Journal Reviews 2025

1. A JR is an academic session in which we go through selected article summaries over 60-75 min.

2. It takes place every Monday and Thursday via our JR Discord channel – see calendar.
3. Its purpose is to:
- Understand the main messages from the summarized articles.
- Recall pivotal concepts pertinent to our clinical practice.
- Train clinical reasoning by connecting key concepts to real-life scenarios.

4. The articles are chosen during the session from a curated, labeled, and codified list of remarkable summarized articles.

5. We take interactive and pedagogic notes in a shared document, using visual aids, highlighting, underlining, arrows, and conceptual links to connect ideas and facilitate understanding.
6. For each session, we create RECAP key points and publish them on our website.

7. In the following session, we briefly recall the previous JR’s RECAP to reinforce learning through retrieval practice.

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).

𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope

⚡️ = cardiac arrest, 🤓 = analysis, 💨 = flow, 📈 = arrhythmia, 🗣 = suggestion(s), 🩸 = blood = hematology, 🪲 = infections, 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🫃🏽 = abdomen = abdominal, ♾️ = kidneys = renal, ◸ = liver = hepatic, ➰ = pressure, 💪🏽 = muscle, ⭕️ = circulation, 🥊 = inflammation, ★ = recommendation(s), ↑ = increase, ↓ = decrease, ↗️ = improve, ↘️ = worsen, 𝗘𝗫 = exclusion, 𝗜𝗡 = inclusion, CIpxs = critically ill patients, 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, pOC = primary outcome(s), pxs = patients, RCT = randomized controlled trial, sOC = secondary outcome(s), sr = systematic review, SS = survival, w_ = with, wo_ = without, yo = years old

Glossary (most used)

Complete glossary here.

March, 2026

2025 NEJMc - Watchful Waiting or Oral Antihypertensives f_, Asymptomatic Hypertension (NEJM).pdf

2025 NEJMcd - To Treat or Not to Treat Watchful Waiting or Oral antiHTA (Gorey) [case].pdf

Codified by YAPG + 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary: AdvEve = adverse events, ATC = awareness, TTO and control, MI = myocardial infarction, OSA = obstructive sleep apnea, PCP = primary care physician, S† = stroke, ⚡️ = cardiac arrest, 🤓 = analysis, 🧠 = brain, 🫀 = heart, 🫀 injury = myocardial injury, 🫁 = lungs

1. 63yo ♂︎ ➩ uncomplicated diverticulitis + ATB + conservative TTO

2. Vitals ➩ 185/115, the rest ✔︎ , no symptoms (headache, dyspnea, chest or ab pain)

3. Slightly stressed at being admitted

4. Physical exam ➩ 166/97, 4h earlier.

5. LAB ➩ ↑LEU + inflammatory markers ➖ renal and liver profiles ✔︎

6. Monitors have been calibrated recently.

7. 10min rest ➩ 182/103

8. NOT TO TREAT

a. Michael Rothberg

b. No immediate danger.

c. Not treated HTA ➩ ↑r 🫀DIS + ♾️ DIS + 🧠 Stroke ▶︎ over years, NOT DAYS

d. SEVERAL REASONS:

i. Acute illness

1. TRANSIENT ↑ABP

2. Incorrect to treat

3. Inaccurate measurements

a. Mispositioning

b. Cuff size

c. Situational factors (anxiety + pain + wakened from sleep)

ii. Side effects

1. AntiHTA 💉 ➩ ↓ABP ▶︎ ↑ ↑ ↑ dangerous than ↑HTA ➩ hypoperfusion

2. ↓K or ↑K

3. For inpatient settings ▶︎ No RCTs ➕ Yes OBS (need for caution)

4. Propensity-matched 🤓 ▶︎ ↑ 🫀 injury ➕ AKI

5. Target trial emulation ▶︎ if TTO 48h 🟰 ↑ incidence of AdvEve

iii. Time and resources

1. GL ▶︎ if immediate TTO = f-up 4w

2. Monitoring at least every shift

3. Pressure to ↑ therapy ➩ overTTO

4. Might seem likely to f-up + better BP control ➩ BUT OBS studies do not support this assertion but DO suggest potential harm.

5. Readmitted within 30d (filling and refilling of the medication)

6. PCP is needed.

e. MOST IMP ➩ education ➕ f-up

i. Shortage of PCP in the US

ii. f-up is challenging.

iii. It should be done.
9. TO TREAT

a. GL outpatient setting ▶︎ STRONG EVIDENCE (epidemiologic ➕ RCTs)

b. Inpatient setting ▶︎ 🤷🏽‍♂️ when + how to treat ASYMPTOMATIC HTA

c. RCTs lacking

d. OBSs ➩ ↑r of adverse clinical OCs: death + AKI + S†

e. Modest reductions 🟰 ↓r MI ➕ S† ➕ HF ➕ MM

f. ATC ▶︎ Awareness ➕ TTO ➕ control ➩ Low prevalence: 60, 51, 21%, respectively.

g. Demographics ▶︎ ♂︎ ➕ >60yo ▶︎ 70% are ♂︎ ➕ 63yo ↪︎ HTA most likely

h. Multiple checks + calibrated device + after 10min rest + no pain + no meds 🟰 chronic HTA (vignette case)

i. UNIQUE OPPORTUNITY to ATC

i. Better chance to receive help

ii. Discharge management to refills and control

iii. outpatient f-up ➩ weight ➕ OSA

iv. PCP + pharmacists + technology ➩ TRANSITION “inpatient → outpatient”

v. "we should seize each chance we have to make a positive change."

