Abstract Background Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. Objectives To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. Methods Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. Results The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49). Conclusion Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.

Abstract Background and objectives: Inguinal hernia repair is associated with significant postoperative pain. We assessed the analgesia efficacy of unilateral Erector Spinae Plane block (ESP) performed under ultrasound guidance in patients submitted to open unilateral inguinal hernia repair, comparing ESP to spinal anesthesia administered with or without opioid. Methods: Forty-five patients with ages ranging from 27 to 83 years were randomly allocated into three groups: control group receiving spinal anesthesia (n = 14), ESP group receiving ESP block combined with spinal anesthesia (n = 16), and spinal morphine group receiving spinal anesthesia with morphine 1 mcg.kg-1 as adjuvant drug (n = 15). ESP was performed at the T8 level using 0.5% ropivacaine, 20 mL. We assessed the pain intensity in the initial 24 hours after surgery using the Visual Analogue Scale - VAS and rescue opioid requirement. Results: The ESP group showed four times higher consumption of rescue opioids than the spinal morphine group, or 26.7% vs. 6.2%, respectively (RR = 4.01; 95% CI: 0.82 to 19.42; p = 0.048). The spinal morphine group showed higher incidence of adverse effects than the ESP group, 37.5% vs. 6.7%, respectively (p = 0.039). There were no statistically significant differences among groups for the mean values of VAS score at 24 hours after surgery (p = 0.304). Conclusion: At the doses used in this study, the ESP block was an ineffective technique for providing postoperative analgesia in unilateral open inguinal hernioplasty and was associated with higher consumption of rescue opioids when compared to spinal anesthesia with or without opioid.

Abstract Objective So far, at least 18 different severe acute respiratory syndrome coronavirus-2 vaccines have been approved. Until October 2022, 12.8 billion doses had been administered all over the world. Vaccination of high-risk groups and healthcare professionals was initially prioritized. This cross-sectional survey aimed to investigate the occurrence of vaccine side effects, as well as the incidence of COVID-19 among vaccinated healthcare professionals. Methods A survey was structured and shared with healthcare professionals using a digital platform to collect data between May and June 2021. Results This study included 6,115 participants. The most prevalent age group was 30-39 years (31.3%), 67.3% were female and 73.2% accounted for physicians, and nearly half worked in frontline care for COVID-19. Approximately, two-thirds of them were vaccinated with CoronaVac, and about 60% reported at least one side effect following the vaccination. Nevertheless, minor reactions were more frequent, such as pain at site of injection, fatigue, and headache. Our data could be used to inform people on the likelihood of side effects of COVID-19 vaccines, particularly CoronaVac, since this is the largest study about vaccine reactions using this vaccine, to our best knowledge. Conclusion The incidence of side effects in Brazilian healthcare professionals was 60%, and the most common side effects included local swelling/pain, fatigue/tiredness, fever, headache, and limb pain.

Resumo A ocorrência de acidentes e de doenças relacionadas ao trabalho são expressões concretas da exposição dos trabalhadores aos riscos presentes no ambiente laboral. Historicamente o conflito de interesses entre empregadores e trabalhadores obrigou o Estado a assumir a função de regulação desta relação, instituindo leis e fiscalizando a aplicação das normas de saúde e segurança no trabalho. O Fator Acidentário de Prevenção (FAP) é uma dessas estratégias. O objetivo deste artigo é analisar a correlação entre as taxas de risco de acidentes de trabalho no Brasil antes (2006-2009) e depois (2010-2016) da vigência do FAP. Estudo ecológico com análise temporal de séries de taxas de acidentes de trabalho registrados nas bases de dados da Previdência Social no período 2006 e 2016. A análise incluiu o cálculo das taxas de risco de acidentes segundo grandes regiões brasileiras, divisões do CNAE, motivo/situação, capítulos do CID-10, sexo e idade. A comparação entre os resultados dos dois períodos foi realizada utilizando-se as taxas de risco médias com a aplicação do teste t de Student e da correlação de Spearman. Basicamente todas as séries de taxas analisadas obtiveram forte tendência de redução no período de vigência do FAP, ao contrário do que ocorreu no período imediatamente anterior.

Abstract Historically, the conflict of interests between employers and workers obliged the State to assume the role of regulating this relationship, instituting laws and overseeing the application of health and safety standards at work. The Accident Prevention Factor (FAP) is one of these guidelines. This article aims to analyze the correlations between the FAP and the risk rate for occupational accidents in Brazil in the period between 2006 and 2016. Ecological study, which analyzed the occupational accidents, registered in the Brazilian Social Security database in the period between 2006 and 2016. The analysis included the calculation of accident risk rates according to the Brazilian regions, divisions of the CNAE, reason/situation, ICD-10 chapters, sex and age. The comparison between results from the two periods was performed using the average risk rates from the two periods using Student t test, Spearman correlation and beta value. Basically, all rate series analyzed had a strong downward trend in the FAP period, contrary to what occurred in the immediately previous period.

