Ta de Clinicagem

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Fred, Pedro e Raíza discutem sobre nódulo pulmonar! Confira o Resumo Visual do episódio no nosso canal no YouTube: https://youtu.be/m0wuZIq00GE Referências:1. Albert, R. H., & Russell, J. J. (2009). Evaluation of the solitary pulmonary nodule. American family physician, 80(8), 827-831.2. Mazzone, Peter J., and Louis Lam. "Evaluating the patient with a pulmonary nodule: a review." JAMA 327.3 (2022): 264-273.3. McWilliams, Annette, et al. "Probability of cancer in pulmonary nodules detected on first screening CT." New England Journal of Medicine 369.10 (2013): 910-919.4. Balekian, Alex A., et al. "Accuracy of clinicians and models for estimating the probability that a pulmonary nodule is malignant." Annals of the American Thoracic Society 10.6 (2013): 629-635.5. Gould, Michael K., et al. "Evaluation of individuals with pulmonary nodules: When is it lung cancer?: Diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines." Chest 143.5 (2013): e93S-e120S.6. Chung, Kaman, et al. "Brock malignancy risk calculator for pulmonary nodules: validation outside a lung cancer screening population." Thorax 73.9 (2018): 857-863.7. Melo, Cromwell Barbosa de Carvalho, et al. "Análise e validação de modelos probabilísticos de malignidade de nódulo pulmonar solitário em uma população no Brasil." Jornal Brasileiro de Pneumologia 38 (2012): 559-565.8. https://www.acr.org/-/media/ACR/Files/RADS/Lung-RADS/LungRADS_AssessmentCategories.pdf?la=en9. MacMahon, Heber, et al. "Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society." Radiology 237.2 (2005): 395-400

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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-36HmMReferências: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.2015.04.0112. 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.2017.12.0243. 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.2015.04.0104. 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:10.4065/82.11.13296. 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.2003.0127658. 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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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. 6. 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. 7. Parks NE. Metabolic and Toxic Myelopathies. Continuum (Minneap Minn). 2021 Feb 1;27(1):143-162.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Pedro, Fred e Amyr discutem sobre a punção do líquido pleural e os exames de análise do líquido pleural. Referências:1. Feller-Kopman, D., & Light, R. (2018). Pleural disease. New England Journal of Medicine, 378(8), 740-751.2. Bhatnagar, R., & Maskell, N. (2015). The modern diagnosis and management of pleural effusions. bmj, 351.3. 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-e2120306.4. Maskell, N. (2010). British thoracic society pleural disease guidelines-2010 update. Thorax, 65(8), 667-669.5. Light, R. W. (1995). A new classification of parapneumonic effusions and empyema. Chest, 108(2), 299-301.6. Jany, B., & Welte, T. (2019). Pleural effusion in adults—etiology, diagnosis, and treatment. Deutsches Ärzteblatt International, 116(21), 377.7. 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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨 🔴 Junte-se aos mais de 1.000 assinantes. Assine o Guia, ganhe tempo e atualize-se sem esforço. 🟠 Um serviço de revisão e atualização continuados em clínica médica. A informação que você precisa, do jeito que você prefere. 📚 Confira agora mesmo a edição aberta do Guia TdC sobre a Nova Diretriz de Hiperglicemia no Paciente Internado: https://www.tadeclinicagem.com.br/guia/edition/revisao-2 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

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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? 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

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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 1. Gumz ML, Rabinowitz L, Wingo CS. An integrated view of potassium homeostasis. N Engl J Med. 2015;373:60-72. 2. Palmer BF. Regulation of potassium homeostasis. Clin J Am Soc Nephrol. 2015; 10: 1050-1060 3. 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. 4. VIERA, Anthony J.; WOUK, Noah. Potassium disorders: hypokalemia and hyperkalemia. American family physician, v. 92, n. 6, p. 487-495, 2015. 5. GRAMS, Morgan E.; HOENIG, Melanie P.; HOORN, Ewout J. Evaluation of hypokalemia. Jama, v. 325, n. 12, p. 1216-1217, 2021. 6. 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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.br Referências: 1. Guia de Vigilância Epidemiológica Emergência de Saúde Pública de Importância Nacional pela Doença pelo Coronavírus 2019 (Ministério da Saúde, janeiro de 2022) 2. Uptodate Jan 2022. COVID-19: Vaccines. Kathryn M Edwards,Walter A Orenstein, Martin S Hirsch, Allyson Bloom, MD. 3. 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, 2022.4. 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. 5. 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. 6. MMWR. Morbidity and Mortality Weekly Report, v. 71, 2022. 7. 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. 8. NEMET, Ital et al. Third BNT162b2 vaccination neutralization of SARS-CoV-2 Omicron infection. New England Journal of Medicine, 2021. 9. SIGAL, Alex. Milder disease with Omicron: is it the virus or the pre-existing immunity?. Nature Reviews Immunology, p. 1-3, 2022. 10. 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. 11. GOTTLIEB, Robert L. et al. Early remdesivir to prevent progression to severe Covid-19 in outpatients. New England Journal of Medicine, 2021. 12. KAWANO-DOURADO, Leticia; ROCHWERG, Bram. Therapeutics and COVID-19: living guideline. 2021. 13. https://www.gov.br/anvisa/pt-br/assuntos/paf/coronavirus/medicamentos (acesso em 27/01/2022) 14. CAO, Yunlong Richard et al. B. 1.1. 529 escapes the majority of SARS-CoV-2 neutralizing antibodies of diverse epitopes. BioRxiv, 2021. 15. 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. 16. 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. 17. JAYK BERNAL, Angélica et al. Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients. New England Journal of Medicine, 2021. 18. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-additional-phase-23-study-results 19. Rhee, 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). 20. 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).