2026 NEJMc - Updated Guidelines for Advanced, ACLS (Circulation).pdf

Codified by YAPG

Glossary: ★ = recommendation(s), AED = automated external defibrillator, AF = atrial fibrillation, Afib = atrial fibrilation, ARDS = acute respiratory distress syndrome, CA = cancer, FA = flutter, GE = gastroenterology, IO = intraosseus, OHCA = out of hospital cardiac arrest, PEA = pulseless electrical activity, 💉 = intravenous, 🗣 = suggestion(s), 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🫃🏽 = abdomen = abdominal

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

2. 𝙄𝙌𝘾 BS 🟰 2025, CIRCULATION, USA ➖ GL ➕ NA ➕ UPDATE from 2020 ➖ P I C O:

- P: adults
- 🅸: ACLS
- 🅲: NA
- O: NA

3. No substantive additions, few relevant changes

4. OPIODS

a. Do not DELAY CPR, EVEN when naloxone is being considered

5. CPR, mechanical devices

a. Only in special circumstances ➩ d_transport

b. OHCA not recommended

6. ACCESS

a. 💉 before IO

b. IO only if 💉 fails OR is inaccesible

7. DEFIBRILLATION

a. 1st synchronized cardioversion at 200J (biphasic) ➩ Afib ➕ AF
b. For refractory ventricular fibrillation ➩ DO NOT USE vector change ➕ double sequential defibrillation
c. In polymorphic ventricular tachycardia ➩ immediate defibrillation

8. ULTRASOUND
a. Use by an experienced clinician
b. Purpose ➩ to DX reversible causes (pneumothorax ➕ 🫀 tamponade)
c. Do not STOP CPR

9. POST ROSC

a. 36ºC for at least 36h

10. EDUCATION

a. 12yo ➩ can learn CPR ➕ AED use

b. Cognitive aids:

i. NOT for lay rescuers
ii. YES for health care professionals

11. RATIONALE

a. POCUS valuable in PEA and asystole

b. Education + training ★ ➩ encourage the team to use smart devices + teens to get training.

⏳ TIME MANAGEMENT
02:18:20

Round: 16 02:42:36 Comments
Round: 15 26:43:61 Wrap-up
Round: 14 13:37:28 Interpretation
Round: 13 04:26:72 Reading + notes
Round: 12 17:42:78 Interpretation
Round: 11 04:14:13 Reading + notes
Round: 10 07:02:71 Reading + notes (+4 min)
Round: 9 05:05:57 Comments
Round: 8 12:01:55 Wrap-up
Round: 7 15:07:75 Interpretation

Round: 6 04:02:34 Reading + notes

Round: 5 06:57:57 Reading + notes

Round: 4 01:26:84 Discussion

Round: 3 03:52:58 ART Selection

Round: 2 00:59:82 Comments

Round: 1 12:17:29 Past JR

Thursday, March 26, 2026 at 17:15:45 in BE

MG, LH, EQO, YZE, ASCA, MASP, AAQC

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.

⏳ 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

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

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

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

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

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

BAR, HIBN, MASP, AAQC

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.

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.

⏳ 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

[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

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. 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 5, 2026 at 17:15:21 in BE

MT, MJVA, JJTM, HIBN, AHRM, 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

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

7. BELIEF hypocapia is SAFE or PREFERABLE ➩ ↑ hypocapnia (↓CO2). .

8. CO2 ↓ more DUE TO ↑ elimination (unusual the ↓ production) ▶︎ rate of elimination. So:

a. MAIIN CAUSE ➩ hyperventilation that comes from:

i. MV

ii. ECMO

b. Hypocapnic alkalosis

i. ↓ 🫁 💨

ii. E.g. CPR

iii. Dissociation: VENOUS 🆚 ARTERIAL blood (↓ 💨 ➕ N ventilation):

1. V: ↑CO2 + ↓pH

2. A: ↓CO2 + ↑pH

3. This is PSEUDORESPIRATORY ALKALOSIS.

⏳ 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, March 30, 2026 at 18:34:27 in BE

EQO, MASP, AAQC

2026 NEJMc - Reassessing the Role of Fever in the Duke Endocarditis Criteria (Clin Infect Dis).pdf

Codified by YAPG

Glossary: DX = diagnosis, E = specificity, IE = infective endocarditis, ISCVID = International Society for Cardiovascular Infectious Diseases, S = sensitivity

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

2. 𝙄𝙌𝘾 - S 🟰 2025, CID, CH ➖ retro ➕ 3700 ➕ 2014-2024 ➖ P I C O:

- 🅿: pxs w_suspected IE

- 🅸: modified criteria (wo_fever)

- 🅲: 2023 Duke-ISCVID criteria

- 🅾: pOC = S + E | sOC = possible IE cases ➕ erroneus non-IE

3. EVIDENCE.

a. Duke criteria = > and < criteria

b. Revised multiple times to ↗️ accuracy.

c. Last revision 2023 (ISCVID)

d. Fever has remained ▶︎ would criteria ↗️ wo_FEVER ❓

4. METHODS.

- INTERV ➠

> Classified as: DEFINITE | POSSIBLE | NO IE

> 1st ▶︎ 2023 Duke-ISCVID criteria

> 2nd ▶︎ modified criteria

5. RESULTS.

a. 35% confirmed IE DX

b. Fever: = prevalent

i. with confirmed IE

ii. without confirmed IE

c. Modified criteria performed BETTER:

i. ↗️ S ➩ 77% 🆚 74%

ii. ↗️ E ➩ 80% 🆚 49%

iii. ↓ possible IE ➩ 17% 🆚 39%

iv. ↓ ↓ non-IE cases ➩ 0.4%

6. RATIONALE.

a. Modified criteria halved the “possible IE” category.

b. ↓ extensive WORKUP

c. If confirmed (additional studies), ↗️ ability to DISCRMINATE:

i. true IE

ii. Alternative DXs

⏳ TIME MANAGEMENT
40:26:43

Round: 5 00:53:29 Comments

Round: 4 21:06:71 Wrap-up

Round: 3 11:39:59 Interpretation

Round: 2 03:03:12 Reading + notes

Round: 1 03:43:71 ART selection

April, 2026

⏳ TIME MANAGEMENT
01:03:09

Round: 7 01:45:77 Comments

Round: 6 27:52:42 Wrap-up

Round: 5 17:56:59 Interpretation

Round: 4 04:09:25 Reading + notes

Round: 3 04:28:50 ART selection

Round: 2 01:07:46 Comments

Round: 1 05:49:28 Past JR

2025 NEJMc - Real-World Data on Helicobacter pylori TTO Success (Clin Gastroenterol Hepatol).pdf

Codified by YAPG

Glossary: ATB = antibiotic, HP = Helicobacter pylori, INF = infection, OCAM = PPI (omeprazol, etc.) ➕ clarithro ➕ amoxi ➕ metro, PBMT-14 = PPI, bismuth, metronidazole, and tetracycline, PPI = proton-pump inhibitor

