Ta de Clinicagem

Iaaaaagoo Joooorge convida Caroline Millon e Luciano Assunção para discutir sobre um dos exames mais comuns da medicina: o hemograma! Nesse episódio, apronfudamos sobre a avaliação da série vermelha do hemograma!

Referências:

1. Tefferi A. Anemia in adults: a contemporary approach to diagnosis. Mayo Clin Proc. 2003;78(10):1274-1280. 
2. Bain BJ. Morphology in the diagnosis of red cell disorders. Hematology. 2005;10 Suppl 1:178-181.
3. Ford J. Red blood cell morphology. Int J Lab Hematol. 2013;35(3):351-357. 
4. Palmer L, Briggs C, McFadden S, Zini G, Burthem J, Rozenberg G, et al. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. Int J Lab Hematol. 2015;37(3):287-303. 
5. Zini G, d’Onofrio G, Erber WN, Lee SH, Nagai Y, Basak GW, et al; International Council for Standardization in Hematology. 2021 update of the 2012 ICSH recommendations for identification, diagnostic value, and quantitation of schistocytes: impact and revisions. Int J Lab Hematol. 2021;43(6):1264-1271. 
6. Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet. 2021;397(10270):233-248. 
7. Ganz T. Anemia of inflammation. N Engl J Med. 2019;381(12):1148-1157.
8. Kaferle J, Strzoda CE. Evaluation of macrocytosis. Am Fam Physician. 2009;79(3):203-208. 

Aline Campos, Caio Bastos e Jonatas Zanoveli estão de volta para discutir sobre clinicagens em (hemo)diálise. Nessa segunda parte, serão abordadas as principais complicações agudas: infecções relacionadas ao cateter, dor torácica, hipotensão, cãibras e alterações neurológicas. Ao final do episódio, a volta do desafio com direito a premiação para o primeiro ouvinte que acertar o diagnóstico. Deixe nos comentários sua resposta! 

Referências:

1. Douvris A, Zeid K, Hiremath S, Bagshaw SM, Wald R, Beaubien-Souligny W, Kong J, Ronco C, Clark EG. Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review. Intensive Care Med. 2019 Oct;45(10):1333-1346. 
2. Farrington CA, Allon M. Management of the Hemodialysis Patient with Catheter-Related Bloodstream Infection. Clin J Am Soc Nephrol. 2019 Apr 5;14(4):611-613. 
3. Davenport A. Why is Intradialytic Hypotension the Commonest Complication of Outpatient Dialysis Treatments? Kidney Int Rep. 2022 Nov 10;8(3):405-418. 
4. Aoun M, Combe C, Jadoul M. Life support in hemodialysis emergencies-treatment standard. Nephrol Dial Transplant. 2025 Oct 30;40(11):2046-2057. 

Joanne Alves e Marcela Belleza convidam Raphael Barreto para discutir sobre a vacinação no adulto, dividindo o tema de forma prática em 4 pontos: conceitos básicos de vacinação, vacinação no jovem hígido, vacinação no idoso e vacinação no paciente imunossuprimido.

Referências:
1. https://www.gov.br/saude/pt-br/vacinacao/publicacoes/instrucao-normativa-que-instrui-o-calendario-nacional-de-vacinacao-2026.pdf

2. https://sbim.org.br/images/files/notas-tecnicas/informe-sbim-esclarecimentos-vacinas-hpv-240415-v2.pdf

3. Gagneur, Arnaud et al. “From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling.” Human vaccines & immunotherapeutics vol. 20,1 (2024): 2391625. doi:10.1080/21645515.2024.2391625

4. A. Heidenreich, P, Bhatt, A, Nazir, N. et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on Adult Immunizations as Part of Cardiovascular Care: A Report of the American College of Cardiology Solution Set Oversight Committee. JACC. 2025 Nov, 86 (21) 2085–2098. https://doi.org/10.1016/j.jacc.2025.07.003

5. Johansen, Niklas Dyrby et al. “Electronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial.” Lancet (London, England) vol. 401,10382 (2023): 1103-1114. doi:10.1016/S0140-6736(23)00349-5

6. Larson, Heidi J et al. “The Vaccine-Hesitant Moment.” The New England journal of medicine vol. 387,1 (2022): 58-65. doi:10.1056/NEJMra2106441

7. Dinga, Jerome Nyhalah et al. “Quantitative Synthesis of Factors Associated with COVID-19 Vaccine Acceptance and Vaccine Hesitancy in 185 Countries.” Vaccines vol. 12,1 34. 28 Dec. 2023, doi:10.3390/vaccines12010034

Lucca Cirillo apresenta um caso de aumento de enzimas hepáticas para Amyr Chacar e Djoni Moraes.