Resumo A ocorrência de acidentes e de doenças relacionadas ao trabalho são expressões concretas da exposição dos trabalhadores aos riscos presentes no ambiente laboral. Historicamente o conflito de interesses entre empregadores e trabalhadores obrigou o Estado a assumir a função de regulação desta relação, instituindo leis e fiscalizando a aplicação das normas de saúde e segurança no trabalho. O Fator Acidentário de Prevenção (FAP) é uma dessas estratégias. O objetivo deste artigo é analisar a correlação entre as taxas de risco de acidentes de trabalho no Brasil antes (2006-2009) e depois (2010-2016) da vigência do FAP. Estudo ecológico com análise temporal de séries de taxas de acidentes de trabalho registrados nas bases de dados da Previdência Social no período 2006 e 2016. A análise incluiu o cálculo das taxas de risco de acidentes segundo grandes regiões brasileiras, divisões do CNAE, motivo/situação, capítulos do CID-10, sexo e idade. A comparação entre os resultados dos dois períodos foi realizada utilizando-se as taxas de risco médias com a aplicação do teste t de Student e da correlação de Spearman. Basicamente todas as séries de taxas analisadas obtiveram forte tendência de redução no período de vigência do FAP, ao contrário do que ocorreu no período imediatamente anterior.

Abstract Historically, the conflict of interests between employers and workers obliged the State to assume the role of regulating this relationship, instituting laws and overseeing the application of health and safety standards at work. The Accident Prevention Factor (FAP) is one of these guidelines. This article aims to analyze the correlations between the FAP and the risk rate for occupational accidents in Brazil in the period between 2006 and 2016. Ecological study, which analyzed the occupational accidents, registered in the Brazilian Social Security database in the period between 2006 and 2016. The analysis included the calculation of accident risk rates according to the Brazilian regions, divisions of the CNAE, reason/situation, ICD-10 chapters, sex and age. The comparison between results from the two periods was performed using the average risk rates from the two periods using Student t test, Spearman correlation and beta value. Basically, all rate series analyzed had a strong downward trend in the FAP period, contrary to what occurred in the immediately previous period.

OBJECTIVES: The current study compared the impact of pretreatment with melatonin and N-acetylcysteine (NAC) on the prevention of rat lung damage following intestinal ischemia-reperfusion (iIR). METHODS: Twenty-eight Wistar rats were subjected to intestinal ischemia induced by a 60 min occlusion of the superior mesenteric artery, followed by reperfusion for 120 min. Animals were divided into the following groups (n=7 per group): sham, only abdominal incision; SS+iIR, pretreated with saline solution and iIR; NAC+iIR, pretreated with NAC (20 mg/kg) and iIR; MEL+iIR, pretreated with melatonin (20 mg/kg) and iIR. Oxidative stress and inflammatory mediators were measured and histological analyses were performed in the lung tissues. RESULTS: Data showed a reduction in malondialdehyde (MDA), myeloperoxidase (MPO), and TNF-alpha in the animals pretreated with NAC or MEL when compared to those treated with SS+iIR (p<0.05). An increase in superoxide dismutase (SOD) levels in the NAC- and MEL-pretreated animals as compared to the SS+iIR group (34±8 U/g of tissue; p<0.05) was also observed. TNF-α levels were lower in the MEL+iIR group (91±5 pg/mL) than in the NAC+iIR group (101±6 pg/mL). Histological analysis demonstrated a higher lung lesion score in the SS+iIR group than in the pretreated groups. CONCLUSION: Both agents individually provided tissue protective effect against intestinal IR-induced lung injury, but melatonin was more effective in ameliorating the parameters analyzed in this study.

Resumo Justificativa e objetivos Não há consenso sobre qual é a técnica ideal para prover analgesia em reconstruções ligamentares de joelho. Objetivou‐se comparar a intensidade da dor pós‐operatória desses pacientes sob diferentes modalidades de analgesia. Método Ensaio clínico randomizado e controlado de pacientes submetidos à reconstrução do ligamento cruzado anterior com tendões flexores entre dezembro de 2013 e 2014. Todos os pacientes foram submetidos a raquianestesia e analgesia de resgate com tramadol. Compararam‐se os grupos C, M, R0,375 e R0,25; aos quais se ofertou apenas a técnica anteriormente descrita, morfina subaracnóidea (100 µg) ou bloqueio de nervo femoral com 25 mL de ropivacaína 0,375% e 0,25%, respectivamente. Avaliou‐se intensidade da dor em 6, 12 e 24 horas, idade, sexo, analgesia de resgate, reações adversas e satisfação. Resultados Entre os 83 pacientes elegíveis, observou‐se predomínio do sexo masculino (85,7%) entre 28 e 31 anos. O Grupo C solicitou mais opioide (27,3%) do que os demais grupos, sem significância quando comparados. Não houve diferenças significativas na intensidade da dor em 6, 12 e 24 horas. Houve maior incidência de retenção urinária no Grupo M (23,8%) do que no R0,375 (0%) e de bloqueio motor prolongado do quadríceps no Grupo R0,375 (30%) do que nos Grupos M e C (0%), com significância estatística (p< 0,05). Conclusão Não houve diferença na intensidade da dor pós‐operatória nos pacientes submetidos à reconstrução de ligamento cruzado anterior com tendões flexores sob as modalidades analgésicas avaliadas, apesar do predomínio de retenção urinária no Grupo M e bloqueio motor no Grupo R0,375.

