Blog

■ Bone health after diagnosis of breast cancer

S M Ruzyck, N A Nixon

CMAJ 2019, vol 191 (49): E1452

1 – Treatment of breast cancer may increase fracture risk

2 – Patients with breast cancer should be assessed for fracture risk using a validated tool

3 – Bone is the most common site of metástases for patients with breast cancer

4 – Bisphosphonates can reduce morbidity from boné metástases

5 – Bisphosphonates improve survival and prevent boné metastasis in postmenopausal women with early-stage breast câncer

https://www.cmaj.ca/content/190/49/E1452

 

■ Melanoma

R Micieli, K Pon

CMAJ 2019, VOL 191 (19): e535

1 – Sun exposure plays an importante role in melanoma pathogenesis

2 – Melanomas also occur on sites of minimal sun exposures

3 – The mitogen-activated protein kinase pathway is implicated and may be diagnostically challenging

4 – Off all melanomas, 10% are amelanotic or hypopigmented and may be diagnostically challenging

5 – Any lesions suspicious for melanoma should be referred to dermatology

https://www.cmaj.ca/content/191/19/E535

 

■ Diagnosing ovarian cancer

M Walker, Mara Sobel

CMAJ 2018, vol 190 (42): E125

1 – Early-stage ovarian câncer is difficult to diagnose because presenting symptoms are vague and nonspecific

2 – Transvaginal ultrasonography is the initial imaging modality for women with symptoms of ovarian câncer

3 – Serum tumours markers can be helpul when a complex ovarian cyst is identified

4 – The RMI II can be used in primary care identify women requiring urgente assessment

5 – Women with a Strong family history of breast, ovarian or colonj câncer should be referred to a genetic counsellor

https://www.cmaj.ca/content/190/42/E1259

 

■ Human papilomavírus vaccines

S J Ismail. S L Deeks

CMAJ 2017, vol 189 (38): E121

1 – Human papilomavírus (HPV) can lead to câncer

2 – HPV vacines can prevent câncer

3 – HPV vacines are safe

4 – Canada´s National Advisory Committee on immunization recommends use of HPV vacines for females and males

5 – HPV vaccination rates are suboptimal

https://www.cmaj.ca/content/189/38/E1212

 

■ Myelodysplastic syndrome

R A Wells, R Buckstein, J Removitz

CMAJ 2016, VOL 188 (10): 751

1 – Myelodysplastic syndrome is a disease ofolder adult  and is becomming more common

2 – Myelodysplastic syndrome commonly presentes as fatigue

3 – Myelodysplastic syndrome should be  in older patients with macrocytic anemia

4 – Patients with unexplained severe or progressive cytopenia should be referred toa hematologista

5 – Active treatment is available and improves outcomes in myelodysplastic syndrome

https://www.cmaj.ca/content/188/10/751

 

■  Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Consultório: Rua Padre Rolim 815/sala 601

Tel: 33245518

CRMMG: 7026

Email: pfleite1873@gmail.com

Data: Fev 2020

■ Transcatheter aortic valve implantation for severe aortic stenosis

A Garg, S Verna

CMAJ 2019, vol 191 (5): E134

1 – Transcatheter aortic valve implantation is first-line therapy for high-risk patients with severe symptomatic aortic stenosis

2 – The procedure should be performed at a dedicated centre of excellence specializing in treatment of valvular heart disease

3 – There are unique postoperative risk associated with transcatheter aortic valve implantation

4- While thromboprophylaxis is recommended after transcatheter replacement, the choice of therapy is controversial

5 – Routine endocarditis prophylaxis is recommended for patients with na implanted transcatheter aortic valve

https://www.cmaj.ca/content/191/5/E134

 

■ E-cigarettes

M Allosh, J Johnston, B Harvey

CMAJ 2019, vol 191 (41): E1136

1. E-cigarette use is increasing in Canada, especially among youth

2 – E-cigarette use is strongly associated with the initiation and ongoing use of cigarette smoking

