Friday, January 24 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

2021 HHP - How many fruits+vegetables do we really need (Circulation).pdf
2021 CIRCULATION - Fruit and Vegetable Intake and Mortality, 2 Prospective Cohort Studies + MA of 26 Studies (wang) [MA]

Codified by ABFL
Codified by ACE ᵗᵉᵃᵐ

Glossary: 

🫁 = lungs, COPD; 🧠 = brain, stroke; 🫀 = heart, cardiovascular disease; WHO = World Health Organization; WCRF = World Cancer Research Fund; NHSE = National Health Service of England

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2021, CIRCULATION, USA ➖ obs_PROS + MA ➕ 2M | pros = >66k in ♀ (1984-2014) – >42k iin ♂ (1986-2014) ▶ MA = 1.8M ➕ 30y ➖ P I C O:
   - P: adults
   - I: pooled self-reported health and diet information
   - C: NA
   - O: MM ➩ Results:
            • 10%. ↓r CA - (0.90)
            • 12%. ↓r 🧠 🫀 (HR 0.88)
            • 13%. ↓r MM (HR 0.87)
            • 15 35%. ↓r 🫁 COPD (0.65)
3. EVIDENCE:
  - Leafy green vegetables: kale + spinach
  - Fruits & vegetables: vitamin C + beta carotene (ANTIOXIDANTS)
  - NO BENEFIT in MM ➩ >5 servings OR starchy veggies OR potatoes OR drinking fruit juices.
  - Veggies only = no ↓ CA (p=0.62)
  - RECCO diver among countries ➩
       * 8.5 servings in AUS
       * 6 servings in DEN
       * 5 servings in WHO, WCRF, NHSE

  - Fruit juices + potatoes = ↑ glycemic load (various DIETARY RECOMM include them)

  - How much you eat in average MATTERS ➩ if NOT achieved THE GOAL, you can

    compensate the day after.

⏳ TIME MANAGEMENT.
01:27:38

Round: 8 00:01:30 The end
Round: 7 06:31:64 Wrap-up
Round: 6 12:09:86 Images + keypoints
Round: 5 37:44:75 ART 1 original
Round: 4 21:01:46 ART 1 prequel
Round: 3 04:19:04 Selection
Round: 2 02:13:15 Past JCRound: 1 03:37:75 Past JC

2024 CC - Comparison of methods to normalize urine output in CIpxs, a multicenter cohort study (monard) [R].pdf

Codified by MAAT

Glossary: 

♾ = kidneys; ABW = actual body weight; AKD = acute kidney disease;

CH = Switzerland; coh = cohort; DE = Germany; h_DIS  =  Hospital discharge; IBW = ideal body weight;

mc = multicentric; UO = urinary output.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, CC, CH + USA ➖ mc_coh ➕ 15,322 + 28,610 (derivation + validation) ➕ CH 2010-2020 ➖ P I C O:
     - P: adults, CI pxs
     - I: CH (Laus’AKI, derivation coh) 🆚 USA (MIMIC-IV, validation coh)
     - C: NA
     - O: best predictor for UO
3. EVIDENCE:
   - Oliguria = <0.5mL/Kg/h in ≥6h
   - Presents in 75% of CI pxs + ↔ MM90
   - Estimation of weight is inaccurate
   - ABW ➩ massive variations (fluid overload + muscle mass loss + obesity + underweight)
   - Types of BW: pre-admission + actual + ideal + adjusted
   - Series (493 pxs = overestimation) + 2 large studies (USA + DE = confirmed)
   - 4th study (S + 569pxs) not influenced by the method (oliguria & MM)
   - The four studies = single center
4. METHODS.
- DEF ➠ Best predictor for UO = most closely ↔ w_mean UO d_UCI
- IN ➠
  * Laus’AKI: ≥18yo, Lausanne, Jan 2010 - Jun 2020
  * MIMIC-IV: Boston, 2008 - 2019
- EX ➠
  * Laus’AKI + MIMIC-IV: refused, u_HD, <6h UO measurement, no sCr, no weight, no height,

    vesical irrigation d_ICU stay.
- RANDOM ➠
- INTERV ➠ 1st. Best predictor was chosen 2nd. Compared OLIGURIA INCIDENCE w_: a. MM90, b. AKD at H+dis ➩ according to ABW or IBW (which normalized better)
6. RESULTS
   - USA cohort: heavier, older, lower in SAPS-II (than CH cohort)
   - Best UO predictor = IBW (‘oliguria incidence’ was constant)

   - IBW ➩ ↗️ association ↔ oliguria w_: MM90 & AKD

   - After correction (sex, SAPS-II): ALL FINDINGS PERSISTED

Friday, January 17 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

⏳ TIME MANAGEMENT.
01:18:15
Round: 5 06:07:41 Figures
Round: 4 20:28:69 Content + wu
Round: 3 33:11:79 Article UO

Round: 2 06:06:67 Article choice

Round: 1 12:21:18 Past JC

2025 CC - Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in MV pxs w_low Vt in ICU (mallat) [srMA].pdf

Codified by MAAT

Glossary: 

💨 = flow = perfusion; 🫁 = lungs; 🫀 = heart; FC = fluid challenge; FR = fluid responsiveness; PPV = pulse pressure variation.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, UAE ➖ srMA ➕ 5 studies (474 pxs) ➕ PROSPERO - publication (1y) ➖ P I C O:
     - P: ↓Vt 
     - I: ∆PPV & ∆PPV% a_PLR following ‘…not a drop of fluid’
     - C: fluid challenge or response to PLR
     - O: ability to predict FR in ↓ Vt MV
3. EVIDENCE:
   - 1st line therapy = fluid administration ➩ tissue hypoperfusion context
   - FC AIM = ↑ preload + CI ➩ 🔝 DO2 + tissue 💨
   - Excessive fluid ➩ peripheral + 🫁 edema + poor OC
   - Deficient fluid ➩ MOF + MM
   - 50% are fluid responsive- PPV accurately predicts FR in MV pxs ➩ only if Vt ≥8 ➩

     OTHERWISE (Vt <8), insufficient to induce changes in THORACIC PRESSURE &

     PRELOAD.

Friday, January 31 , 2025 at 18h30 at BO - 23h30 at BE

AMA, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:28:32
Round: 4 06:18:93 Comments
Round: 3 01:07:40 ART
Round: 2 09:17:00 ART selection
Round: 1 05:16:43 Past JC

Friday, March 14 , 2025 at 18h30 at BO - 23h30 at BE

AMA, MACR, DFM, JQB, MAAT, HIBN, AAQC

2024 JACC - From ST-Segment Elevation MI to Occlusion MI (McLaren) [r].pdf

Codified by ABFL

Glossary: 

ACC = American College of Cardiology, ACO = acute coronary occlusion, Computerized Tomography, Delayed Invasive Intervention in Patients With Non–ST-Segment–Elevation Myocardial Infarction, INT = interpretation, MI = myocardial infarction, OMI = occlusion MI, RIDDLE-NSTEMI = Randomized Study of Immediate Versus, STD = ST-segment depression, STEMI = ST-segment elevation MI, TIMACS = Timing of Intervention in Acute Coronary Syndromes, VERDICT = Very EaRly vs Deferred Invasive evaluation using.

1. Image of non-STEMI = STEMI (occluded) + non-STEMI (nonocclusive thrombus)
2. Clear deviation from actual evidence ➩ real occlusion in non-STEMI
3. ST criteria (age, sex) = Healthy 🆚 CKMB measured MI pxs ➩ DESPITE THIS… REC

    differentiation of MI w_ & wo_ACO
4. NORMAL SCIENCE = persistence of a paradigm (successful in its aim, steady expansion) =

    DOES NOT aim at novelties
5. OCs of STEMI criteria ➩ best reperfuse + ↓ reperfusion delays
6. STEMI paradigm ➩
       * ↗️REPERFUSION strategies & techniques
            - Angiography
            - Stenting
            - Medications
            - Door-to-balloon (time is myocardium)
       * ↗️🫀 ER + INTERdisciplinary collaboration:
            - ⊕ Cath lab
            - Paramedics BYPASSING ER departments
            - Rapid assembling of interventional 🫀 teams
       * 2 quality ↗️:
            - ↓ reperfusion delays
            - ↓ false positives STEMI
       * NOVELTY:
            - No false negatives found ➩ ECG wo_STEMI criteria + ACO = NOT considered a false

              (-) STEMI ➩ “As a result, the patient will be denied emergent reperfusion”
            - McLaren stated this problem in 2023 AJEM, Missing occlusion
       * Evidence
            - Trials have not regarded this type of cases
            - Many non-STEMI trials have reperfusion time limitations ➩ TIMACS 16h (unstable

              angina, non-STEMI) to reperfusion.
            - VERDICT (unstable angina, non-STEMI) = benefit from 4.7h of reperfusion.
            - RIDDLE-NSTEMI = ↓ MM in immediate reperfusion
            - NSTEMI exclude refractory ischemia OR HD/electrical instability

            - 6.4% of VERY-HIGH NSTEMI ➩ angio in 2h

⏳ TIME MANAGEMENT.
01:24:22
Round: 4 00:50:82 Comments
Round: 3 23:33:13 wrap-up
Round: 2 47:53:53 JC
Round: 1 12:05:49 Past 2 JCs

⏳ TIME MANAGEMENT.
01:25:47
Round: 7 07:25:35 Comments
Round: 6 11:46:41 Results
Round: 5 30:00:94 Methods
Round: 4 16:27:26 INTRO
Round: 3 11:42:31 JC, abstract
Round: 2 03:16:61 ART selection
Round: 1 05:08:43 past JC

2024 JACC - From ST-Segment Elevation MI to Occlusion MI (McLaren) [r].pdf

Codified by ABFL

Glossary: 

ACC = American College of Cardiology, ACO = acute coronary occlusion, INT = interpretation, MI = myocardial infarction, OMI = occlusion MI, STEMI = ST-segment elevation MI.

