Journal Reviews 2025

2021

1. A JR is an academic session where we go through some articles previously codified/labeled, for 45-60 min.
2. The articles are selected during the session based on the participants interests and backgrounds.
3. Its purpose is to understand and discuss relevant content elements applying systematized note-taking methodologies.
4. We generate discussion and recall pivotal concepts about different topics, all pertinent to our clinical practice.
5. We write down the key points of every session and publish them on our website.
6. In the following session we briefly recall the key-points from the previous JR, applying the 'reinforcing technique’.
7. Check out our calendar and see you in the DISCORD server.

2022

2023

2024

2025

2026

Brief scope glossary

𝙄𝙌𝘾 - S 🟰 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ scope
Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
year (Y), journal (J), country (C) ➖ type of study (T) ➕ number of patients/sample (N) ➕ time (t) ➖population (P), intervention (I), comparison (C), outcome (O, OC).

General Glossary

Glossary (most used)

↑ = increase, ↓ = decrease,↗️ = improve,↘️ = worsen, 𝗘𝗫 = exclusion, 𝗜𝗡 = inclusion, ★ = recommendation(s), 🗣 = suggestion(s), critILL = critically ill, DX = diagnosis, h_LOS = Hospital length of stay, icu_LOS = ICU length of stay, inc_ = incident, MA = metaanalysis, mc = multicentric, MM = mortality, MM90 = mortality at 90 days, pxs = patients, pOC = primary outcome(s), sOC = secondary outcome(s), SS = survival, w_ = with, wo_ = without, RCT = randomized controlled trial, sr = systematic review, yo = years old.

Complete glossary here.

March, 2026

⏳ TIME MANAGEMENT
01:18:17

Round: 11 00:47:41 Comments
Round: 10 15:51:98 Wrap-up
Round: 9 16:01:46 Interpretation
Round: 8 08:42:97 Reading + notes
Round: 7 01:14:96 Comment
Round: 6 13:35:28 Wrap-up
Round: 5 11:55:52 Interpretation
Round: 4 03:13:34 Reading + notes
Round: 3 06:03:45 ART selection
Round: 2 00:42:78 Comments

Round: 1 00:08:02 +15min Past JR

2026 CC - Citrate accumulation during CRRT, the impact of DX criteria (Perschinka) [ma].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal

◸ = liver = hepatic
♾️ = kidneys = renal
🩸= blood = hematology
🪲 = infections
💨 = flow
➰ = pressure
🤓 = analysis;
⚡️ = cardiac arrest;
📈 = arrhythmia;
🗣 = suggestion(s)
★ = recommendation(s)

AF = atrial fibrillation;
CVVHDF = continuous veno-venous hemodiafiltration
MM = mortality;
GE = gastroenterology;
ALB = albumin

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

2. 𝙄𝙌𝘾 BS 🟰 2026, CC, AT ➖ ma ➕ Muller et al. Citrate accumulation ➕ 2025 ➖ P I C O:

- P: CI pxs
- 🅸: CVVHD
- 🅲: CVVHD**F**
- O: **pOC** = MM | **sOC** = incidence, accumulation

3. EVIDENCE.

a. Definition ▶︎ ↑ tCa/iCa > 2,5

b. tCa was corrected to ALB

c. 17% ➩ citrate accumulation affectation:

i. 64% CVVHD

ii. 36% CVVHDF

4. Ca correction.

a. Uncorrected tCa/iCa is the standard practice

b. Bohr et al. ▶︎ ALB ↔ tCa/iCa ratio

c. ↑ALB ➩ ↑tCa/iCa ratio

d. CIRCULATION Ca is protein-bound OR ionized.

5. DX criteria.

1. The ratio solely was used.
2. Usually CITRATE ACCUMULATION 🟰 metabolic acidosis ➕ systemic ↓Ca (requires Ca substitution).
3. In Muller study ▶︎ did not have Ca requirement OR metabolic acidosis.
4. So MM was underestimated.
5. Other studies ➩ ↑MM w_comprehensive DX criteria
6. Kjadzhynov et al ▶︎

i. ↓iCa despite Ca supplementation
ii. At least 2 criteria were used:

1. ↑ tCa
2. ↑ tCa/iCa
3. Relevant metabolic acidosis (pH < 7,2 ± BE < -5)
4. ↑anion gap (>11)

iii. No multivariate 🤓

iv. MM ↑ ↑ ↑
v. All died, at 22h or 48h due to citrate accumulation.
vi. SEVERITY **was comparable** to Muller et al.