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

2. 𝙄𝙌𝘾 BS 🟰 2025, CG&H, USA ➖ OBS_cohort_real-world ➕ 25k ➕ 2y (2000-2022) ➖ P I C O:

- 🅿: pxs w_HP

- 🅸: comparison of regimens

- 🅲: NA

- 🅾: pOC = efficacy | sOC = frequency of use

3. EVIDENCE.

a. TTO is complicated by 2 problems:

i. ↑ rates of community ATB resistance

ii. No data on resistance patterns for HP

b. GL ➩ 2017, reviewed 2024 ➩ PBMT-14

c. Other regimens are still used

4. METHODS.

- Completed DIETARY INTAKE ASSESSMENTS ➩ SELF-REPORTED (2-4y)

- Levels of intake ➩ subgroups

- 11k w_dementia

5. RESULTS.

a. 17 ≠ regimens for INITIAL INF, the 3 most EFFECTIVE:

i. OCAM ▶︎ 90%

ii. PBMT-14 ▶︎ 88%

iii. OCA ▶︎ 87%

b. Stable EFFICACY of the 3 regimens, through 20y of study.

c. Salvage regimens ➩ LESS EFFECTIVE

i. Particularly, IF duplicated previous regimens.

ii. PBMT-14 = best ▶︎ 69%

d. Prior use of MACROLIDES ⌄ METRONIDAZOL ➩ >3y ▶︎ ↓ SUCESS RATES using clarithromycin ⌄ metronidazole

6. RATIONALE.

a. Amoxi regimens still work well, despite not 1st line TTO option.

b. Caution ➩ study done in Nothern California ➕ applies to other communities 🤔 ❓

c. MAIN LESSION ➩ carefully query pxs (PREVIOUS ATB use) before constructing a regimen.

d. Multiple drug exposure ➩ perform HP susceptibility testing.

Thursday, April 9, 2026 at 18:15:02 in BE

AS, MASP, HIBN, AAQC

⏳ TIME MANAGEMENT
42:16:57

Round: 6 02:09:52 Comments

Round: 5 15:54:71 Wrap-up

Round: 4 09:28:65 Interpretation

Round: 3 03:33:02 Reading + notes

Round: 2 04:28:54 ART selection

Round: 1 06:42:11 Past JR

2026 NEJMc - Can Coffee and Tea Prevent Dementia (JAMA).pdf

Codified by YAPG

Glossary: HCP = healthcare providers, Q = quartiles

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

2. 𝙄𝙌𝘾 BS 🟰 2026, JAMA, USA ➖ obs, long, 2 cohorts ➕ 130k HCP ➕ 40y ➖ P I C O:

- 🅿: HCP

- 🅸: caffeinated coffee, decaffeinated coffee, tea

- 🅲: NA

- 🅾: pOC = dementia prevention

3. EVIDENCE.

a. Short-term cognitive effect ➩ ↗️ focus + ↗️ alertness

b. OBS ➩ possible long-term benefit ▶︎ ↓r DEMENTIA

4. METHODS.

- Completed DIETARY INTAKE ASSESSMENTS ➩ SELF-REPORTED (2-4y)

- Levels of intake ➩ subgroups

- 11k w_dementia

5. RESULTS.

a. ↓ 2 Q ➩ median caffeinated ☕️ = <1/2 cup daily

b. ↑ 2 Q ➩ median caffeinated ☕️:

i. 2,5-4,5 cups daily ♀

ii. 1 - 2,5 cups daily ♂︎

c. Social ➕ clinical variables ADJUSTED:

i. Caffeinated ☕️ ▶︎ “↑2Q” (↓r dementia) 🆚 “↓2Q”

d. Tea ▶︎ ↓r dementia EVEN w_only 0.07 ☕️ daily.

e. Decaffeinated NOT ASSOCIATED w_↓r dementia.

6. RATIONALE.

a. caution

b. Self-reported intake + residual confounding

c. Caffeine might be NEUROPROTECTIVE.

Monday, April 6, 2026 at 18:10:24 in BE

MG, EQO, AHO, MASP, HIBN, AAQC

⏳ TIME MANAGEMENT
28:12:44

Round: 7 00:52:82 Comments

Round: 6 10:34:69 Wrap-up

Round: 5 06:22:19 Interpretation

Round: 4 00:05:81 Interpretation

Round: 3 03:10:71 Reading + notes

Round: 2 02:48:35 ART selection

Round: 1 04:17:84 Past JR

Thursday, April 16, 2026 at 18:10:02 in BE

LH, MASP, AAQC

2026 NEJMc - A New Noninvasive Testing Strategy P. jirovecii pneumonia. (Open Forum Infect Dis)

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (YAPG)

Glossary: BAL-PCR = bronchoalveolar lavage PCR testing, DX = diagnosis, JPJ = Pneumocystis jirovecii, ↓ supression = immunosupression

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

2. 𝙄𝙌𝘾 BS 🟰 2026, OFID, ? ➖ retro, single center ➕ 114 ➕ ? ➖ P I C O:

- 🅿: pxs w_suspected JPJ + non-HIV ↓ supression

- 🅸: ß-D-glucan, oral wash PCR or both

- 🅲: bronchoalveolar lavage PCR testing

- 🅾: pOC = DX

3. EVIDENCE.

a. PJP DX wo_BAL is challenging due to the limitations of tests of:

i. sputum

ii. serum

b. Combining both NON-INVASIVE to ↗️ DX accuracy ➩ MAKES SENSE

4. METHODS.

a. Oral wash PCR ➩ vigorous gargling of saline for 30s

5. RESULTS.

a. PJP ➩ 15/114 pxs ▶︎ symptoms + imaging + BAL

b. ß-D-glucan:

i. ⊕ 14/15 PJP cases (S 93%)

ii. false ⊕ 13/99 cases wo_PJP.

c. Oral wash PCR:

i. 47 pxs
ii. 11 DX w_PJP
iii. ⊕ 11 PJP cases
iv. false ⊕ 4/36 nonPJP

d. Both:

i. 1. ⊕ 10pxs, all w_PJP
ii. both ⊖ ➩ PJP ruled out

6. RATIONALE.

a. This combination appears DECISIVE

b. Px selection would be an issue ➩ only a subset had “oral wash PCR”

c. Check w_your local laboratory for the tests available.