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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:1. 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. 2. 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.3. Uptodate 2021. Glomerular disease: Evaluation and differential diagnosis in adults. Jai Radhakrishnan, Richard J Glassock, Brad H Rovin, Albert Q Lam.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.Referências1. 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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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:1. Nasa, Prashant, et al. "Euglycemic diabetic ketoacidosis: A missed diagnosis." World journal of diabetes 12.5 (2021): 514. 2. Kapoor, Dheeraj, Meghana Srivastava, and Pritam Singh. "Point of care blood gases with electrolytes and lactates in adult emergencies." International journal of critical illness and injury science 4.3 (2014): 216. 3. Gupta, Shalini, et al. "Are sodium and potassium results on arterial blood gas analyzer equivalent to those on electrolyte analyzer?." Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine 20.4 (2016): 233.4. The Management of Diabetic Ketoacidosis in Adults Revised June 2021. Joint British Diabetes Society. https://abcd.care/resource/jbds-02-management-diabetic-ketoacidosis-adults

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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:1. Tringali, Alberto, et al. "Comparing intravenous and oral proton pump inhibitor therapy for bleeding peptic ulcers following endoscopic management: a systematic review and meta‐analysis." British Journal of Clinical Pharmacology 83.8 (2017): 1619-1635. 2. Stanley, Adrian J., and Loren Laine. "Management of acute upper gastrointestinal bleeding." Bmj 364 (2019). 3. Laine, Loren, et al. "ACG clinical guideline: upper gastrointestinal and ulcer bleeding." Official journal of the American College of Gastroenterology| ACG 116.5 (2021): 899-917. 4. Srygley, F. Douglas, et al. "Does this patient have a severe upper gastrointestinal bleed?." Jama 307.10 (2012): 1072-1079. 5. Siau, Keith, et al. "British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding." Frontline gastroenterology 11.4 (2020): 311-323. 6. Guo, Cosmos LT, et al. "Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study." Gut 71.8 (2022): 1544-1550. 7. Ioannou, George N., Jenny Doust, and Don C. Rockey. "Terlipressin for acute esophageal variceal hemorrhage." Cochrane Database of Systematic Reviews 1 (2003). 8. Kim, Bong Sik Matthew, et al. "Diagnosis of gastrointestinal bleeding: A practical guide for clinicians." World journal of gastrointestinal pathophysiology 5.4 (2014): 467. 9. Chavez‐Tapia, Norberto C., et al. "Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding." Cochrane Database of Systematic Reviews 9 (2010).10. Villanueva, Càndid, et al. "Transfusion strategies for acute upper gastrointestinal bleeding." New England Journal of Medicine 368.1 (2013): 11-21.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨 🔴 Junte-se aos mais de 1.000 assinantes. Assine o Guia, ganhe tempo e atualize-se sem esforço. 🟠 Um serviço de revisão e atualização continuados em clínica médica. A informação que você precisa, do jeito que você prefere. 📚 Confira agora mesmo a edição aberta do Guia TdC sobre a Nova Diretriz de Hiperglicemia no Paciente Internado: https://www.tadeclinicagem.com.br/guia/edition/revisao-2 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).

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Fred, Rapha e Iago comentam 3 casos de Asma no Pronto Socorro:1. Uma paciente com exacerbação leve/moderada2. Um paciente com exacerbação grave3. Um paciente com risco iminente de vidaReferências: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).

