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 techniqueโ€™.
7. Check out our calendar and see you in the DISCORD server.

General Glossary

Glossary (most used)

โ†‘ = increase, โ†“ = decrease,โ†—๏ธ = improve,โ†˜๏ธ = worsen, ๐—˜๐—ซ = exclusion, ๐—œ๐—ก = inclusion, โ˜… = recommendation(s), ๐Ÿ—ฃ = 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.

Brief scope glossary

    - ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ ๐™„๐™‰๐˜ผ๐˜ผ๐™Œ๐˜พ แดฎแดผ brief scope โ†ฉ
    - Y, J, C โž– T โž• N โž• t โž– P I C O: โ†ฉ
   - year (Y), journal (J), country (C) โž– type of study (T) โž• number of patients/sample (N) โž• time (t) โž–population (P),

     intervention (I), comparison (C), outcome (O, OC).

Complete glossary here.

January, 2026

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

EMQC, PFLC, EM, 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. ๐™„๐™Œ๐˜พ BS โžฉ Y, J, C โž– T โž• N โž• t โž– P I C O:
2. ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ 2025, ?, IN โž– observational โž• >1k โž• 2020-2024 (1y ๐Ÿ…ธ ) โž– P I C O:
      - P: T2DM + CKD drug-naive
      - ๐Ÿ…ธ: life_INT (diet + exercise + psycho + consultations)
      - โ€œ๐Ÿ…ฒโ€: renoprotective therapy โžฉ hypoglycemiants (95%) + ACEI or SGLT2i or statins
      - O: pOC = r_CKD progression | sOC = BMI + HbA1c + UACR + eGFR3. EVIDENCE.

      a. Pramod Tripathy โžฉ Freedom from Diabetes, India
      b. Study presented in Dallas โžฉ American College of Lifestyle Medicine annual conference 2025
4. METHODS.
      - ๐—œ๐—ก โž  UACR >73,1 mg/g

      - ๐—˜๐—ซ โž 

      - INTERV โž  4 components of life_INT:

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

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

      - Initially every week or 2, then every month. 

      - Daily blood sugar โž• rt feedback









5. RESULTS.
      a. Drug-naive pxs โžฉ more benefi
      b. โ†—๏ธ BMI (โ†“:27 to 25), HbA1c (โ†“:8 to 7), UACR (โ†“:73 to 34), eGFR (โ†“:97 to 96).
      c. โ†—๏ธ moderate/high_r to low_r โžฉ CKD (79%/21% ๐Ÿ†š 53%/10%)

      d. pOC โ–ถ๏ธŽ low_r for CKD โžฉ drug naive ๐Ÿ†š renoprotective group (68% ๐Ÿ†š 41%)
6. RATIONALE.
      a. โ€œlegitimate, powerful therapeutic toolโ€ Tripathi
      b. โ€œifestyle intervention as a serious first-line treatment optionโ€ Tripathi
      c. Not as definitive proof.
      d. eGFR finding โžฉ UNIQUE (compared to others) โ–ถ๏ธŽ further research needed.

      e. Drug-naive classified as low_r

      f. โ€œDelaying progression of the diseaseโ€โ€ฆ extract. 

7. LIMITATIONS.

      a. It was not randomized. 

โณ 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

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

Codified by ๐™„๐™‰๐˜ผ๐˜ผ๐™Œ๐˜พ แดฎแดผ (RICH)


Glossary:
CI = critically ill, CPR = cardiopulmonary resuscitation, ICH = intracranial hypertension, PAH = pulmonary-artery hypertension, ๐Ÿ’จ = flow, ๐Ÿซ = lungs


1. PaCO2 = production ๐Ÿ†š elimination




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
















.
6. Appear in many diseases, usually UNDERESTIMATED. .

7. BELIEF hypocapia is SAFE or PREFERABLE โžฉ โ†‘ hypocapnia (โ†“CO2). .

8. CO2 โ†“ more DUE TO โ†‘ elimination (unusual the โ†“ production) โ–ถ๏ธŽ rate of elimination. So:

      a. MAIIN CAUSE โžฉ hyperventilation that comes from:

         i. MV

         ii. ECMO

      b. Hypocapnic alkalosis 

         i. โ†“ ๐Ÿซ ๐Ÿ’จ 

         ii. E.g. CPR

         iii. Dissociation: VENOUS ๐Ÿ†š ARTERIAL blood (โ†“ ๐Ÿ’จ โž• N ventilation):

