RESUMO
PURPOSE: Propofol has become the sedative of choice for endoscopy and colonoscopy. However, it has shown associations with various adverse effects, specifically in the geriatric population. In contrast, remimazolam is a novel benzodiazepine, demonstrating a superior clinical safety profile. Hence, this systematic review and meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol in elderly patients (≥ 60 years) undergoing gastrointestinal endoscopic and colonoscopy procedures. METHODS: Electronic databases including PubMed, Cochrane Library, ScienceDirect, and Google Scholar were explored from inception till January 7, 2024. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (RoB-2) was utilized to evaluate the quality of each included study reported in this meta-analysis. RESULTS: Seven randomized control trials were included, resulting in the pooling of 1,466 patients (remimazolam: 731 patients; propofol: 735 patients). Propofol demonstrated a significantly lower time to loss of consciousness (P < 0.00001, 4 studies, 784 patients) and a greater sedation success after first dose (P = 0.05, 5 studies, 1,271 patients). Remimazolam reported a significantly lower risk of bradycardia (P = 0.02, 5 studies, 1,323 patients), hypoxemia (P < 0.00001, 6 studies, 1,389 patients), and pain on injection site (P < 0.00001, 5 studies, 1,184 patients). No statistically significant differences in sedation time, number of supplemental doses, procedural parameters, and other adverse outcomes were reported. CONCLUSION: As per the results of our analyses, propofol demonstrated comparatively superior efficacy, however, remimazolam demonstrated comparatively superior safety. The debatable evidence generated from this meta-analysis may not currently be powerful enough to advocate for the use of remimazolam in elderly patients undergoing gastrointestinal procedures; hence, further comprehensive studies are necessary in order to arrive at a robust conclusion.
RESUMO
Over the years, worsening climate change has led to multiple spells of heavy rain and floods in Pakistan, with the 2022 floods ranked as the deadliest in world history. To top it off, decades of political instability, mental health stigma, and lack of psychological support have tipped the after-effects over the edge. These floods have taken a toll on more than 13 000 people, with inaccessibility to vital necessities leading to further deaths every week. Local and international support is imminent for better handling of the crisis and reducing the incidence of post-traumatic stress disorders and other mental health-related issues.
RESUMO
With over seven pandemics and four million reported cases, Cholera remains of the most prevalent acute watery diarrheal diseases in the world to date. As in other developing countries, Iraq once again combats Cholera - and its past encounter in 2015, where the death toll reached 1500, highlights the importance of quickly addressing the current outbreak. The war-torn state of the nation, malnourished public, lack of sanitation and hygiene, mass displacement and global warming all contribute to the prevalence of Cholera in Iraq. Along with the current efforts, additional strategies are recommended for managing cholera cases, such as awareness campaigns, monitoring the safety of water bodies, and food inspection.