1. SHIFT ➩ scope + precision change OR stay when PARADIGM is more successful (few

    problems resolved) - acute ones
2. STEMI criteria as SURROGATE of ACO = limited in scope + precision
3. 1994 MA ➩ “ECG w_STEMI criteria = emergent reperfusion”
      - Suspected MI
      - w_limited or NO ECG
      - Treated w_streptokinase
      - MI determined by CK-MB
      - CRUDE separation = poor definition
      - 4 studies ➩ no ECG requirements for enrollment
      - cautioned about denying reperfusion in patients without STE.
      - Few deaths + data-dependent emphasis could be misleading
4. Kuhn ➩ paradigms start FLEXIBLE… and then become RIGID
5. GLs:
      1. 1996 ➩ advised THROMBOLYTICS for hyper acute T or ST-seg depression V1-V4 from

           POSTERIOR MI (experienced expertise is needed)
      2. 1999 ➩ advised CLASSIFY “w_STE or LBBB” + “nonDx ECGs” (even being posterior

           infarctions)
      3. ∑ STEMI paradigm emerged w_2 ≠ entities: STEMI 🆚 non-STEMI

Friday, March 07 , 2025 at 18h30 at BO - 23h30 at BE

MAAT, HIBN, AAQC

2025 ICM - How we use ultrasound in the mm of weaning from MV (Tuinman) [ed].pdf

Codified by ABFL

Glossary: 

🫁  = lungs, 🫀 = heart,🫃🏽 = abdomen = abdominal, AbP = abdominal pressure, af_ = after, antiISCHE = anti-ischemic, CCUS = critical care ultrasound, DE = diaphragm excursion, Di = diaphragm, DIS = disease, DYSF = dysfunction, DW = difficult weaning, HTA = hypertension, IAP = intraabdominal pressure, iFunction = impaired function, MIP = maximal inspiratory effort = maximal inspiratory pressure, MV = mechanical ventilation, PSIC = parasternal intercostal, PSLA = parasternal long axis, PSSA = parasternal short axis, SBT = spontaneous breathing trial, TECHS = techniques, TFdi = thickening fraction of the diaphragm, WF = weaning failure.

1. DW ➩ ↑ adverse clinical OCs➕ resources (limited healthcare)
2. DW = failure SBT ➩ causes of WF ▶ iFunction: 🫁 🫀 Di
3. CCUS ➩ valuable DX tool ➩ MV, weaning, readiness for weaning, causes of WF, 🫀–🫁 function, TTO response.
4. ABCDE-US ➩ pathophysioly of WF ➩ DX ➕ monitoring = CAUSE oF WF
       1. ABCDE ➩
              - it is an ADJUNCT to clinical parameter + physical examination
              - Timing: MV > 48h
              - Frequency: follow-up determined by a. Cause, b. Course DIS     
        2. 🫀:
              - DYSF ➩ MOST frequent causes of WF
              - 1st. TTE. views (PSLA, PSSA, apical 2, 3, 4, 5 chamber, subcostal) ➩ eye-balling: to

                 estimate SIZE + FUNCTION both ventricles ➕ wall abnormalities OR 🫀 effusion
              - 2nd. TTE by educated in ECHO. If CAUSE not clear
              - 3rd. TEE. Diastolic function (E/A and E/e’ ratios) when FAILING an SBT. Wall motion

                abnormalities + 🫀 valves (stenosis + regurgitation)
              - TTO ➩ fluid removal ➕ antiHTA ➕ antiISCHE
        3. 🫁 :
              - Aeration score + P.eff.
                  * QUALITATIVE ▶ 6 views DX cause of ARF (sliding, pleural abnormalities, lung

                     profiles ABC, pleural effusion, consolidation w_or wo_ air bronchograms) ➖

                     careful w_deterministic fashion interpretation
                  * QUANTITATIVE ▶ 12 views ➩ calculare 🫁 aeration score ➩ monitor 🫁

                     pathology over time
                  * r_extubation failure ▶ 8 views ➩ ← → SBT ➩
                  * ≥5 B-lines = extubation failure (independent fro LV filling presssures)
                  * OCs ▶ weaning readiness + WF cause + monitor DIS progression & TTO

                     response.
         4. 🫃🏽:
               - ↑ AbP ➩ can affect MECHS ∑ weaning
               - US ▶ screen aspect FREE FLUID (↓ anechoic) 🆚 heterogenous (↑ echoic) +

                  septum (useful for the cause of free fluid)
               - Paracentesis DX and TTO
           5. Di:
               - Highly prevalent ➩ DYSF of Di
               - US: to exclude Di DYSF ➩ af_FAILED initial SBT
               - DE = subcostal OR subxiphoid (liver OR spleen as acoustic windows)
                  * IF not clear ▶ use  INTERCOSTAL (zone of apposition to DISPLACEMENT of

                     liver

                     OR spleen) = qualititve alternative.
                  * Measured d_spontaneous breathing wo_ventilator support.
                  * In cooperative PXS ➩ MIP to assess MAX excursion
               - Contractility: TFdi (via INTERCOSTAL) ▶
                  * ↑ = edema ➖ fibrosis (careful)
                  * ↓ = atrophy
                  * DYSF = DE <20mm
                  * WF (predictive) = TFdi <30-35% ➕ DE <10-15mm
            6. Extra-Di
                - ExtraDi muscles help Di weakness ➩ successful SBT BUT potential WF
                - Expiratory muscle atrophy = impairment of airway clearance ➩ WF
                - US: PSIC + rectus abdominis muscle + external oblique, internal oblique &

                  transversus abdominis (same window).
                - Consider always IAP (due to GEOMETRY + MOBILITY)
                - Thickening fraction of INTERCOSTAL MUSCLES >10% = ↑r_WF
7. FUTURE DIRECTIONS
                - CLINICAL trials ▶↗️  predictive performance of 🫁 + Di
                - DX continuous data ▶ ↗️ predictive performance of 🫁 + 🆕 indications
                - Advanced TECHS ▶ speckle tracking (quantification of perfusion + better function

                  estimation).

8. These measurements can be used to form a definition of diaphragm dysfunction, although

    there is variation in this definition: It has been defined as a thickening fraction of less than

    20% or a tidal excursion of less than 10 mm – 2019 UJ - A narrative review of diaphragm

    ultrasound to predict weaning from MV, where are we and where are we heading (turton) [r]

Friday, March 28 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AHO, GMC, HIBN, AAQC

⏳ TIME MANAGEMENT.
02:13:08
Round: 5 06:52:74 Comments
Round: 4 58:27:56 Wrap-up
Round: 3 46:41:93 ART
Round: 2 06:47:19 ART selection
Round: 1 14:19:46 past JC

Friday, April 11 , 2025 at 18h30 at BO - 23h30 at BE

HIBN, AAQC

2025 CC - Ventilation-induced AKI in ARF Do PEEP levels matter (Benites) [r].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

🫧 = alveolar, AF = atrial fibrillation, AKI = acute kidney injury, ARDS = acute respiratory distress syndrome, CA = cancer, GE = gastroenterology, MV = mechanical ventilation, Ppl = pleural pressure, VR = vascular resistance.

1. ARDS & MV
       - ARDS = major issue in CIpxs
       - MV = crucial for TTO, with PEEP (Positive End-Expiratory Pressure) being a key setting.
2. High vs. Low PEEP – The Debate
       - ↑ PEEP:
           * a.↗️🫁 compliance ➕ O2
           * b. ❌ inconclusive effects ➩ MM or d_MV.
       - ↓ PEEP:
           * May ⊖ overdistension but r_↑ poor O2
       - Optimal PEEP is still controversial.
3. Organ Crosstalk
       - Improper PEEP affects: ❤️ 🧠 🧽
       - ARDS pxs develop AKI (strong MM marker)
4. 🫁 - 🧽 crosstalk d_MV
       - Gas Exchange Issues (↓O2, ↑CO2)
       - Remote Biotrauma = Inflammatory mediators affecting distant organs
       - HD changes = ↓ venous return + ↓ CO → Renal perfusion issues
5. h_PEEP & 🧽 Function – The 🫁 Dynamics
       - w_high recruitability = 🫧 reopening + ↑ Pp ➩ Vena cava compression → Systemic &

         renal congestion
       - w_low recruitability = Minimal volume gain + 🫧 overdistension + 💥 Vascular

         compression + ↑ 🫁 VR ➩ renal impairment.
6. More research is needed to:
       - Fine-tune PEEP settings
       - Maximize 🫁 benefits
       - ↓ 🧽 and systemic harm
7. Think beyond the lungs when ventilating ARDS patients!