             1. V: โ†‘CO2 + โ†“pH

             2. A: โ†“CO2 + โ†‘pH

             3. This is PSEUDORESPIRATORY ALKALOSIS.

Monday, January 5, 2026 at 17:15:21 in BE

MT, MJVA, JJTM, HIBN, AHRM, MASP, AAQC

โณ TIME MANAGEMENT
01:12:51

Round: 5 01:23:70 Comments
Round: 4 16:17:05 Wrap-up
Round: 3 31:43:30 Reading + notes
Round: 2 04:46:28 Selection
Round: 1 18:40:70 +30 min Past JR

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

RMF, EMQC, PFLC, AHO, MASP, AAQC

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

Codified by ๐™„๐™‰๐˜ผ๐˜ผ๐™Œ๐˜พ แดฎแดผ (RICH)


Glossary: โ“ = 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. ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ 2025, JAMAno, โ€ฆ โž– commโž• โ€ฆ โž• โ€ฆ โž– P I C O โ€ฆ
2. In humans
      a. Controlled studies are hard, due to human lifespan. 

      b. Correa-Burrows:

         i. DNA methylation โ†’ most accurate to estimate biological age. 

            1. Conflicting interpretations โžฉ โˆ‘ no solidity to recommend them, yet. 

            2. Anyhow, they are the most reliable.

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

             (when superimposed in the graph)

         iii. Multiple factos โžฉ influence BIOLOGICAL AGE

            1. Obesity (most important)

            2. Genetic variants

            3. Q of diet

            4. Tobacco

            5. Environmental pollutants

         iv. Epigenetic pattern โžฉ has โ†‘ technical variability โ–ถ๏ธŽ makes the graph have ups and downs. 

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

            2. The elevation suggests โžฉ TIME TO CHANGE from โ€œcalRe to obesityโ€

3. We can hypothesize that either ๐Ÿ‘‡๐Ÿฝ MAY ACCELERATE the aging process.

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

      c. combination of both
4. Gerontologist found the same in bibliographic research โžฉ aging โ†” obesity โ†’ CLEAR OVERLAP.     
5. We should make EDUCATIONAL CAMPAIGNS to address the globesity epidemic. .
      a. Not only hunger
      b. avoid mental + physical STRESS
      c. โ†‘ physical activity 

      d. Modifiy the diet โžฉ โ†‘ prevent obesity โž• โ†“ promote obesity. 
6. ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ 2021, IJGO, UK โž– srMA โž• 2524, 59 IN โž• -Nov 11, 2020 โž– P I C O:.
      - P: hALT pregnant
      - ๐Ÿ…ธ: preg hALT

      - ๐Ÿ…ฒ: preg non-hALT

      - O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW

โณ 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

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

Codified by ๐™„๐™‰๐˜ผ๐˜ผ๐™Œ๐˜พ แดฎแดผ (RICH)


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


1. MV in PO ICU pxs โžฉ NEEDS a TAILORED APPROACH but after the core principles
2. IMPROVE trial โžฉ ๐Ÿซ protective ventilation + โ†“ Vt + โ†“ PEEP + recruitment โžฉ โˆ‘ โ†“ COMPLICATIONS (intra      & extra ๐Ÿซ) intermediate-high_r pxs (๐Ÿซƒ๐Ÿฝ Qx)

3. Trials โžฉ PEEP or Vt ALONE โ–ถ๏ธŽ do not reduceK ๐Ÿซ complications

      a. PROVILHO & PROBESE โžฉ no benefit in โ†‘ ๐Ÿ†š โ†“ PEEP
      b. Australian trial โžฉ no difference: โ†“ ๐Ÿ†š โ†‘ Vt

      c. Evidence โ–ถ๏ธŽ EFFECTIVENESS d_Qx โžฉ โ†“โˆ†P โž• โ†“Vt ๐ŸŸฐ MOST BENEFICIAL (in low ๐Ÿซ compliance)

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

      a. Qx pxs have healthier ๐Ÿซ (than other ICU pxs)

      b. Practices differ (OR ๐Ÿ†š ICU)

      c. Registry data โ–ถ๏ธŽ โ†“Vt in the ICU af_OR โžฉ worse OC (โ†‘RR + โ†‘MV intensity + โ†‘MM28)

5. Weaning

     a. Inhomogeneous ventilation patterns โžฉ measured by EIT โ–ถ๏ธŽ worse OC (DELAYED weaning + โ†‘         

         ๐Ÿซ complications + โ†‘ icuLOS)

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

Codified by ๐™„๐™‰๐˜ผ๐˜ผ๐™Œ๐˜พ แดฎแดผ (RICH)


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


1. ๐™„๐™Œ๐˜พ BS โžฉ Y, J, C โž– T โž• N โž• t โž– P I C O:
2. QUESTION โ–ถ๏ธŽ if aging process is SLOWED by CalRe? โ€œhas been hoveringโ€
3. Correa-Burrows study:.

      a. 2025, JAMAno, CL โž– obs_coh_Santiago Long. Study โž• 205 par โž• โ“ โž– PICO:

         i. P. Healthy volunteeers.