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨João, Raphael e Marcela Belleza trazem quatro clinicagens importantes sobre um remédio muito comum da nossa prática médica: os opioides. Como prescrever? Quais efeitos adversos são comuns e como tratar? Como é a intoxicação por opioide? Como usar essa classe na dispneia e na tosse? Escala RIOSORD de risco de intoxicação por opioideshttps://paindr.com/wp-content/uploads/2015/09/RIOSORD-tool.pdfReferências:1. Uptodate Dez 2021. Prevention and management of side effects in patients receiving opioids for chronic pain. Russell K Portenoy,Zankhana Mehta, Ebtesam Ahmed, Janet Abrahm, Diane MF Savarese2. TASSINARI, Davide et al. Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine: a meta-analysis and systematic review of the literature. Journal of palliative medicine, v. 11, n. 3, p. 492-501, 20083. Uptodate Nov 2021. Approach to symptom assessment in palliative care. Victor T Chang, Thomas J Smith, Jane Givens4. Manual de Cuidados Paliativos - Ministério da Saúde. 2020.5. Uptodate 2021. Assessment and management of dyspnea in palliative care. Deborah Dudgeon, Eduardo Bruera, Jane Givens,Helen Hollingsworth.6. JOHNSON, Miriam J.; CURROW, David C. Opioids for breathlessness: a narrative review. BMJ supportive & palliative care, v. 10, n. 3, p. 287-295, 2020.7. Palliative care: Overview of cough, stridor, and hemoptysis in adults. Charles von Gunten, Gary Buckholz, Eduardo Bruera, Jane Givens.8. MOLASSIOTIS, Alex et al. Interventions for cough in cancer. Cochrane Database of Systematic Reviews, n. 5, 2015. 9-YANCY JR, William S. et al. Efficacy and tolerability of treatments for chronic cough: a systematic review and meta-analysis. Chest, v. 144, n. 6, p. 1827-1838, 2013.9. YANCY JR, William S. et al. Efficacy and tolerability of treatments for chronic cough: a systematic review and meta-analysis. Chest, v. 144, n. 6, p. 1827-1838, 2013.10. Caraceni A, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. European Palliative Care Research Collaborative (EPCRC), on behalf of the European Association for Palliative Care (EAPC) - Lancet Oncol 2012; 13: e58–68 www.thelancet.com/oncology Vol 13 February 201211. Jost L, Rolia F. Management of cancer pain: ESMO Clinical Recommendations. Annals of Oncology Volume 19, Supplement 2, May 2008, Pages ii119-ii12112. Zeppetella, Giovambattista Impact and management of breakthrough pain in cancer, Current Opinion in Supportive and Palliative Care: March 2009 - Volume 3 - Issue 1 - p 1-6 doi: 10.1097/SPC.0b013e328326065813. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e114. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline Judith A. Paice, Russell Portenoy, Christina Lacchetti, Toby Campbell, Andrea Cheville, Marc Citron, Louis S. Constine, Andrea Cooper, Paul Glare, Frank Keefe, Lakshmi Koyyalagunta, Michael Levy, Christine Miaskowski, Shirley Otis-Green, Paul Sloan, and Eduardo Bruera Journal of Clinical Oncology 2016 34:27, 3325-334515. BABU, Kavita M.; BRENT, Jeffrey; JUURLINK, David N. Prevention of opioid overdose. New England Journal of Medicine, v. 380, n. 23, p. 2246-2255, 2019.16. Osler, W. "Oedema of left lung-morphia poisoning." Montreal Gen Hosp Rep 1 (1880): 291

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Guilherme, Joanne e Kaue debatem sobre o manejo de taquiarritmias. Abordamos alguns conceitos de eletrocardiograma, conversamos sobre o passo a passo da avaliação de taquiarritmias com QRS estreito e largo, além de cardioversão elétrica e as drogas possíveis. Esse episódio foi em parceria com o Whitebook Referências: 1. Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020; 41:655. 2. Kalbfleisch SJ, el-Atassi R, Calkins H, et al. Differentiation of paroxysmal narrow QRS complex tachycardias using the 12-lead electrocardiogram. J Am Coll Cardiol 1993; 21:85. 3. Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation 1991; 83:1649.4. Vereckei A, Duray G, Szénási G, et al. Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. Eur Heart J 2007; 28:589.5. Kaiser E, Darrieux FC, Barbosa SA, et al. Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms. Europace 2015; 17:1422. 6. Ganz LI, Friedman PL. Supraventricular tachycardia. N Engl J Med 1995; 332:162. 7. Katritsis DG, Josephson ME. Differential diagnosis of regular, narrow-QRS tachycardias. Heart Rhythm 2015; 12:1667. 8. Link MS. Clinical practice. Evaluation and initial treatment of supraventricular tachycardia. N Engl J Med 2012; 367:1438. 9. Smith GD, Dyson K, Taylor D, et al. Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia. Cochrane Database Syst Rev 2013; :CD009502. 10. Appelboam A et al. Postural Modification to the Standard Valsalva Manoeuvre for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomised Controlled Trial. Lancet 2015.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Pedro e Raphael convidam o Victor Delia para falar sobre Pancreatite Aguda: Como diagnosticar? Como fazer a expansão volêmica? Como progredir a dieta? Quais etiologias pensar? Tudo isso aqui nesse episódio! Esse episódio foi em parceria com o Whitebook.Referências: 1. Management of acute pancreatitis. Uptodate Nov 2021 Santhi Swaroop Vege, David C Whitcomb, Shilpa Grover. 2. LEPPÄNIEMI, Ari et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World journal of emergency surgery, v. 14, n. 1, p. 1-20, 2019. 3. CROCKETT, Seth D. et al. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology, v. 154, n. 4, p. 1096-1101, 2018. 4. CROCKETT, Seth D. et al. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology, v. 154, n. 4, p. 1096-1101, 2018. 5. HELM, J. F. et al. Effects of morphine on the human sphincter of Oddi. Gut, v. 29, n. 10, p. 1402-1407, 1988. 6. ONA, Xavier Basurto; COMAS, David Rigau; URRÚTIA, Gerard. Opioids for acute pancreatitis pain. Cochrane Database of Systematic Reviews, n. 7, 2013. 7. ONA, Xavier Basurto; COMAS, David Rigau; URRÚTIA, Gerard. Opioids for acute pancreatitis pain. Cochrane Database of Systematic Reviews, n. 7, 2013. 8. ONA, Xavier Basurto; COMAS, David Rigau; URRÚTIA, Gerard. Opioids for acute pancreatitis pain. Cochrane Database of Systematic Reviews, n. 7, 2013. 9. CHOOSAKUL, Sararak et al. Comparison of normal saline versus Lactated Ringer's solution for fluid resuscitation in patients with mild acute pancreatitis, A randomized controlled trial. Pancreatology, v. 18, n. 5, p. 507-512, 2018. 10. LEE, Alice et al. Lactated ringers vs normal saline resuscitation for mild acute pancreatitis: a randomized trial. Gastroenterology, v. 160, n. 3, p. 955-957. e4, 2021. 11. MEDEROS, Michael A.; REBER, Howard A.; GIRGIS, Mark D. Acute pancreatitis: a review. JAMA, v. 325, n. 4, p. 382-390, 2021. 12-

