 6, p. 612-622, 2012.

    COOPER, Nichola; GHANIMA, Waleed. Immune thrombocytopenia. New England Journal of Medicine, v. 381, n. 10, p. 945-955, 2019.

    GREINACHER, Andreas. Heparin-induced thrombocytopenia. New England Journal of Medicine, v. 373, n. 3, p. 252-261, 2015.

    TAN, Geok Chin et al. Pseudothrombocytopenia due to platelet clumping: a case report and brief review of the literature. Case reports in hematology, v. 2016, 2016.

    ARNOLD, Donald M.; CUKER, Adam; KUNINS, Lisa. Diagnostic approach to the adult with unexplained thrombocytopenia.

  • Kaue e Raíza discutem um caso de monoartrite aguda apresentado pelo Iago. Quais as causas mais importantes no pronto-socorro? Como iniciar a investigação? O que pedir no líquido sinovial? 

    Referências: 

    1) Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007;297(13):1478-1488 

    2) Sack K. Monarthritis: differential diagnosis. Am J Med 1997; 102:30S. 

    3) Mohana-Borges AV, Chung CB, Resnick D. Monoarticular arthritis. Radiol Clin North Am 2004; 42:135. 

    4) Shmerling RH, Delbanco TL, Tosteson AN, Trentham DE. Synovial fluid tests. What should be ordered? JAMA 1990; 264:1009. 

    5) McCutchan HJ, Fisher RC. Synovial leukocytosis in infectious arthritis. Clin Orthop Relat Res 1990; :226. 

    6) Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. 2003 Jul 1;68(1):83-90. PMID: 12887114. 

    7) Becker JA, Daily JP, Pohlgeers KM. Acute Monoarthritis: Diagnosis in Adults. Am Fam Physician. 2016 Nov 15;94(10):810-816. PMID: 27929277. 

    8) Jeong H, Kim AY, Yoon HJ, et al. Clinical courses and predictors of outcomes in patients with monoarthritis: a retrospective study of 171 cases. Int J Rheum Dis. 2014;17(5):502–510. 

    9) Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: what is the cause of my patient's painful swollen joint? CMAJ. 2009;180(1):59–65. 

    10) Baker DG, Schumacher HR Jr. Acute monoarthritis. N Engl J Med. 1993;329(14):1013–1020. 

    11) Kienhorst LB, Janssens HJ, Fransen J, Janssen M; British Society for Rheumatology. The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. Rheumatology (Oxford). 2015;54(4):609–614. 

    12) Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003;17(2):201–208.

    13) Davis, Benjamin T., and Mark S. Pasternack. "Case 19-2007: A 19-Year-Old College Student with Fever and Joint Pain." New England Journal of Medicine 356.25 (2007): 2631-2637.

  • Joanne e Bernardo discutem sobre as diferenças entre BNP e NT-proBNP, uso na prática clínica e mais! Ouça mais um TdC em bolus! Referências
    UpToDate: Natriuretic peptide measurement in heart failure
    UpToDate: Natriuretic peptide measurement in non-heart failure settings
    Yancy CW, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation [Internet]. 2017 Aug 8;136(6):e137–61.
    Yancy CW, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. Circulation [Internet]. 2013 Oct 15;128(16):e240–327.