⏳ TIME MANAGEMENT.
01:04:43
Round: 5 00:29:71 FInal comments
Round: 4 50:21:89 ART all
Round: 3 06:06:42 ART abstract
Round: 2 07:24:68 ART selection
Round: 1 00:21:12 Last JC 8 min

2021 Intl J Gynecology Obste - Fetal growth and spontaneous preterm birth in high‐altitude pregnancy (grant) [srMA].pdf

Codified by AAACC

Glossary: 

👶🏼 = infants = infancy, bW = birth weight, hALT = high altitude, LBW = Low Birth Weight, Preg = pregnant, SGA = Small for Gestational Age, sPTB = Spontaneous Preterm Birth

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2021, IJGO, UK ➖ srMA ➕ 2524, 59 IN ➕ -Nov 11, 2020 ➖ P I C O:
      - P: hALT pregnant
      - I: preg hALT
      - C: preg non-hALT
      - O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW
3. EVIDENCE:
      - hALT physiological changes ➩ pregnancy adaptations + hypobaric hypoxia
      - 👶🏼 born at hALT = "lighter” (LBW)
      - LBW ↔ short/long-term uOC
      - https://www.floodmap.net
4. METHODS.
      - 𝗜𝗡 ➠
      - 𝗘𝗫 ➠
      - RANDOM ➠
      - INTERV ➠
6. RESULTS
7. RATIONALE
8. LIMITATIONS

Friday, April 04 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AHO, BAH, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:48:53
Round: 7 04:24:00 Finish
Round: 6 37:28:01 Results
Round: 5 14:58:50 Methods + Inclusion
Round: 4 09:53:45 Introduction
Round: 3 07:54:63 ART abstract
Round: 2 10:10:66 ART selection
Round: 1 24:04:51 Past JC

Friday, April 25 , 2025 at 18h30 at BO - 23h30 at BE

AHO, HIBN, AAQC

2025 CC - Limitations of SpO2 FiO2-ratio f_ class_ + monitoring of ARDS (Erlebach) [R].pdf

Codified  by AMA

Glossary: 

ARDS = acute respiratory distress syndrome, C = ICU cockpit, DBs = databases, M = MIMIC-IV, MV = mechanical ventilation, PF = PaO2/FiO2, RLS = resource limited settings, S = SICdb, SF = SpO2/FiO2.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, CH ➖ retro_obs_cohort ➕ >700 ➕ 3 DATABASES (MIMIC-IV = 2008-2022, SICdb = 2013-2021, ICU cockpit = since 2016 ) ➖ P I C O:
         * P: ARDS
         * 🅸: SpO2, FiO2, PaO2 ➩ SF
         * 🅲: NA ➩ PF
         * O: pOC = accuracy (correct/total classifications) | sOC = accuracy per severity +

           trending ability to correlate w_FiO2
3. EVIDENCE:
   - New global definition ➩ SpO2/FiO2 (additional ↓O2 criterion) for RLS
   - PF used by major interventional trials
   - Simplicity + practicality ➩ most widely used surrogate
   - Disadvantage ➩ ABG needed ➕ availability in RLS ➕ complications (vascular injury, 🩸

      oma, 🪲 , thrombosis, nerve injury)
4. METHODS.
   - 𝗜𝗡 ➠
     * M = USA, 65k - 1h resolution
     * S = Austria - 27k, 1-per-min data
     * C = Switzerland - 2,4k - >200Hz, continuous signals
     * ARDS population
          * C = manually selection w_Berlin definition.
          * S + M = ICD codes (9 and 10)
          * ↓O2: PF≤300 ➩ MV, NIV, CPAP ➕ PEEP ≥5 or HFNO flow≥30.
          * IF multiple admission, only the 1st was IN
   - 𝗘𝗫 ➠ ECMO
   - INTERV ➠ 3 datapoints ➕ severity based on thresholds
   - DATA MANAGEMENT ➠ Datapoints for each ABG measurement:
     * M = with hourly data, values were matched within a 30-minute window.
     * C = ABG timing was identified using gaps in arterial pressure waveforms. If no gap =

        within 15 min ← the ABG timestamp, median values from 5 to 2 minutes prior (FiO₂ and

        SpO₂)
     * S, FiO₂ and SpO₂ were matched with some time delay allowance (details cut off).
    - ANALYSIS
     * Confusion matrices
     * Density plots
     * Limitations: SpO2 🆚 SaO2 ➩ bias + precision
5. RESULTS
     * Misclassification ➩ 33% of datapoints ➩ 84% more severe ▶ Explanation: Imprecision of

       SpO2 + equation to transform SF to PF
     * High dependence SF on FiO2 settings ➩ Implications: major TTO + limited capability to

        track severity (<20% events)
     * Severity comparison = 69% ➖ individual datapoints = 67%
     * Performance = BEST in more severe PF
          * SF ↑ estimated = 28%

          * SF ↓ estimated = 2.9%

     * Accuracy = different ↔ DBs ➩ C = second 🆚 S = minute 🆚 M = hour

⏳ TIME MANAGEMENT.
01:53:25
Round: 9 01:09:86 Summary
Round: 8 47:47:74 Wrap-up
Round: 7 21:09:56 Tables & Figures
Round: 6 04:51:09 Wrap-up
Round: 5 02:47:08 INTRO
Round: 4 21:58:44 Wrap-up
Round: 3 05:04:28 ART intro + abstract
Round: 2 03:42:78 ART selection
Round: 1 04:55:03 Past JC

2025 NEJM - Liberal or Restrictive Transfusion Strategy in Aneurysmal SAH (English) [R].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

CFR = case fatality rate, DCI = delayed cerebral ischemia, E&D = early & delayed, EQ-5D-5L = EuroQol five-dimension, five-level, FIM = functional independence measure, M_ = mean, RC = red cell, VAS = visual analogue scale

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS ➩ SAHARA ➩ 2025, NEJM, 23_c ➖ RCT ➕ 742 pxs (→ 725) ➕ 12 m ➖

P I C O:
      - P: adults w_ ‘acute_aneu_SAH + anemia’
      - 🅸: liberal transfusion (≤10 g/dL)
      - 🅲: restrictive transfusion (≤8 g/dL)
      - O:
            * pOC = u🧠OC12m (≥4 m_Rankin; 0-6)
            * sOC = f_INDEPENDENCE12m (FIM; 18-126) ➕ QOL (EQ-5D-5L utility index; -10.1–

              0.95 + VAS; 0-100)
3. EVIDENCE:
      - SAH
            * Condition ➩ Severe + life-threatening
            * Cause ➩ early MM + loss of productive life years
            * CFR ➩ 8-67%
            * Affects ➩ young + mostly ♀
            * Clinical course ➩ complicated by E&D 🧠 INSULTS
            * Survivors ➩ <1/3 = full recovery ➖ [substantial] = dependent living.
      - ↓Hb
            * >50% of SAH ↔ worse_clin_OC
            * ↓DO2 = ↑ E&D 🧠 insults ↪ aneurysm rupture (DCI) MAJOR contributors ➩ poor 🧠

              recovery.
      - RC Transfusion
            * Limited + conflicting
            * Based on small OBS studies
            * GL ➩ vague ⓘ
            * Threshold is unknown
4. RESULTS
      - pOC
            * 725pxs (98%)
            * uOC = 122/364 (34%) 🅸 🆚 136/361 (38%) 🅲 (p=0.22)
      - sOC
            * FIM* = 83 🅸 🆚 80 🅲
            * EQ-5D-5L* = 0.5 in both
            * VAS* = 52 🅸 🆚 50 🅲
            * AdvEve† = similar in both

Friday, April 18 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AAQC

⏳ TIME MANAGEMENT.
01:24:11
Round: 6 10:40:74 Summary with AMA
Round: 5 16:05:19 Wrap-up
Round: 4 43:37:05 Wrap-up + ART intro
Round: 3 07:20:46 ART intro
Round: 2 01:48:24 ART selection
Round: 1 04:39:83 Past JC

Friday, May 9 , 2025 at 18h30 at BO - 23h30 at BE

AMA, EAM, AAQC

2025 CC - The ventilator of the future_ key principles and unmet needs (marini) [persp].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

🫁 = lungs, Di = diaphragm, LV = left ventricular, MV = mechanical ventilation, P-SILI = patient self-induced lung injury, RMP = respiratory muscle pump, RR = respiratory rate, TP = transpulmonary, VD = dead space.

1. iMV ➩ conditioned gas + adequate ventilation energy ➩ 🫁 expansion to prevent ATELECTASIS + consequences.
2. iMV allows monitoring:
       * Airway pressures
       * Flows
       * Frequency
       * Vt
3. NEW ADVANCES = Flow delivery patterns + sophisticated online processing
4. Applications in ‘PO ventilation + NM weakness’ ➩ machine incremental improvements
5. “Less than ideal for the most critically ill”
6. Technology + engineering ➩ ↗ capability + safety
7. LIMITATIONS
       * P-SILI
       * Sysinchony
       * Muscle fatigue
       * ↓ O2
       * Di_DYS
8. Tracking the NET physiologic effect of CV system requires (caregivers): Independent detection + integration.
9. ❝ expertise and time to spend at the bedside
10. Reaction is OK, but intermittent adjustment + reaction to alarms = dangerous
11. Primary hazards:
       * HD impairment
       * VILI
       * Impairment RMP
12. Insufficient surveillance + complex interactions among organs ➩ vary w_training + expertise of caregivers = universal PROBLEM.
13. GL not enough
       * Helpful as 1st approximations
       * Imprecise definition of: DIS OR synd + clinical trial.
       * ∑ limit personalization.
14. ❝ no single set of parameters would suit all patients
15. UNMET GOALS of VENTILATORY support
       * GAS EXCHANGE
             * PAP ➩ disrupts homeostasis V/Q
             * MV ↑ FiO2 + ↑ TPaw ➩ ∑ ✖ atelectasis ↗ O2, PROBLEMS:
                 * ↑ Pp ∑HD compromise + 💧 retention.
                 * Overdistention of aerated 🫁 zones ➩ suboptimal reperfusion ∑↑VD
       * HDs
             * ↑ intrapleural + → atrial pressure ➩ ↓ venous return + ↑ pre-capillary 🫁 vasculature

                PRESSURE.
             * ATRIAL pressure ➩ → ventricle ➩ LV filling ➩ ↓ CO… provokes ➩ Reflex fluid

                loading (caregiver) ➩ ⊕ fluid balance (compressive forces on alveoli):
                 * Lung edema
                 * Pleural effusion
                 * Ascitis
       * 🫁 injury
             * VILI ➩ Tidal repetition excessive tissue strains produced by the energy of 🫁

                distension.
             * Extensively investigaged in LABS, less at bedside
             * DIS type, stage and local environment = parenchymal VULNERABILITY (stress

                threshold)
             * HAZARDS = TP airspace pressure (analogue of tissue stress) + power (mechanical

                energy * RR)

⏳ TIME MANAGEMENT.
01:53:25
Round: 9 01:09:86 Summary
Round: 8 47:47:74 Wrap-up
Round: 7 21:09:56 Tables & Figures
Round: 6 04:51:09 Wrap-up
Round: 5 02:47:08 INTRO
Round: 4 21:58:44 Wrap-up
Round: 3 05:04:28 ART intro + abstract
Round: 2 03:42:78 ART selection
Round: 1 04:55:03 Past JC

2021 Intl J Gynecology Obste - Fetal growth and spontaneous preterm birth in high‐altitude pregnancy (grant) [srMA].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2021, IJGO, UK ➖ srMA ➕ 2524, 59 IN ➕ -Nov 11, 2020 ➖ P I C O:
P: hALT pregnant
🅸: preg hALT
🅲: preg non-hALT
O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW
3. EVIDENCE:
   - …
4. METHODS.
   - 𝗜𝗡 ➠
   - 𝗘𝗫 ➠
   - RANDOM ➠
   - INTERV ➠
5. RESULTS
6. RATIONALE

7. LIMITATIONS

Friday, May 2 , 2025 at 18h30 at BO - 23h30 at BE

BLAS, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:19:21
Round: 3 59:56:38 The rest
Round: 2 01:59:03 ART selection
Round: 1 17:26:31 Past JC

Friday, May 23 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AHO, BAH, GMC, HIBN, AAQC

2025 CC - “The NET effect” Neutrophil extracellular traps—a potential key component of the dysregulated host immune response in sepsis (retter)[r].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MAAT)

Glossary: 

Com = complement, coa_factors = coagulation factors, DAMPs = damage-associated molecular patterns, M = monocytes, N = neutrophils, OD = organ dysfunction, PLT = platelets, PRRs = pattern recognition receptors, ROS = reactive oxygen species.