7. SOURCE: Falcó-Roget A, et al. Combined serum (1,3)-β-D-glucan and oral wash PCR as a noninvasive diagnostic strategy for early detection of Pneumocystis jirovecii pneumonia: An observational retrospective study. Open Forum Infect Dis 2026 Feb; 13:ofag033. DOI: 10.1093/ofid/ofag033.

⏳ TIME MANAGEMENT
46:34:63

Round: 7 02:03:28 Comments

Round: 6 23:07:23 Wrap-up

Round: 5 08:38:45 Interpretation

Round: 4 02:57:45 REading + notes

Round: 3 07:39:86 ART selection

Round: 2 00:42:01 Comments

Round: 1 01:26:32 Past JR (+5min)

2025 NEJMc - Phosphatidylethanol Can Inform the DX SLD. (J Hepatol + Lancet GH).pdf

Codified by YAPG

Glossary: -ol = alcohol, AF = atrial fibrillation, ALD = alcohol-associated liver disease, ARDS = acute respiratory distress syndrome, CA = cancer, GE = gastroenterology, JH = Journal of Hepatology, MASLD = metabolic-associated steatotic liver disease, MetALD = metabolic and alcohol-associated liver disease, SLD = steatotic liver disease

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

2. 𝙄𝙌𝘾 BS 🟰 2025, JH, USA ➖ obs, cross-sec ➕ ~400 ➕ ? ➖ P I C O:

- 🅿: overweight/obesity + SLD

- 🅸: phosphatidylethanol

- 🅲: NA

- 🅾: pOC = DX reclassification

3. 𝙄𝙌𝘾 BS 🟰 2025, LANCET GH, DK ➖ Ω pros, cohort ➕ ~2000 ➕ ? ➖ P I C O:

- 🅿: -ol consumption ⌄ metabolic DYSF wo_↑↑↑ -ol use

- 🅸: phosphatidylethanol

- 🅲: NA

- 🅾: pOC = DX reclassification

4. EVIDENCE.

a. MASLD 🆚 ALD depends ➩ ACCURACY ▶︎ self-reported alcohol use

b. Phosphatidylethanol ➩ biomarker of recent -ol use (1-4 weeks)

5. METHODS.

- Correspondence: 🅸 🆚 self-reported -ol intake

- Then assessed to reclassify the DX.

- Steatotic liver disease was categorized (in both studies) on either:

> MASLD

> ALD

> MetALD

- Cutoffs:

> light 🟰 🅸 <25 ng/mL

> moderate 🟰 🅸 25-200 ng/mL

> heavy 🟰 🅸 >200 ng/mL

6. RESULTS.

a. US study ▶︎ MASLD ➩ 95% → 16%:

i. 13% MetALD

ii. 3% ALD

b. DK study ▶︎ MASLD ➩ 70% → 39%:

i. 31% MetALD

ii. 8% ALD

iii. Reclassification w_ALD ⌄ MetALD ➩ rare (<1%)

7. RATIONALE.

a. 🅸 helps:

i. DX + TTO

ii. classifying SLD

b. There is room for error ➩ due to 1-4-week window

c. Never use 🅸 IN ISOLATION ▶︎ ALWAYS w_other factors (careful history)

8. SOURCES.

a. Tavaglione F, et al. Clinical utility of phosphatidylethanol to detect underreported alcohol use and enhance steatotic liver disease subclassification. J Hepatol 2025 Jun
13; [e-pub]. DOI: 10.1016/j.jhep.2025.05.030.

b. Torp N, et al. Phosphatidylethanol and self-reported alcohol intake to subclassify in individuals at risk of steatotic liver disease: An analysis of data from a prospective
cohort study. Lancet Gastroenterol Hepatol 2025 Sep 10; [e-pub]. DOI: 10.1016/S2468-1253(25)00187-6.

Monday, April 13, 2026 at 18:10:09 in BE

MG, AS, AHO, MASP, HIBN, AAQC

Thursday, April 30, 2026 at 18:00:36 in BE

TGA, HIBN, MASP, AAQC

2025 NEJMc - Ceftriaxone for Patients Hospitalized w_Pneumonia, One Gram or Two (J Antimicrob Chemother).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (TGA)

Glossary: CAP = community acquired pneumonia

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

2. 𝙄𝙌𝘾 BS 🟰 2025, JAC, JP ➖ retro_cohor ➕ 470k ➕ 7d ➖ P I C O:

- 🅿: CAP
- 🅸: 2g ceftriaxone
- 🅲: 1g ceftriaxone
- 🅾: pOC = MM30

3. EVIDENCE

a. 2019 GL ➩ ATS + IDSA: 1-2g ceftriaxone for H+ pxs w_CAP, wo_precise advice about DOSING

4. METHODS.

- 55% ♂︎
- weight ~50Kg
- 63% 2g = 🅸
- 37% 1g = 🅲

5. RESULTS

a. MM30 = NO DIFFERENCES = 4,5% overall
b. s_CAP 2g ➩ ↓MM30 (17% 🆚 20%)

6. RATIONALE.

a. Cannot be GENERALIZABLE to Western natios (e.g. US)

i. 40% are obese
ii. Few <50Kg

b. George’s hospital ➩ 2g q12h for nonmeningeal INF (≥120Kg)
c. George’s practice ➩ 2g daily in non-obese w_CAP. (regardless of severity)
d. Rather than BASAL GANGLIA, PD is likely a whole-brain action network.