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

         iii. C: NA

         iv. O: pOC = aging

         v. METHOD: 

            1. Biological age: several methods. 

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

               b. Cytokines, adipokines, myokines,

               c. GF levels

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

         vi. RESULTS: โ†‘ BMI since (childhood/adolescence) โ†” โ†‘ epigenetic age (compared to chronological                  age) โžฉ 2 - 5 years (depending on OBESITY + EPIGENETIC CLOCK).  

4. 90y โžฉ prolongevity effect of CalRe BEFORE โ€œbiology of agingโ€
5. Over the years โžฉ EXPERIMENTAL TOOL to modulate the models: yeast and Caenorhabditis elegans to ๐ŸŸ, ๐Ÿฆ, ๐Ÿ•, ๐Ÿ„.
6. To date โžฉ 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 โ–ถ๏ธŽ โ†‘โ†‘โ†‘ lifespan
      c. IF CalRe is absent, โ†‘LONGEVITY is SMALLER.

7. RATS + MICE:

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

      b. โ†‘ longevity โ‰ˆ โ†“ weight โžฉ when fed AD LIBITUM (conventional housing approach)

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

9. In humansโ€ฆ.

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

JJTM, MJVA, PFLC, MASP, AAQC

โณ 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

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

MNVC, PFLC, AHO, AJRM, HIBN, 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. ๐™„๐™Œ๐˜พ BS โžฉ Y, J, C โž– T โž• N โž• t โž– P I C O:
2. ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ 2025, JAC, โ“ โž– retro_cohort โž• 182 โž• โ“ โž– P I C O:
      - P: older pxs
      - ๐Ÿ…ธ: hospitalized for bacteriemia multidrug-resistant K. pneumoniae (CR-Kp BSIs)
      - ๐Ÿ…ฒ: NA
      - O: pOC = MM | sOC = MM28, relapse
3. EVIDENCE.

      - Invasive INF from drug-resistan bacteria โ‰ˆ โ†‘ MM โ–ถ๏ธŽ particularly in OLDER PXS
      - Specially w_frailty โž• comorbidities
4. METHODS.
      - ๐—œ๐—ก โž  1st 4 days of H+

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

      b. 26% died

      c. Older = NON-survivors (age: 70 ๐Ÿ†š 60):
          i. โ†‘ SEVERE OD (at onset of INF)
          ii. โ†‘ frailty scores (0.66 ๐Ÿ†š 0.33)        
      d. Frailty index โžฉ EXCELLENT PREDICTIVE POWER โ–ถ๏ธŽ MM โž• MM28 โž• relapse

      e. S+E = ihMM โ–ถ๏ธŽ 100% + 76%

      f. Multivariate analysis โ–ถ๏ธŽ โ†‘ 0,10 frailty score ๐ŸŸฐ โ†‘ 2.07 HR
6. RATIONALE.
      a. Px FRAILTY โžฉ โ†‘ 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 โžฉ โ†‘ ATB exposure

      d. INCORPORATE โ€˜px frailtyโ€™ into medical decision making to:

         i. โ†—๏ธ selection of ATBs (px-specific)

         ii. set appropriate GOALS OF CARE. 

โณ 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

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

Codified by ๐™„๐™‰๐˜ผ๐˜ผ๐™Œ๐˜พ แดฎแดผ


Glossary:

๐Ÿซ = 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. ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ 2000, NEJM, USA โž– mc_RCT โž• >800 โž• Mar 1996-1999 โž– P I C O
      - P: ALI + ARDS
      - ๐Ÿ…ธ: Vt 6 โž• Pplat 30
      - ๐Ÿ…ฒ: Vt 12 โž• 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 ๐Ÿซ injury. 
3. RESULTS..
      a. Trial stopped at 861 pxs

      b. MM โ†“ in ๐Ÿ…ธ โžฉ 31 ๐Ÿ†š 40% (p=0.007)

      c. fdMV โ†‘ in ๐Ÿ…ธ โžฉ 12 ๐Ÿ†š 10 (p=0.007)4. . RATIONALE.  