1. Sepsis definition
2. 11M deaths per year ➕ 49M cases
3. Advancements ➩ S• immunobiology = ↗️ nuanced conceptualization (resistance, tolerance,

    resilience, resolution, repair)
4. Immunothrombosis ➩ immune ➕ coagulation ➩ to ✖ pathogens
         * ⊕ cellular + molecular ➩ N, PLT, M, com, DAMPs, coa_factors
         * ⊕ excesive + uncontrolled ➩ thromboinflammation
5. DAMPs ➩ danger signals ▶ triggers INFLAMMATORY RESPONSES thought PRRs:
          * TLR
          * NOD
6. ↑ DAMPs ➩ amplifies + perpetuates 📈INFLAMMATION ➩ S• + OD
7. NETs ➩ histones + granular proteins ➩ TRAPS
8. ↑ FORMATION ± DYSREGULATED clearance ➩ pathophysiology of S• + thrombosis
9. N ➩ short lifespan = 5-7d ➩ ↓ once ACTIVATED:
          - (+) rapid response to INF
          - (-) obstacle to research (isolate cells + expand ➩ in vitro)
          - Few hours life AFTER ISOLATION
          - Triggers: PROCESSES ➩ degranulation + ROS
10. N requires PLT + M to get activated (makes it harder to study in vitro)
11. N have different PHENOTYPES + PROFILES (functionals) ➩ still being explored.
12. Not only affect BLOODSTREAM, but also TISSUES
13. Sophisticated techniques are needed (not universally available). E.g. intravital microscopy
14. Ethical and technical CONSIDERATIONS make it difficult to study in humans.
15. 2004. Brinkmann ➩ nuclear content ➩ traps + kill bacteria ➩ scepticism (short-lived

      concept challenged)
16. 2007. Fuchs ➩ net formation was triggered by NETosis (active cell detah) ➩ requires ROS

      by NADPH.
17. NEt release ⊕ stimuli:
          - Bacteria
          - Viruses
          - Fungi
          - Parasites

          - Pro-inflammatory mediators: IL8, lymphotoxin-alpha

Friday, May 16 , 2025 at 18h30 at BO - 23h30 at BE

AMA, HIBN, AAQC

2025 JAMA - Metformin for Knee Osteoarthritis in Pxs W_ Overweight or Obesity (pan) [RCT].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

ACR = American College of Rheumatology, AMPK = Adenosine Monophosphate–Activated Protein Kinase, ES = Effect Size, 💉 = Intravenous, OA = Osteoarthritis, VAS = Visual Analog Scale..

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, AUS ➖ par_db_RCT ➕ 54 🆚 53 ➕6m of intervention – total 2y (2021 to 2023), last f-up Feb 2024 ➖ P I C O:
    - P: symp_knee OSTEOARTHRITIS + overweight OR obesity
    - 🅸: metformin 2g/d
    - 🅲: placebo
    - O: pOC = change in knee pain (VAS) | sOC = WOMACS + AQoL
3. EVIDENCE:
    - Preclinical + preliminary ➩ ↓ inflammation ➕ preserves cartilage ➕ ↗ knee pain
    - OA IN 365M
    - Knee OA ➩ ↑ weight joints, inflammation, imp_GLU & LIP metabolism ▶ SYST

      inflammation + oxidative stress + metabolic DYS in JOINT TISSUES (cartilage degradation

      + DIS progression)
    - METFORMIN >60y known as 1st line for DM
    - SAFE, inexpensive, well-tolerated biguanide
    - ↓ liver_GLU production ➕ ↓ IR ➕ ↓ ENDOGENOUS hyperINSULINEMIA
    - Modest weight loss ➕ ↓ inflammation (w_ & wo_DM)
    - PLEIOTROPIC EFFECTS: ↓ knee pain in OA
       * Inflammatory properties
       * ↑ GLU & LIP metabolism ➩ ↑ ⊕ AMPk
4. METHODS.
    - 𝗜𝗡 ➠ pain (>4/10 VAS) ➕ BMI ≥25 ➕ >40yo ➕ ≥6m pain➕ know OA by criteria ACR
    - 𝗘𝗫 ➠ sev_Xray knee OA (Kellgren-Lawrence grade 4) ➕ Severe knee pain (>80 mm

      VAS) ➕ Inflammatory arthritis ➕ Significant knee injury ➕ DM ➕ Knee surgery (past

      year or next 6 m) ➕ Intra-articular hyaluronic acid 💉 (past 6 m) ➕ Corticosteroid 💉

      (past 3 m) ➕ investigational drug or device (30d prior to randomization) ➕ Conditions

      affecting lower limb function (NEURO disorders, stroke) ➕ ♾ & liver IMPAIRMENT.
    - RANDOM ➠ contacted by website, email, phone ➕local and social media

      advertisements.
    - Physical examination not performed by a physician ➩ participants reported KNEE         

      CREPITUS + TENDERNESS + WARMT + bony enlargement ✖
    - INDEX KNEE:
       * The symptomatic OA knee
       * IF both SYMP + eligible VAS ➩ ↑VAS ✔
       * If pain levels = ➩ less severe Xray ✔
       * IF both identical ➩ dominant ✔
    - INTERV ➠ Telemedicine (remote follow-up)
    - DESIGNS: Originally 2 studies ➕ 2 ethical committees ➕ funding only for study 1   

      ➕CONSORT
5. RESULTS
    - pOC:
       * 🅸 ↓ 31.3 mm 🅲 ↓ 18.9 mm
       * ES: 0.43 (95% CI: 0.02 to 0.83); P = .01
    - sOC – WOMAC Scores:
       * Pain Subscale ➩ 🅸 : ↓ 113.9 🅲 : ↓ 68.2 ➖ Adjusted DIFF: –42.4 (95% CI: –83.9 to –

         1.0); P = .045
       * Stiffness Subscale ➩ 🅸 : ↓ 56.9 🅲 : ↓ 26.7 ➖ Adjusted DIFF: –23.0 (95% CI: –40.4 to –

         5.7); P = .01
      * Function Subscale ➩ 🅸 : ↓ 426.1 🅲 : ↓ 221.7 ➖ Adjusted DIFF: –179.8 (95% CI: –313.0 

        to –46.6); P = .009
    - oOC
       * AQoL-8D ➩ 0.01 (95% CI: –0.02 to 0.05); P = .47
       * OMERACT-OARSI Responder ➩ 🅸 : 65% responders 🅲 : 45% responders ➩ OR: 2.21 

         (95% CI: 0.92 to 5.31); P = .07
       * VAS Change 3m ➩ DIFF: –2.5 mm (95% CI: –11.7 to 6.6 mm); P = .58

⏳ TIME MANAGEMENT.
01:44:07
Round: 6 00:22:58 Comment
Round: 5 54:52:26 Wrap-up + analysis
Round: 4 30:43:87 Abstract + intro
Round: 3 06:51:44 ART selection
Round: 2 09:40:43 Past JC

Friday, June 20 , 2025 at 18h30 at BO - 23h30 at BE

AMA, HIBN, AAQC

2024 NEJM - Case 22-2024 A 30-Year-Old Woman w_ Postpartum Fever, Abdominal Pain + Skin Ulcers (Merola) [cr].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