7. SOURCE: Taniguchi J, Aso S, Matsui H, Fushimi K, Yasunaga H. Outcomes of ceftriaxone 2 g versus 1 g daily in hospitalized patients with pneumonia: a nationwide retrospective cohort study. J Antimicrob Chemother. 2025;80(8):2194-2202. doi:10.1093/jac/dkaf189

⏳ TIME MANAGEMENT
33:37:12

Round: 6 00:36:43 Comments
Round: 5 14:34:96 Wrap-up
Round: 4 05:23:99 Interpretation
Round: 3 03:29:88 Reading + notes
Round: 2 05:03:64 ART selection
Round: 1 04:28:20 Past JR

2025 CC - Reconsidering the urea-to-creatinine ratio as a signal of muscle catabolism in patients with cirrhosis (Oussalah) (ma).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (TGA)

Glossary: AA = aminoacid, ACLD = acute on CLD, AUR = ammonia to urea ratio, CI = critically ill, CLD = chronic liver disease, CREA = creatinine, giBLEED = gastrointestinal bleeding, HRS = hepatorenal syndrome, imp = impaired, ma = matters arising, MECHS = mechanisms, N = nitrogen, R = research = original, sr = systematic review, UCR = urea-to-creatinine ratio, ∑ = so = therefore

1. UREA issues

a. Portal hypertension ➕ hepatocelualr DYS ▶︎ alter N METABOLISM (↓UREAGENESIS efficiency)
b. Ammonia (intestines) → urea (water-soluble, excreted in the urine) ▶︎ ◸

i. Both are indicators of the same pathway
ii. They reflect urea-cycle efficiency

c. Cirrhosis perturbs this pathway:

i. ↑ vascular R ➕ portosystemic shunts 🟰 imp ◸ clearance ➩ ↑ ammonia (systemically)
ii. imp hepatocellular function 🟰 ↓ urea-cycle ➩ ↓ urea (for a given N load)

d. Combined effect ▶︎ ↑ ammonia ➕ ↓ urea
e. CLINICALLY ▶︎ pxs have ↓ ⌄ “normal” UCR ➩ limited ◸ capacity to convert ammonia to urea.
f. AUR > 1,53 mg/g ↔ portal hypertension

i. Complications can modify it.
ii. giBLEED (e.g. variceal) ➩ «↑N load → portal ⭕️» due to 🫃🏽Hb “digestion + reabsorption”
iii. N input ▶︎ ↑ ureagenesis + ↑ urea (not ↔ to 💪🏽 catabolism)
iv. ↑UCR 🟰 exogenous N influx + prerenal dynamics (not AA use ⌄ protein breakdown)

2. INCLUSION of these pxs in pooled 🤓 wo_ stratification = conflating distinct MECHS + limits generalizability.

3. SOLUTIONS

a. Studies should:

i. PROSPECTIVELY stratify

1. cirrhosis
2. portal hypertension

ii. UCR reported

b. ♾️ assessment in cirrhosis ➩ internationally validated approaches OVER CREA-only:

i. cystating C-based equations
ii. measured CREA clearance

c. In NUTRITIONAL 🅸

i. plasma ammonia
ii. plama N balance
iii. Both **distinguish** imp ureageneis **from** protein intake.
iv. In cirrhosis ➩ ↑ UCR + ↑ ammonia = urea-cycle oveload (not excessive catabolism) ▶︎ ∑: «ammonia ↓ strategies» ARE THE PRIORITY (OVER reflective protein restriction)
v. Avoid protein RESTRICTION in ◸ encephalopathy (GL) ➩ 1,2 - 1,5 g/Kg/day to **preserve** N balance + **prevent** sarcopenia

d. giBLEED ⌄ pre♾️ states

i. UCR should prompt TARGETED DX evaluation.
ii. Do not interpret as a STAND-ALONE SIGNAL of 💪🏽 proteolysis

4. SOURCE: Oussalah A, Haghnejad V, Audouy A, et al. Reconsidering the urea-to-creatinine ratio as a signal of muscle catabolism in patients with cirrhosis. Crit Care. 2025;29(1):428. Published 2025 Oct 8. doi:10.1186/s13054-025-05703-1.

Thursday, April 27, 2026 at 18:00:36 in BE

LH, TGA, MASP, AAQC

⏳ TIME MANAGEMENT
01:20:58

Round: 3 00:36:85 Comments.
Round: 2 49:20:47 Abbreviations update
Round: 1 31:01:59 Past JR recap

2025 CC - Reconsidering the urea-to-creatinine ratio as a signal of muscle catabolism in patients with cirrhosis (Oussalah) (ma).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (TGA)

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

2. ma ▶︎ 2025, CC, FR ➖ ma ➕ Paulus et al. (MA, UTC CC 2025) ➕ ❓

3. R ▶︎ 2025, CC, NL ➖ srMA ➕ 47/1450 ➕ Sep 3, 2024 ➖ P I C O:

- 🅿: CI pxs
- 🅸: UCR value (at least 1)
- 🅲: NA
- 🅾: pOC = protein catabolism

4. CAUTION. Cirrhosis ➕ portal hypertension:

a. This type of admissions are frequent ➩ 2-4,5% (national cohorts + sr)
b. In ICU ():

i. 20% = cirrhosis ➩ decompensation + ACLD + variceal hemorrhages + HRS
ii. 1/3 = CLD (high-dependency)

c. Both components of UCR are influenced by OTHER processes:

i. ureagenesis
ii. sarcopenia

d. IF this subgroup is taken in the pooled 🤓 → BIAS (inflating⌄attenuating: ↔ ).

5. CREA issues

a. Cirrhosis ➩ 💪🏽 homeostasis
b. Sarcopenia:

i. 14-55% in cirrhosis
ii. ↔: ↓ skeletal 💪🏽

c. CLD MECHS ➩ ↓ CREA (not ↑GFR)

i. imp ◸ creatine synthesis
ii. ↑ fractional tubular secretion
iii. underestimation in ↑bilirrubinemia
iv. Combined effect ➩ ↓shift in CREA for any GFR
v. ∑: ↑UCR in cirrhosis REFLECTS ↓CREA production (not ↑ protein catabolism)

6. UREA issues.

a. Portal hypertension ➕ hepatocelualr DYS ▶︎ alter N METABOLISM (↓UREAGENESIS efficiency)
b. Ammonia (intestines) → urea (water-soluble, excreted in the urine) ▶︎ ◸brain action network.

i. Both are indicators of the same pathway
ii. They reflect urea-cycle efficiency

c. Cirrhosis perturbs this pathway:

i. ↑ vascular R ➕ portosystemic shunts 🟰 imp ◸ clearance ➩ ↑ ammonia (systemically)
ii. imp hepatocellular function 🟰 ↓ urea-cycle ➩ ↓ urea (for a given N load)

