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" The practice of Medicine is an art, based on Science, not a trade, not a business; a calling in which your heart will be exercised equally with your head "
Sir William Osler, 1932
English
Bernardo Vidal Pimentel
1.2K posts
Bernardo Vidal Pimentel
@BVidalPimentel
Internal Medicine Quem não lê é como quem não vê.
Portugal Katılım Kasım 2019
1.2K Takip Edilen285 Takipçiler
Se Março foi isto, esperem por Abril
esFOAMeados@esfoameados
Inventário do mês Várias pérolas, com destaque para: - TAPER-V c/ Vancomicina em desmame lento para CDiff - COBRA c/ vitória do apixa - PETRUSHKA c/ app de apoio à medicação na depressão - Acabamos com restrição de líquidos na IC? ... esfoameados.pt/post/março-202…
Português
Api-tonga-xabano
E agora, apixa para todos? Foi só no TEV, mas...
esFOAMeados@esfoameados
Mar26 #2 🎂⚪️Canabinóides 🍰 🟢TEV: apixa>rivaroxa 🟢aGLP1: s/+aspiração ⚪️InsRespI: HFNC≈O2 🟠TrombocitopQT: Romiplostim (+EAs/morte?) 🔴IC+NeoIV: TMP 🔴Escabiose: ivermPO<permetrinaTÓP 🔴Trauma préHosp: Sangue total ⚪️Precauções contacto SAMR mais.. esfoameados.pt/post/mar%C3%A7…
Português
Bernardo Vidal Pimentel retweetledi
@ABsteward @DrToddLee @jasonroberts_pk @PulmCrit I see I missed a lot on Twitter today. It's amazing that an organization that has gotten virtually everything it recommended over the years dead wrong, objective by subsequent RCTs, continues to make recommendations. We shall simply ignore these as the others. Shmidelines.
English
1º grande ECA no O2 alto-fluxo: SOHO
~1k, Aberto, multic França
P — Ins. resp. hipoxémica
I — HFNC
C — O2 habitual
O 1º » IGUAL morte
2º » Talvez MENOS EOT e mais dias s/ VM...mas PIOR PaO2 e PCR/Pneumotórax
Não me convence mas aguardo #FOAMed
nejm.org/doi/10.1056/NE…
Português
Bernardo Vidal Pimentel retweetledi
> 600,000 left atrial appendage devices have been placed
NOT NONINFERIOR 👇🏻
Trial is large, nonindustry funded and done in experienced centers in Germany
Endpoint had both efficacy and safety components and still did not make non-inferiority
I tried to tell you all
NEJM@NEJM
Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results: nejm.org/doi/full/10.10… Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? nejm.org/doi/full/10.10…
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V TaperImpério
esFOAMeados@esfoameados
Mar26 #1 🎂 DeliriumPósOP | aGLP1 | S.MãoPé | NeoPróst PósCx 🍰 🟢Cdiff:Vanco-taper 🟢Orfoglipron vs Sema 🟢Depressão:App-apoio 🟡Derrame pl.mal.:Catéter-tunel 🟣DorAguda:Morfina±paracet 🟠DM1+“DRC”:Fineren 🔴EAM:Rivarox2,5mg 🔴PósAVC+FA:Ablação mais.. esfoameados.pt/post/mar%C3%A7…
Čeština
@zacroBID @Wiki_Guidelines I had the exact same thought. How so?
English
This got through peer review without anyone noticing that an entire guideline directly relevant to the content was omitted? Perplexing…
@Wiki_Guidelines
#IDTwitter
jamanetwork.com/journals/jaman…
Clinical Infectious Diseases@CIDJournal
Uncomplicated Urinary Tract Infections: From an Invisible Impact to a Visible Change in Complex Care ✅ Just Accepted 🔗 bit.ly/4lqckI9
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@AppleHelix People are too biased nowadays
The trial has several limitations. At best, it was a "meh trial" on non truly CKD (eGFR~60) that didn't meaningfuly changed eGFR
I wish it worked, but if we truly want to treat patients and not get lost in X-Wars, we should raise the evidence bar
English
So Mandrola wants an non-approved drug as the comparator arm??
English
nejm.org/doi/full/10.10…
Sometimes I don't get NEJM
This (small) trial, if only, supports not using finerenone in this "CKD" (eGFR~60...) and T1D
➡️ Worse eGFR and hiperK
"Conclusions" should have made this clear
I'm open to finerenone having a place...but not w/ this trial.
