Review question / Objective: To compare Once-Weekly Insulin Icodec and Once-Daily Insulin Glargine U100 in patients with Type 2 Diabetes Mellitus using oral hypoglycemic drugs in need of insulin therapy. Condition being studied: Patients with Diabetes Mellitus Type 2 using oral hypoglycemic drugs in need for basal insulin. Eligibility criteria: Inclusion in this meta-analysis was restricted to studies that met all the following criteria: (1) randomized trials; (2) comparing the use once weekly insulin icodec to once daily insulin glargine; (3) enrolling patients with type 1 or type 2 diabetes mellitus; (4) evaluating any of the desired outcomes; (4) articles in written on english language. We excluded studies with (1) no control group; (2) overlapping studies population; clinical trial register entry only; (3) non-human studies and (4) studies reported only as abstracts.

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Objetivo: Avaliar as características maternas e desfechos adversos perinatais relacionados ao baixo peso ao nascer. Métodos: Trata-se de um estudo caso controle, realizado na Maternidade Darcy Vargas em Joinville–SC, período de março de 2018 a fevereiro de 2019 através de amostra randomizada composta de 722 puérperas que realizaram o acompanhamento pré-natal exclusivamente em Atenção Primária à Saúde, divididas em 2 grupos: pacientes com recém-nascidos de baixo peso e pacientes com recém-nascidos de peso normal. No cálculo de razão de chance, os valores foram considerados significativos quando P<0,05. Adotou-se prematuridade como fator de confusão. Resultados: Dividiu-se a população em dois grupos, pacientes com recém-nascidos de baixo peso (33/4,57%) e com recém-nascidos de peso normal (689/95,43%). Características maternas diferiram quanto ao número de pessoas na casa, o número de consultas, o uso de tabaco e drogas na gestação e incidência de doença hipertensiva específica da gestação. Após o cálculo de razão de chance ajustado, observou-se que o fumo aumenta a chance de baixo peso ao nascer em 6,5 vezes (IC95% 1,375-31,250). Os recém-nascidos foram diferentes no capurro, peso, Apgar de 1º e 5º minuto, prematuridade, necessidade de UTI neonatal e Apgar baixo de 1º minuto. No cálculo de razão de chance ajustado, o baixo peso aumentou a chance de UTI neonatal em 5,3 vezes (IC95% 1,039-27,523). Conclusão: O fumo durante a gestação eleva a chance de baixo peso ao nascer em 6,5 vezes. Ademais, o baixo peso ao nascer eleva em 5,3 vezes as chances de internação em UTI neonatal.   Objective: To assess maternal characteristics and adverse outcomes related to low birth weight. Methods: This is a case control study, carried out at Maternidade Darcy Vargas in Joinville-SC, from March 2018 to February 2019 through a random sample composed of 722 puerperal women who underwent prenatal care exclusively in Primary Health Care, divided into 2 groups: patients with low birth weight newborns and patients with normal weight newborns. In calculating the odds ratio, values were considered significant when P <0.05. Prematurity was adopted as a confounding factor. Results: The population was divided into two groups, patients with low birth weight newborns (33 / 4.57%) and normal weight newborns (689 / 95.43%). Maternal characteristics differed in terms of the number of people in the household, the number of consultations, the use of tobacco and drugs during pregnancy and the incidence of pregnancy-specific hypertensive disease. After calculating the adjusted odds ratio, it was observed that smoking increases the chance of low birth weight 6.5 folds (95% CI 1.375-31.250). The newborns were different in capurro, weight, 1st and 5th minute Apgar, prematurity, need for neonatal ICU and low 1st minute Apgar. In the adjusted odds ratio calculation, low weight increased the chance of neonatal ICU 5.3 folds (95% CI 1.039-27.523). Conclusion: Smoking during pregnancy increases the chance of low birth weight 6.5 folds. Furthermore, low birth weight increases the chances of admission to the neonatal ICU 5.3 folds.

Introduction: Aortic stenosis (AS) patients admitted for elective transcatheter aortic valve replacement (TAVR) frequently present significant coronary artery disease (CAD). Despite the increasing number of TAVR procedures, it remains unclear if the strategy of performing percutaneous coronary intervention (PCI) and TAVR during the same hospitalization differs from isolated TAVR. Methods: We performed a systematic review and meta-analysis of observational studies in patients with AS and significant CAD (lesions ≥50%). The aim of the study was to compare TAVR and PCI on same hospitalization (with no regard for whether in the same procedure) to TAVR and deferred PCI. In-hospital mortality, acute kidney injury and major bleeding were our outcomes of interest. Results: We included 4 studies with 2917 patients, 665 treated with TAVR+PCI and 2252 treated with TAVR alone. TAVR+PCI was associated with higher in-hospital mortality (OR 1.66; 95% CI 1.21 - 2.27; p=0.002; Fig. 1). However, there was no difference in acute kidney injury (OR 0.59; 95% CI 0.26 - 1.32; p=0.20; Fig. 2A). Furthermore, TAVR+PCI seemed to lower the rate of major bleeding (OR 0.65; 95% CI 0.46 - 0.93; p=0.02 Fig. 2B). Conclusions: In this meta-analysis of retrospective studies, TAVR and PCI on same hospital admission was associated with higher in-hospital mortality when compared to isolated TAVR.

