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Arquivos do dia: Outubro 18, 2021

Estudo randomizado embasa o uso de heparina em dose terapêutica para pacientes não críticos internados por Covid-19.

18 Out, 2021 | 08:57h

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial – The BMJ

Comentário: High-dose of readily available blood thinner reduces risk of death for moderately ill COVID-19 patients – St. Michael’s Hospital

Estudos relacionados (alguns resultados conflitantes)

RCT: Therapeutic-dose heparin superior to standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

M-A: Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19 – According to this analysis, standard-dose prophylactic anticoagulation should be the standard of care for hospitalized patients with COVID-19 who do not have an indication for therapeutic anticoagulation, irrespective of disease severity.

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

RCT: In patients hospitalized with Covid-19 with elevated D-Dimer, a full-dose anticoagulation strategy based on rivaroxaban (full-dose heparins in unstable patients) + rivaroxaban to day 30 was not better than prophylactic anticoagulation and increased bleeding risk.

 

Comentário no Twitter

 

Vacina da J&J contra COVID-19: FDA recomenda dose de reforço para adultos acima de 18 anos pelo menos 2 meses depois da vacinação com dose única.

18 Out, 2021 | 08:55h

Comunicado de imprensa: Johnson & Johnson COVID-19 Vaccine Booster Shot Unanimously Recommended for Emergency Use Authorization by U.S. FDA Advisory Committee

Comentários:

FDA panel endorses booster shot for J&J COVID-19 vaccine – Associated Press

The Johnson & Johnson one-dose vaccine offers good protection now. A booster shot will maximize that, experts say – CNN

FDA advisers recommend J&J Covid-19 vaccine boosters, talk mix and match boosters – CNN

Conteúdo relacionado: [Press release – not published yet] J&J says booster shot at two months provided 75% protection against moderate to severe COVID-19 globally and 94% of such cases in the U.S.

Revisão | Dose de SARS-CoV-2, infecção e desfechos de doença para COVID-19.

18 Out, 2021 | 08:53h

SARS-CoV-2 Dose, Infection, and Disease Outcomes for COVID-19 – A Review – Clinical Infectious Diseases

Conteúdo relacionado: Seroconversion and fever are dose-dependent in a nonhuman primate model of inhalational COVID-19.

 

Comentário do autor no Twitter (fio – clique para saber mais)

 

[Preprint] Avanço das infecções por SARS-CoV-2 em 620.000 veteranos americanos, de 1/2/2021 a 13/8/2021 – “A proteção da vacina diminuiu de 91,9% em março para 53,9% em meados de agosto.”

18 Out, 2021 | 08:51h

Breakthrough SARS-CoV-2 infections in 620,000 U.S. Veterans, February 1, 2021 to August 13, 2021 – medRxiv

Conteúdos relacionados:

Observational study in Qatar showed the effectiveness of Pfizer vaccine against any SARS-CoV-2 infection dropped to 20% in months 5 through 7 after the second dose, but effectiveness against severe Covid-19 remained high.

Cohort study: Pfizer vaccine effectiveness against any infections declined from 88% during the first month after full vaccination to 47% after 5 months. Vaccine effectiveness against hospital admissions remained high; 87% within 1 month, and 88% at 5 months after full vaccination, with no significant waning.

Editorial | Covid-19 vaccination: evidence of waning immunity is overstated.

COVID vaccine immunity is waning — how much does that matter? – “As debates about booster shots heat up, what’s known about the duration of vaccine-based immunity is still evolving”.

COVID vaccine effects wane over time but still prevent death and severe illness.

Perspective | What we actually know about waning immunity.

Another study shows Pfizer mRNA vaccine immunity is reduced over time.

[Press release – not published yet] Study shows vaccine protection wanes over time, but vaccines still offer good protection against severe disease.

Studies: COVID vaccine protection waning against infection but not hospitalization.

 

Comentário no Twitter

 

Oito meses depois: pesquisadores comparam as respostas imunes elicitadas por 3 vacinas contra COVID-19.

18 Out, 2021 | 08:50h

Comunicado de imprensa: Eight months later: Researchers compare immune responses elicited by three COVID-19 vaccines – Beth Israel Deaconess Medical Center

Estudo original: Differential Kinetics of Immune Responses Elicited by Covid-19 Vaccines – New England Journal of Medicine

 

Comentário no Twitter

 

O que as máscaras podem fazer? Parte 2 | O que é preciso para se realizar um bom estudo sobre máscaras – e por que a maioria falha.

18 Out, 2021 | 08:48h

COMMENTARY: What can masks do? Part 2: What makes for a good mask study — and why most fail – CIDRAP

Ver também: COMMENTARY: What can masks do? Part 1: The science behind COVID-19 protection – CIDRAP

Tratamento do diabetes melito em pacientes com doença renal crônica: Core Curriculum 2022.

18 Out, 2021 | 08:47h

Management of Diabetes Mellitus in Patients With CKD: Core Curriculum 2022 – American Journal of Kidney Diseases

Diretrizes para anestesiologistas sobre o manejo do sangue do paciente em cirurgia cardíaca.

18 Out, 2021 | 08:46h

2021 Clinical Practice Guidelines for Anesthesiologists on Patient Blood Management in Cardiac Surgery – Journal of Cardiothoracic and Vascular Anesthesia

 

Comentário no Twitter

 

Diretrizes para a abordagem cirúrgica da retocolite ulcerativa.

18 Out, 2021 | 08:44h

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis – Diseases of the Colon & Rectum

 

Comentário no Twitter

 

Ponto de vista | Excesso de tratamento cirúrgico e tomada de decisão compartilhada – Os limites da escolha. “Modelos de pagamento incentivam ainda mais a intervenção cirúrgica. Planos de pagamento por serviço premiam cirurgiões por operação, e não por garantirem que aquela cirurgia é a ideal para o paciente.”

18 Out, 2021 | 08:43h

Surgical Overtreatment and Shared Decision-making—The Limits of Choice – JAMA Surgery (gratuito por tempo limitado)

 

Comentário no Twitter

 

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