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Abstract Background: Respiratory responses to extubation can cause serious postoperative complications. Beta-blockers, such as metoprolol, can interfere with the cough pathway. However, whether metoprolol can effectively control respiratory reflexes during extubation remains unclear. The objective of this study is to evaluate the efficacy of intravenous metoprolol in attenuating respiratory responses to tracheal extubation. Methods: Randomized, double-blinded, placebo-controlled trial. Setting: Tertiary referral center located in Brasília, Brazil. Recruitment: June 2021 to December 2021. Sample: 222 patients of both sexes with an American Society of Anesthesiologists (ASA) physical status I-III aged 18-80 years. Patients were randomly assigned to receive intravenous metoprolol 5 mg IV or placebo at the end of surgery. The primary outcome was the proportion of patients who developed bucking secondary to endotracheal tube stimulation of the tracheal mucosa during extubation. Secondary outcomes included coughing, bronchospasm, laryngospasm, Mean Blood Pressure (MAP), and Heart Rate (HR) levels. Results: Two hundred and seven participants were included in the final analysis: 102 in the metoprolol group and 105 in the placebo group. Patients who received metoprolol had a significantly lower risk of bucking (43.1% vs. 64.8%, Relative Risk [RR = 0.66], 95% Confidence Interval [95% CI 0.51-0.87], p = 0.003). In the metoprolol group, 6 (5.9%) patients had moderate/severe coughing compared with 33 (31.4%) in the placebo group (RR = 0.19; 95% CI 0.08-0.43, p < 0.001). Conclusion: Metoprolol reduced the risk of bucking at extubation in patients undergoing general anesthesia compared to placebo.
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Abstract Background Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. Methods We searched 6 databases until January 2023 for phase 2-4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. Results The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113-10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554-3.161, p < 0.001) for ACR70 compared to tocilizumab. Conclusion We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab. Key messages Abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab.
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ABSTRACT Objective: To identify the prevalence of non-communicable chronic diseases: arterial hypertension, diabetes mellitus, and associated risk factors in long-lived elderly people from three Brazilian regions. Methods: This is a multicenter, cross-sectional, and comparative study conducted with elderly people aged 80 years or older. Results: Higher prevalence of arterial hypertension were observed among those who use polypharmacy (75.7%), among elderly people aged between 80 and 84 years (33.9%), as well as in elderly people who are overweight (78.2%). The prevalence of diabetes was 24% (RP: 0.76; 95% CI: 0.59-0.98) lower among women compared to men and 2.15 times higher among those who use five or more medications (RP: 2.15; 95% CI: 1.63-2.85). Conclusions: In our sample, polypharmacy, body weight, and gender determine the prevalence of non-communicable chronic diseases: arterial hypertension and diabetes mellitus in long-lived elderly people.
RESUMEN Objetivo: Identificar la prevalencia de enfermedades crónicas no transmisibles: hipertensión arterial, diabetes mellitus y los factores de riesgo asociados en ancianos longevos de tres regiones brasileñas. Métodos: Se trata de un estudio multicéntrico, transversal y comparativo, realizado con ancianos con edad igual o superior a 80 años. Resultados: Se observaron mayores prevalencias de hipertensión arterial entre aquellos que hacen uso de polifarmacia (75,7%), entre los ancianos con edad entre 80 y 84 años (33,9%), así como en ancianos que presentan sobrepeso (78,2%). La prevalencia de diabetes fue 24% (RP: 0,76; IC 95%: 0,59-0,98) menor entre las mujeres en comparación con los hombres y 2,15 veces mayor entre aquellos que utilizan cinco o más medicamentos (RP: 2,15; IC 95%: 1,63-2,85). Conclusión: En nuestra muestra, la polifarmacia, el peso corporal y el sexo determinan la prevalencia de las enfermedades crónicas no transmisibles: hipertensión arterial y diabetes mellitus en ancianos longevos.
RESUMO Objetivo: identificar a prevalência das doenças crônicas não transmissíveis: hipertensão arterial, diabetes mellitus e os fatores de risco associados em pessoas idosas longevas de três regiões brasileiras. Métodos: trata-se de um estudo multicêntrico, transversal e comparativo, realizado com pessoas idosas com idade igual ou superior a 80 anos. Resultados: foram observadas maiores prevalências de hipertensão arterial entre aqueles que fazem uso de polifarmácia (75,7%), entre as pessoas idosas com idade entre 80 e 84 anos (33,9%), bem como em pessoas idosas que apresentam sobrepeso (78,2%). A prevalência de diabetes foi 24% (RP: 0,76; IC 95%: 0,59-0,98) menor entre as mulheres quando comparadas aos homens e 2,15 vezes maior entre aqueles que utilizam cinco ou mais medicamentos (RP: 2,15; IC 95%: 1,63-2,85). Conclusões: Em nossa amostra, a polifarmácia, o peso corporal e o sexo determinam a prevalência das doenças crônicas não transmissíveis: hipertensão arterial e diabetes mellitus em pessoas idosas longevas.
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Objetivo: Investigar as lives disponibilizadas nas redes sociais de instituições e conselhos profissionais brasileiros sobre pessoas idosas no contexto de enfrentamento da Covid-19, publicadas entre abril e setembro de 2020. Método: Realizou-se um estudo retrospectivo, exploratório, descritivo e infométrico. Resultados: Três instituições relacionadas diretamente a pessoas idosas divulgaram lives vol-tadas para essa população ou para cuidadores e familiares. Entre os profissionais que mais tiveram participações nas lives encontram-se os médicos geriatras. O maior número de acesso (quase oito mil) ocorreu em uma live intitulada "Pande-mia Covid-19", realizada em junho, por um geriatra. Ela foi divulgada no YouTu-be da Sociedade Brasileira de Geriatria e Gerontologia instituição que mais di-vulgou lives sobre a temática. A rede social mais utilizada para esse fim foi o Ins-tagram. Conclusão: há uma carência na atenção e no cuidado com a pessoa idosa no contexto da pandemia de Covid-19.