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Kaue, Fred e José Marcos discutem um caso de paciente com HIV e cefaleia, desde abordagem inicial até os exames.Referências:1. Ho, Emily L., and Christina M. Marra. "Treponemal Tests for Neurosyphilis–Less Accurate Than What We Thought?." Sexually transmitted diseases 39.4 (2012): 298.2. Harding, Alexander S., and Khalil G. Ghanem. "The performance of cerebrospinal fluid treponemal-specific antibody tests in neurosyphilis: a systematic review." Sexually transmitted diseases 39.4 (2012): 291-297.3. Saylor, Deanna. "Neurologic complications of tuberculosis." CONTINUUM: Lifelong Learning in Neurology 27.4 (2021): 992-1017.Grill, Marie F. "Neurologic complications of human immunodeficiency virus." CONTINUUM: Lifelong Learning in Neurology 27.4 (2021): 963-991.4. Koralnik, IJ Approach to the patient with HIV and central nervous system lesions. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.5. Gandhi, RT Toxoplasmosis in patients with HIV. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.

Como investigar um paciente com o achado de Ferritina elevada? Quais as principais causas dessa alteração e quais exames solicitar na investigação? Quando suspeitar de sobrecarga de ferro? Descubra isso e mais nesse episódio curtinho de 15 minutos Referências: 1) VanWagner LB, Green RM. Elevated serum ferritin. Jama. 2014 Aug 20;312(7):743-4. 2) Kelly AU, McSorley ST, Patel P, Talwar D. Interpreting iron studies. Bmj. 2017 Jun 15;357. 3) Koperdanova M, Cullis JO. Interpreting raised serum ferritin levels. BMJ, 351, h3692. 4) Cullis JO, Fitzsimons EJ, Griffiths WJ, Tsochatzis E, Thomas DW, British Society for Haematology. Investigation and management of a raised serum ferritin. British journal of haematology. 2018 May;181(3):331-40. 5) Fleming RE, Ponka P. Iron overload in human disease. New England Journal of Medicine. 2012 Jan 26;366(4):348-59. 6) Bacon RB, KwiatkowskiJL. Approach to the patient with suspected iron overload. Acesso em uptodate.com em outubro/2021

