Lidocaine Needling in Myofascial Pain Syndrome for Palliative Oncologic Care: A Randomized Clinical Study.

Background: Physical pain is highly prevalent and impacts the well-being of patients with advanced oncologic disease. Although myofascial pain syndrome (MPS) can be one of the components of pain in cancer patients on palliative care (PC), so far there is no evidence about the benefit of treatment with 1% lidocaine needling. Objectives: To evaluate the efficacy of MPS treatment with injection of 1% lidocaine on the reduction of pain in cancer patients on PC. Design: Single-blind randomized clinical trial. Subjects: Patients aged 50 years or older with end-stage cancer, admitted to a cancer ward or monitored during radiotherapy in three Brazilian hospitals, with a diagnosis of MPS with a pain intensity of five or more according to the Visual Analog Scale (VAS). The patients were divided into two groups: trigger point (TP) injection with 1% lidocaine and control. Measurements: Pain intensity was assessed with the VAS, pain threshold with an algometer, and the medications being used were determined before and 72 hours after the intervention. Results: Thirty patients (15 per group) were assessed. After 72 hours, there was a reduction in referred pain intensity (p < 0.001) and an increase in pressure threshold (p = 0.007) in the intervention group (IG), with no difference in the control. The frequency of individuals who reduced the doses and/or classes of pain medications was higher in the IG (p = 0.011). Conclusion: One percent lidocaine needling in TPs was an effective therapy for pain reduction in MPS.

The effect of frailty on the 24-hour blood pressure pattern in the very elderly.

Frailty plays a crucial role in the management of hypertension in the very elderly and has a strong association with cardiovascular diseases. Nevertheless, its influence on the 24-hour blood pressure pattern, including elevated asleep systolic blood pressure (BP) and the lack of BP fall during sleep (non-dipping) has not been explored in a population above 80 years. Patients older than 80 years were classified into frail or robust subtypes by the five item frailty phenotype criteria. All participants were submitted to office blood pressure measurements and ambulatory BP monitoring over a 24-hour period. Nocturnal dipping was defined as nighttime BP fall ≥10%. Thirty-eight frail and 36 non-frail individuals (mean age 85.3 ± 3.7 years; 67% females) were analyzed. Awake systolic and diastolic BP were similar for frail and robust individuals. Frail patients had higher systolic BP during sleep (128 ± 15 mm Hg vs. 122 ±13 mm Hg p = .04) and reduced systolic BP fall [1 (-4.5 - 5)% vs. 6.8 (2.1 - 12.8)% p < .01]. Frailty was independently associated with higher risk of non-dipping (OR 12.4; CI 1.79 - 85.9) and reduced nighttime systolic BP fall (-6.1%; CI -9.6 - -2.6%). In conclusions, frailty has a substantial influence on nighttime BP values and pattern in patients older than 80 years.

Importância da avaliação gerontológica global na decisão do tratamento da estenose aórtica grave / Importance of global gerontological assessment in the decision to treat severe aortic stenosis

RESUMO: OBJETIVO: A Estenose Aórtica (EAo) é extremamente prevalente em idosos e, quando sintomática, influência de forma significativa na qualidade e expectativa de vida. Decidir entre o tratamento clínico, percutâneo ou cirúrgico é uma árdua decisão e deve valorizar não apenas os aspectos cardiológicos e ecocardiográficos, mas todo o contexto do idoso. O objetivo deste estudo é utilizar a Avaliação Gerontológica Global (AGG) como ferramenta na tomada de decisão, frente ao idoso portador de EAo Grave e Sintomática. MÉTODOS: Foram selecionados pacientes atendidos em ambulatório de cardiogeriatria de hospital terciário de São Paulo-SP, de outubro de 2018 a janeiro de 2019, a partir de 75 anos e com EAo Grave (definida pela área valvar 40mmHg), com queixas de angina, síncope, dispneia ou insuficiência cardíaca congestiva. A estratificação do risco cirúrgico foi feita pelo EuroSCORE II. Os idosos eram submetidos à AGG, que incluía análise da Funcionalidade (Katz e Lawton), Fragilidade (FRAIL), Depressão (Escala de Depressão Geriátrica), Cognição (Mini-exame do estado mental, teste do relógio, fluência Verbal) e Estado Nutricional (Mini-avaliação nutricional). Após tal avaliação, clínicos, hemodinamicistas, ecocardiografistas e cirurgiões se reuniam e chegavam ao consenso de qual tratamento indicar. Trata-se de estudo observacional, prospectivo, descritivo, aprovado pelo comitê de ética. As variáveis quantitativas foram apresentadas em forma de média e desvio padrão. RESULTADOS: Dos 10 pacientes portadores de EAo grave e sintomática avaliados, a média de idade foi 83,8 anos (±3,7), sendo 55% homens. Quanto à classe funcional de NYHA, 30% apresentavam-se em classe III. 70% eram parcialmente dependentes para atividades diárias, 30% frágeis, 40% tinham humor deprimido e 20% risco nutricional. Nos pacientes com EuroSCORE II de alto risco, 20% também apresentavam fragilidade, tendo sido mantidos em tratamento clínico. Os classificados como de risco baixo a intermediário não apresentavam fragilidade associada e foram submetidos à troca valvar aórtica, por via aberta e/ou transcateter (TAVR). CONCLUSÃO: Os achados da AGG, somados aos aspectos clínicos e ecocardiográficos habitualmente utilizados, constituem ferramenta importante para a decisão terapêutica de idosos portadores de EAo grave e sintomática. (AU)