Dr. Euclides Cavalcanti

MD 🩺 | General Practitioner & Internal Medicine | 🇧🇷 Brazil | Editor of

[Dr. Euclides Cavalcanti @Links_Medicus]

🌞📚 𝐍𝐄𝐖! #InternalMedicine 𝐀𝐫𝐭𝐢𝐜𝐥𝐞 𝐨𝐟 𝐭𝐡𝐞 𝐃𝐚𝐲 launches 𝐓𝐎𝐃𝐀𝐘! 🚨

📌 𝐖𝐡𝐚𝐭 𝐭𝐨 𝐞𝐱𝐩𝐞𝐜𝐭:
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✅ Links to the 𝐨𝐫𝐢𝐠𝐢𝐧𝐚𝐥 𝐚𝐫𝐭𝐢𝐜𝐥𝐞 & 𝐞𝐱𝐩𝐚𝐧𝐝𝐞𝐝 𝐚𝐧𝐚𝐥𝐲𝐬𝐞𝐬 on https://t.co/1L8kwfKWpc

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🇬🇧 𝐄𝐧𝐠𝐥𝐢𝐬𝐡: https://t.co/wFeW06BN70
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𝐊𝐧𝐨𝐰𝐥𝐞𝐝𝐠𝐞 𝐭𝐡𝐚𝐭 𝐟𝐢𝐭𝐬 𝐲𝐨𝐮𝐫 𝐛𝐮𝐬𝐲 𝐫𝐨𝐮𝐭𝐢𝐧𝐞 ⏳✨

[The Lancet @TheLancet]

A study, presented at @ESCMID, found that Nitrofurantoin was the most effective treatment and single-dose fosfomycin the least effective treatment for uncomplicated urinary tract infections (UTIs).

Explore the research: https://t.co/syoVSAALDo #ESCMIDGlobal2026 #ESCMID

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!

Just published in @TheLancet: Non-inferiority RCT comparing reduced vs full-dose DOACs for extended VTE treatment 🩸💊

Why it matters: Finding the right dose is critical for high-risk patients to balance preventing recurrence vs. bleeding.

Key Findings:
✅ Recurrent VTE low in both arms (2.2% vs 1.8%) but did NOT meet non-inferiority
✅ Bleeding significantly lower with reduced dose (9.9% vs 15.2%)
✅ Net Clinical Benefit favored reduced dose (11.8% vs 16.5%)
✅ Mortality similar (4.3% vs 6.1%, p=NS)

⚠️ Caveats:
- Possibly underpowered for key subgroups (obesity, cancer, high-risk PE)
- Open-label design → potential bias

🔗 Summary on LM: https://t.co/TauMYolkeL
🔗 Full Article (Open Access): https://t.co/fOmE2O2xq5

#VTE #Thrombosis #Anticoagulation #MedEd #MedTwitter #MedX

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!
Just released in @CircAHA @JACCJournals: 2025 AHA/ACC ACS Guideline 🚑🩺

*Why it matters: Critical updates on timely reperfusion, lipid targets, and DAPT duration.*

Key Strategies:
✅ Rapid ECG (<10 min) & high-sensitivity troponin for diagnosis.
✅ Primary PCI preferred for STEMI; fibrinolysis if PPCI delayed >90-120 min.
✅ Invasive strategy for intermediate/high-risk NSTE-ACS; selective for low-risk.
✅ Complete revascularization for stable STEMI with multivessel disease.
✅ High-intensity statin; add ezetimibe/PCSK9 if LDL ≥70 mg/dL.
✅ DAPT ≥12 mo in most; *shorter durations feasible if high bleeding risk.*

⚠️ Caveats: Balancing ischemic and bleeding risks is crucial. Individualize DAPT duration and consider bleeding reduction strategies.

🔗 Summary on LM: https://t.co/Uxyap3lJBs
🔗 Full guideline: https://t.co/KICquQPod7

#Cardiology #ACS #MedEd #MedX

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!