6. Third point INCIDENCE to continue.

2026 PsyAdv - Psychotherapy Can Improve Grief Disorder f_Bereaved Pxs (AIM).pdf

Codified by YAPG

Glossary:
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal

AF = atrial fibrillation;
ARDS = acute respiratory distress syndrome;
CA = cancer;
RCT = randomized controlled trial
ROB = risk of bias

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

2. 𝙄𝙌𝘾 BS 🟰 2026, AIM, USA, California ➖ r ➕ 169 RCT, 303 publications ➕ -Feb 3 ➖ P I C O:

- P: Adults + children: bereaved persons
- 🅸: Pshychotherapy ➖ expert-facilitated support groups ➖ 💊 ➖ 👨🏽‍🤝‍👨🏻 ➖ self-help 🅸 ➖ ✍️ ➖ 🎶 ➖ 🎨 ➖ ➖ enhanced provider contact ➖ integrative medicine
- 🅲: NA
- O: **pOC** = ↗️ grief disorder, grief, depression symptoms

3. EVIDENCE.

a. Also for soon-to-be bereaved persons

4. RESULTS.

a. ROB = substantial

b. Children only in 15 RCT

c. Strenght of evidence:

i. MODERATE ➩ individual psychoterapy

ii. LOW ➩ expert-facilitated support groups

iii. CONFLICTING ➩ other 🅸

iv. INSUFFICIENT ➕ NO EVIDENCE ➩ others
5. RATIONALE.

a. Growth in research ➩ past 3 decades.

b. More info is needed to TARGET these 🅸 ➩ specific circumstances

Thursday, March 12, 2026 at 17:08:55 in BE

MG, KH, JM, EM, EQO, ASCA,HIBN, MASP, AAQC

2026 ICM - Ups and downs of CAR in the ICU, why should we care (Robba) [r].pdf

Codified by YAPG

Glossary: ★ = recommendation(s), ABP = arterial blood pressure, af_ = after, CA = cerebral autoregulation, CBF = cerebral blood flow, CPP = cerebral perfusion pressure, HTA = arterial hypertension, IC = intracerebral, ICP = intracranial pressure, iStroke = ischemic stroke, NIRS = near-infrared spectroscopy, SAH = subarachnoid hemorrhage, TBI = traumatic brain injury, TCD = transcranial doppler, 🧠 = brain

1. CAR impairment ➩ dependent:

a. severity

b. Time af_injury ➩ 2-3d ▶︎ deeper disturbances ➩ then, gradual ↗️

c. 3d is significative to define survival and death.

d. Factors influencing CAR:

i. CO2.

1. Complex relationship.
2. Part of CBF regulation, BUT ≠mech.
3. Conceptually + functionally ≠
4. ↑PaCO2 ➩ CAR impairs ▶︎ lower limit ↑ ➕ upper limit ↓
5. ↓ PaCO2 ➩ CAR improves ▶︎ lower limit ↓ ➕ upper limit ↑
6. Hypocapnia ➩ ⛔️ “↓💨 ➕ ↓O2“ (secondary 🧠 damage)

ii. Vasogenic waves (ICP)

1. Require INTACT CAR at baseline ➩ to develop the CASCADE (vasodilatotary)
2. Top of the wave ▶︎ ↓ CPP 🟰 loss of CAR
3. Plateu 🟰 5-15min (vasodilatation TO vasoconstriction)
4. IF “plateau ↑ ICP” last longer ➩ HYPERVENTILATION should be applied (as a vasocontrictory stimulus)

iii. ↑ ICP

iv. ↑ flow + ↓ CPP ischemia

v. ↑ Tº

vi. Anesthetics

vii. post-traumatic SAH

viii. Ht changes

⏳ TIME MANAGEMENT
43:51:52

Round: 4 01:02:45 Comments
Round: 3 31:39:78 Wrap-up (past JR)
Round: 2 02:16:58 ART selection

Round: 1 08:52:69 Past JR

Thursday, March 5, 2026 at 17:45:08 in BE

KH, EQO, HIBN, AAQC

2026 NEJMc - Where to Place a Central Line, Revisiting Site Choice in the Age of US (CC).pdf

Codified by YAPG

Glossary: AF = atrial fibrillation, ARDS = acute respiratory distress syndrome, BSI = bloodstream infections, CIpxs = critically ill patients, DVT = deep venous thrombosis

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

2. 𝙄𝙌𝘾 BS 🟰 2025, CC, ? ➖ obs ➕ 3SITES - 3400 ➕ one decado ago ➖ P I C O:

- P: CIpxs
- 🅸: CVCs placement
- 🅲: NA
- O: **pOC** = safety

3. EVIDENCE.

a. Nowadays, we use US ↑ frequently.

b. Time to revisit 3SITES to test the safety of its results.

c. Perhaps even more few complications w_US

d. 3SITES:

i. Subclavian CVCs ➩ ↓ BSI ➕ ↓ DVT

ii. ↑ mechanical complications (PNEUMOTHORAX) w_subclavian CVCs, compared to:

1. internal juguylar vein

2. femoral vein

iii. US was used < 1/3 of cases

iv. US was used in 5% of subclavian lines.

4. METHODS.

- INTERV ➠ TARGET-TRIAL EMULATION

- As if US guidance had been performed

- Adjusting for potential COUNFOUNDERS
5. RESULTS.
a. Subclavian CVCs 🟰 NO DVT ➕ NO BSI 🆚 3% in internal yugular & femoral veins.

b. Mechanical complications 🟰 RARE (~1%) ➩ similar FOR ALL CVCs sites.