🫃🏽 = abdomen = abdominal

1. ♀ 30yo ➩ SYMP = fever + 🫃🏽pain
2. H+ 6d af_DELIVERY | 35w + colonization B streptococcus (vancomycin) + spontaneous rupture membranes + 8h later: infant of 3,5Kg, large for gestational age.
3. 4d af_DELIVERY ➩ mild diffuse 🫃🏽 & PELVIC cramping + vaginal bleeding (clots).
4. Admission ➩ fever + chills
          - Inguinal area w_bumps (small + painful), drained blood & pus
          - Leg swelling (abated since childbirth)
5. CLINICS ➩
          - T 38,7 ➕ BP 125/80
          - Erythematous pustules drained yellow, purulent fluid (right inguinal area)
          - Scarring (left inguinal area)
          - LEU 22,9
          - Blood and cervical cultures
6. HISTORY
          - Epiploic appendagitis 10w before ADM
          - Acetaminophen + ibuprofen for 🫃🏽 pain
          - Amoxicillin + cephalexin = caused HIVES
          - Father and paternal grandfather ➩ arthritis
          - Brother ➩ Crohn’s disease
          - Brother ➩ neurofibromatosis
7. CT Abdomen & pelvis
          - Normal
          - Mild adjacent fat
8. INFECTO
          - Genta + clinda
          - Endometritis
          - Fever + 🫃🏽 pain + ↑ LEU
          - Vanco on D3
          - Cefepime on D4 (once = TEST DOSE) ➩ ✔ ➩ genta + clinda ✖
          - Vanco + cefepime + metro
9. PATHOLOGY
          - D6, biopsy ➩ neutrophilic debris (dense neutrophilic infiltrate)
10. MRI
          - Angio MRI ➩ ascitis + anasarca
          - 4D later ➩ ↑ ascitis + anasarca ➩ 2 new fluid collections
             * Left parametrical 6.3
             * Right uterocervical junction 3.2
11. INFECTO
          - Cefepime + metro ✖
          - Vanco ✔ + MERO (due to fever)
          - Catheter into left parametrial fluid collection (20mL purulent fluid) drained ➩ cultures no

            growth
12. CLINICS
          - D11. SpO2 86% AA ➕ O2 2L ➩ ↗️ SpO2 91%
          - T 36,7, BP 109/58, HR 112 (regular), RR 24
          - Tired and ill
          - Marked jugular venous distention
          - Scant purulent drainage (percutaneous catheter)
          - Anasarca ➕ symmetric 1+ ankle edema
13. LABS
          - Inflammation clearly shown
          - Biventricular ok, right atrium and right ventricle DILATED + septum flattened d_dyas -   

            pulmonary arteries DILATED
14. IMAGENO
          - No PE, yes sub segmental atelectasis
          - ↑ ascitis and anasarca
          - Splenomegaly + hepatomegaly
          - Collection resolved
          - Right remained unchanged
          - Liver enzymes ABNORMAL ➩ cholangiopancreatography = multiple intrahepatic fluid

            collections = hyperintensty T2-wighted
15. D12.
          - Plaques ➩ in the peripheral IV catheter
          - Bulla ➩ left abdominal wall
          - Plaques ➩ ulcerated
          - New skin lesions ➩ Right inguinal crease and mons pubis
16. Next 2 days
          - Bulla ➩ ulcerated
          - Another lesion in percutaneous drainage catheter
          - ↑ area & depth ➩ left upper arm, right inguinal crease, mons pubis
          - Furosemide
          - Vanco ✖ , mero ✔ , DAPTOMICIN + MICAFUNGIN started
17. DIFFERENTIAL

          - Hepatobiliar source ➩ ↑ ALK Phosp ➕ GGT

          - Biopsy does not allow us to exclude ENDOMETRITIS

          - Fungal + mycobacterial INF should be considered ➩ empirical ATB without results +

            new collections + ↑ HR + ↑ RR + ↑ hypoxemia + negative cultures

Friday, June 13 , 2025 at 18h30 at BO - 23h30 at BE

AMA, MAAT, AAQC

2025 EHJ - Heart rate-lowering drugs+outcomes in HTA+CVD a MA (Sanidas) [RCT].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

CHD = Coronary heart disease, MACE = Major CV events, MI = myocardial infarction, S† = Stroke.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, EHJ, GR ➖ srMA ➕ 74 RCT (>150k pxs) ➕ - July 2024 ➖ P I C O:
   - P: HTA ± CVD
   - 🅸: HR↓ over 2,7y
   - 🅲: PLACEBO + less intense TTO
   - O:
       1. CHD (Coronary † ➕ Non-fatal MI
       2. S† (Fatal ➕ Non-fatal)
       3. Hº-HF (Hº d_ HF) 
       4. MACE (Composite: S† + CHD)
       5. Expanded composite CV events (Composite: S† ➕ CHD ➕ HF or MACE)
       6. CV†
       7. acMM
       8. AdvEve w_ TTO ✋🏽 (Serious AdvEve → permanent TTO ✋🏽)
3. EVIDENCE:
- …
4. METHODS.
- 𝗜𝗡 ➠
       • RCTs w_ parallel design
       • On-TTO ƒ-up ≥6m
       • HR Δ between arms: ≥2 b.p.m.
       • Trials where:
       • HR↓ 🆚 non-HR-lowering agents
       • More- 🆚 less- intense HR-lowering agents
       • Non-intended HR Δ ≥2 b.p.m. occurred
       • HR↓ randomized on background of other HR↓ therapies or added per protocol
       • Any comorbidities, incl. AF or CKD (incl. dialysis)
- 𝗘𝗫 ➠
       • HR Δ <2 b.p.m. between arms
       • Cross-over designs
       • Sub-studies of main trials
       • Trials wo_ HR data d_ ƒ-up
       • Trials <6 mo ƒ-up

       • Trials w_ <5 total events

⏳ TIME MANAGEMENT.
01:49:03
Round: 6 15:51:49 Comment
Round: 5 51:28:43 Method
Round: 4 19:10:37 intro
Round: 3 12:18:10 ART abstract
Round: 2 04:23:64 ART selection
Round: 1 05:51:08 Last JC

Friday, July 18 , 2025 at 18h30 at BO - 23h30 at BE

MASP, AAQC

2025 ICM - Metabolic septic shock sub phenotypes, stability over time+association w_ clinical OC (Antcliffe) [R].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

 † = deaths, HC = hydrocortisone, ID = identification, MEDs = medications, ML = machine learning, PLA = placebo, VP = vasopressin

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, ICM, UK ➖ 2_db_RT ➕ LeoPARDS (<1,5k samples, >400pxs) & VANISH (<500 samples, >170 pxs) ➕ LeoPARDS (Jan 2014 - Dec 2015) & VANISH (Feb 2013 - May 2015) ➖ P I C O:
   - P: SØ metabolic clusters
   - 🅸: serum at 4 time points – LeoPARDS = derivation ➕ VANISH = validation.
   - 🅲: NA
   - O: pOC = MM | sOC = cluster membership ↔ 28d_OC ➕ SOFA mean tatal ➕ interaction

     “trial TTO ↔ baseline cluster membership” on OC
3. EVIDENCE.
   - S• ➩ 11M † per year ➕ 20% of global †
   - TTO limited ➩ failure is due to HETEROGENEITY
   - ML was applied to make progress on TECHNIQUES to biological data:
         * Gene expression
         * Inflammatory proteins.
   - Questions are:
         * Are sub-phenotypes stable?
         * Is transition ↔ sub-phenotypes are predictable of OC?

   - Metabolomics ➩ measurement of small molecules → host ↔ environment (encapsulate

     wide range of origins: genome, proteome, pathogen)

   - Many studies exposed DX, prognosis and pathogen ID in S•

   - Few studies used metabolois to ID S• sub-phenotypes (DEF: not apparent to clinicians + 

     note yet validated)
   - MEDs used in S• (vasopressin, levosimendan, glucocorticoids) could show heterogeneity of

     TTO based on px METABOLIC profiles.
4. METHODS.
   - 𝗜𝗡 ➠ S• + 6h vasopressor ➩ randomized to VP or NE, followed by HC or PLA (last 2 given

     ONLY if max infusion of the 1st study drug was reached)
   - RANDOM ➠ Hierarchical, k-means, consensus clustering ➩ applied to ID “metabolic sub-

     phenotypes”:
      * 70% derivation (LeoPARD)
      * 30% validation (VANISH)
5. RESULTS.

⏳ TIME MANAGEMENT.
01:49:26
Round: 4 03:39:44 Comments
Round: 3 01:31:22 ART
Round: 2 08:02:32 ART selection
Round: 1 06:22:58 Past JC

   - The 3 metabolic subgroups EVOLVE over time 
   - Low lysophospholipid sub-phenotypes ↔ ↑ MM
   - Monitoring could help ID:

         * pxs at r_poor_OC

         * Direct novel therapies (lysophospholipid supplementation)

Friday, August 15 , 2025 at 18h30 at BO - 23h30 at BE

AMA, MASP, HIBN,  AAQC

2025 NEJM - A Randomized Trial of Acute Normovolemic Hemodilution in Cardiac Surgery (monaco) [R].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

ACIP = CDC Advisory Committee for Immunization Practices, ANH = acute normovolemic hemodilution, ARC = allogenic red-cell tranfusion, COR = class of recommendation, CPB = cardiopulmonary bypass, IO = intraoperative, LOE = level of evidence, NA = North America, TACO = transfusion-associated circulatory overload, TRALI = transfusion-related lung injury, UC = usual care, 🦠 = infections, 🤧 = allergic reactions, 🥶 = chills, 🌡️ = fever.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS ➩ 2025, NEJM, IT ➖ mn_sb_prag_RCT ➕ 32 centers, 11 countries (NA, SA, EU,      ASIA) ➕ … ➖ P I C O:
     - P: 🫀 Sx w_CPB
     - 🅸: ANH
     - 🅲: usual care (ARC)
     - O: pOC = transfusion of ≥1 unit of ARC | sOC = ac_MM30 af_Sx OR d_H+ ➕ bleeding

       complications ➕ ischemic ➕ AKI.
3. EVIDENCE.
      a. 10M of RCU transfused (USA) per year
      b. 3 main concerns: costs ➕ shortages ➕ transfusion-related complications
      c. COST ➩ $150 - $634 per unit (country dependent).
      d. AVAILABILITY ➩ fluctuates over time w_periods of shortages ▶︎ postponement of

          nonurgent Sx
      e. DELAYS ➩ affect: px health ➕ costs
      f. RISKS ➩ mild🌡️, 🥶, 🤧, 🦠, TRALI, TACO (1-5%)
      g. 🫀 Sx anually (worldwide) ▶︎ >2M pxs ➖ 35% receive ≥1 URC
      h. ANH ▶︎ 20% 🫀 Sx (USA) ➕ 27% 🫀 anesthesiologists ➕ 14% pxs wordwide. (before

          heparin + CPB)
         i. RETROSPECTIVE ➩ 18k pxs, USA, 🫀Sx ➩ OCs:
           i. ANH only (LOWEST % of IO transfusion)
           ii. retrograde autologous priming only
           iii. both
           iv. neither
      j. MA ➩ 29 RCT, 🫀Sx, USA + 10 others ➩ ↓ need of URC w_ANH ▶︎ $magnified$ when