  • Rapha, Raíssa e João conversam sobre Osteoporose! Como diagnosticar? Qual é o manejo correto?
    Referências: 1- Overview of the management of osteoporosis in postmenopausal women. Uptodate 2021. Harold N Rosen, Marc K Drezner, Clifford J Rosen, Kenneth E Schmader, Jean E Mulder. 2- EASTELL, Richard et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, v. 104, n. 5, p. 1595-1622, 2019. 3- CAMACHO, Pauline M. et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2020 update. Endocrine Practice, v. 26, p. 1-46, 2020. 4- KANIS, John A. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis international, v. 30, n. 1, p. 3-44, 2019. 5- BLACK, DM; et al. Postmenopausal Osteoporosis. NEJM, 2016 6- SHANE, E; et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research, JBMR, Vol. 29, Nº1, 2014. 7- PEREZ, AD; et al. Treatment failure in osteoporosis, Osteoporos Int, 2012. 8- ADLER, RA; et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. JBMR, Vol. 31, Nº 1, 2016. 9- - BLACK, DM; et al. Postmenopausal Osteoporosis. NEJM, 2016 - AACE/ACE Clinical Practice Guidelines for the diagnosis and Treatment of Postmenopausal Osteoporosis - 2020 Update. 10- - SHANE, E; et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research, JBMR, Vol. 29, Nº1, 2014. 11- PEREZ, AD; et al. Treatment failure in osteoporosis, Osteoporos Int, 2012. 12- ADLER, RA; et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. JBMR, Vol. 31, Nº 1, 2016.

    Minutagem

    (1:40) Divisão do episódio

    (2:18) Caso clínico

    (3:00)Abordagem inicial

    (4:20) Definição - critérios diagnósticos

    (9:15) Densitometria óssea

    (14:03) FRAX

    (20:00) Voltando ao caso

    (21:25) Rastreio

    (25:40) Caso Clínico 2

    (32:40) Avaliação laboratorial

    (35:00) Tratamento e suplementação

    (39:30) Tratamento farmacológico

    (47:15) Reações adversas

    (51:00) Contraindicações

    (51:55) Relacionando com os casos

    (56:00) Terapia anabólico

    (59:56) Até quando usar os medicamentos?

    (1:03:22) Falha de tratamento

    (1:05:43) Salves

    (1:07:53) Respost do desafio da semana anterior

    (1:08:50) Desafio da semana

  • Pedro, Joanne e Fred discutem as novidades sobre COVID-19, em especial sobre a variante delta, os novos tratamentos aprovados e os efeitos colaterais de vacina. Esse episódio foi em parceria com o Whitebook! Acesse o aplicativo que te ajuda de forma rápida com informação de confiança na hora que você mais precisa! Clique no link para descobrir mais https://tinyurl.com/TdC-Whitebook e use o cupom CLINICAGEM para 30 dias grátis!  Minutagem (2:10) Parceria com Whitebook (3:45) Variantes do covid (7:30) Variante delta (8:40) Sintomas da variante (10:45) Transmissibilidade (12:15) Vacina e a variante (16:20) Novos tratamentos (23:59) Inibidores da JAK (25:20) Corticoides (29:40) Anticorpos monoclonais (32:40) Reações vacinais (43:23) Resposta do desafio da semana anterior (44:23) Desafio da semana (45:16) Salves Referências em breve. 

    Referências: 

    Pinzón, Miguel Alejandro, et al. "Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia." PloS one 16.5 (2021): e0252057. 

    Ranjbar, Keivan, et al. "Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial." BMC infectious diseases 21.1 (2021): 1-8. 

    Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial.

    Guimarães, Patrícia O., et al. "Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia." New England Journal of Medicine (2021). 

    Kalil, Andre C., et al. "Baricitinib plus remdesivir for hospitalized adults with Covid-19." New England Journal of Medicine 384.9 (2021): 795-807. 

    ALLEN, Hester et al. Increased household transmission of COVID-19 cases associated with SARS-CoV-2 Variant of Concern B. 1.617. 2: a national casecontrol study. Public Health England, 2021.