7. INCLUSION of these pxs in pooled 🤓 wo_ stratification = conflating distinct MECHS + limits generalizability.

8. SOLUTIONS

a. Studies should:

i. PROSPECTIVELY stratify

1. cirrhosis
2. portal hypertension

ii. UCR reported

b. ♾️ assessment in cirrhosis ➩ internationally validated approaches OVER CREA-only:

i. cystating C-based equations
ii. measured CREA clearance

c. In NUTRITIONAL 🅸

d. giBLEED ⌄ pre♾️ states

i. UCR should prompt TARGETED DX evaluation.
ii. Do not interpret as a STAND-ALONE SIGNAL of 💪🏽 proteolysis

9. SOURCE: Oussalah A, Haghnejad V, Audouy A, et al. Reconsidering the urea-to-creatinine ratio as a signal of muscle catabolism in patients with cirrhosis. Crit Care. 2025;29(1):428. Published 2025 Oct 8. doi:10.1186/s13054-025-05703-1.

Thursday, April 23, 2026 at 18:10:36 in BE

LH, TGA, MASP, YAPG,HIBN, AAQC

⏳ TIME MANAGEMENT
01:20:58

Round: 3 00:36:85 Comments.
Round: 2 49:20:47 Abbreviations updateRound: 1 31:01:59 Past JR recap

2026 NEJMc - Reconceiving Parkinson’s Disease as Whole-Brain Action Netw. Disord. (Nature).pdf

Codified by YAPG

Glossary: somato-cognitive action network, PD = Parkinson’s disease, TTO = treatment(s), US = ultrasound, 🧠 = brain

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

2. 𝙄𝙌𝘾 BS 🟰 2026, NATURE, ❓ ➖ obs ➕ 863 ➕ ❓ ➖ P I C O:

- 🅿: PD pxs

- 🅸: imaging: SCAN

- 🅲: NA

- 🅾: pOC = impairment

3. EVIDENCE.

a. Dopaminergic degeneration: basal ganglia ➩ motor ↔ nonmotor PATHWAYS

b. Explains TREMOR ➕ RIGIDITY

c. Cognitive ➕ motivational ➕ autonomic FEATURES ➩ NOT EXPLAINED

d. Is a broader, integrated 🧠 network the problem?

4. METHODS.

- SCAN 🟰 recently described. Network linking the control of:

> movement
> cognition
> motivation
> autonomic

5. RESULTS.

a. PD ▶︎ ↑ connectivity:

i. SCAN ↔ subcortical structures

ii. ↑ ↑ ↑ hyperconnectivity ≈ WORSE motor ➕ cognitive impairment.

b. Effective TTOs, ALL ↓ SCAN:

i. levodopa

ii. Deep brain stimulation

iii. transcranial magnetic stimulation

iv. focused US

c. ↑ normalization of CONNECTIVITY ≈ ↑ clinical ↗️

d. Targeting SCAN ▶︎ ↗️ TTO EFFECTIVENESS for:

i. transcranial magnetic stimulation

ii. focused US

6. RATIONALE.

a. SCAN might underlie PD

b. Current TTO might MODULATE this network.

c. Rather than BASAL GANGLIA, PD is likely a whole-brain action network.

d. SCAN dysfunction 🟰 core circuit abnormality.

e. If validated, it will influence:

i. the neuromodulation

ii. how we think about IMAGING BIOMARKERS ➩ personalized therapy.

7. SOURCE: Ren J, et al. Parkinson’s disease as a somato-cognitive action network disorder.Nature 2026 Feb 4; [e-pub]. DOI: 10.1038/s41586-025-10059-1.

Monday, April 20, 2026 at 18:05:06 in BE

AHO, TGA, MASP, YAPG, AAQC

⏳ TIME MANAGEMENT
01:40:51

Round: 13 27:59:21 Comments

Round: 12 16:49:89 Wrap-up 2

Round: 11 00:42:85 Wrap-up 1

Round: 10 06:03:38 Interpretation

Round: 9 02:26:33 Reading + notes

Round: 8 02:16:18 Comments

Round: 7 18:14:10 Wrap-up

Round: 6 09:51:46 Interpretation
Round: 5 02:28:02 Reading + notes

Round: 4 04:17:67 ART Selection

Round: 3 00:32:04 Comments

Round: 2 08:37:45 Last JR

Round: 1 00:33:00 Opening

2025 NEJMc - Is Exercise a Brain-Changer Parkinson Dis (Neurology)

Codified by YAPG

Glossary: l-t = longer-term, PA = physical activity, PD = Parkinson’s disease, TTO = treatment(s)

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

2. 𝙄𝙌𝘾 BS 🟰 2025, NEUROLOGY, USA ➖ long, obs ➕ 120 ➕ 4y ➖ P I C O:

- 🅿: very early PD, older adults

- 🅸:exercise ➕ MRI

- 🅲: NA

- 🅾: pOC = correlation w_🧠 changes

3. EVIDENCE.

a. Exercise is GOOD for:

i. general health

ii. symptomatic effect.

b. Changes in STRUCTURE ⌄ COGNITIVE health ❓

4. METHODS.

- regular PA” ↔ “neurodegeneration + cognitive ↓”
- Databse: Parkinson’s Progression Markers Initiative.
- PA ➩ Physical Activity Scale for the Elderly
- MRI ➩ at 2 points

5. RESULTS.

a. “↑ average regular PA” ≈ SLOWER cortical thinning (in multiple 🧠 regions)

b. “↑ regular PA” ≈ SLOWER volume loss:

i. Hippocampus

ii. Amygdala

c. ↑ memory + attention by slower ↓ in:

i. TEMPOROPARIETAL CORTICAL thickness

ii. Hippocampal volume

6. RATIONALE.

a. Exercise ≈ < 🧠 thinning.

b. CAUTIOUS ➩ overinterpreting this study:

i. too selective + small

ii. very early PD

c. CAUTIOUS to infer ➩ EXERCISE ≈ w_:

i. slower rate of neurodegeneration

ii. ↗️ l-t cognitive functions

d. Current TTO might MODULATE this network.

e. Rather than BASAL GANGLIA, PD is likely a whole-brain action network.

f. SCAN dysfunction 🟰 core circuit abnormality.

g. If validated, it will influence:

i. the neuromodulation

ii. how we think about IMAGING BIOMARKERS ➩ personalizad therapy.

h. Primary care doctors + neurologist SHOULD precribe exercise for PD pxs.