Referências:
1. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017; 112:18.
2. Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 2008; 48:169.
3. Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S. Abnormal liver enzymes: A review for clinicians. World J Hepatol. 2021 
4. Kwo P, Masuoka H, Schaefer E. Evaluation of Abnormal Liver Biochemical Test Results Gastroenterology, 2026; 170, 1457-1472
5. Eric Sulava, Samuel Bergin, Brit Long, Alex Koyfman, Elevated Liver Enzymes: Emergency Department–Focused Management,
The Journal of Emergency Medicine.
6. Reutemann B, Gordon FD. Evaluation of the Patient with Markedly Abnormal Liver Enzymes. Clin Liver Dis. 2023 
7. Andrade RJ, Aithal GP EASL DHILI Consortium. Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report. J Hepatol. 2023 
8. Heneghan M, Lohse A Update in clinical science: Autoimmune hepatitis Journal of Hepatology, 2025
9. Rosenberg J, Sola O, Visconti A Approach to Elevated Liver Enzymes Primary Care: Clinics in Office Practice, 2023
10. Reutemann B, Gordon FD. Evaluation of the Patient with Markedly Abnormal Liver Enzymes. Clin Liver Dis. 2023 

Esse tema foi abordado na edição 153 do Guia TdC. Para saber mais, acesse: https://www.tadeclinicagem.com.br/guia/542/manejo-de-hemorragia-digestiva-alta-nao-varicosa/.

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Aline Campos e João Mendes convidam João Felipe, residente de medicina intensiva do HCFMUSP, para discutir novamente sobre polêmicas da sepse, dessa vez abordando o novo Surviving Sepsis Campaign de 2026 através de casos clínicos. O tema já foi abordado anteriormente nos episódios #41 e #111.

Referências:
1. Prescott HC et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026.
2. Mekontso Dessap A et al. European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2-the volume of resuscitation fluids. Intensive Care Med. 2025.
3. Yealy DM et al. Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report. Ann Emerg Med. 2021. 

4. Jones BE et al. Empirical Anti-MRSA vs Standard Antibiotic Therapy and Risk of 30-Day Mortality in Patients Hospitalized for Pneumonia. JAMA Intern Med. 2020. 

5. Bai AD et al. Anaerobic Antibiotic Coverage in Aspiration Pneumonia and the Associated Benefits and Harms: A Retrospective Cohort Study. Chest. 2024. 

6. Leung LY et al. Door-to-antibiotic time and mortality in patients with sepsis: Systematic review and meta-analysis. Eur J Intern Med. 2024. 

7. Alam N et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respir Med. 2018.
8. Peake SL et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026.

9. Douglas IS et al. Fluid Response Evaluation in Sepsis Hypotension and Shock: A Randomized Clinical Trial. Chest. 2020.

10. Meyhoff TS et al. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med. 2022.

11. Shapiro NI et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023.

12. Permpikul C et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Am J Respir Crit Care Med. 2019.

13. Russell JA et al. Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock. N Engl J Med. 2008.

14. Gordon AC et al. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. JAMA. 2016.

15. Hajjar LA et al. Vasopressin versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial. Crit Care Med. 2019.

16. Kalimouttou A et al. Optimal Vasopressin Initiation in Septic Shock: The OVISS Reinforcement Learning Study. JAMA. 2025.

17. Mallmann C et al. Reduction of Norepinephrine versus Vasopressin in the Stabilization Phase of Septic Shock: RENOVA Clinical Trial. Med Intensiva (Engl Ed). 2025.