6. RATIONALE..

a. Zero INF ⌄ Zero thrombosis:

i. LIMITATION of target-trial emulation trials.

ii. but ALSO reflect safety.

iii. Michael suggests: 1st. Subclavian, 2nd. Internal yugular, 3rd. Femoral.

iv. Hard to justify otherwise.

2026 ICM - Ups and downs of CAR in the ICU, why should we care (Robba) [r].pdf

Codified by YAPG

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

2. 𝙄𝙌𝘾 BS 🟰 2026, ICM, IT+UK ➖ r ➕ NA ➕ NA

3. CA ➩ protective mechanism + maintains stable CBF ➩ despite CHANGES in ABP & CPP. .

a. ↑ ABP ⌄ CPP ▶︎ VASOCONSTRICTION ➩ to prevent ↑ CBF

b. ↓ ABP ⌄ CPP ▶︎ VASODILATION ➩ to maintain CBF

c. Healthy limits of CAR 🟰 50-150mmHg

d. Limits VARY in DIFFERENT CONDITIONS:

i. age

ii. history or HTA

iii. dysautonomy
iv. endothelial function
v. acute brain lesion, etc.

4. In ABI ➩ CA is disturbed, especially af_:.

a. TBI

b. SAH

c. IC bleeding

d. iStroke

5. The ABILITY to maintain CA FLUCTUATES OVER TIME, responding to intra- + extracranial factos: CO2 ⌄ ICP.

6. GL ➩ CPP = 60-70mmHg. ▶︎ the target may depend on the specific patient.

7. Neuromonitoring:

a. Invasive: ICP, PbtO2, thermodilution CBF, etc.

b. Non-invasive: TCD, NIRS.

8. Static CAR:

a. MAP challenge

b. Observing changes in ICP

c. ★ SIBICC GL ➩ tier 2 therapy.

9. Dynamic CAR

a. PRx ➩ to detect changes of CA status.

i. 5-min windowed coefficient

ii. 10s average MAP + ICP

iii. >0.25 = impaired ▶︎ MM 20-60%

10. Dynamic is MORE APPROPRIATE for continuous monitoring.

⏳ TIME MANAGEMENT
01:13:32

Round: 12 01:34:40 Comments
Round: 11 15:39:39 Wrap-up
Round: 10 09:46:42 Interpretation
Round: 9 08:50:08 Reading + notes
Round: 8 01:14:86 Intro
Round: 7 01:40:64 Comments
Round: 6 12:26:67 Wrap-up
Round: 5 07:55:92 Interpretation
Round: 4 04:38:52 Reading + notes
Round: 3 04:25:97 ART selection
Round: 2 00:34:19 Comments

Round: 1 04:45:58 Past JR

Monday, March 2, 2026 at 17:13:47 in BE

YAPG, AS, RCH,HIBN, MASP, AAQC

February, 2026

⏳ TIME MANAGEMENT
01:06:16

Round: 4 02:14:97 Comments
Round: 3 47:33:86 Wrap-up
Round: 2 05:52:83 CONTINUE previous JR
Round: 1 10:35:10 Past JR

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

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal

AF = atrial fibrillation;
ARDS = acute respiratory distress syndrome;
CA = cancer;
GE = gastroenterology;
MV = mechanical ventilation

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.

2026 HEALIO - Harms of tramadol ‘likely outweigh its limited benefits’ for chronic pain (BMJ).pdf

Codified by JQB

Glossary:
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal

AF = atrial fibrillation;
ARDS = acute respiratory distress syndrome;
CA = cancer;
GE = gastroenterology;
MV = mechanical ventilation

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

2. 𝙄𝙌𝘾 BS 🟰 2026, BMJ, UK ➖ srMA ➕ 19 RCTs ➕ -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.

Monday, February 23, 2026 at 17:00:35 in BE

BAR, HIBN, MASP, AAQC

[2025 ICM - Serum sickness, a mimic of SS• (Todaka) [img].pdf]

Codified by YAPG

Glossary: HD = hemodynamic, INF = infection, mm = management, PO = per os, SeSi = serum sickness, 💉 = intravenous.

1. ♀ 84yo ➩ 13d af_equine-derived habu antivenom

a. Rash: lower legs

b. Vasoplegic shock
2. Labs: ↓ complement ➕ ↑ lactate ➕ AKI

3. SERUM SICKNESS (SeSi).

a. Manifests 7-14d af_ exposure

b. Heterologous proteins: antivenoms ➕ vax ➕ immune-modulating agents (RITUXIMAB + INFLIXIMAB)

c. Resolve w_withdrawal the offending agent

d. If severe systemic involvement ➩ CORTICOSTEROIDS

e. Immune complex-mediated type III reaction

4. INVASIVE PNEUMOCOCCAL or MENINGOCOCCAL INF:

a. ↓ AP

b. ↑ HR

c. ↑ lactate
5. SeSi Clinical characteristics:.
a. pruritic rash: heterogenous, urticarial, morbiliform, maculopapular, palpable purpura. Mucous spared.

b. fever

c. malaise

d. polyarthralgia

e. Severe cases ➩ ↓ C3, C4, CH50.
6. SeSi differentials:.

a. Invasive meningococcal INF ➩ rash ➕ shock

i. Resuscitation concurrently

b. Local INF ➩ control precautions

7. SeSi mm.

a. Prognosis ▶︎ excellent ➩ recovery in days or weeks wo_scarring or sequelae

b. In ICU ▶︎ prioritize: resuscitation ➕ HD support

c. If systemic involvement ▶︎ hydrocortisone 💉 200mg/day ➕ taper 5-7 w_prednisone/prednisolone PO

d. Stop the exposure ➕ document the product ➕ counsel against re-exposure (anaphylaxis).