7. SOURCE: Diaz-Galvan P, et al. Association of physical exercise with structural brain changesand cognitive decline in patients with early Parkinson disease. Neurology 2025 Sep9; 105:e21393210.1212/WNL.0000000000213932.40768688

2026 CC - Phenotype, subphenotype, and endotype in S• and ARDS, a new layer of heterogeneity (Zhao) (corr).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (TGA)

Glossary: I2 = heterogeneity, PD = Parkinson’s disease, POV = point of view, PSE = phenotype, subphenotype, endotype, S• = sepsis, SCAN = somato-cognitive action network, SOC = standard of care, TTO = treatment(s), US = ultrasound

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

2. 𝙄𝙌𝘾 BS 🟰 2026, CC, CH ➖ corr ➕ NA ➕ NA ➖ P I C O:

- 🅿: CIpxs
- 🅸: USG → lower limb muscle
- 🅲: NA
- 🅾: pOC = utility

3. ARDS = syndrome ➩ masks BIOLOGICAL I2 🟰 primary obstacle to TTO

4. Studies identify PSE ➩ but THE EFFORTS create new layer of I2

a. IMPEDE rather than enable discarding the “syndrome” label.
b. despite inventive cogitation + methodological sophistication

5. PURPOSE

a. Deconstruct heterogeneous clinical syndromes ➩ biological homogeneous + clinical TTO subgroups
b. Facilitate PRECISION medical➕ optimize INDIVDUAL TTO

6. CLASSIFICATIONS

a. Derive from multiple analytical approaches:

i. high-dimensional clinical variables
ii. multi-omics data ➩ integrated analysis of multiple molecular layers (e.g., genomics, transcriptomics, proteomics, metabolomics) to obtain a holistic view of biological systems.
iii. AI-driven deep learning

b. Evidence shows INCOMPLETE CONCORDANCE → loosely correlate biological phenomena.
c. Question: which type or subtype, if any, represents “true” disease biology?
d. The risk of multiplicity classification ➩ fragmented atlas INSTEAD OF unified map of S• + ARDS pathobiology.

7. ACHIEVEMENT

a. RCT ➩ hidden TTO effect obscured in unselected populations.
b. They are retrospective + hypothesis-generating ➩ ∑ yet to be incorporated in SOC. (intellectually fascinating + mechanistically informative)
c. Solution ➩ to validate prospectively
d. Assumption ➩ the subgroups reflect DISTINCT EXPRESSIONS of a single underlying disease.
e. Sth more unsettling ➩ S• ➕ ARDS 🟰 represents a multitude of distinct diseases ❓ ▶︎ “ENDEAVOR built on shifting sands”.

i. Unique utility → ID subgroups that responds to a given therapy.
ii. DOES NOT RESOLVE:

1. definition problem

2. question if S• is a coherent disease

8. POV

a. PSE ➩ implies complexity of ▶︎ pxs ➕ methodology & taxonomy
b. Instead of DESCRIPTIVE, go for CAUSAL investigation
c. Statistical artifacts 🆚 biological realities.

9. SOURCE: Z[hao, L., Zhao, C., Wang, M. *et al.* Phenotype, subphenotype, and endotype in sepsis and ARDS: a new layer of heterogeneity?. Crit Care 30, 173 (2026). https://doi.org/10.1186/s13054-026-06022-9

Thursday, May 14, 2026 at 18:21:36 in BE

TGA, RCH, SLDC, HIBN, AAQC

⏳ TIME MANAGEMENT
01:17:25

Round: 7 02:51:40 Comments
Round: 6 27:58:20 Recap
Round: 5 30:54:32 Interpretation
Round: 4 03:56:45 Reading + notes
Round: 3 06:15:83 ART selection
Round: 2 00:34:26 Comments
Round: 1 04:55:17 Past JR

⏳ TIME MANAGEMENT
58:48:87

Round: 6 00:43:28 Comments
Round: 5 25:52:54 Wrap-up
Round: 4 15:16:22 Interpretation
Round: 3 04:16:43 Reading + notes
Round: 2 07:13:41 ART selection
Round: 1 05:26:98 Past JR

2026 CC - Ultrasound assessment of muscle atrophy and its association with functional OC in CIpxs (Lin) (srMA).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (TGA)

Glossary: AF = atrial fibrillation, CI pxs = critically ill patients, CT = computed tomography, DEXA = dual-energy X-ray absorptiometry, ICU-AW = ICU-acquired weakness, MRI = magnetic resonance imaging, USG = ultrasound, ≠ = differences

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

2. 𝙄𝙌𝘾 BS 🟰 2026, CC, TW ➖ srMA ➕ 69 ➕ -Oct 11, 2025 ➖ P I C O:

- 🅿: CIpxs
- 🅸: USG → lower limb muscle
- 🅲: NA
- 🅾: pOC = muscle atrophy monitoring

3. EVIDENCE

a. CIpxs → skeletal muscle wasting:

i. immobility
ii. systemic inflammation

b. Accuracy 🆚 impracticality ➩ cost + radiation + logistics

i. CT
ii. MRI
iii. DEXA

c. USG ➩ bedside + radiation-free + repeatable ➕ assess:

i. quantitative → cross-sectional area + muscle tickness
ii. qualitative → echointensity + pennation angle

4. RESULTS.

a. D7 of ICU admission

i. CROSS-SECTIONAL AREA:

1. Rectus femoris 🟰 ↓16%
2. Quadriceps 🟰 ↓ 11%

ii.. ECHOINTENSITY ↑
iii. PENNATION ANGLE ↓
iv. ∑ ▶︎ compositional + architectural **deterioration.**
v. Heterogeneity is ↑ ↑ ➩ reflects ≠ in px characteristics

1. pxs characteristics
2. anatomical landmarks
3. USG technical factors

vi. Limited data ▶︎ USG changes ↔ ICU-AW

b. D1-3 of ICU admission (excluding an outlier)

i. CROSS-SECTIONAL AREA:

1. Rectus femoris 🟰 GREATER ↓ ↓ ↓ in ICU-AW
2. Compared to non ICU-AW

5. CONCLUSIONS.

a. USG detects: early, rapid muscle wasting → concurrent QUALITY degradation.
b. Very low CERTAINTY OF EVIDENCE:

i. Heterogeneity
ii. Methodological limitations
iii. BOTH ➩ hinder clinical translation.

c. Needs clarification of the USG potential clinical utility.