18. Jeon K et al. Incidence of Hypotension According to the Discontinuation Order of Vasopressors in the Management of Septic Shock: A Prospective Randomized Trial (DOVSS). Crit Care. 2018.

Raphael Coelho e Letícia Angoleri convidam Vivian Fernandes, residente em geriatria na UNIFESP, para discutir a abordagem de quedas no idoso, desde a abordagem inicial no PS e tratamento até a identificação de fatores de risco e prevenção. 

Referências:
1. Welch SA et al. The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients. J Am Med Dir Assoc. 2020.
2. Centers for Disease Control and Prevention (CDC). About Older Adult Falls. 2026. 
3. Moreland BL et al. A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States, 2015. Am J Lifestyle Med. 2021.
4. Moreland B et al. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018. MMWR Morb Mortal Wkly Rep. 2020.
5. Albasri A et al. Association Between Antihypertensive Treatment and Adverse Events: Systematic Review and Meta-analysis. BMJ. 2021.
6. Xu Q et al. The Risk of Falls Among the Aging Population: A Systematic Review and Meta-analysis. Front Public Health. 2022.
7. Coulter JS et al. Falls in Older Adults: Approach and Prevention. Am Fam Physician. 2024.
8. Pimentel WRT et al. Quedas entre Idosos Brasileiros Residentes em Áreas Urbanas: ELSI-Brasil. Rev Saude Publica. 2018.

Gabriel Paes apresenta um caso clínico de plaquetopenia para Kaue Malpighi e a convidada Mariana Tourinho, residente de Hematologia do HCFMUSP.

Referências em breve.

Esse tema foi abordado na edição 134 do Guia TdC. Para saber mais, acesse: https://www.tadeclinicagem.com.br/guia/474/nova-diretriz-americana-de-2025-sobre-tratamento-de-pneumonia/

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Jonatas Zanoveli e Ana Carolina Malvaccini convidam Alice Mendonça para discutir o que o clínico precisa saber sobre a Furosemida. 

Referências:
1. Novak JE, Ellison DH. Diuretics in States of Volume Overload: Core Curriculum 2022. Am J Kidney Dis. 2022.
2. Mullens W et al. Combining Loop with Thiazide Diuretics for Decompensated Heart Failure: The CLOROTIC Trial. Eur Heart J. 2023. 
3. Ellison DH. Diuretic Treatment in Heart Failure. N Engl J Med. 2017. 
4. Brater DC. Diuretic Therapy. N Engl J Med. 1998. 
5. Felker GM et al. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. N Engl J Med. 2011. 
6. Marques P et al. Systematic Review on the Management of Diuretic Resistance in Acute Heart Failure across the Spectrum of Kidney Disease. Cardiorenal Med. 2025.
7. Mullens W et al. The Use of Diuretics in Heart Failure with Congestion: A Position Statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019.
8. Frea S et al. Diuretic Treatment in High-Risk Acute Decompensation of Advanced Chronic Heart Failure: Bolus Intermittent vs. Continuous Infusion of Furosemide. Clin Res Cardiol. 2020.
9. Tang WH, Kiang A. Acute Cardiorenal Syndrome in Heart Failure: From Dogmas to Advances. Curr Cardiol Rep. 2020.
10. Yamada T et al. Systematic Review of the Association Between Worsening Renal Function and Mortality in Patients With Acute Decompensated Heart Failure. Kidney Int Rep. 2020.
11. Mullens W et al. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload. N Engl J Med. 2022.
12. Diuretic Strategies in Acute Decompensated Heart Failure: A Narrative Review. Can J Hosp Pharm. 2024.
13. Prata AA et al. Protocolized Natriuresis-Guided Diuretic Therapy in Acute Heart Failure: A Systematic Review and Meta-analysis. Crit Care. 2025.
14. Ter Maaten JM et al. Natriuresis-Guided Diuretic Therapy in Acute Heart Failure: A Pragmatic Randomized Trial. Nat Med. 2023.
15. Felker GM et al. Diuretic Therapy for Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020.

16. Chawla LS et al. Development and Standardization of a Furosemide Stress Test to Predict the Severity of Acute Kidney Injury. Crit Care. 2013.