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Joanne, Kauê e Iago debatem sobre o manejo no PS da crise álgica aguda em pacientes com Anemia Falciforme. Além da conduta na analgesia, abordamos alguns diagnósticos diferenciais importantes e um guia para casos de dores refratárias e para a prescrição de analgesia domiciliar. Tem alguma dúvida ou sugestão? Mande mensagem no @tadeclinicagem no instagram ou twitter.Referências:1. Goddu, P. et al. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J GEN INTERN MED 33, 685–691 (2018).2. Haywood C Jr. et al. A video-intervention to improve clinician attitudes toward patients with sickle cell disease: the results of a randomized experiment. J Gen Intern Med. 2011 May;26(5):518-23. Epub 2010 Dec 23.3. Vichinsky E. Evaluation of acute pain in sickle cell disease. Acesso em uptodate.com em outubro/20214. DeBaun M. Acute vaso-occlusive pain management in sickle celldisease. Acesso em uptodate.com em outubro/20215. Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020;4(12):2656-2701.6. Sins JWR, Mager DJ, Davis SCAT, et al. Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review. Blood Adv 2017; 1:1598.7. Brookoff D, Polomano R. Treating sickle cell pain like cancer pain. Ann Intern Med 1992; 116:364.8. Smith WR, McClish DK, Dahman BA, et al. Daily home opioid use in adults with sickle cell disease: The PiSCES project. J Opioid Manag 2015; 11:243.9. van Beers EJ, van Tuijn CF, Nieuwkerk PT, et al. Patient-controlled analgesia versus continuous infusion of morphine during vaso-occlusive crisis in sickle cell disease, a randomized controlled trial. Am J Hematol 2007; 82:955.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Raphael e João recebem mais uma vez a Dra. Nathalie Santana, dessa vez para discutir o tratamento farmacológico da obesidade! Quais as indicações de tratamento farmacológico? Quais as opções on-label? Quais as diferenças de preço e potência das medicações? Isso e muito mais nesse episódio!Referências:1. Obesity in adults: Drug therapy Author:Leigh Perreault, MD Section Editor: F Xavier Pi-Sunyer, MD, MPH Deputy Editor: Lisa Kunins, MD2. ABESO - Diretrizes brasileiras de Obesidade 20163. SCHUTZ, Dominique Durrer et al. European practical and patient-centred guidelines for adult obesity management in primary care. Obesity facts, v. 12, n. 1, p. 40-66, 2019.4. VA/DoD Clinical Practice Guideline for the Management of Adult Overweight and Obesity5. AMERICAN DIABETES ASSOCIATION et al. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care, v. 44, n. Supplement 1, p. S15-S33, 2021.6. APOVIAN, Caroline M. et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, v. 100, n. 2, p. 342-362, 2015.7. WILDING, John PH et al. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 2021.8. JAMES, W. Philip T. et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. New England Journal of Medicine, v. 363, n. 10, p. 905-917, 2010.9. JAMES, W. Philip T. et al. Effect of sibutramine on weight maintenance after weight loss: a randomised trial. The Lancet, v. 356, n. 9248, p. 2119-2125, 2000.10. YEH, James S.; KUSHNER, Robert F.; SCHIFF, Gordon D. Obesity and management of weight loss. New England Journal of Medicine, v. 375, n. 12, p. 1187-1189, 2016.11. KAHAN, Scott; MANSON, JoAnn E. Obesity treatment, beyond the guidelines: practical suggestions for clinical practice. Jama, v. 321, n. 14, p. 1349-1350, 2019.12. MCALLISTER, Emily J. et al. Ten putative contributors to the obesity epidemic. Critical reviews in food science and nutrition, v. 49, n. 10, p. 868-913, 200913. GBD 2015 OBESITY COLLABORATORS. Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine, v. 377, n. 1, p. 13-27, 2017.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Joanne, Pedro e João trazem mais uma versão do Polêmicas do Sepse, logo depois da nova publicação do Surviving Sepsis! Nesse episódio mencionamos:1) Escolha e tempo de antibioticoterapia2) Qual solução para expansão volêmica e a quantidade necessária3) Qual droga vasoativa realizar e como fazerE por último, a indicação de bicarbonato na sepse! Referências:1. EVANS, Laura et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive care medicine, v. 47, n. 11, p. 1181-1247, 2021.2. WUTRICH, Yann et al. Early increase in arterial lactate concentration under epinephrine infusion is associated with a better prognosis during shock. Shock, v. 34, n. 1, p. 4-9, 2010.3. MAITLAND, Kathryn et al. Mortality after fluid bolus in African children with severe infection. New England Journal of Medicine, v. 364, n. 26, p. 2483-2495, 2011.4. CHURPEK, Matthew M. et al. Quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit. American journal of respiratory and critical care medicine, v. 195, n. 7, p. 906-911, 2017.5. GARCIA-ALVAREZ, Mercedes; MARIK, Paul; BELLOMO, Rinaldo. Sepsis-associated hyperlactatemia. Critical care, v. 18, n. 5, p. 1-11, 2014.6. ZAMPIERI, Fernando G. et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. Jama, v. 326, n. 9, p. 818-829, 2021.7. ZAMPIERI, Fernando G. et al. Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA, v. 326, n. 9, p. 830-838, 2021.8. JABER, Samir et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, v. 392, n. 10141, p. 31-40, 2018.9. SEMLER, Matthew W. et al. Balanced crystalloids versus saline in critically ill adults. New England Journal of Medicine, v. 378, n. 9, p. 829-839, 2018.10. SELF, Wesley H. et al. Balanced crystalloids versus saline in noncritically ill adults. New England Journal of Medicine, v. 378, n. 9, p. 819-828, 2018.