Introduction: Sacubitril-Valsartan is an angiotensin receptor neprilysin inhibitor (ARNI) associated with a decreased risk of death and of hospitalization for heart failure. However, its effects on atherosclerotic disease outcomes are not definitively known. Methods: We performed a systematic review and meta-analysis comparing the effects of ARNI with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) on acute coronary syndrome (ACS), myocardial infarction (MI), stroke, angina pectoris and peripheral artery disease (PAD). PubMed, Scopus and Cochrane Central were searched for randomized studies until June 2022. Results: Thirteen randomized controlled trials, with 20,981 patients were included; 10,483 (50%) patients received ARNI and 10,498 were treated with ACEI or ARB (50%). The incidence of MI (OR 0.96; 95% CI 0.79-1.16; p=0.62; Fig. 1A), ACS (OR 0.98; 95% CI 0.61-1.59; p=0.97; Fig. 1B), angina pectoris (OR 0.95; 95% CI 0.78-1.15; p=0.58) and stroke (OR 1.00; 95% CI 0.85-1.17; p=0.96) were not statistically different between groups. However, ARNI was associated with higher incidence of PAD (OR 1.60; 95% CI 1.03-2.47; p=0.04; Fig. 2). Conclusions: There was no significant difference between ARNI and ACEI or ARB in terms of ACS, MI, angina pectoris, or stroke, although there was a slightly higher incidence of PAD in patients treated with ARNI.

O sarcoma epitelioide de vulva é um tumor muito raro, com altas taxas de recidiva e prognóstico desfavorável, principalmente se houver atraso no diagnóstico correto. É caracterizado por crescimento nodular na região da vulva, de aspecto benigno, com sintomas iniciais inespecíficos. O diagnóstico precoce e assertivo, aliado ao tratamento precoce, melhora o prognóstico e aumenta a chance de cura. Caso:Mulher, 42 anos, multípara, branca, apresentando tumor sólido e doloroso em região vulvar à direita. Apesar de realizar tumorectomia com margem ampla de segurança, apresentou recidiva. Foi submetida a vulvectomia associada a quimioterapia adjuvante, sem radioterapia. A paciente evoluiu com metástases e óbito seis meses após o diagnóstico. Conclusão: Sarcoma epitelioide de vulva é uma subcategoria de sarcomas epitelioides do tipo proximal que ocorrem no tronco e na região pubiana. Por ser uma neoplasia extremamente agressiva e insidiosa, o seu diagnóstico deve ser considerado a fim de permitir o tratamento precoce adequado, evitar possíveis complicações e até mesmo o óbito da paciente.

Context: Ramsay Hunt syndrome is uncommon, with an incidence of 5 / 100,000 people (1), characterized by the triad of ipsilateral peripheral facial paralysis, otalgia and vesicles in the ear canal and / or auricular pavilion (1,2,3). It results from the reactivation of the Varicella Zoster virus in the geniculate ganglion and may extend to other cranial pairs, causing inflammation, edema and nerve dysfunction (1,3). As the second leading cause of peripheral facial palsy (1), its importance lies in a lower likelihood of recovery with a worse prognosis compared to Bell’s palsy (4). Case report: M.R.S, female, 54 years old, went to the emergency room due to ophthalmological complaints (blurred vision, diplopia, floaters, photophobia), nausea and vomiting, associated with vertigo, headache and facial hypoesthesia on the left. With the worsening of the condition, she was referred to the neurology service of the municipal hospital São José, presenting dysarthria, vesicular lesions in the left external auditory canal, preserved tactile sensitivity, MRC grade V and facial paralysis on the left (House Brackmann grade IV). Lumbar puncture and cerebrospinal fluid analysis were performed to discard other pathologies of the central nervous system. The diagnosis of Ramsay Hunt syndrome was established and treatment with Acyclovir and prednisone was started. After worsening renal function, drug therapy was suspended and venous hydration increased. She continued with improved renal function and was discharged with valacyclovir and corticosteroids. Conclusions: The importance of early diagnosis and treatment is emphasized in order to avoid permanent sequelae of the disease (1,3).

Introduction: Atrial fibrillation (AF) is associated with an increased risk of impaired quality of life, stroke, and mortality. Despite multiple studies, the optimal target for rate control in AF is not definitively known. Methods: We performed a systematic review and meta-analysis comparing the effects of strict rate control (<80 bpm at rest) with a lenient rate control strategy (<110 bpm at rest) in patients with AF. The outcomes analyzed were all-cause mortality, cardiovascular (CV) death and CV hospitalization. A subgroup analysis was also performed in patients with heart failure (HF). PubMed, Scopus and Cochrane Central were searched for randomized controlled trials or observational studies with multivariable analyses adjusting for confounders. Results: Seven studies were included. All studies were either randomized or reported multivariate adjusted hazard ratios. There were 14,154 (59.6%) patients in the strict rate control strategy and 9,606 (40.4%) in the lenient group. AF was reported as paroxysmal in 1,697 (7.3%) patients. All-cause mortality was not statistically different between a strict vs. lenient heart rate control strategy, although there was a tendency towards improvement in the strict control group (HR 1.10; 95% CI 1.00-1.22; p=0.05; Figure 1A). In patients with AF and HF, there was also no significant difference between groups (HR 1.13; 95% CI 0.99-1.30; p=0.08; Figure 1B). Furthermore, CV death (HR 0.91; 95% CI 0.75-1.11) and CV hospitalization (HR 1.01; 95% CI 0.96-1.06) were also not significantly different between the two strategies. Conclusions: There was no significant difference in all-cause mortality between strict and leninent rate control in patients with AF among randomized trials or multivariable adjusted studies. In a subgroup of patients with HF, there was also no significant difference between the two rate control strategies.