    https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

    https://covid.joinzoe.com/post/new-top-5-covid-symptoms

  • Kaue e Pedro discutem um caso de febre na UTI trazido pelo Fred. Como começo a investigação? Peço culturas sempre? Como pegar informações sem o paciente se comunicar? Esse episódio foi em parceria com o Whitebook! Acesse o aplicativo que te ajuda de forma rápida com informação de confiança na hora que você mais precisa! Clique no link para descobrir mais https://tinyurl.com/TdC-Whitebook e use o cupom CLINICAGEM para 30 dias grátis! Minutagem (1:33) Parceria com Whitebook (4:00) início do Caso clínico (6:20) Organização do caso (10:30) Febre x hipertermia (13:25) Abordagem inicial ao paciente (13:46) Exame físico (18:55) O que falar da equipe de enfermagem (20:40) Abordagem com fisioterapia (21:15) Usg à beira leito (24:05) Continuação do caso (25:26) Quais exames solicitar (25:55) Culturas (33:00) Exame de imagem (34:25) PCR e Procalcitonina (35:50) Febre e Prescrição (37:46) Continuação do caso (41:00) Raciocínio clínico (45:50) Finalização do caso e comentários (51:50) Resposta do desafio da semana anterior (53:00) Desafio da semana (53:24) Salves

    Referências

    1. O’GRADY, Naomi P. et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Critical care medicine, v. 36, n. 4, p. 1330-1349, 2008.

    2. REHMAN, Tayyab; DEBOISBLANC, Bennett P. Persistent fever in the ICU. Chest, v. 145, n. 1, p. 158-165, 2014.

    3. KULLBERG, Bart Jan; ARENDRUP, Maiken C. Invasive candidiasis. New England Journal of Medicine, v. 373, n. 15, p. 1445-1456, 2015.

    4. PAPPAS, Peter G. et al. Invasive candidiasis. Nature Reviews Disease Primers, v. 4, n. 1, p. 1-20, 2018.

    5. NIVEN, Daniel J.; LAUPLAND, Kevin B. Pyrexia: aetiology in the ICU. Critical Care, v. 20, n. 1, p. 1-9, 2016.

    6. Jonathan Ryder, MD no Twitter: "1/ "Does DVT/PE cause fever?" 🌡️🤒🌡️🤒🌡️ This #Tweetorial was inspired by a recent @DxRxEdu thread. So I did a deep dive into the evidence behind this dogma and also asked, "if so, how?" https://t.co/QVZ0GNmQBz" / Twitter

    7. VAN ZANTEN, Arthur RH et al. Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients. Critical Care, v. 9, n. 5, p. 1-8, 2005.

  • Rapha e Pedro em uma conversa rápida sobre benzodiazepínicos! Por que devem ser evitados? Como fazer o desmame? Ouça agora mais um TdC em Bolus!Referências:1- POTTIE, Kevin et al. Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline. Canadian Family Physician, v. 64, n. 5, p. 339-351, 2018.2- CROKE, Lisa M. Deprescribing benzodiazepine receptor agonists for insomnia in adults. American family physician, v. 99, n. 1, p. 57-58, 2019.3- POLLMANN, André S. et al. Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review. BMC pharmacology and toxicology, v. 16, n. 1, p. 1-12, 2015.4- NG, Brendan J.; LE COUTEUR, David G.; HILMER, Sarah N. Deprescribing benzodiazepines in older patients: impact of interventions targeting physicians, pharmacists, and patients. Drugs & aging, v. 35, n. 6, p. 493-521, 2018.5- SOYKA, Michael. Treatment of benzodiazepine dependence. New England Journal of Medicine, v. 376, n. 12, p. 1147-1157, 2017.6- Mugunthan K, McGuire T, Glasziou P. Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis. Br J Gen Pract. 2011;61(590):e573–8.

  • Pedro e Kaue chamaram José Marcos e o novo colaborador João Urbano para discutir um caso de primeiro episódio convulsivo! Qual exame pedir? O que coletar na história? Tudo isso no episódio de hoje.

    Esse episódio foi em parceria com o Whitebook! Acesse o aplicativo que te ajuda de forma rápida com informação de confiança na hora que você mais precisa! Clique no link para descobrir mais https://tinyurl.com/TdC-Whitebook e use o cupom CLINICAGEM para 30 dias grátis! Minutagem em breve.

    Minutagem e Referências em breve. 