         ≥650mL was withdrawn preOP.
      k. MA ➩ RCTs ▶︎ ANH = ↓ % pxs ➕ ↓ number URC.
      l. GL 2021 ACP * ANH is a reasonable method to reduce bleeding and transfusion
      m. GL 2024 EU ** ANH may be considered to reduce postoperative transfusions   

           (LOE A, COR IIb)
      n. Consensus statement ▶︎ studies were underpowered to assess SAFETY + HD

           procedures varied among studies.
4. METHODS.
      - 𝗜𝗡 ➠ low-dose aspirin was permitted.
      - 𝗘𝗫 ➠ unstable CAD ➕ critical periOP state ➕ ER Sx ➕ inadequate DC antiCOAG or

         antiPLAT. 2nd screening ➩ r_HD instability OR anemia af_ANH.
      - RANDOM ➠ Web-based system, computer generated, permuted-block sequences,

        w_stratification (sites).
      - INTERV ➠ ≥650mL of whole blood w_crystalloid replacement if needed.
          - 3mL of crystalloids / 1mL withdrawal, stored, reinfused.
          - heparin reversed w_protamine
          - Withdrawn w_large-bore, central, rapid-infusion catheter
          - Thresholds: <28% ← CPB, <20% d_CPB, <25% immediately af_CPB weaning, <27%

             d_PO H+ stay.
          - If anemic ← or d_ANH = transfusion (anesthesiologist)
      - BLINDED ▶︎ pxs, investigators, data collectors, OC assessors, statisticians.
5. RESULTS.
      - 2010 randomized ➩ 1010 ANH 🆚 1000 UC
      - One ARC ▶︎ 27% ANH 🆚 29% UC (p=0.34)
      - Bleeding ▶︎ 4% ANH 🆚 3% UC
      - MM30 ▶︎ 1,4% ANH 🆚 1,6% UC

      - Safety ▶︎ were SIMILAR in both

⏳ TIME MANAGEMENT.
02:19:33
Round: 5 00:58:20 Close
Round: 4 01:14:45 Wrap-up
Round: 3 53:46:91 Reading + notes
Round: 2 04:03:97 ART selection
Round: 1 05:58:64 Past JC

Friday, August 8 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AHO, RAH, HIBN, YZE, AAQC

2025 JAMA - The CDC No Longer Recommends C19 Shots During Pregnancy Now What (rubin) [mn].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

ACIP = CDC Advisory Committee for Immunization Practices, VAX = vaccines, VRBPAC = FDA’s Vaccines and Related Biological Products Advisory Committee.

1. Kennedy ▶︎ announced he had removed C19 vax for: healthy children + pregnant ♀

    (video in X)
2. Kennedy = founder and former chair of antivaccine organization Children’s Health Defense.
3. NIH + FDA had repesentatives, BUT no one from the CDC.
4. No one explain why the annoucement. (the rationale)
5. Confusing ➩ people involved publisehd a week earlier ➩ NEJM = CDC list of undelying

    ondicions that ↑r_sC19: pregnancy + recent pregnancy.
6. 4 weeks after the announcement ➩ ACIP (created in 1964) 1st meeting EMPHASIZED ▶︎

    IMP C19 vax d_pregnancy.
7. MacNeil (CDC respiratory viruses Branch) ▶︎ vax protect pregnant ♀ + infants + severe DIS
8. 17 panelists from ACIP were fired before the announcement. The new ones did not note the

    CONTRADICTION with the epimedio data.
9. Medical profesional independent groups started to develop + promote their OWN ★
10. VRBPAC ▶︎ May 22 = continue C19 VAX during fall ➕ TARGET JN.1 (or on of its

      descendants). Asked to manufacture monovalent + JN.1-lineage based VAX.
11. Brewer ▶︎ one of the 17 fired ACIP panelists ➩ ❝we need to vaccinate pregnant women to

      protect those kids and protect the pregnancy itself.
12. ACIP agenda ➩ 3 regular meeting yearly: August, September, October.
13. Panagiotakopoulos ▶︎ decided to quit, worked for 12 years… did not agree with the

      announcement.
14. Access ➕ insurance are AFFECTED. (pharmacist won’t vaccinate even if you want it)
15. Riley (laison: ACOG ↔ ACIP) ▶︎ reviewed new vax’s safety METICULOUSLY with her team

      ➩ makes her angry “…. biased in our deliberations”.
16. Muñoz (laison: IDSA ↔ ACIP) ▶︎ did not attend, either online.
17. Anyhow, new ACIP voted:
   a. clesrovimab ➩ newly approved anti-RSV mAb ➩ <8m (mothers not vax)
   b. flu vax without thimerosal ➩ ≥6m
   c. thimerosal-free flu vax ➩ ♀ + children + adolescents through 18yo.

18. Many antiVAX groups are taking advantage of the situation. 19. Gorham ▶︎ ❝ lives are at

      risk, and decades of public health and trust are being actively and carelessly undermined.”

⏳ TIME MANAGEMENT.
02:29:16
Round: 10 02:13:20 Comments
Round: 9 29:43:66 Wrap-up
Round: 8 22:37:99 Analysis
Round: 7 28:44:28 Reading + notes
Round: 6 06:07:19 Reading + notes
Round: 5 30:40:10 Analysis
Round: 4 06:44:94 Reading + notes
Round: 3 07:54:37 ART selection
Round: 2 00:20:40 Comments
Round: 1 14:10:54 Past JC

Friday, August 29 , 2025 at 18h30 at BO - 23h30 at BE

JJFM, MASP, AAQC

⏳ TIME MANAGEMENT.
02:29:16
Round: 10 02:13:20 Comments
Round: 9 29:43:66 Wrap-up
Round: 8 22:37:99 Analysis
Round: 7 28:44:28 Reading + notes
Round: 6 06:07:19 Reading + notes
Round: 5 30:40:10 Analysis
Round: 4 06:44:94 Reading + notes
Round: 3 07:54:37 ART selection
Round: 2 00:20:40 Comments
Round: 1 14:10:54 Past JC

2025 JAMA - Higher Educational Attainment and Accelerated Tau Accumulation in Alzheimer Disease (cai) [R].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 

🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal
♾️ = kidneys = renal
🩸= blood = hematology
🪲 = infections
💨 = flow
➰ = pressure
🤓 = analysis;
⚡️ = cardiac arrest;
📈 = arrhythmia;
🗣 = suggestion(s)

★ = recommendation(s)

AD = Alzheimer disease;

TTO = treatment

Aß = amiloid beta (ß)

h_EA = high educational attainment

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, CH ➖ analysis_3cohort ➕ 887 = >350 (ADNI), <400 (A4),

    >100 (GHABS) ➕ -Nov 11, 2020 ➖ P I C O:
   - P: adults
      - Aß⊕ & Aß⊖
      - ADNI 73yo | A4 72yo | GHABS 66yo
   - 🅸: h_EA
   - 🅲: l_EA
   - O:pOC = tau changes | sOC =
      1. interactions w_aßburden ➕ entorhinal tau ➕ p-tau217 (Aß⊕)
      2. Connectivity-associated tau spread (Aß/EA groups)
      3. Treatment attenuated tau accumulation (Aß⊕ h_EA)
3. EVIDENCE.
   a. Aß plaques + neurofibrillary tau tangles:
       i. AD hallmarks.
       ii. PET detected
   b.Lista
4. METHODS.
   - 𝗜𝗡 ➠
   - 𝗘𝗫 ➠
   - RANDOM ➠
   - INTERV ➠
5. RESULTS.
   a. Aß⊖ ➩ `tau accumulation:`h_EA < l_EA (*p=.03*)
   b. Aß⊕:
      i. `Tau accumulation:` h_EA > l_EA (*p=.03*)
          1. Aß-associated (*p=.006*)
          2. Tau-associated (*p=.01*)
          3. p-tau217-associated (*p=.04*)
          4. connectivity-associated (p=.048)
   c. Aß-targeting TTO ➩ mitigated p-tau217-associated (AD+h_EA) (*p<.001*)
   d. ∑ ➩ h_EA ↔ faster `tau accumulation` ➕ `spread in Aß ⊕`
6. RATIONALE.
   a. In AD & h_EA ➩ Aß clearance is IMP to ↓ `tau progression`

7. LIMITATIONS.

Saturday, September 13, 2025 at 00:30:23 in BE

AAQC

⏳ TIME MANAGEMENT.
49:54:14

Round: 3 35:51:43 Read + notes

Round: 2 04:06:18 Selection

Round: 1 09:56:51 Past JC

2025 JAMA - Systemic Strategies to Prevent Nonbeneficial Treatments Near the End of Life (weiss) [R].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: A4 = Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Disease study, Aß = amiloid beta (ß), AD = Alzheimer disease, ADNI = Alzheimer’s Disease Neuroimaging Initiative, GHABS = Greater-Bay-Area Healthy Aging Brain Study, h_EA = high educational attainment, l_EA = low educational attainment, TTO = treatment.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, USA-GB ➖ qual_semiStruc_in-depth_ITW ➕ 1 NHS ➕ Feb 2021 - 2023 ➖ P I C O:

- P: caregivers surveys
- 🅸: 13 clinicians + 14 caregivers
- 🅲: NA
- O: pOC = individual-, institutional-, system-level FACTORS that affect TTO escalation decisions among PLWD

3. EVIDENCE.

- …

4. METHODS.

- 𝗜𝗡 ➠
- 𝗘𝗫 ➠
- RANDOM ➠
- INTERV ➠

5. RESULTS.

- Institutional-level factors ▶︎ protocols, resources, practices
- System-level factors ▶︎ national policies, laws, cultural norms

6. RATIONALE.

7. LIMITATIONS.

Friday, October 3, 2025 at 12:31:09 in BE

EMS, AMA, AAQC

⏳ TIME MANAGEMENT.
02:29:16

Round: 5 00:58:20 Close
Round: 4 01:14:45 Wrap-up
Round: 3 53:46:91 Reading + notes
Round: 2 04:03:97 ART selection
Round: 1 05:58:64 Past JC

2025 NEJMcd - Choice of Intravenous Fluid for Resuscitation in DKA (Li).pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:★ = recommendation(s), 0.9% NS = normal saline = isotonic saline, GL = guidelines, HD = hemodynamic, HOITS = hyperosmolarity-induced transcellular shift, INS = insuline, LR = lactated Ringer’s, VOL = volume.