O uso da Varfarina é extremamente comum na nossa prática clínica e precisamos saber como manejar sua intoxicação. Kaue e Rapha conversam sobre essa intoxicação em 3 situações - Paciente com sangramento grave, sangramento leve e o paciente com RNI (ou INR) alterado mas sem sangramento. Referências: Crowther MA, Ageno W, Garcia D, et al. Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial. Ann Intern Med 2009; 150:293. Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv 2018; 2:3257. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:160S. Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol 2008; 83:137. Gunther KE, Conway G, Leibach L, Crowther MA. Low-dose oral vitamin K is safe and effective for outpatient management of patients with an INR>10. Thromb Res 2004; 113:205. Farrow GS, Delate T, McNeil K, et al. Vitamin K versus warfarin interruption alone in patients without bleeding and an international normalized ratio > 10. J Thromb Haemost 2020; 18:1133. Refaai MA, Goldstein JN, Lee ML, et al. Increased risk of volume overload with plasma compared with four-factor prothrombin complex concentrate for urgent vitamin K antagonist reversal. Transfusion 2015; 55:2722. Goldstein JN, Refaai MA, Milling TJ Jr, et al. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 2015; 385:2077. Hylek EM, Regan S, Go AS, et al. Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin. Ann Intern Med 2001; 135:393. Kuijer PM, Hutten BA, Prins MH, Büller HR. Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism. Arch Intern Med 1999; 159:457.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Iago, Joanne e Pedro convidam Dr. Igor Pietrobom para falar sobre abordagem inicial no PS e investigação ambulatorial de litíase. Referências:1. Gary C Curhan, Kidney stones in adults: Diagnosis and acutemanagement of suspected nephrolithiasis. Acesso em uptodate.com2. Gary C Curhan, Kidney stones in adults: Epidemiology and risk factors. Acesso em uptodate.com3. Glenn M Preminger, Kidney stones in adults: Evaluation of the patient withestablished stone disease. Acesso em uptodate.com4. Gary C Curhan, Kidney stones in adults: Prevention of recurrent kidneystones. Acesso em uptodate.com

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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: Bacteremia nosocomial Culturas de controle negativas dentro de 4 dias do início do tratamento. Ausência de dispositivo intracardíacoSem hemodiálise Sem sinais clínicos de endocardite ou infecção secundáriaReferências: 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; 60:492. 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.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.

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! Referência: Shen, Win-Kuang, et al. "2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society." Journal of the American College of Cardiology 70.5 (2017): e39-e110.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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: 1. CARTWRIGHT, Sarah L.; KNUDSON, Mark P. Evaluation of acute abdominal pain in adults. American family physician, v. 77, n. 7, p. 971-9778, 2008. 2. LYON, Corey; CLARK, Dwayne C. Diagnosis of acute abdominal pain in older patients. American family physician, v. 74, n. 9, p. 1537-1544, 2006. 3. CLAIR, Daniel G.; BEACH, Jocelyn M. Mesenteric ischemia. New England Journal of Medicine, v. 374, n. 10, p. 959-968, 2016. 4. http://getthediagnosis.org/diagnosis/Appendicitis.htm 5. http://getthediagnosis.org/diagnosis/Cholecystitis.htm 6. ROSS, James T.; MATTHAY, Michael A.; HARRIS, Hobart W. Secondary peritonitis: principles of diagnosis and intervention. Bmj, v. 361, 2018. 7. 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. 8. MANTEROLA, Carlos et al. Analgesia in patients with acute abdominal pain. Cochrane Database of Systematic Reviews, n. 3, 2007. 9. KELSEY, Peter B.; CHEN, Steven; LAUWERS, Gregory Y. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 37-2003. A 79-year-old man with coronary artery disease, peripheral vascular disease, end-stage renal disease, and abdominal pain and distention. The New England journal of medicine, v. 349, n. 22, p. 2147-2155, 2003.

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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Rastreio de câncer colorretal:- 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 LynchReferências: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, MD2. USPSTF Recommendation: Screening for Colorectal Cancer. Entrevista do Jama, disponível em https://edhub.ama-assn.org/jn-learning/audio-player/186120463. 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/20219. Michael J Hall. Lynch syndrome (hereditary nonpolyposis colorectalcancer): Cancer screening and management. Acesso em uptodate.com em setembro/202110. Finlay A Macrae. Overview of colon polyps; Acesso em uptodate.com em setembro/2021