Just released in @jac_amr: Short-Course Antibiotic Review 🦠💊

Why it matters: Practical stewardship tips to fight resistance & reduce side effects

Key Strategies:
✅ Community-acquired pneumonia: 5 days for mild/moderate outpatient cases, 7-10 days for severe/complicated.
✅ Acute Bacterial Sinusitis: 5-7 days for adults, 10-14 if pediatric (IDSA).
✅ Uncomplicated Cystitis: 5 days of nitrofurantoin or 3 days of TMP/SMX.
✅ Skin/Soft Tissue Infections: 5-6 days if uncomplicated, longer if complicated.
✅ Intra-abdominal Infections: 4 days with adequate source control.
✅ GAS Pharyngitis: 10 days of penicillin/amoxicillin remains standard to ensure bacterial eradication & ↓ rheumatic fever risk.
✅ <24h perioperative prophylaxis in most surgeries

⚠️ Caveats:
- Limited data for severe infections and immunocompromised patients.
- Tailor treatment to individual patient factors and local resistance patterns.

🔗 Full article: https://t.co/AJ5MNkZr72
🔗 Summary on LM: https://t.co/HmdG1Q3UMR
🔗 For more articles, follow our WhatsApp channel: https://t.co/TPHYbTIxI9

#AntibioticStewardship #InfectiousDiseases #MedEd #MedX

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!

Just released in @NatureMedicine: Large Cohort Study on GLP-1 Receptor Agonists 🩺📊
Why it matters: A real-world look at benefits vs. risks in T2DM.

🔑 Key Findings:
✅ Cardiac arrest ↓22% (HR 0.78), HF ↓11% (HR 0.89)
🧠 Neuro benefits: Alzheimer’s ↓12%, suicidal ideation ↓10%
💔 Coagulopathy and clotting disorders ↓8%, acute kidney injury ↓12%
⚠️ Risks: Drug-induced pancreatitis ↑146% 😮, nephrolithiasis ↑15%, arthritis ↑11%

📊 Study Design:
- n=215,970 GLP-1RA users vs. 1.9M controls
- 3.68 yrs median follow-up, propensity-score weighted

⚠️ Caveats:
- Mostly older male (VA data)
- Observational design → residual confounding

🔗 Summary on LM: https://t.co/IkDYPIxAaL

🔗 Full article: https://t.co/51a3BFrP0F

#T2DM #Obesity #MedEd #MedX 📉🩺

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!

Just released @bmj_latest: Dapagliflozin + Calorie Restriction Increases T2DM Remission in a 12-month RCT ⚕️🔬

🔑 Key Findings:
🧪 Multicenter trial (n=328), double-blind, placebo-controlled
🩺 44% remission vs. 28% with diet alone (RR=1.56, p=0.002)
⚖️ Greater weight loss: −5.0 kg vs. −3.2 kg (Δ−1.3 kg)
📉 Improved systolic BP, body fat, triglycerides in dapagliflozin group
⚠️ Safety: 2 UTI hospitalizations in dapagliflozin arm; overall similar AE rates

Caveats:
⚠️ Very short median T2DM duration (0.2–0.3 yrs) → limited generalizability
⚠️ Remission defined as only 2 months of normoglycemia (vs. expert-recommended 3 months)

🔗 Full article: https://t.co/pxsMKddueF
🔗 Editorial: https://t.co/LRJ5QFT4ak
🔗 Summary on LM: https://t.co/qE9iUfp1vI

#T2DM #Endocrinology #MedEd #MedX

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!

New @ESC_Journals review: Type 2 MI Challenges & Strategies 🩺💡 #openaccess

Key Strategies:
✅ Address triggers (e.g., sepsis, hypoxia, anemia) → vital to reduce ischemia
🫀 Underlying CAD present in ~68%
🩺 Use imaging (CTCA or angiography) if uncertain → can reclassify ~5% as Type 1 MI
💡 Consider single antiplatelet + statin if atherosclerosis is confirmed → no dedicated T2 MI RCT
🏥 Assess LV function → initiate HF therapy if indicated

Caveats:
⚠️ No proven outcome-improving interventions specific to Type 2 MI
⚠️ Heterogeneous subtypes (some with 2x mortality vs. tachyarrhythmia)

🔗 Full review: https://t.co/bh8L2KrZ1a

🔗Summary on LM: https://t.co/girFKXyRRQ

#Cardiology #MedEd #MedX

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!