    ASADI, Payman et al. Prevalence of tramadol consumption in first seizure patients; A one-year cross-sectional study. Emergency, v. 3, n. 4, p. 159, 2015.

    SMITH, Phil EM. Initial Management of Seizure in Adults. New England Journal of Medicine, v. 385, n. 3, p. 251-263, 2021.

    SCHACHTER, Steven C. Evaluation and management of the first seizure in adults. Disponible en: https://www. uptodate. com/contents/evaluation-and-management-of-the-first-seizure-in-adults? search= primera% 20crisis, 2018.

    KRUMHOLZ, Allan et al. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the guideline development subcommittee of the American academy of neurology and the american epilepsy society: evidence-based guideline. Epilepsy currents, v. 15, n. 3, p. 144-152, 2015.

    GAVVALA, Jay R.; SCHUELE, Stephan U. New-onset seizure in adults and adolescents: a review. Jama, v. 316, n. 24, p. 2657-2668, 2016.

    DEVINSKY, Orrin; GAZZOLA, Deana; LAFRANCE JR, W. Curt. Differentiating between nonepileptic and epileptic seizures. Nature Reviews Neurology, v. 7, n. 4, p. 210, 2011.

    BEGHI, Ettore et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia, v. 51, n. 4, p. 671-675, 2010.

  • Rapha, João e Fred discutem sobre três aspectos da dengue: em quem pensar? Como diagnosticar? Como tratar? Esse episódio foi em parceria com o Whitebook! Acesse o aplicativo que te ajuda de forma rápida com informação de confiança na hora que você mais precisa! Clique no link para descobrir mais https://tinyurl.com/TdC-Whitebook e use o cupom CLINICAGEM para 30 dias grátis! 

    Minutagem 

    (0:35) Parceria com Whitebook

    (3:35) Quando pensar na dengue

    (6:00) Epidemiologia da dengue

    (7:35) Clínica da Dengue

    (11:40) Definição de caso suspeito

    (15:35) Manifestações atípicas

    (17:46) COVID e Dengue

    (19:45) Alguns diagnósticos diferenciais

    (23:00) Exames gerais

    (27:30) Prova do laço

    (33:10) Exames específicos

    (38:30) Estratificação do paciente

    (45:40) Conduta de acordo com estratificação

    (49:50) Grupo A

    (53:08) Grupo B

    (56:00) GrupoC/D

    (57:20) Outras condutas

    (1:04:32) Salves

    (1:05:45) Resposta do desafio da semana anterior

    (1:06:30) Desafio da semana

     Referências: 1- Dengue - Diagnóstico e Manejo Clínico, adulto e criança. Ministério da Saúde. 2016. 2- JOUBERT, Antoine et al. Distinguishing non severe cases of dengue from COVID-19 in the context of co-epidemics: a cohort study in a SARS-CoV-2 testing center on Reunion island. PLoS neglected tropical diseases, v. 15, n. 4, p. e0008879, 2021. 3- ZENG, Zhilin et al. Global, regional, and national dengue burden from 1990 to 2017: A systematic analysis based on the global burden of disease study 2017. EClinicalMedicine, v. 32, p. 100712, 2021. 4- MASYENI, Sri et al. Serological cross-reaction and coinfection of dengue and COVID-19 in Asia: Experience from Indonesia. International Journal of Infectious Diseases, v. 102, p. 152-154, 2021. 5- Wilder-Smith, A., & Schwartz, E. (2005). Dengue in Travelers. New England Journal of Medicine, 353(9), 924–932. 6-NG, W. Y. et al. Atypical presentation of dengue infection among elderly: A retrospective cohort study. International Journal of Infectious Diseases, v. 101, p. 500, 2020. 7- ASHBURN, Percy Moreau; CARAIG, Charles F. Experimental investigations regarding the etiology of dengue fever. The Journal of infectious diseases, p. 440-475, 1907.