⏳ TIME MANAGEMENT
49:24:59

Round: 7 00:48:48 Comments
Round: 6 13:53:30 Wrap-up
Round: 5 10:59:23 Interpretation
Round: 4 06:14:45 Reading + notes
Round: 3 02:23:81 ART selection
Round: 2 00:42:47 Comments

Round: 1 14:22:83 Past JR

Thursday, February 19, 2026 at 17:42:35 in BE

YZE, RCH, BAR,HIBN, MASP, AAQC

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

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary::

🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal

VOL = volume

↘️ = worse

↗️ = better

🐷 = obesity

AFib = atrial fibrilation

mcREG = multicenter registry
SSC = surviving sepsis campaign
VP = vasopressor;
NE = norepinephrine;

® = result(s)
AVP = vasopressin

mm = management

PDMS = patient data management systems

1. AVP is better started early:

a. Before, it ↓ NE doses

b. Earlier ➩ ↓: SØ duration ➕ hMM
2. AVP ok as a second VP

3. SSC 2025 ▶︎ start AVP at NE of 0.25-0.5 ∂

4. Dutch mcREG (Melchers et al, 2025):

a. NE: ↑ doses ➕ ↑ durations = ↑ SØ durations (from onset of AVP).

b. Although: NE≥0.3 = ↗️ HD response to AVP ➩ UNKOWN relation to ↓ SØ duration OR ↗️SS.

c. Pxs had ↓ AFib ➕ ↓ VOL load ▶︎ due to NE sparing effect

d. Benefits ✔︎ (short-term) 🤔 (long-term)

5. Dose or time ❓

a. OVISS ▶︎ optimal AVP administration: NE dose = 0.2∂ ➕ SØ duration = 4h af_ (Kalimouttou et al, 2025)

b. Retrospective (White et al, 2024) ▶︎ 6h ➩ ↓ hMM

c. Multiple 🤓 ▶︎ pH ➕ lactate:

i. ↑lactate + ↓pH 🟰 ↘️ HD response

ii. Acidosis ➩ ↓ V1 receptor sensitivity (smooth muscle) ▶︎ NOT A REASON TO DELAY AVP.

d. SØ + 🐷 (Melchers et al, 2025) ▶︎ ↓ response ➕ ↑ SØ duration

e. Current practice ▶︎ protolized NE ↔ NE infusion rate = +0.16

i. ⊕ ↑ response rate

ii. ⊖ other OC ➩ ↑duration ➕ ↓ SS

6. PROPOSAL.

a. START AVP ▶︎ ≥0.2∂ ➕ 6h

b. PREPARE AVP ▶︎ if rapid NE escalation = >0.05∂ per 30min

c. AVP BEFORE ▶︎ NE ≥0.3∂
7. How to implement ➩ adjust PDMS triggers ➕ team training ➕ inventory mm

8. Clinical context is ALSO A FUNDAMENTAL FACTOR.

⏳ TIME MANAGEMENT
01:27:15

Round: 6 01:17:43 Comment
Round: 5 34:55:67 Wrap-up
Round: 4 25:56:35 Interpretation
Round: 3 05:18:93 Reading + notes
Round: 2 05:29:39 ART selection
Round: 1 14:17:69 Past JR

Thursday, February 5, 2026 at 17:03:56 in BE

YAPG, RMF, PFLC, MNVC, LH, HIBN, EM, APES, MASP, AAQC

2025 NEJMjw - Statin Use Might Affect Breast Cancer SS (JAMA).pdf

Codified by JJTM

Glossary: CA = cancer

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, DK ➖ OBS (registry) ➕ 67k ➕ 21y (2000-2021), f-up 10y OR death ➖ P I C O:

- P: ♀ breast cancer stage I-III

- 🅸: statin initiation = INITIATORS

- 🅲: no statin = NONINTIATORS

- O: pOC = breast cancer-related MM
3. EVIDENCE.

a. ⊖ mevalonate pathway

b. ↓ cholesterol production

c. CA cell proliferation, SS, metastases

4. METHODS

- 𝗜𝗡 ➠ wo_prior stating exposure
5. RESULTS.
a. 3y af_CA ▶︎ ↓ MM (10y breast CA-related) ➩ 12% 🅸 🆚 🅲 14%

b. MM (all-cause) ▶︎ numeric but not statistical ↓ MM ➩ 🅸 🆚 🅲

c. CLOSER TO THE DX ▶︎ more-favorable EFFECTS ➩ MM (all cause ➕ breat CA-related)

d. 5y SS (overall) ▶︎ significantly BETTER ➩ 90% 🅸 🆚 🅲 88%

6. RATIONALE.

a. Emulation of MASTER

b. MASTER = Mammary Cancer Statin ER Positive study

c. Atorvastatin is being studied.