Objective: Investigate the lives made available on the social networks of institutions and professional advice about people going to s in the face of Covid-19 to verify which institutions most disseminated these lives which was the most used social network and which professional had more participations. Method: A retrospective, exploratory, descriptive and infometric study was conducted. Results: Three institutions, SBGG, FNILPI and ABG directly related to elderly disseminated lives aimed at this population or at caregivers and family members; among the professionals who had the most participation in the lives were geriatric doctors, the largest number of access was given to the live entitled "Covid-19 Pandemic", which was held in June by a geriatrician, and which had 7.829 accesses, being disclosed in the YT of SBGG. SBGG was the institution that most disseminated lives, the most used social network was IG, and July was the month with the highest number of disclosures. Conclusion: There is a lack of attention and care for the elderly.
Objetivo: Investigo las lives puestas a disposición en las redes sociales de instituciones y asesoramiento profesional sobre personas que acuden a s frente al Covid-19 para verificar qué instituciones más difundieron estas lives, cuál fue la red social más utilizada y qué profesional tuvo más participaciones. Método: Se realizó un estudio retrospectivo, exploratorio, descriptivo e infométrico. Resultados: Tres instituciones, SBGG, FNILPI y ABG directamente relacionadas con las personas atendidas difundieron vidas dirigidas a esta población o a cuidadores y familiares; entre los profesionales que más participación tuvieron en la live fueron los médicos geriátricos, el mayor número de acceso se dio al live titulada "Pandemia Covid-19", que se realizó en junio por un geriatra, y que tuvo 7.829 accesos, siendo divulgado en el YT de SBGG. SBGG fue la institución que más difundió lives, la red social más utilizada fue IG, y julio fue el mes con mayor número de divulgaciones. Conclusión: Hay una falta de atención y cuidado para los ancianos.
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Anciano , Red Social , COVID-19RESUMEN
Objetivo: Verificar quais as comorbidades podem ser preditoras do risco para uso de medicamentos potenciamente inapropriados para idosos (MPII) e desenvolver um modelo preditor para o consumo de MPII. Método: Trata-se de um estudo retrospectivo, transversal, com alocação consecutiva de idosos atendidos ambulatorialmente. Foram desenvolvidos modelos probabilísticos com a utilização de regressões logísticas binárias. Resultados: Um modelo contendo as variáveis dor, ansiedade, depressão, escore de Elixhauser, e número de medicamentos atingiu área sob a curva de 0,853 (IC95% 0,813-0,893) para identificar idosos sob risco de receber prescrição de MPII. Os resultados corroboram que a ansiedade [OR 10,6 (IC95% 1,29-87,0), p=0.028] e depressão [OR 40,3 (IC95% 5,05-321), p<0.001] são fatores de risco independentes para o uso de MPII.Conclusão: Ferramentas de suporte à decisão clínica podem incorporar modelos preditores como os desenvolvidos no presente trabalho, aumentando o nível de informação e facilitando a sinalização de MPII no ato da prescrição.
Objective: To verify which comorbidities may be predictors of the risk for use of potentially inappropriate medication for the elderly (PIME) and to develop a predictive model for the consumption of PIME. Method: It is a study retrospective, cross-sectional study with consecutive allocation of elderly patients treated on an outpatient basis. Probabilistic models have been developed using binary logistic regressions. Results: A model containing the variables pain, anxiety, depression, Elixhauser score, and number of medications reached an area under the curve of 0.853 (95%CI 0.813-0.893) to identify elderly people at risk of receiving PIME prescription. The results corroborate that anxiety [OR 10.6 (95%CI 1.29-87.0), p=0.028] and depression [OR 40.3 (95%CI 5.05-321), p<0.001] are independent risk factors for the use of PIME.Conclusion: Clinical decision support tools can incorporate predictive models such as those developed in the present study, increasing the level of information and facilitating the signaling of PIME at the time of prescription.
Objetivo: Verificar qué comorbilidades pueden ser predictoras del riesgo de uso de medicación potencialmente ianpropriada para los ancianos (MPIA) y desarrollar un modelo predictivo para el consumo de MPIA. Método: És un estudio retrospectivo, transversal, con asignación consecutiva de ancianos atendidos de forma ambulatoria. Se han desarrollado modelos probabilísticos utilizando regresiones logísticas binarias. Resultados: Un modelo que contenía las variables dolor, ansiedad, depresión, puntaje de Elixhauser y número de medicamentos alcanzó un área bajo la curva de 0,853 (IC95% 0,813-0,893) para identificar ancianos con riesgo de recibir prescripción de MPIA. Los resultados corroboran que la nestidade [OR 10,6 (IC95% 1,29-87,0), p=0,028] y la depresión [OR 40,3 (IC95% 5,05-321), p<0,001] son factores de riesgo independientes para el uso de MPIA. Conclusión: Las herramientas de apoyo a la decisión clínica pueden incorporar modelos predictivos como los desarrollados en el presente estudio, aumentando el nivel de información y facilitando la señalización del MPIA en el momento de la prescripción.