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

EMQC, AJRM, MASP, AAQC

โณ TIME MANAGEMENT
01:12:27

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

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

Codified by JJTM


Glossary: ๐Ÿง  = brain, AUD = alcohol use disorder, CVr = cardiovascular risk, GLP-1 RA = Glucagon-Like Peptide-1 Receptor Agonist(s), HPA = hypothalamicโ€“pituitaryโ€“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 ๐Ÿง   โžฉ SYMPTOMS โžฉ psychiatric (addiction)โž• neurologic (dementia)
2. Understanding MECHS is important
3. GLP-1 was approved for DM2 โžฉ โ†“ weight โžฉ APPETITE regulation.

4. 2024 โžฉ 12% use in US had ever used โžฉ 6% currently.
5. FDA-approved indications:.
      a. โ†“ MACE

      b. address OSA

      c. โ†“ โ™พ๏ธ  disease โž• โ™พ๏ธ failure โž• CVr
6. Research in EARLY stages.

7. Preliminary finding s in OFF LABEL

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

9. ADDICTION: GLP-1 โžฉ in the response-reward PATHWAYS โ–ถ๏ธŽ 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 โžฉโ†“ nicotine โž• opioid use โžฉ evidence less conclusive than for โ†“ alcohol craving

11. Real-world data: โžฉโ†“ 40% opioid overdose/โ†“ 50% alcohol intoxication in AUD

12. RCT: Semaglutide (low dose) โžฉโ†“ weekly alcohol craving โžฉโ†“ consumption โžฉ 9 weeks โžฉ 48 patients with AUD

13. Population-based study (Sweden): GLP-1 use in T2DM/obesity โžฉ โ†“ alcohol-related hospitalization

14. Anti-obesity pharmacotherapy โžฉ โ†“ problematic alcohol use

15. Bariatric surgery โ–ถ๏ธŽ โ‰  effect โžฉ up to 33% pxs developed AUD postSx

16. Treating obesity with pharmacotherapy โžฉ โ†“ problematic eating โž•โ†“ alcohol consumption

17. LIMITATIONS: Evidence insufficient for widespread use in SUDs

      a. SUD neurobiology = heterogeneous โžฉ single target โ‰  universal solution

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

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

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

โณ 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

February, 2026

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

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

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

Codified by ๐™„๐™‰๐˜ผ๐˜ผ๐™Œ๐˜พ แดฎแดผ (ABFL)


Glossary::

      ๐Ÿง  = brain
      ๐Ÿซ = lungs
      ๐Ÿซ€ = heart
      ๐Ÿซƒ๐Ÿฝ = abdomen = abdominal

      โ—ธ = liver = hepatic
      โ™พ๏ธ = kidneys = renal
      ๐Ÿฉธ= blood = hematology
      ๐Ÿชฒ = infections
      ๐Ÿ’จ = flow
      โžฐ = pressure
      ๐Ÿค“ = analysis;
      โšก๏ธ = cardiac arrest;
      ๐Ÿ“ˆ = arrhythmia;
      ๐Ÿ—ฃ = suggestion(s)
      โ˜… = recommendation(s)

      VOL = volume

      โ†˜๏ธ = worse

      โ†—๏ธ = better

      ๐Ÿท = obesity

      AFib = atrial fibrilation

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

      ยฎ = result(s)
      AVP = vasopressin

      mm = management

      PDMS = patient data management systems

1. AVP is better started early:

      a. Before, it โ†“ NE doses

      b. Earlier โžฉ โ†“: Sร˜ duration โž• hMM
2. AVP ok as a second VP

3. SSC 2025 โ–ถ๏ธŽ start AVP at NE of 0.25-0.5 โˆ‚

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

      a. NE: โ†‘ doses โž• โ†‘ durations = โ†‘ Sร˜ durations (from onset of AVP). 

      b. Although: NEโ‰ฅ0.3 = โ†—๏ธ HD response to AVP โžฉ UNKOWN relation to โ†“ Sร˜ duration OR โ†—๏ธSS. 

      c. Pxs had โ†“ AFib โž• โ†“ VOL load โ–ถ๏ธŽ due to NE sparing effect 

      d. Benefits โœ”๏ธŽ (short-term) ๐Ÿค” (long-term)