d. This OBS not enough due to:

i. residual counfounding

ii. causality not defined

2025 NEJMc - Does Coffee Really Worsen Afib (JAMA).pdf

Codified by JJTM

Glossary: advE = adverse events, AFib = atrial fibrilation, AFL = atril flutter, F-up = follow-up, w = week

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, ? ➖ mc_RCT ➕ 200 ➕ f-up 6m ➖ P I C O:

- P: persistent AFib or AFL

- 🅸: 1 cup of caffeinated coffee / day

- 🅲: no caffeine at all (even decaffeinated)

- O: pOC = Afib + AFL recurrence | sOC = Afib, advE.
3. EVIDENCE.

a. Believed coffee was PROARRHYTHMIC

4. METHODS

- 𝗜𝗡 ➠ underwent CARDIOVERSION + history of coffee consumption
5. RESULTS.
a. Baseline coffee ▶︎ 7cups/w ➩ BOTH groups

b. F-up (6m) ▶︎ 7/w (🅸) 🆚 0/w (🅲)

c. pOC (lasting ≥30s) ↓ in 🅸 47% 🆚 64% 🅲

d. AE ▶︎ no difference

e. Same benefit ▶︎ AFib recurrence only
6. RATIONALE.

a. It definitely contradicts the conventional thinking (proarrhythmic)

b. Mechanisms still unknown.

c. The benefit with MORE THAN 1 cup/d is still in question.

d. We can let these type of patients take their morning coffee (Paul Mueller)

⏳ TIME MANAGEMENT
01:09:47

Round: 10 01:59:19 Comments
Round: 9 11:47:81 Wrap-up
Round: 8 12:03:26 Interpretation
Round: 7 03:32:76 Reading + notes
Round: 6 01:17:72 Comments
Round: 5 15:02:89 Wrap-up
Round: 4 07:09:52 Interpretation
Round: 3 05:49:09 Reading + notes
Round: 2 03:07:86 ART selection
Round: 1 07:57:68 Past JR + 10min

Monday, February 2, 2026 at 17:05:43 in BE

YAPG, RMF, PFLC, MNVC, LH, HIBN, EM, APES, MASP, AAQC

January, 2026

[2025 HEALIO - Addiction, depression, cognition, How GLP-1s may benefit the brain (JAMA).pdf]

Codified by JJTM

Glossary: 🧠 = brain, AUD = alcohol use disorder, CVr = cardiovascular risk, GLP-1 RA = Glucagon-Like Peptide-1 Receptor Agonist(s), HPA = hypothalamic–pituitary–adrenal axis, MACE = major adverse cardiovascular event, MECHS = mechanisms of action, OSA = obstructive sleep apnea, RCT = randomized clinical trial, SUDs = substance use disorders, Sx = surgery

1. GLP-1s in the 🧠 ➩ SYMPTOMS ➩ psychiatric (addiction)➕ neurologic (dementia)
2. Understanding MECHS is important
3. GLP-1 was approved for DM2 ➩ ↓ weight ➩ APPETITE regulation.

4. 2024 ➩ 12% use in US had ever used ➩ 6% currently.
5. FDA-approved indications:.
a. ↓ MACE

b. address OSA

c. ↓ ♾️ disease ➕ ♾️ failure ➕ CVr
6. Research in EARLY stages.

7. Preliminary finding s in OFF LABEL

8. Repurposing drugs has ADVANTAGES of data ➕ experience. (Rebecca Edelmayer)

9. ADDICTION: GLP-1 ➩ in the response-reward PATHWAYS ▶︎ addictive behaviors. Proposed MECHANISMS:

a. Modulation of dopamine release (reward centers)

b. Impact on the HPA axis

c. Regulation of stress-related pathways

10. GLP-1 ➩↓ nicotine ➕ opioid use ➩ evidence less conclusive than for ↓ alcohol craving

11. Real-world data: ➩↓ 40% opioid overdose/↓ 50% alcohol intoxication in AUD

12. RCT: Semaglutide (low dose) ➩↓ weekly alcohol craving ➩↓ consumption ➩ 9 weeks ➩ 48 patients with AUD

13. Population-based study (Sweden): GLP-1 use in T2DM/obesity ➩ ↓ alcohol-related hospitalization

14. Anti-obesity pharmacotherapy ➩ ↓ problematic alcohol use

15. Bariatric surgery ▶︎ ≠ effect ➩ up to 33% pxs developed AUD postSx

16. Treating obesity with pharmacotherapy ➩ ↓ problematic eating ➕↓ alcohol consumption

17. LIMITATIONS: Evidence insufficient for widespread use in SUDs

a. SUD neurobiology = heterogeneous ➩ single target ≠ universal solution

b. GLP-1 safety profile in SUDs ➩ not well defined

⏳ TIME MANAGEMENT
01:00:45

Round: 5 11:56:02 Wrap-up + comments
Round: 4 18:41:90 Interpretation
Round: 3 08:29:06 Reading + notes
Round: 2 05:50:12 ART selection
Round: 1 09:28:04 Past JR