3 – E-cigarettes are na additional smoking cessation tool

4 – E-cigarettes are unregulated products with potentially dangerous health effects

5 – Clinicians should ask about e-cigarette use

https://www.cmaj.ca/content/191/41/E1136

 

■ Proprotein convertase subtilisin-kexin type 9 (PCSK9)

D Leong, P E Wu

CMAJ 2019, vol 191 (32): E894

1 – Protein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a new class of low-density lipoprotein (LDL-c) lowering medications

2 – PCSK9 inhibitors have been shown to improve cardiovascular outcomes

3 – PCSK9 inhibitors are recommended as add-on therapy in patientes at very high risk

4 – PCSK9 inhibitors are well tolerated, but long-term safety data are lacking

https://www.cmaj.ca/content/191/32/E894

 

■ The cardiovascular benefits of low-dosage acetylsalicylic acid

P Koipillai, N S Nishtala

CMAJ 2019, vol 191 (43): E1194

1 – Acetysalicylic acid (ASA) has established benefit in the secondary prevention of cardiovascular disease

2 – The benefit of ASA in the primary prevention of cardiovascular disease is offset by potential bleeding risks

3 – Patients with diabetes, despite their increased cardiovascular risk, have questionable benefit from ASA used for primary prevention

4 – Perioperative use of ASA in noncardiac surgery is unlikely to reduce the risk of myocardial infarction or venous thromboembolism

5 – Acetysalicylic acid should be used patients with myocardial injury or ischemia after noncardiac surgery

https://www.cmaj.ca/content/191/43/E1194

 

■ Direct oral anticoagulante and the bleeding patients

B Wood, M Sholberg, A Ackery

CMAJ 2016, vol 188 (3): 215

1 – Direct oral anticoagulante agentes are now routinely used for the prevention of stroke in nonvalvular atrial fibrillation

2 – Risk of bleeding with direct oral anticoagulantes is lower than with vitamin K antagonists, but varies by site

3 – Direct oral anticoagulants are characterized by rapid onset of action and short half-live

4 – Direct oral antiagulants variably affect standard clot-based assays

5 – Idarucizumab has recently been approved by the US Food and Drug Administraton to reverse the activity of dabigatran

https://www.cmaj.ca/content/188/3/215

 

■ Postpartum hypertension

K Powles, S Gandhi

CMAJ 2017, vol 189 (27): E913

1 – Blood pressure should be measured three to six day after delivery

2 – Onset of preeclampsia can be postpartum

3 – Treatment is recommended if high blood pressure is presente persistently (systolic > 140 and/or diastolic > 90 mmHg)

4 – Pospartum hypertension may persist for several weeks

5 – Postpartum hypertension can be treated safely during breastfeeding

https://www.cmaj.ca/content/189/27/E913

 

■ Screening for fetal congenital heart disease

A Pham, M Melchior

CMAJ 2017, vol 189 (12): E468

1 – Congenital heart disease is the most common caue of infant death and morbidity from birth defects

2 – Referral for fetal echocardiography should bem ade in cases where nuchal tanslucency is above the 99th percentile

3 – Most cases of congenital heart disease occur n low-risk populations

4 – Both maternal and fetal factors may prompt referral for fetal echocardiography

5 – Some lesions can be treated antenatally

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367993/

 

■ Cardiopulmonary resuscitation

F Khan, C Vaillancourt

CMAJ 2017, vol 189 (1): E25

1 – Chest compressions during cardiopulmonar resuscitation should be fast pushes

2 – Perischock pauses should be limited to improve survival

3 Rescuers may adopt an interrrupted or continuous CPR strategy

4 – Vasopressin offers no advantage over epinephrine in cardiac arrest

5 – A target temperature should be maintained in the postcardiac arrest period

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224950/

 

■  Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Consultório: Rua Padre Rolim 815/sala 601

Tel: 33245518

CRMMG: 7026

Email: pfleite1873@gmail.com

Data: Fev 2020