1. 24yo ♀, T1DM, ER, 1d_H
2. Nausea + 🤮 + 🫃🏽 pain
3. Did not take INS ➩ 28UI glargine nights + 8 UI lispro w_meals
4. VIT: 36,5ºC, 98/51, 107, 20, 98% (AA)
5. EXAM: dry mucous membranes + ↓ skin turgor + 🫃🏽 no pain
6. LAB: crea 1,6 ➖ Na 131 ➖ K 5,7 ➖ HCO3 10 ➖ anion GAP 28 ➖ GLU 372 ➖ pH       7,26 ➖ B-OH-butyrate 5,1 ➖ HbA1c 8.7%.
7. DX: DKA
8. INS infusion STARTED ➕ px to MED floor.
9. EVIDENCE:
    a. Most GL ★ 0.9% NS in DKA
    b. Recent studies 🗣 balanced crystalloids (LR) ➩ FASTER RESOLUTION
10. 1st expert = Bassem MIKHAEL (balanced crystalloids)
    a. Case: hypovolemia ➕ metabolic acidosis
    b. TTO: rapid expansion of intravascular compartment (HD resuscitation) ➕ metabolic disturbances
    c. Renal impairment ➩ + ↑K = warrants use of NS
        i. Urinary K excretion ↔ distal tubular Na delivery (compared to LR)

             > if ↑ Na given to the tubule, ↑ K excretion
             >
        ii. DKA ➩ ↑K is: transient ➕ sec. to ↑HOITS

       iii. INS will RAPIDLY reverse the shift (HOITS)

⏳ TIME MANAGEMENT.
02:29:16

Round: 5 00:58:20 Close
Round: 4 01:14:45 Wrap-up
Round: 3 53:46:91 Reading + notes
Round: 2 04:03:97 ART selection
Round: 1 05:58:64 Past JC

2025 ICM - ESICM guidelines on circulatory shock and hemodynamic monitoring[Monnet) [GL]

Glossary: ★ = recommendation(s), ⚡️ = cardiac arrest, 🤓 = analysis, 📈 = arrhythmia, 🗣 = suggestion(s), 🩸 = blood = hematology, 🪲 = infections, 💨 = flow, ➰ = pressure, 🧠 = brain, 🫁 = lungs, 🫀 = heart, 🫃🏽 = abdomen = abdominal, ♾️ = kidneys = renal, § = shock, AMes = Antonio Messina, CO = cardiac output, CRT = capillary refill time, CVC = central venous catheter, DX = diagnosis, DYS = dysfunction, FR = fluid responsiveness, GC = Giacomo Coppalini, INO = inotropic, JB = Jan Bakker, MCS = mechanical circulatory support, MECHS = mechanisms, MG = Massimiliano Greco, MNT = monitoring, MSa = Marzia Savi, OH = Oliver Hunsicker, orgPER = organ perfusion, PvaCO2 = veno-arterial difference in CO2, ROB = risk of bias, ScvO2 = central venous oxygen saturation, SV = stroke volume, TK = Thomas Kaufmann, Tº = temperature, UGPS = ungraded good practice statements, XM = Xavier Monnet.CAP = community-acquired pneumonia.

1. 1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, ICM, EUR ➖ GL ➕ 50 ★ ➕ -2024 (2014 update) ➖ P I C O:
     - P: shock pxs
     - 🅸: 4 domains: definition (JB) + fluids (AMes) + HD monitoring (XM) + echo (MCh)
     - 🅲: NA
     - O: pOC = DX + MNT of §
3. EVIDENCE.
    a. State of acute circulatory failure + 4 basic MECHS:
        i. ↓ VOL
        ii. 🫀 
        iii. obstructive
        iv. distributive
    b. Unifying pathological process:
        i. ↓ O2 supply
        ii. ↓ cell O2 uptake
    c. MM from § 🟰 20 - 50%
    d. §mm ➩ timely + evaluation:
        i. presence
        ii. mechs
        iii. cause
        iv. plan
        v. intervention ➩ ↑ orgPER + O2
          1. FR
          2. VP
          3. INO
          4. MCS
4. METHODS.
     - INTERV ➠ PICO-formatted questions + GRADE + UGPS
          - Chairs: XM, MCh
          - 24 panelists: # scientific publications + gender balance
          - NEXT members: OH, TK
          - Methodologist: MG + MSa & GC: data extraction + synthesis + ROB
5. RESULTS.
     a. CRT ✔︎ w_skin Tº + mottling
     b. IF w_CVC: (UGPS)
         i. Serial S(c)vO2
         ii. ∆ PvaCO2
     c. IF w_persistent § (af_initial fluids)
         i. FR should be assessed ← continuing FR (UGPS)
         ii. ✔︎ Dynamic variables | ✖︎ static markers ➩ of preload for predicting FR, WHEN APPLICABLE (GRADED STATEMENT)
     d. CO ± SV ➩ IF no response to initial therapy (UGPS)
     e. AL ➩ IF no response to initial therapy ± requiring VP infusion (UGPS)
     f. ECHO:
         i. 1st modality – type of §

         ii. Defined phenotypes of ← + → ventricular DYS

Friday, November 28, 2025 at 17:15:54 in BE

MASP, AAQC

Friday, November 21, 2025 at 20:22:32 in BE

MLHG, AMA, AAQC

⏳ TIME MANAGEMENT.
01:42:12

Round: 6 20:20:16 Comments
Round: 5 55:50:44 Intro + wrap-up
Round: 4 16:43:50 Wrap-up
Round: 3 05:05:24 Interpretation + wrap-up (abstract)
Round: 2 02:55:41 Reading + notes (abstract)

Round: 1 01:17:92 ART selection

2025 NEJM - SONIA, A Pragmatic Trial of Glucocorticoids f_ CAP (Lucinde) [RCT].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: ★ = recommendation(s), LRS = low-resource setting, HRS = high-resource setting, SC = standard of care, GC = glucocorticoids, MM30 = mortality at 30d, ACIP = CDC Advisory Committee for Immunization Practices, CAP = community-acquired pneumonia.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, NEJM, Kenya (18H+) ➖ prag_ol_RCT ➕ >2k (~1k each group) ➕ April 2022 - June 2024 ➖ P I C O:
     - P:Adults w_sev_CAP (53yo)
     - 🅸: adjunctive glucocorticoids (f_10d)
     - 🅲: standard care
     - O: pOC = MM30
3. EVIDENCE.
      a. GC ↓ MM in sev_CAP in WELL-RESOURCED settings.
      b. In LRS IT IS UNCLEAR (risks + benefits)
      c. Case-fatality ➩ **3-5x** more than high-income settings (despite younger age)
      d. 2 recent studies:
          i. Meduri, ICM 2024 ➩ methylprednisolone
          ii. Dequin, NEJM 2023 ➩ hydrocortisone
          iii. srMA ➩ ICU ➩ ↓ MM
          iv. NO BENEFIT from other studies.
          v. Studies are done in older people + excluding HIV + TBC.
          vi. Delayed presentation to a H+ ➩ ↓ effectiveness (early GC TTO is needed )
          vii. ↓ DX capacity ➩ to stratigy pxs (LRS)
          viii. Studies were done in the ICU - NONE in non-ICU looking at MM.
4. METHODS.
     - 𝗜𝗡 ➠ ≥18yo + CAP + UNCLEAR indication of GC.
     - 𝗘𝗫 ➠
     - CAP defined as ≥ signs + symptoms:
         - <14d
         - cough, fever, dyspnea, hemoptysis,
chest pain, or crackles
         - <48h af_H+ admission
    - RANDOM ➠
    - INTERV ➠
5. RESULTS.
     a. MM30 = GC 23% 🆚 SC 26% (p=0.02)
     b. AdvEve (frequency + seriousness)= SIMILAR

     c. AdvEve RELATED TO GC = 0.5%

Thursday, December 18, 2025 at 17:30:45

MLHG, AMA, AAQC

[**2025 HARVARD - 6 new terms for healthy eating (godman) [r].pdf**](https://www.dropbox.com/scl/fi/agwdlhedhnucxccjdlafz/2025-HARVARD-6-new-terms-for-healthy-eating-godman-r.pdf?rlkey=ru13rc28pjkwvvy1574u9ek1p&dl=0)

`Codified by JQB`

Codified  by (MLHG)