Thursday, January 29, 2026 at 17:20:15 in BE

CDRA, MNVC, EM, PFLC, AJRM, MASP, AAQC

[2025 NEJMc - Frailty Predicts Outcomes in Resistant Klebsiella pneumoniae Bacteremia (JAC).pdf]

Codified by (AHRM)

Glossary: CR-Kp BSIs = carbapenemase-resistant Klebsiella pneumoniae bloodstream infections, FI-Lab = frailty index laboratory, H+ = hospitalization, HR = hazard ratio, INF = infection(s), OD = organ dysfunction, S+E = sensitivity and specificity.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAC, ❓ ➖ retro_cohort ➕ 182 ➕ ❓ ➖ P I C O:
- P: older pxs
- 🅸: hospitalized for bacteriemia multidrug-resistant K. pneumoniae (CR-Kp BSIs)
- 🅲: NA
- O: pOC = MM | sOC = MM28, relapse
3. EVIDENCE.

- Invasive INF from drug-resistan bacteria ≈ ↑ MM ▶︎ particularly in OLDER PXS
- Specially w_frailty ➕ comorbidities
4. METHODS.
- 𝗜𝗡 ➠ 1st 4 days of H+

- INTERV ➠ FI-Lab score (35 tests) was used: higher score = greater frailty
5. RESULTS.
a. Hight frailty score at hospitalization for CR-Kp BSIs ➩ strong predictor: RELAPSE ➕ MM

b. 26% died

c. Older = NON-survivors (age: 70 🆚 60):
i. ↑ SEVERE OD (at onset of INF)
ii. ↑ frailty scores (0.66 🆚 0.33)
d. Frailty index ➩ EXCELLENT PREDICTIVE POWER ▶︎ MM ➕ MM28 ➕ relapse

e. S+E = ihMM ▶︎ 100% + 76%

f. Multivariate analysis ▶︎ ↑ 0,10 frailty score 🟰 ↑ 2.07 HR
6. RATIONALE.
a. Px FRAILTY ➩ ↑ antimicrobial RESISTANCE (gram -)
b. REASONS to wider range of INF by less-virulent BUT more-resistant organisms:
i. repetitive cycles of INF
ii. relapse of INF af_TTO

iii. opportunistic conditions

c. Leading to ➩ ↑ ATB exposure

d. INCORPORATE ‘px frailty’ into medical decision making to:

i. ↗️ selection of ATBs (px-specific)

ii. set appropriate GOALS OF CARE.

⏳ TIME MANAGEMENT
58:42:66

Round: 6 02:16:60 Comments
Round: 5 24:08:93 Wrap-up
Round: 4 15:01:75 Interpretation
Round: 3 04:24:33 Reading + notes
Round: 2 03:31:42 ART select
Round: 1 09:19:59 Past JR

Monday, January 26, 2026 at 17:08:59 in BE

MNVC, PFLC, AHO, AJRM, HIBN, MASP, AAQC

2000 NEJM - ARDS network (wiedemann) [RCT].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ

Glossary:

🫁 = lungs, ALI = acute lung injury, ARDS = acute respiratory distress syndrome, fdMV = free day of mechanical ventilation, hMM = hospital mortality, PBW = predicted body weight, Vt = tidal volume.

1. 𝙄𝙌𝘾 BS 🟰 2000, NEJM, USA ➖ mc_RCT ➕ >800 ➕ Mar 1996-1999 ➖ P I C O
- P: ALI + ARDS
- 🅸: Vt 6 ➕ Pplat 30
- 🅲: Vt 12 ➕ Pplat 50
- O: 1st. pOC = hMM | 2nd. pOC = fdMV
2. EVIDENCE.

a. Traditional Vt = 10 to 15 mL/Kg PBW
b. May cause stretch-induced 🫁 injury.
3. RESULTS..
a. Trial stopped at 861 pxs

b. MM ↓ in 🅸 ➩ 31 🆚 40% (p=0.007)

c. fdMV ↑ in 🅸 ➩ 12 🆚 10 (p=0.007)4. . RATIONALE.