5. Dose or time โ“ 

      a. OVISS โ–ถ๏ธŽ optimal AVP administration: NE dose = 0.2โˆ‚ โž• Sร˜ duration = 4h af_ (Kalimouttou et al, 2025)

      b. Retrospective (White et al, 2024) โ–ถ๏ธŽ 6h โžฉ โ†“ hMM

      c. Multiple ๐Ÿค“ โ–ถ๏ธŽ pH โž• lactate:

         i. โ†‘lactate + โ†“pH ๐ŸŸฐ โ†˜๏ธ HD response

         ii. Acidosis โžฉ โ†“ V1 receptor sensitivity (smooth muscle) โ–ถ๏ธŽ NOT A REASON TO DELAY AVP.  

      d. Sร˜ + ๐Ÿท (Melchers et al, 2025) โ–ถ๏ธŽ โ†“ response โž• โ†‘ Sร˜ duration

      e. Current practice โ–ถ๏ธŽ protolized NE โ†” NE infusion rate = +0.16

         i. โŠ• โ†‘ response rate 

         ii. โŠ– other OC โžฉ โ†‘duration โž• โ†“ SS

6. PROPOSAL.

      a. START AVP โ–ถ๏ธŽ โ‰ฅ0.2โˆ‚ โž• 6h 

      b. PREPARE AVP โ–ถ๏ธŽ if rapid NE escalation = >0.05โˆ‚ per 30min

      c. AVP BEFORE โ–ถ๏ธŽ NE โ‰ฅ0.3โˆ‚
7. How to implement โžฉ adjust PDMS triggers โž• team training โž• inventory mm

8. Clinical context is ALSO A FUNDAMENTAL FACTOR. 

โณ 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

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. ๐™„๐™Œ๐˜พ BS โžฉ Y, J, C โž– T โž• N โž• t โž– P I C O:
2. ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ 2025, JAMA, ? โž– mc_RCT โž• 200 โž• f-up 6m โž– P I C O:

      - P: persistent AFib or AFL

      - ๐Ÿ…ธ: 1 cup of caffeinated coffee / day

      - ๐Ÿ…ฒ: no caffeine at all (even decaffeinated)

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

      a. Believed coffee was PROARRHYTHMIC

4. METHODS

      - ๐—œ๐—ก โž  underwent CARDIOVERSION + history of coffee consumption
5. RESULTS.
      a. Baseline coffee โ–ถ๏ธŽ 7cups/w โžฉ BOTH groups

      b. F-up (6m) โ–ถ๏ธŽ 7/w (๐Ÿ…ธ) ๐Ÿ†š 0/w (๐Ÿ…ฒ)

      c. pOC (lasting โ‰ฅ30s) โ†“ in ๐Ÿ…ธ 47% ๐Ÿ†š 64% ๐Ÿ…ฒ

      d. AE โ–ถ๏ธŽ no difference

      e. Same benefit โ–ถ๏ธŽ 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)

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

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

โณ 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

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

Codified by JJTM


Glossary: CA = cancer

1. ๐™„๐™Œ๐˜พ BS โžฉ Y, J, C โž– T โž• N โž• t โž– P I C O:
2. ๐™„๐™Œ๐˜พ BS ๐ŸŸฐ 2025, JAMA, DK โž– OBS (registry) โž• 67k โž• 21y (2000-2021), f-up 10y OR death โž– P I C O:

      - P: โ™€ breast cancer stage I-III

      - ๐Ÿ…ธ: statin initiation = INITIATORS

      - ๐Ÿ…ฒ: no statin = NONINTIATORS

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

      a. โŠ– mevalonate pathway

      b. โ†“ cholesterol production

      c. CA cell proliferation, SS, metastases

4. METHODS

      - ๐—œ๐—ก โž  wo_prior stating exposure
5. RESULTS.
      a. 3y af_CA โ–ถ๏ธŽ โ†“ MM (10y breast CA-related) โžฉ 12% ๐Ÿ…ธ ๐Ÿ†š ๐Ÿ…ฒ 14%

      b. MM (all-cause) โ–ถ๏ธŽ numeric but not statistical โ†“ MM โžฉ ๐Ÿ…ธ ๐Ÿ†š ๐Ÿ…ฒ

      c. CLOSER TO THE DX โ–ถ๏ธŽ more-favorable EFFECTS โžฉ MM (all cause โž• breat CA-related)

      d. 5y SS (overall) โ–ถ๏ธŽ significantly BETTER โžฉ 90% ๐Ÿ…ธ ๐Ÿ†š ๐Ÿ…ฒ 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

Journal Reviews