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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 :1. Thachil J, Fitzmaurice D. Thrombocytopenia in an adult. Bmj. 2013 Jun 10;346.2. Bradbury C, Murray J. Investigating an incidental finding of thrombocytopenia. BMJ. 2013 Jan 11;346.3. Stasi R. How to approach thrombocytopenia. Hematology 2010, the American Society of Hematology Education Program Book. 2012 Dec 8;2012(1):191-7.4. Swain F, Bird R. How I approach new onset thrombocytopenia. Platelets. 2020 Apr 2;31(3):285-90.5. Donald M Arnold, MD, MSc, Adam Cuker, MD, MS. Diagnostic approach to the adult with unexplained thrombocytopenia. uptodate.com acesso em agosto/20216. GAUER, Robert; BRAUN, Michael M. Thrombocytopenia. American family physician, v. 85, n. 6, p. 612-622, 2012.7. COOPER, Nichola; GHANIMA, Waleed. Immune thrombocytopenia. New England Journal of Medicine, v. 381, n. 10, p. 945-955, 2019.8. GREINACHER, Andreas. Heparin-induced thrombocytopenia. New England Journal of Medicine, v. 373, n. 3, p. 252-261, 2015.9. 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, 2016.10. ARNOLD, Donald M.; CUKER, Adam; KUNINS, Lisa. Diagnostic approach to the adult with unexplained thrombocytopenia.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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? Minutagem:00:10 Apresentação 00:58 Salves e Recados Iniciais Incluindo Curso TdC de Antibióticos02:50 Apresentação do Caso Clínico Paciente jovem com dor articular e febre04:10 Definição de monoartrite aguda e principais etiologias06:00 Investigação - Anamnese dirigida e exame físico08:30 Retorno do Caso Clínico 10:15 Análise dos Achados do Exame Físico e Sinais Vitais11:10 Exames Complementares Iniciais Laboratoriais e de Imagem12:35 Papel da Artrocentese15:00 Resultado do Líquido Sinovial e Desdobramento do Caso16:00 Diagnóstico Diferencial Detalhado (Artrite Séptica, Doença por Cristais Gota/Pseudogota e Outras)17:40 Artrite séptica20:30 Artrite por gota 22:45 Artrite por pseudogota 23:55 Discussão de Tratamento e Manejo do Caso Clínico Empírico vs. Guiado25:20 O que o caso clínico ensina sobre monoartrite 26:50 EncerramentoReferências: 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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Rapha, Raíssa e João conversam sobre Osteoporose! Como diagnosticar? Qual é o manejo correto? Confere com a gente nesse episódio! Minutagem:1:40 Divisão do episódio2:18 Caso clínico3:00 Abordagem inicial4:20 Definição - critérios diagnósticos9:15 Densitometria óssea14:03 FRAX20:00 Voltando ao caso21:25 Rastreio25:40 Caso Clínico 232:40 Avaliação laboratorial35:00 Tratamento e suplementação39:30 Tratamento farmacológico47:15 Reações adversas51:00 Contraindicações51:55 Relacionando com os casos56:00 Terapia anabólico59:56 Até quando usar os medicamentos?1:03:22 Falha de tratamento1:05:43 Salves1:07:53 Respost do desafio da semana anterior1:08:50 Desafio da semanaReferências: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, 20166. 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, 20147. 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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.Minutagem3:45 Variantes do covid7:30 Variante delta8:40 Sintomas da variante10:45 Transmissibilidade12:15 Vacina e a variante16:20 Novos tratamentos23:59 Inibidores da JAK25:20 Corticoides29:40 Anticorpos monoclonais32:40 Reações vacinais43:23 Resposta do desafio da semana anterior44:23 Desafio da semana45:16 SalvesReferências: 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

Pedro e Fred discutem o diagnóstico de HIV na infecção aguda, no rastreamento e na infecção crônica.

Nesse episódio o TdC se reune para comemorar 2 anos de podcast e contar muitas histórias e hobbies.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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!Leia também o tópico do Guia TdC: https://www.tadeclinicagem.com.br/guia/212/nova-diretriz-de-febre-na-uti/Minutagem:01:33 Parceria com Whitebook04:00 Início do caso clínico06:20 Organização do caso10:30 Febre x hipertermia13:25 Abordagem inicial ao paciente13:46 Exame físico18:55 O que falar da equipe de enfermagem20:40 Abordagem com fisioterapia21:15 Ultrassonografia à beira leito24:05 Continuação do caso25:26 Quais exames solicitar25:55 Culturas33:00 Exame de imagem34:25 PCR e Procalcitonina35:50 Febre e Prescrição37:46 Continuação do caso41:00 Raciocínio clínico45:50 Finalização do caso e comentários51:50 Resposta do desafio da semana anterior53:00 Desafio da semana53:24 SalvesReferências: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" / Twitter7. 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.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨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.Leia também o tópico do Guia TdC: https://www.tadeclinicagem.com.br/guia/355/estado-de-mal-epileptico/Referências: 1. 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, 2015.2. SMITH, Phil EM. Initial Management of Seizure in Adults. New England Journal of Medicine, v. 385, n. 3, p. 251-263, 2021.3. 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, 2018.4. 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, 2015.5. GAVVALA, Jay R.; SCHUELE, Stephan U. New-onset seizure in adults and adolescents: a review. Jama, v. 316, n. 24, p. 2657-2668, 2016.6. DEVINSKY, Orrin; GAZZOLA, Deana; LAFRANCE JR, W. Curt. Differentiating between nonepileptic and epileptic seizures. Nature Reviews Neurology, v. 7, n. 4, p. 210, 2011.7. BEGHI, Ettore et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia, v. 51, n. 4, p. 671-675, 2010.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Rapha, João e Fred discutem sobre três aspectos da dengue: em quem pensar? Como diagnosticar? Como tratar? Isso e muito mais!Leia também o tópico do Guia TdC: https://www.tadeclinicagem.com.br/guia/266/dengue-duvidas-comuns-no-manejo/Minutagem 00:35 Parceria com Whitebook03:35 Quando pensar na dengue06:00 Epidemiologia da dengue07:35 Clínica da dengue11:40 Definição de caso suspeito15:35 Manifestações atípicas17:46 COVID e Dengue19:45 Alguns diagnósticos diferenciais23:00 Exames gerais27:30 Prova do laço33:10 Exames específicos38:30 Estratificação do paciente45:40 Conduta de acordo com estratificação49:50 Grupo A53:08 Grupo B56:00 Grupos C/D57:20 Outras condutas1:04:32 Salves1:05:45 Resposta do desafio da semana anterior1:06:30 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.