New in @JACCJournals : 🔬 Sodium Zirconium Cyclosilicate Optimizes Spironolactone Use in HFrEF by Managing Hyperkalemia

✅ 71% maintained normokalemia → vs 36% (placebo; OR 4.45, p<0.001)
🩺 81% on ≥25 mg/d spironolactone → vs 50% (OR 4.33, p<0.001)
💊 Dose discontinuation ↓ → HR 0.37 (p=0.006)

⚠️ HF events ↑ → 11% (SZC) vs 3% (pbo) | Nominal p=0.034 (exploratory)

Caveats:
⚠️ Not powered for HF outcomes
⚠️ Baseline imbalance (older age/higher NT-proBNP in SZC group)
⚠️ More research needed with clinical endpoints! 🚨

🔗 Full article: https://t.co/r2LDjUrGf3

🔗 Summary on LM: https://t.co/WFHf3pySsI

#Hyperkalemia #HeartFailure #Cardiology #MedEd

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine 𝐀𝐫𝐭𝐢𝐜𝐥𝐞 𝐨𝐟 𝐭𝐡𝐞 𝐃𝐚𝐲!

Just released @NEJM: 𝐀𝐛𝐞𝐥𝐚𝐜𝐢𝐦𝐚𝐛 𝐂𝐮𝐭𝐬 𝐁𝐥𝐞𝐞𝐝𝐢𝐧𝐠 𝐢𝐧 𝐀𝐅𝐢𝐛 in Phase 2b Trial 🩸💉

𝐊𝐞𝐲 𝐅𝐢𝐧𝐝𝐢𝐧𝐠𝐬:
✅ 𝟔𝟗% 𝐟𝐞𝐰𝐞𝐫 𝐛𝐥𝐞𝐞𝐝𝐬 → 2.6 vs. 8.4 events/100 PY (vs. rivaroxaban)
🩺 𝐆𝐈 𝐛𝐥𝐞𝐞𝐝𝐢𝐧𝐠 ↓ → 0.5% (abelacimab) vs. 4.2% (rivaroxaban)
🧪 Factor XI suppression → 97-99% sustained reduction
⚠️ 𝐒𝐭𝐫𝐨𝐤𝐞 𝐭𝐫𝐞𝐧𝐝 → 𝐍𝐮𝐦𝐞𝐫𝐢𝐜𝐚𝐥𝐥𝐲 𝐡𝐢𝐠𝐡𝐞𝐫 𝐢𝐬𝐜𝐡𝐞𝐦𝐢𝐜 𝐬𝐭𝐫𝐨𝐤𝐞𝐬 (𝐍𝐒, 𝐩𝐡𝐚𝐬𝐞 𝟑 𝐧𝐞𝐞𝐝𝐞𝐝)

𝐂𝐚𝐯𝐞𝐚𝐭𝐬:
⚠️ Open-label design (vs. rivaroxaban)
⚠️ 𝐍𝐨𝐭 𝐩𝐨𝐰𝐞𝐫𝐞𝐝 𝐟𝐨𝐫 𝐬𝐭𝐫𝐨𝐤𝐞 𝐞𝐟𝐟𝐢𝐜𝐚𝐜𝐲

🔗 𝐒𝐞𝐞 𝐚𝐫𝐭𝐢𝐜𝐥𝐞 (𝐥𝐢𝐧𝐤 𝐭𝐨 𝐚𝐛𝐬𝐭𝐫𝐚𝐜𝐭 - $ 𝐟𝐨𝐫 𝐟𝐮𝐥𝐥-𝐭𝐞𝐱𝐭): https://t.co/7fFwEDYl95
🔗 𝐒𝐮𝐦𝐦𝐚𝐫𝐲 𝐨𝐧 𝐋𝐌: https://t.co/jGRrF3nzIM

#Afib #Cardiology #MedEd #MedX

[Dr. Euclides Cavalcanti @Links_Medicus]

#InternalMedicine Article of the Day!

Just released @AnnalsofIM Stroke Rehab Guidelines 🧠🚀
🎯 𝐊𝐞𝐲 𝐒𝐭𝐫𝐚𝐭𝐞𝐠𝐢𝐞𝐬:

✅ Case management at discharge → boosts daily tasks/independence
🏋️ Task-specific motor therapy → strong for gait/posture/motor recovery
🔄 Mirror therapy → improves neglect + daily tasks (weak)
💊 SSRIs/psychotherapy → prioritize depression treatment (🚫 avoid prophylaxis!)
📲 Telerehab → adjunct option if patient-aligned (weak)
⚠️ 𝗖𝗮𝘃𝗲𝗮𝘁: Many “weak” recs—individualize care (limited evidence)!