.
6. SOURCE: Lin CC, Lin YJ, Chen CT, Chou HM, Hsu WC. Ultrasound assessment of muscle atrophy and its association with functional outcomes in critically ill patients: a systematic review and meta-analysis. Crit Care. Published online March 31, 2026. doi:10.1186/s13054-025-05825-6

Monday, May 11, 2026 at 18:28:41 in BE

TGA, BAR, RCH, SLDC, ASCA, AAQC

May, 2026

2026 NEJM - Side effects of Radiotherapy (NEJM)

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ

Glossary: antiDiarr = antidiarrheals, CAD = coronary artery disease, H2B = H2 blockers, PPI = protom pump inhibitors, SE = side effects, ↓ Hb = anemia, ↓ N = neutropenia, ↓ PLT = thrombocytopenia

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

2. 𝙄𝙌𝘾 BS 🟰 2026, NEJM, USA ➖ r ➕ NA ➕ NA ➖ P I C O:

🅿: onco pxs w_radiotherapy

3. EVIDENCE.

a. Radiotherapy is a KEY TTO ➩ cancers
b. INNOVATIONS ➩ imaging + radiation delivery ➩ ↗️ :

4. REVIEW. Side effect from radiation TTOs:

a. Acute SE

i. 👅 Mucosal.

1. MUCOSITIS ⌄ ESOPHAGITIS ▶︎ top_Anest ➕ nystatin ➕ analgesics ➕ sucralfate ➕ H2B ➕ PPI ➕ nutriSupport

iii.🫃 Gastric

1. GASTRITIS ▶︎ H2B ➕ PPI ➕ sucralfate ➕ antiemetics

iv. 🦠 Intestinal

1. ENTERITIS ▶︎ antiDiarr ➕ low-residue diet ➕ somatostatin
2. Acute PROCTITIS ▶︎ symp_mm ➕ antiDiarr

iv. 🩸 Hematologic

1. ↓N ▶︎ G-CSF
2. ↓Hb ▶︎ erythropoietin ➕ transfusion
3. ↓PLT ▶︎ transfusion

v. 🚽 Urinary

1. OBSTRUCTIVE ▶︎ ♾️ blocker ➕ NSAIDs
2. IRRITATITVE ▶︎ antiMusc ➕ NSAID ➕ phenazopyridine

vi. 🩹 Cutaneous

1. DERMATITIS ▶︎ ↓friction ➕ ↑ barriers (hydrogel, silicone) ➕ topSteroids ➕ topMoisturizers ➕ silver dressing ➕ silver sulfadiazine

b. Subacute ⌄ late SE

i. 🧠 Central nervous system

1. NEUROCOGNITIVE defects ▶︎ neurostimulants ➕ memantine ➕ donepezil
2. NECROSIS ▶︎ steroids ➕ bevacizumab ➕ resection
3. CATARACTS ▶︎ surgical removal
4. OPTICAL neuropathy ▶︎ bevacizumab

ii. 💧 Salivary

1. XEROSTOMIA ▶︎ saliva substitutes ➕ parasympathomimetic drugs ➕ hyperbaric O2 therapy

iii. 🔽 Esophageal

1. STRICTURE ▶︎ dilation ➕ H2B ➕ PPI

iv. 🫁 Pulmonary

1. PNEUMONITIS ▶︎ steroids ➕ O2
2. FIBROSIS ▶︎ O2

v. ❤️ Cardiac

1. PERICARDITIS ▶︎ NSAIDs
2. VALVULAR disease ➕ CAD ▶︎ med_mm ➕ surgery
3. ARRHYTHMIAS ▶︎ HR control ➕ pacemaker

vi. 🦠 Intestinal

1. CHRONIC enteritis ▶︎ antiDiarr ➕ bile-acid sequestrants
2. CHRONIC proctitis ▶︎ sucralfate ⌄ formalin enemas ➕ argon plasma coagulation ➕ hyperbaric oxygen therapy
3. FISTULA ▶︎ surgical repair

vii. 🚽 Urinary

1. IRRITATIVE ▶︎ antiMusc ➕ NSAIDs ➕ phenazopyridine
2. HEMORRHAGIC cystitis ▶︎ irrigation ➕ laser treatment ➕ alum ➕ hyperbaric O2 therapy ➕ formalin ➕ diversion
3. STRICTURE ▶︎ dilation ➕ surgical repair

viii. ⚥ Sexual

1. ERECTILE dysfunction ▶︎ PDE5 ⊖ ➕ mechanical aids ➕ other pharmacologic aids
2. VAGINAL stenosis ▶︎ dilators ➕ lubricants ➕ topEstrogens

ix. 💪 Muscular or cutaneous 🩹

1. ATROPHY ⌄ FIBROSIS ▶︎ physical therapy ➕ botulinum toxin ➕ pentoxifylline ➕ tocopherol
2. LYMPHEDEMA ▶︎ compression
3. NECROSIS ▶︎ antibiotics ➕ débridement ➕ hyperbaric O2 therapy

5. RATIONALE.

a. Despite all TTOs, radiation carries its own risks.

6. SOURCE: [New England Journal of Medicine, Volume 394 • Number 10 • March 5, 2026](https://www.nejm.org/doi/full/10.1056/NEJMra2506017)

Monday, May 18, 2026 at 18:30:33 in BE

LH, TGA, RCH, BAR, DEPZ, ASCA, HIBN, AAQC

⏳ TIME MANAGEMENT
01:01:41

Round: 7 01:07:26 Comments
Round: 6 23:43:83 Recap
Round: 5 14:46:79 Interpretation
Round: 4 02:44:07 REad + notes
Round: 3 10:14:52 ART methodology
Round: 2 03:37:07 ART selection
Round: 1 05:27:60 Past JR