Abstract Targeted temperature management (TTM) is currently the only potentially neuroprotective intervention recommended for post-cardiac arrest care. However, there are concerns among the scientific community regarding conflicting evidence supporting this recommendation. Moreover, the bulk of trials included in systematic reviews that inform guidelines and recommendations have been conducted in developed countries, with case mix and patient characteristics that significantly differ from the reality of developing countries such as Brazil. Elevated body temperatures induce changes in the blood-brain barrier integrity and […]

Abstract Cardiovascular medicine has witnessed remarkable breakthroughs, yet even highly regarded interventions can be undermined by flawed reasoning, excessive mechanistic assumptions, and the selective reporting of data. This article examines crucial pitfalls in contemporary cardiology, such as medical reversals, the impact of spin, and how bayesian methods can offer greater clarity in evaluating evidence, as they integrate prior knowledge with new data to generate more probabilistic, context-driven conclusions. This review advocates for a measured, critical approach to research appraisal, cautioning […]

Abstract Embolic stroke of undetermined source (ESUS) accounts for around 20% of ischemic strokes. The ideal treatment for secondary prevention in ESUS remains unclear. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of direct oral anticoagulants (DOACs) versus aspirin in patients with ESUS. A systematic search of PubMed, Embase, Cochrane, and Web of Science databases was conducted for eligible trials until March 2024. The primary outcome was recurrent […]

Abstract The “Fantastic Four,” a term coined in 2021 to refer to the four key drug pillars in the treatment of heart failure with reduced ejection fraction (beta-blockers, renin-angiotensin system and neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, or SGLT2 inhibitors), has demonstrated excellent performance in reducing morbidity and mortality in this setting. However, in heart failure with mildly reduced or preserved ejection fraction, the same benefits were not observed with this combined treatment where, for many years, […]

Abstract Changes in ventricular repolarization are associated with ventricular arrhythmias and higher mortality. The association between a non-dipper blood pressure pattern and changes in ventricular repolarization remains controversial. This study sought to compare ventricular repolarization measurements (QT interval, QTc, Tp-Te, Tp-Te/QT, and QTd) in hypertensive dippers and non-dippers. Secondary objectives are to compare measurements between controlled and uncontrolled hypertensive patients, as well as resistant and non-resistant hypertensive patients. This observational, cross-sectional study involved patients monitored in a Hypertension Service. The […]

Abstract Medicine is perhaps the only science that values knowledge of the most recent scientific publications more than its history over time. Medical epistemology shows that some mistakes and successes are so close that we often do not readily differentiate between them. The production of medical knowledge makes us understand that knowledge is transitory and theories need to be revalidated, rectified, or polished, if not destroyed and built again on other bases; paradigms that are renewed move science. With this […]

Abstract Value-based healthcare is a patient-centered concept that provides a broad view of all parties involved in the care process. This model is designed to achieve the best possible patient outcomes while maintaining cost sustainability. In its classic description, value-based care is the relationship between outcomes that matter to the patient and the costs required to achieve them. Later, other variables were considered in this equation, such as appropriateness and user experience, to make this model more replicable. With a […]

Abstract Left ventricular hypertrophy (LVH) represents a frequent observation in clinical practice. Nonetheless, the hypertrophic phenotype emerges as a common manifestation of diverse conditions, thereby presenting a diagnostic conundrum for clinicians. Differentiation among the etiologies of LVH is imperative for therapy decision-making, as different approaches must be implemented for distinct conditions, such as LVH secondary to loading changes, hypertrophic cardiomyopathy (HCM), or HCM mimics. In some instances, an erroneous or late diagnosis may lead to a progression of the underlying […]

ABSTRACT Closure of the ductus arteriosus (DA) using cyclooxygenase (COX) inhibitors is considered the first-line treatment for hemodynamically significant patent ductus arteriosus (PDA). Physiologically, prostaglandins have a recognized role in PDA. Admittedly, the comparative efficacy and safety between ibuprofen and acetaminophen need to be determined for rational choice of drug therapy for closure of the DA in clinical protocols. This study aims to present the aspects of the efficacy and therapeutic safety of paracetamol versus ibuprofen in the treatment of […]

Abstract Hypereosinophilia (HE) is defined as an eosinophil count exceeding 1500 cells/microL in peripheral blood in two tests, performed with an interval of at least one month and/or anatomopathological confirmation of HE, with eosinophils comprising more than 20% of all nucleated cells in the bone marrow. Hypereosinophilic syndrome (HES) indicates the presence of HE with organ involvement due to eosinophil action, which can be classified as primary (or neoplastic), secondary (or reactive), and idiopathic. Cardiac involvement occurs in up to […]