English
E tu, já estás vestido a Prasurigor? 👔
esFOAMeados@esfoameados
Mar26 #1 🟢Catéter EV: Clorex+álcool 🟡INR: Automonitorizar 🟡Gonartrose: Joelheira 🟡Opióide: CYP2D6 🟣Cushing: Relacorilant 🟣AVCipost: Tenecteplase <24h 🔴Choque séptico: AlbEV 🔴Tica<Prasu (DM+multivaso) 🟢ANOCA: =RCV | AMPA 🌎BloqOccip (SU) mais.. esfoameados.pt/post/fevereiro…
Português
@DrToddLee @ABsteward @DrEmilyMcD @BradSpellberg @IdVilchez @JAMANetwork Great trial! Why did you compare 4-week taper with 14 days and not with 10 days?
English
@ABsteward @DrEmilyMcD @BradSpellberg @IdVilchez @JAMANetwork The key here is day 38-40. This is where fidaxo follow up stopped. This is where they can be compared
The RCT presented at ID week last October suggests fidaxo may also have later recurrences by day 56.
We are soon to start Vanco P-T vs fidaxo RCT with follow up to day 56
English
🔥Just published 🔥
TAPER-V RCT
Initial Vancomycin Taper for the Prevention of Recurrent Clostridioides difficile Infection
In this randomized clinical trial of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to astandard 2-week pulse regimen in patients a first episode or first recurrence of CDI
*All patients received 14d pulse of vanco (standardized at 125 mg orally 4 times a day at the time of recruitment) →taper (125 mg q12h ×7d,then 125mg q24h ×7d) vs placebo for management of CDI (first episode or recurrence).
Vanco for 10d is obsolete! #IDXposts
jamanetwork.com/journals/jaman…
English
@ABsteward @bmj_latest I wonder which evidence grading system WHO is using. Their own?
English
@ABsteward @bmj_latest Where is the evidence supporting oseltamivir and baloxavir in severe influenza?
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🆕🔥🟢Summary of WHO clinical practice guidelines for influenza @bmj_latest
For seasonal influenza, WHO conditionally recommends treatment within 48 hours of symptom onset with oseltamivir for severe illness, and baloxavir for patients at high risk of progression from non-severe to severe illness.
WHO also conditionally recommends prophylaxis (using baloxavir, laninimavir, oseltamivir, or zanamivir) for anyone exposed to zoonotic influenza, and for those exposed to seasonal influenza who are at extremely high risk.
The panel issued recommendations against the use of adjunctive therapies in patients with non-severe influenza (strong recommendation against antibiotics) and severe influenza (conditional recommendation against corticosteroids, macrolides, mTOR inhibitors, non-steroidal anti-inflammatory drugs, and passive immune therapy.
#IDXposts
bmj.com/content/392/bm…
English
Não vos andamos a enganar !
esFOAMeados@esfoameados
Para quem ouviu o último🎧Hipótese Nula🎙️: @BradSpellberg e @ABsteward também tiveram dúvidas ...mas se não ficaram por brincar ao microfone e tomaram iniciativa 👏 --- Our Portuguese pod (name above) discussed COPAT and reached similar conclusions - kudos for the letter !
Português
Bernardo Vidal Pimentel retweetledi
🎙️Hipótese Nula #20 Fevereiro 26 🎧
➡️ Antibioterapia oral "COPAT"
➡️ "Novo Velho" Antiarrítmico: Vernakalant
*desmame de TMP na ICFEr-FA
*trombólise (não eficaz) na oclusão da a. da retina
esfoameados.pt/post/hipótese-…
Português
D-yalisates and its discontents
esFOAMeados@esfoameados
Fev #1 26 🟢Estatinas s/ EAs 🟢HipoT: LT4 s/jejum 🟢LRA+HD: re-HD só "SOS" 🟢🟣Exerc+SM: €/? 🟢🟣Idoso: nudge+despresc ; TelePsiq 🧾Anemia-DRC (KDIGO) 🟢IBP s/ neo | Empiema: kit PCR | PPj: BDG+PCR 🙄Win ratio (PARACHUTE-HF) 🌎POCUS e mais... esfoameados.pt/post/fevereiro…
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