Comparison of dexmedetomidine and benzodiazepine for intraoperative sedation in elderly patients: a randomized clinical trial.

BACKGROUND AND OBJECTIVES: Elderly individuals have a greater sensitivity to sedation, and the most commonly used drugs for sedation are benzodiazepines, which exhibit some complication. Therefore, this study aimed to compare the use of dexmedetomidine and midazolam regarding proper sedation and postoperative complications in elderly individuals who require intraoperative sedation. METHODS: This study was a parallel-randomized clinical trial, which included 120 patients aged >70 years undergoing regional anesthesia and sedation. The exclusion criteria consisted of bradycardia, heart failure, respiratory failure, a Glasgow Coma Scale ≤14, liver failure and refusal to participate. Patients were divided into two groups: the first group received midazolam (MDZ), while the second group received dexmedetomidine (DEX). The doses were titrated to achieve an intraoperative Richmond Agitation-Sedation Scale (RASS) score between -3 and -1. Incidences of complications were recorded. RESULTS: During a 120 min follow-up, the depth of sedation (RASS score) revealed variations less often in the DEX group (p=0.002). Patients in the DEX group (n=67) had lower rates of intraoperative complications (19.4% vs 73.6%, p<0.001). Intraoperatively, the incidence rates of psychomotor agitation (15.1% vs 1.5%, p=0.005), arterial hypotension (28.3% vs 3.0%, p<0.001) and respiratory depression (73.6% vs 0%, p<0.001) were higher in the MDZ group (n=53). During postanesthesia care, the incidence rates of shivering (p<0.001), residual sedation (p=0.04) and use of supplemental oxygen (p<0.001) were significantly lower in the DEX group. CONCLUSIONS: The use of DEX for sedation during surgery provides better control over the depth of sedation and produces fewer complications in elderly individuals. TRIAL REGISTRATION NUMBER: NCT02878837.

Height and body composition determine arm propulsive force in youth swimmers independent of a maturation stage.

The aim of this study was to examine the relationship between anthropometric variables, body composition and propulsive force in swimmers aged 9-17 years. Anthropometric characteristics (body height and mass, sitting height, arm span, arm muscle area and body composition) and the propulsive force of the arm (tethered swimming test) were evaluated in 56 competitive male swimmers. Tanner's stages of genital maturation (P1-5) were used. The data analysis included correlations and multiple linear regression. The propulsive force of the arm was correlated with body height (r = 0.34; p =0.013), arm span (r = 0.29; p =0.042), sitting height (r = 0.36; p =0.009), % body fat (r = 0.33; p =0.016), lean body mass (r = 0.34; p =0.015) and arm muscle area (r = 0.31; p =0.026). Using multiple linear regression models, the percent body fat and height were identified as significant predictors of the propulsive force of the arm after controlling for the maturation stage. This model explained 22% (R2 = 0.22) of associations. In conclusion, the propulsive force of swimmers was related to body height and percent body fat.

Glomerulonefrite lúpica e ausência de anticorpos antinucleares: relato de caso / Lupus nephritis and absence of antinuclear antibodies: case report

Justificativa e objetivos: O Lúpus Eritematoso Sistêmico (LES) é uma doença autoimune de etiologia desconhecida que se caracteriza por períodos de remissão e de atividade envolvendo múltiplos órgãos. O comprometimento renal associado ao LES ainda constitui um dos fatores de maior morbidade e mortalidade da doença. O Fator Antinuclear (FAN) geralmente é detectado em 95% dos pacientes com LES. Nos 5% restantes, apesar de FAN negativo, o anti-Ro (SS-A) habitualmente é positivo. Em estudos recentes, nos quais FAN é analisado por técnica de imunofluorescência indireta em células Hep-2, somente 0,14% dos casos apresentam esse marcador sorológico negativo. O objetivo deste estudo foi alertar os médicos quanto à possibilidade do diagnóstico de LES, mesmo na ausência dos critérios clínicos e laboratoriais suficientes, salientando a importância da biópsia e do histopatológico na confirmação da doença. Relato de caso: Paciente com 29 anos que evoluiu no final da gestação e puerpério com aumento da creatinina e proteinúria nefrótica (6,153/24h). Apesar da ausência de anticorpos antinucleares detectáveis por pesquisa de FAN em células HEp-2 e apenas dois critérios para LES (serosite e alterações renais), o diagnóstico de LES foi confirmado pelo estudo histopatológico do tecido renal. Conclusão: No caso apresentado houve o diagnóstico de LES pela histopatologia renal, apesar da insuficiência de critérios. Talvez os atuais critérios possam ser reavaliados e novos dados acrescentados.

Background and objectives: Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that is characterized by periods of remission and activity involving multiple organs. The renal impairment associated with SLE is still one of the factors for increased morbidity and mortality of the disease. The antinuclear factor (ANF) is usually detected in 95% of SLE patients. In the remaining 5%, despite negative ANF, anti-Ro (SS-A) is usually positive. In recent studies, in which ANF is analyzed by indirect immunofluorescence technique on Hep-2 cells, only 0.14% of the cases there is negative serologic marker. This study aimed to warn physicians about the possibility of diagnosis of SLE, even in the absence of sufficient clinical and laboratory criteria, stressing the importance of biopsy and histopathologic confirmation of the disease. Case report: Patient 29 years who evolved at the end of pregnancy and puerperium with increased creatinine and nephrotic proteinuria (6.153 g/24h). Despite the absence of detectable antinuclear antibodies in search of ANF in HEp-2 cells and only two criteria for SLE (serositis and renal changes), the diagnosis of SLE was confirmed by histological examination of renal tissue. Conclusion: In the case presented there was the diagnosis of SLE by renal histopathology, despite the lack of criteria. Perhaps the current criteria can be reviewed and new data added.