🔗 Full guidelines: https://t.co/6UN8FnhQ6g
🔗 Summary on LM: https://t.co/xcHVwqOQK7

#Stroke #MedEd #MedX 👨⚕️📚

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

MDR-GNB infections remain a major global health challenge. With new diagnostics &amp; antibiotics emerging, we’re at a crossroads.
Fantastic 🆕💫review about MDR GN by @NenadMacesic
Figures🌟
Thanks @Inox94 #idxposts
https://t.co/axTwrA4AKu

[JAMA Otolaryngology – Head & Neck Surgery @JAMAOto]

While the absolute risk of thyroid cancer among patients treated with #GLP-1 receptor agonists is low, there is an increased risk of new thyroid cancer diagnoses within the first year of treatment.

https://t.co/HGpQTV1B92

[JAMA Internal Medicine @JAMAInternalMed]

Midline catheters used for outpatient parenteral antimicrobial therapy (OPAT) had a lower risk of major complications compared to PICCs, especially for treatments lasting 14 days or fewer. https://t.co/R03deckakY

[The BMJ @bmj_latest]

Actively preparing for major surgery by exercising and improving diet (“prehabilitation”) is associated with fewer complications, less time in hospital, and improved recovery and quality of life in adults, finds an analysis of clinical trials
@mcisaac_d
https://t.co/uOOZ8WOqmF

[Dr. Euclides Cavalcanti @Links_Medicus]

New in @TheLancetInfDis: A phase 2/3 trial in Ethiopia, Kenya, & Mozambique shows a novel albendazole–ivermectin co-formulation is safe, well-tolerated, and significantly more effective than albendazole alone for Trichuris trichiura & hookworms. 💊🦠 Cure rates reached ~97%, with no serious AEs! S. stercoralis data remain inconclusive due to low sample size, but this approach could streamline mass deworming programs.

Check it out: https://t.co/qTpOE469A0

Summary on LM: https://t.co/9Y7T56ceXs

#NTDs #GlobalHealth #InfectiousDiseases

[Dr. Euclides Cavalcanti @Links_Medicus]

🎯 Recent 2024 @ACCinTouch / @American_Heart guidelines in @CircAHA detail comprehensive management of Lower Extremity #PeripheralArteryDisease—covering prevention of major adverse limb & cardiovascular events, structured exercise therapy, and optimal revascularization strategies. Highlights:
• Four PAD subsets (asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia)
• Emphasis on risk-factor control (statins, BP, diabetes, smoking cessation)
• Supervised exercise programs to boost walking distance & QoL
• Individualized approach to endovascular vs. surgical revascularization
• Multispecialty team approach to minimize amputations

Check full article: https://t.co/P9NUnsBpcy

Summary on LM: https://t.co/uOTM2hLBE4

#VascularMedicine #CardioTwitter #MedEd 🩺🔬

[Dr. Euclides Cavalcanti @Links_Medicus]

🧠 Check-out this recent @StrokeAHA_ASA scientific statement on cervical artery dissection—a key cause of stroke in younger adults. Main insights: • Watch for neck/head pain, partial Horner syndrome, and neurological deficits, especially after minor trauma. • Urgent vascular imaging (CTA or MRA) is crucial. • IV thrombolysis & mechanical thrombectomy are viable when indicated. • Tailor anticoagulants vs. antiplatelets based on ischemic vs. bleeding risks. • Continue therapy ≥3–6 months; consider longer if needed.

Data are still limited on the ideal regimen—so individualized care is crucial.

Check out the full article: https://t.co/1q1WyGnd75

Summary on LM: https://t.co/tswKeLjGE7

#Stroke #NeuroTwitter #NeuroX #MedEd #MedX 🩺🔬

[Dr. Euclides Cavalcanti @Links_Medicus]

🚨 New in @JAMAInternalMed: A large systematic review on nonsevere #Influenza finds oseltamivir offers minimal benefit for hospital admission/mortality and only modest symptom relief—plus increased GI side effects. Should we reconsider routine use? 🤔

Article ($): https://t.co/VwzDoq3ITa

Summary: https://t.co/cZWFLvGSo3

#MedEd #MedX #InternalMedicine 💊🔬