Mais um TdC em Bolus, nosso podcast quinzenal para ser consumido de forma rápida e divulgar para quem ainda não ouve podcast! Dessa vez para falar de um assunto muito comum mas nem sempre comentado: profilaxia de úlcera gástrica! Quem precisa? Como fazer? Tudo isso com Pedro e João! Minutagem e Referências em breve

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨Voltando ao episódio de 3 desafios! São três casos clínicos, apresentado por Pedro, Kaue e Iago, e os três casos tem algo em comum! Você conseguiu identificar o que é antes da resolução final? Compartilha com a gente!Referências1. Kiriakidou M, Ching CL. Systemic Lupus Erythematosus. Ann Intern Med. 2020 Jun 2;172(11):ITC81-ITC962. Calixto OJ, Franco JS, Anaya JM. Lupus mimickers. Autoimmunity reviews. 2014 Aug 1;13(8):865-72.3. R Brodsky, Diagnosis of hemolytic anemia in adults. Uptodate.com acesso em julho/20214. Wright DE, Rosovsky RP, Platt MY. Case 36-2013: A 38-Year-Old Woman with Anemia and Thrombocytopenia. New England Journal of Medicine. 2013 Nov 21;369(21):2032-43.5. Velo-García A, Castro SG, Isenberg DA. The diagnosis and management of the haematologic manifestations of lupus. Journal of autoimmunity. 2016 Nov 1;74:139-60.

🚨 www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis 🚨João, Iago e Guilherme Moura trazem 3 clinicagens sobre Anafilaxia: como diagnosticar, tratamento imediato e tratamento adicional! Faltou falar algo? Já teve uma experiência com Anafilaxia? Comenta com a gente nas nossas redes sociais! Leia também o tópico do Guia TdC: https://www.tadeclinicagem.com.br/guia/424/diretrizes-de-anafilaxia-diagnostico-e-manejo/Minutagem 00:58 Parceria com Whitebook02:40 Estrutura do episódio03:23 Definição05:50 Critérios diagnósticos17:30 Tratamento18:45 Adrenalina24:45 Manejo da via aérea26:15 Medicamento associado a pior prognóstico28:05 Anti-histaminicos e corticoide31:15 Tratamento adicional33:30 Caneta de adrenalina38:30 Plano de ação39:55 Resumo do episódio41:35 Salves43:35 Resposta do desafio da semana anterior44:25 Desafio da semana Referências1) Di Gesu, G. M. S., Rosário Filho, N., Tebyriça, J. N., Solé, D., Bernd, L. A. G., Spindola, M. A. C., & Simões, R. Anafilaxia: Diagnóstico.2) Ronna L Campbell, John M Kelso: Anaphylaxis: Acute diagnosis. Acesso em uptodate.com em 26.06.213) https://anafilaxiabrasil.com.br/adrenalina-auto-injetavel#. Acesso em 25/06/20214) Muraro, Antonella, et al. "Anaphylaxis: guidelines from the E uropean A cademy of A llergy and C linical I mmunology." Allergy 69.8 (2014): 1026-1045.5) Banerji, Aleena, et al. "Retrospective study of drug-induced anaphylaxis treated in the emergency department or hospital: patient characteristics, management, and 1-year follow-up." The Journal of Allergy and Clinical Immunology: In Practice 2.1 (2014): 46-51.6) Shaker, Marcus S., et al. "Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis." Journal of Allergy and Clinical Immunology 145.4 (2020): 1082-1123

Um TdC em bolus que mais parece uma infusão estendida! Voltamos no nosso formato quinzenal para falar de D-Dímero. Um exame muito solicitado durante a pandemia e que volta e meia a gente tem que interpretar. As possíveis aplicações do D-Dímero são vastas, mas nesse episódio resolvemos focar em: trombose venosa profunda, tromboembolismo pulmonar, dissecção de aorta e COVID-19. Críticas ou sugestões? Entra em contato com a gente no @tadeclinicagem no Instagram, Twitter ou gmail. Não esquece do nosso canal no YouTube, tem video toda semana! REFERÊNCIAS 1) Kearon, Clive, et al. "Diagnosis of pulmonary embolism with d-dimer adjusted to clinical probability." New England Journal of Medicine 381.22 (2019): 2125-2134. 2) van der Hulle, Tom, et al. "Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study." The Lancet 390.10091 (2017): 289-297. 3) Schutte, T., A. Thijs, and Y. M. Smulders. "Never ignore extremely elevated D-dimer levels: they are specific for serious illness." Neth J Med 74.10 (2016): 443-448. 4) Weitz, Jeffrey I., James C. Fredenburgh, and John W. Eikelboom. "A test in context: D-dimer." Journal of the American College of Cardiology 70.19 (2017): 2411-2420. 5) Thachil, Jecko, David A. Fitzmaurice, and Cheng Hock Toh. "Appropriate use of D-dimer in hospital patients." The American journal of medicine 123.1 (2010): 17-1 6) Lim, Wendy, et al. "American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism." Blood advances 2.22 (2018): 3226-3256. 7) Konstantinides, Stavros V., et al. "2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)." European heart journal 41.4 (2020): 543-603