Glossary:  🍉 = fruits, 🥗 = salad, 🌾 = corn, 🥜 = nuts, 🛢️ = oil

1. 6 new terms:
     a. Plant-forward
     c. Plant-based protein
     b. Clean eating
     d. Clean label expectations
     e. Sustainable eating
     f. A climate-conscious diet
2. These terms refer to:
     a. ↑ fruits ➕ vegetables
     b. Online ➕ venacular use
3. Plant-forward
     a. Same as PLANT-BASED
     b. FOCUS on 🍉, 🥗, legumes (such as pea pods, peas, beans, and lentils), 🌾,
          🥜, seeds, and healthy vegetable 🛢️ (such as olive, canola, or peanut oil).
     c. MOMENTUM is the point of the term ➩ gradually implementing ➩ moving in that direction
4. Plant-based protein
     a. Rich in protein: legumes, nuts, seeds, and many whole grain
     b. Doubt ➩ whole food 🆚 processed foods
     c. No standarized definition
     d. High amount of plant protein ➩ all mentioned ➕ farro (Impossible + Beyond)
5. Clean eating
     a. Bussword 🤩 
     b. Depends on people:
         i. Restaurateurs, manufacturers, SoMe infliuencers 🟰 WHOLE, UNPROCESSED                        FOODS
         ii. Plant-forward diet 🟰 packaged foods MININALLY processeed
6. Clean label expectations
     a. In response to CLEAN EATING
     b.Easily recognizable ➩ refrigerator OR kitchen
     c. WON’T HAVE:
        i. long chemical-sounding names
        ii. added sugars
        iii. artificial OR genetically MODIFIED
     d. Be cautious ➩ **high in sugars & salt** ➩ NOT necessarily healthier
7. Sustainable eating
     a. `Help` the ENVIRONMENT + health + PLANET
     b. LOWER carbon footprint than red meat (more resources ➩ generate ↑ greenhouse gases ➩ ↑ global warming)
     c. Roots + stems
8. A climate-conscious diet
     a. Similar to SUSTAINABLE EATING
     b. FOCUS ➩ `preserve OR protect` the environment.
     c. We avoid:
        i. red meat production

        ii. unsustanable water + land use practice

     e. Try eating locally sourced plants ➕ ↓ red meat consumption

⏳**01:13:36**

`Round: 7 06:34:21 Comments
Round: 6 18:20:12 Wrap-up
Round: 5 31:17:12 Interpretation 2
Round: 4 00:09:70 Interpretation
Round: 3 06:25:23 Reading + notes
Round: 2 02:37:23 ART selection
Round: 1 08:12:98 Past JR + 10 min`

Friday, December 19, 2025 at 17:11:54 in BE

MLHG, AMA, AAQC

⏳ TIME MANAGEMENT.
01:53:07

Round: 11 33:17:79 Wrap-up
Round: 10 07:43:26 Results
Round: 9 27:47:94 Methods
Round: 8 01:35:92 Comments
Round: 7 10:15:81 Interpretation
Round: 6 03:27:81 Intro
Round: 5 00:25:44 Comments
Round: 4 07:41:05 Interpretation
Round: 3 07:47:27 Abstract (R+N)
Round: 2 05:41:63 SelectionRound: 1 07:23:60 Past JC

2025 JAMA - BICARICU-2, Sodium Bicarbonate for Severe Metabolic Acidemia + AKI (jung) [RCT].pdf

Codified  by (MLHG)

Glossary: ★ = recommendation(s), oSUPP = organ support, VP = vasopressin, iMV = invasive mechanical ventilation, LOS = length of stay, ICU_INF = ICU related infections, OF = organ failure, KRT = kidney replacement therapy, f-up = follow-up.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, FR ➖ ol_ii_mc_RCT ➕ 640 (313 🅲 🆚 314 🅸) [43 ICUs] ➕ Oct 2019 - Dec 2023 (90d f-up)➖ P I C O:
     - P: CI pxs

     - 🅸: bicarbonate
     - 🅲: no bicarbonate
     - O: pOC = MM90 | **sOC** = 18: MM28, MM180, oSUPP, VP, iMV, LOS, ICU_INF…
3. EVIDENCE.
      a. Consequences ➩ ph ≤ 7,2 ➩ imp_🫀 contractility + 📈 + 🫁 vasoCONS + sys_vasoDIL + imp_♾️💨 + 🧠 edema + 💪🏽DYS
      b. Causes ➩ ↑Cl acidosis + lactate ↑ + anion ↑
      c. BICARICU-1, 4,2% BICA 🆚 no BICA (sev_metabolic acidemia)
           i. MM28 ± OF7: NOT DIFFER.
           ii. Pre-planned 🤓 of mod-sev_AKI ▶︎ MM28: 63% 🅲 🆚 46% 🅸
           iii. Same stratum (mod-sev_AKI) ▶︎ KRT: 73% 🅲 🆚 51% 🅸
      d. OBS study ➩ benefits BICAR in pxs w_:
           i. sev_acidemia
           ii. sev_AKI
           iii. very sev_AKI (pH <7,15)
           iv. >60yo + sepsis + mod_acidemia
4. METHODS.
       - 𝗜𝗡 ➠
       - 𝗘𝗫 ➠
       - RANDOM ➠
       - INTERV ➠
5. RESULTS.
      a. Primary 🤓 ➩ 90MM: 62,1% 🅸 🆚 🅲 61,7%
      b. NO EVIDENCE of group effect ➩ MM28, MM180
      c. 18 sec ➩ KRT 35% 🆚 50% 🅲
      d. NO EVIDENCE ➩ other sOC.
6. RATIONALE.

7. LIMITATIONS.

Monday, December 15, 2025 at 17:02:22

MLHG, AMA, AAQC

2025 NEJMjw - SOFA-2 A Revised Organ Failure Score (JAMA).pdf

`Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)`

`

Glossary: 🫃🏽 = abdomen = abdominal, 🧠 = brain, 🫀 = heart, ♾️ = kidneys = renal, 🫁 = lungs, AF = atrial fibrillation, CI pxs = critically ill patients, HFNC = high-flow nasal cannula, OD = organ dysfunction, RRT = renal replacement therapy, sr = systematic review, vp = vasopressin.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, ❓  ➖ analysis (sr + AI computation + 10 databases) ➕ 60 members ➕ ❓ ➖ P I C O:
      - P: CI pxs
      - 🅸: SOFA 2
      - 🅲: NA

      - O: **pOC** = ICU mortality
3. EVIDENCE.
       a. APACHE + MODS + SOFA ➩ vital organ function
       b . Quantitify ILNESS SEVERITY ➩ CI pxs
       c. SEPSIS-3
          i. SOFA score
          ii. q-SOFA
          iii. Estimates OUTCOMES during conversations (**be cautious**)
4. METHODS.
     - After 3 decades ➩
          - 60-member international task force 
          - SOFA ✖︎ 🆚  SOFA-1 ✔︎
5. RESULTS.
     a. SOFA-2 ➩ 6 organs ▶︎ 🫀 + 🫁  + ♾️ + 🫃🏽 + 🧠  + COAG
          i. 0-4 ➩ TOTAL 0-24
          ii. MODERN SUPPORT: (4) ECMO, vp, RRT, HFNC
      b. MM risk ▶︎ no BIG DIFFERENCE in `overall discrimitation`
          i. Score 4-8 🟰 <20% MM
          ii. Score >16 🟰 >75% MM
      c. Limitations with some VARIABLES
          i. Chronic OD
          ii. Acute-on-chronic OD
          iii. Clinical PRACTICE VARIABILITY
6. RATIONALE.
      a. USEFUL ➩ advancing care ▶︎ research + quality
      b. LESS USEFUL ➩ bedside care ▶︎ value remains LIMITED
      c. GESTALT remains the way to go

      d. Careful with GREY AREAS ➩ MOST of our pxs ▶︎ `FLIP A COIN` score (SOFA-2)

⏳**01:13:36**

`Round: 7 06:34:21 Comments
Round: 6 18:20:12 Wrap-up
Round: 5 31:17:12 Interpretation 2
Round: 4 00:09:70 Interpretation
Round: 3 06:25:23 Reading + notes
Round: 2 02:37:23 ART selection
Round: 1 08:12:98 Past JR + 10 min`

Friday, December 19, 2025 at 17:11:54 in BE

MLHG, AMA, AAQC

⏳ TIME MANAGEMENT.
01:53:07

Round: 11 33:17:79 Wrap-up
Round: 10 07:43:26 Results
Round: 9 27:47:94 Methods
Round: 8 01:35:92 Comments
Round: 7 10:15:81 Interpretation
Round: 6 03:27:81 Intro
Round: 5 00:25:44 Comments
Round: 4 07:41:05 Interpretation
Round: 3 07:47:27 Abstract (R+N)
Round: 2 05:41:63 SelectionRound: 1 07:23:60 Past JC

2025 JAMA - BICARICU-2, Sodium Bicarbonate for Severe Metabolic Acidemia + AKI (jung) [RCT].pdf

Codified  by (MLHG)

Glossary: ★ = recommendation(s), oSUPP = organ support, VP = vasopressin, iMV = invasive mechanical ventilation, LOS = length of stay, ICU_INF = ICU related infections, OF = organ failure, KRT = kidney replacement therapy, f-up = follow-up.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, FR ➖ ol_ii_mc_RCT ➕ 640 (313 🅲 🆚 314 🅸) [43 ICUs] ➕ Oct 2019 - Dec 2023 (90d f-up)➖ P I C O:
     - P: CI pxs

     - 🅸: bicarbonate
     - 🅲: no bicarbonate
     - O: pOC = MM90 | **sOC** = 18: MM28, MM180, oSUPP, VP, iMV, LOS, ICU_INF…
3. EVIDENCE.
      a. Consequences ➩ ph ≤ 7,2 ➩ imp_🫀 contractility + 📈 + 🫁 vasoCONS + sys_vasoDIL + imp_♾️💨 + 🧠 edema + 💪🏽DYS
      b. Causes ➩ ↑Cl acidosis + lactate ↑ + anion ↑
      c. BICARICU-1, 4,2% BICA 🆚 no BICA (sev_metabolic acidemia)
           i. MM28 ± OF7: NOT DIFFER.
           ii. Pre-planned 🤓 of mod-sev_AKI ▶︎ MM28: 63% 🅲 🆚 46% 🅸
           iii. Same stratum (mod-sev_AKI) ▶︎ KRT: 73% 🅲 🆚 51% 🅸
      d. OBS study ➩ benefits BICAR in pxs w_:
           i. sev_acidemia
           ii. sev_AKI
           iii. very sev_AKI (pH <7,15)
           iv. >60yo + sepsis + mod_acidemia
4. METHODS.
       - 𝗜𝗡 ➠
       - 𝗘𝗫 ➠
       - RANDOM ➠
       - INTERV ➠
5. RESULTS.
      a. Primary 🤓 ➩ 90MM: 62,1% 🅸 🆚 🅲 61,7%
      b. NO EVIDENCE of group effect ➩ MM28, MM180
      c. 18 sec ➩ KRT 35% 🆚 50% 🅲
      d. NO EVIDENCE ➩ other sOC.
6. RATIONALE.

7. LIMITATIONS.