⏳ TIME MANAGEMENT
01:12:27

Round: 4 01:21:73 Wrap-up
Round: 3 33:04:13 ∆ pressure
Round: 2 00:09:39 Comments + ARDS network
Round: 1 37:52:37 Past JR

Thursday, January 22, 2026 at 17:05:10 in BE

EMQC, AJRM, MASP, AAQC

2025 ICUmmp - Ventilatory Management of the Qx Clpx (ICM).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (RICH)

Glossary: af_ = after, d_ = during, EIT = electrical impedance tomography, MV = mechanical ventitation, PO = postoperative, Pp = plateau pressure, Vt = tidal volume, _r = risk, ∆P = driving pressure

1. MV in PO ICU pxs ➩ NEEDS a TAILORED APPROACH but after the core principles
2. IMPROVE trial ➩ 🫁 protective ventilation + ↓ Vt + ↓ PEEP + recruitment ➩ ∑ ↓ COMPLICATIONS (intra & extra 🫁) intermediate-high_r pxs (🫃🏽 Qx)

3. Trials ➩ PEEP or Vt ALONE ▶︎ do not reduceK 🫁 complications

a. PROVILHO & PROBESE ➩ no benefit in ↑ 🆚 ↓ PEEP
b. Australian trial ➩ no difference: ↓ 🆚 ↑ Vt

c. Evidence ▶︎ EFFECTIVENESS d_Qx ➩ ↓∆P ➕ ↓Vt 🟰 MOST BENEFICIAL (in low 🫁 compliance)

d. ∆P = Pplat - PEEP
4. MV in OR-to-ICU transfer

a. Qx pxs have healthier 🫁 (than other ICU pxs)

b. Practices differ (OR 🆚 ICU)

c. Registry data ▶︎ ↓Vt in the ICU af_OR ➩ worse OC (↑RR + ↑MV intensity + ↑MM28)

5. Weaning

a. Inhomogeneous ventilation patterns ➩ measured by EIT ▶︎ worse OC (DELAYED weaning + ↑

🫁 complications + ↑ icuLOS)

[2025 JAMAno - Calorie Restriction, Obesity, and the Aging Process (lorenzini) [comm].pdf]

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (RICH)

Glossary: ❓ = not mentioned, AAs = amino acids, CalRe = caloric restriction, FM = fasting-mimicking, GF = growth factor, IF = intermittent fasting, par = participants, Q = quality, yo = years old.

1. 𝙄𝙌𝘾 BS 🟰 2025, JAMAno, … ➖ comm➕ … ➕ … ➖ P I C O …
2. In humans
a. Controlled studies are hard, due to human lifespan.

b. Correa-Burrows:

i. DNA methylation → most accurate to estimate biological age.

1. Conflicting interpretations ➩ ∑ no solidity to recommend them, yet.

2. Anyhow, they are the most reliable.

ii. Key findings: by the 2 epigenetic clocks → Horvath & GrimAge → show the EXTENT of effect

(when superimposed in the graph)

iii. Multiple factos ➩ influence BIOLOGICAL AGE

1. Obesity (most important)

2. Genetic variants

3. Q of diet

4. Tobacco

5. Environmental pollutants

iv. Epigenetic pattern ➩ has ↑ technical variability ▶︎ makes the graph have ups and downs.

1. Despite it, OBESITY is present in both groups (multiple factors ➕ epigenetic pattern)

2. The elevation suggests ➩ TIME TO CHANGE from “calRe to obesity”

3. We can hypothesize that either 👇🏽 MAY ACCELERATE the aging process.

a. excess calories ➩ precede + accompany obesity
b. obesity itself (modified hormonal balance)

c. combination of both
4. Gerontologist found the same in bibliographic research ➩ aging ↔ obesity → CLEAR OVERLAP.
5. We should make EDUCATIONAL CAMPAIGNS to address the globesity epidemic. .
a. Not only hunger
b. avoid mental + physical STRESS
c. ↑ physical activity

d. Modifiy the diet ➩ ↑ prevent obesity ➕ ↓ promote obesity.
6. 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

⏳ TIME MANAGEMENT
01:21:28

Round: 8 04:23:30 Comments
Round: 7 34:56:73 Interpretation
Round: 6 04:27:37 Reading + notes
Round: 5 02:30:52 Comments
Round: 4 15:38:87 Wrap-up
Round: 3 09:00:47 Interpretation
Round: 2 04:41:40 Select ART
Round: 1 05:50:19 Past JR

Monday, January 19, 2026 at 17:05:02 in BE

RMF, EMQC, PFLC, AHO, MASP, AAQC

[2025 HEALIO - Lifestyle intervention may lower CKD r for pxs w_type 2 DM.pdf]

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (RICH)

Glossary: ❓ = not mentioned, AAs = amino acids, CalRe = caloric restriction, FM = fasting-mimicking, GF = growth factor, IF = intermittent fasting, par = participants, yo = years old.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. QUESTION ▶︎ if aging process is SLOWED by CalRe? “has been hovering”
3. Correa-Burrows study:.

a. 2025, JAMAno, CL ➖ obs_coh_Santiago Long. Study ➕ 205 par ➕ ❓ ➖ PICO:

i. P. Healthy volunteeers.

ii. I: caloric restriction ➩ from birth to 28-31yo.

iii. C: NA

iv. O: pOC = aging

v. METHOD:

1. Biological age: several methods.

a. 2 estimations: DNA methylation ➕ methylation-based leukocyte telomere length.

b. Cytokines, adipokines, myokines,

c. GF levels

2. Assessments are RECOGNIZED as valid. (gerontological community).

vi. RESULTS: ↑ BMI since (childhood/adolescence) ↔ ↑ epigenetic age (compared to chronological age) ➩ 2 - 5 years (depending on OBESITY + EPIGENETIC CLOCK).

4. 90y ➩ prolongevity effect of CalRe BEFORE “biology of aging”
5. Over the years ➩ EXPERIMENTAL TOOL to modulate the models: yeast and Caenorhabditis elegans to 🐟, 🐦, 🐕, 🐄.
6. To date ➩ many experimental approaches:
a. simple CalRe, ketogenic diets, IF, FM diets, time-restricted feeding, protein restriction, and AAs

restricted.
b. All w_CalRe as the common component ▶︎ ↑↑↑ lifespan
c. IF CalRe is absent, ↑LONGEVITY is SMALLER.

7. RATS + MICE:

a. Brevity of lifespans (1-2y) ➩ choice in gerontology.

b. ↑ longevity ≈ ↓ weight ➩ when fed AD LIBITUM (conventional housing approach)

8. PRIMATES: Rhesus monkeys ➩ the benefit might be on PREVENTION of EXCESS WEIGHT.

9. In humans….

⏳ TIME MANAGEMENT
01:28:23

Round: 7 08:36:23 Comments
Round: 6 03:08:85 Summary
Round: 5 52:43:43 Interpretation + wrap-up
Round: 4 08:21:51 Reading + notes
Round: 3 06:59:29 ART selection
Round: 2 00:46:85 Comments
Round: 1 07:47:40 Past JR

Thursday, January 15, 2026 at 17:23:13 in BE

JJTM, MJVA, PFLC, MASP, AAQC

[2025 HEALIO - Lifestyle intervention may lower CKD r for pxs w_type 2 DM.pdf]

Codified by: JQB

Glossary: ACEI = angiotensin-converting enzyme inhibitors, CKD = chronic kidney disease, life_iNT = lifestyle interventions, r = risk, rt = real-time, SGLT2i = Sodium-Glucose Cotransporter-2 Inhibitors, T2DM = type 2 diabetes.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, ?, IN ➖ observational ➕ >1k ➕ 2020-2024 (1y 🅸 ) ➖ P I C O:
- P: T2DM + CKD drug-naive
- 🅸: life_INT (diet + exercise + psycho + consultations)
- “🅲”: renoprotective therapy ➩ hypoglycemiants (95%) + ACEI or SGLT2i or statins
- O: pOC = r_CKD progression | sOC = BMI + HbA1c + UACR + eGFR3. EVIDENCE.

a. Pramod Tripathy ➩ Freedom from Diabetes, India
b. Study presented in Dallas ➩ American College of Lifestyle Medicine annual conference 2025
4. METHODS.
- 𝗜𝗡 ➠ UACR >73,1 mg/g

- 𝗘𝗫 ➠

- INTERV ➠ 4 components of life_INT:

- DIet ▶︎ plant-based renal diet (smoothies, juice, water fasting + int. fasting)
- Exercice ▶︎ lymphatic circulation + muscle activation + yoga + strength + stamina + flexibility
- Psychological ▶︎ group goal + journal writing + meditation
- Medical consultation ▶︎ lat tests

- All 4 in the pocket ➩ electronic support (mobile app)

- Initially every week or 2, then every month.

- Daily blood sugar ➕ rt feedback

5. RESULTS.
a. Drug-naive pxs ➩ more benefi
b. ↗️ BMI (↓:27 to 25), HbA1c (↓:8 to 7), UACR (↓:73 to 34), eGFR (↓:97 to 96).
c. ↗️ moderate/high_r to low_r ➩ CKD (79%/21% 🆚 53%/10%)

d. pOC ▶︎ low_r for CKD ➩ drug naive 🆚 renoprotective group (68% 🆚 41%)
6. RATIONALE.
a. “legitimate, powerful therapeutic tool” Tripathi
b. “ifestyle intervention as a serious first-line treatment option” Tripathi
c. Not as definitive proof.
d. eGFR finding ➩ UNIQUE (compared to others) ▶︎ further research needed.

e. Drug-naive classified as low_r

f. “Delaying progression of the disease”… extract.

7. LIMITATIONS.

a. It was not randomized.

⏳ TIME MANAGEMENT
01:22:08

Round: 5 02:26:95 Comments
Round: 4 01:00:06 Interpretation + wrap-up
Round: 3 08:25:93 Reading + notes
Round: 2 05:24:25 ART selection
Round: 1 05:45:12 Past JR

Monday, January 12, 2026 at 17:05:39 in BE

EMQC, PFLC, EM, MASP, AAQC

[2002 NEJM - Hypocapnia (laffey) [r].pdf]

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (RICH)

Glossary:
CI = critically ill, CPR = cardiopulmonary resuscitation, ICH = intracranial hypertension, PAH = pulmonary-artery hypertension, 💨 = flow, 🫁 = lungs

1. PaCO2 = production 🆚 elimination

2. Healthy ➩ narrow physiologic limits
3. Well tolerated ➩ few effects. .
4. Transient INDUCTION:.
a. Lifesaving: ICH + neonatal PAH
b. Damage: longer duration in CI pxs
5. CAUSES