Abstract Background and objectives There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia. Method Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100░µg), or Femoral Nerve Block (BNF) with 25░mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24░hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated. Results Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24░hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0%), with statistical significance (p░<░0.05). Conclusion There was no difference in the intensity of postoperative pain in patients submitted to ACL reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M group and motor block in the R0,375 group.

Resumo Justificativa e objetivo: O Bloqueio do Plano do Músculo Eretor da Espinha (ESP block) é um bloqueio relativamente novo, inicialmente descrito para analgesia de dor torácica crônica, porém já descrito para anestesia e analgesia em procedimentos cirúrgicos torácicos e, mais recentemente, para cirurgias abdominais altas. O estudo objetivou comparar as técnicas de bloqueio ESP e bloqueio Epidural com morfina e anestésico local para analgesia pós-operatória de cirurgias de colecistectomia aberta. Método: Estudo clínico randomizado controlado, unicego com 31 pacientes (ESP block, n = 15; Epidural, n = 16), de ambos os sexos, idades entre 27 e 77 anos. O ESP block foi realizado no nível de T8 com injeção de 20 mL de ropivacaína 0,5% bilateral. O bloqueio Epidural foi realizado no espaço T8-T9 com 20 mL de ropivacaína 0,5% e 1 mg de morfina. Resultados: O grupo ESP block apresentou valores médios de dor pela Escala Visual Numérica (EVN) maiores nas avaliações até 2 horas (p= 0,001) e em 24 horas (p= 0,001). O grupo ESP block apresentou um risco três vezes maior - 43,7%vs.13,3% - de uso de opioide de resgate em 24 horas pós-operatórias do que o grupo epidural (RR = 3,72; 95% IC 0,91 a 15,31; p= 0,046). Conclusão: Nas doses realizadas nesse estudo, o ESP block não se mostrou uma técnica efetiva para analgesia pós-operatória de colecistectomia aberta, com mais uso de opioide de resgate e sem diferenças na escala visual numérica de dor. Necessita-se de estudos mais abrangentes avaliando a eficácia do ESP block para o componente visceral e somático abdominal, considerando o nível do bloqueio específico.

Abstract Introduction and objectives: Blockade of the Erector Spinal Muscle (ESP Block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural Block, with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries. Methods: Controlled single-blind randomized clinical trial with 31 patients (ESP Block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine. Results: The ESP Block group presented higher mean Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP Block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046). Conclusion: ESP Block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.

Resumo Introdução: A hipotensão intradialítica (HID) é uma das principais complicações da hemodiálise, com uma prevalência de cerca de 25% durante as sessões de hemodiálise, causando aumento da morbimortalidade. Objetivo: Estudar os efeitos da sertralina na prevenção da HID em pacientes em hemodiálise. Métodos: Este foi um ensaio clínico duplo-cego, cruzado, comparando o uso de sertralina versus placebo para reduzir a hipotensão intradialítica. Resultados: Dezesseis pacientes completaram as duas fases do estudo durante um período de 12 semanas. A prevalência de HID foi de 32%. Uma comparação entre intervenções intradialíticas, sintomas intradialíticos (ID) e episódios de HID não revelou diferença estatística na redução dos episódios de HID (p = 0,207) entre os dois grupos de intervenção. No entanto, o risco de intervenções para HID foi 60% maior no grupo placebo em comparação com o grupo Sertralina, e o risco de sintomas ID foi 40% maior no grupo placebo em comparação com o grupo Sertralina. A análise de sobrevida utilizando o estimador de Kaplan-Meier corroborou os resultados deste estudo. A sertralina apresentou um número necessário para tratar (NNT) de 16,3 pacientes para prevenir um episódio de intervenção de HID e 14,2 pacientes para prevenir um episódio de sintomas intradialíticos. Conclusão: Este estudo sugere que o uso de sertralina pode ser benéfico para reduzir o número de sintomas e intervenções de HID, embora não tenha havido diferença estatisticamente significante nos níveis pressóricos.

Abstract Introduction: Intradialytic hypotension (IDH) is a major complication of hemodialysis, with a prevalence of about 25% during hemodialysis sessions, causing increased morbidity and mortality. Objective: To study the effects of sertraline to prevent IDH in hemodialysis patients. Methods: This was a double-blind, crossover clinical trial comparing the use of sertraline versus placebo to reduce intradialytic hypotension. Results: Sixteen patients completed the two phases of the study during a 12-week period. The IDH prevalence was 32%. A comparison between intradialytic interventions, intradialytic symptoms, and IDH episodes revealed no statistical difference in the reduction of IDH episodes (p = 0.207) between the two intervention groups. However, the risk of IDH interventions was 60% higher in the placebo group compared to the sertraline group, and the risk of IDH symptoms was 40% higher in the placebo group compared to the sertraline group. Survival analysis using Kaplan-Meier estimator supported the results of this study. Sertraline presented a number needed to treat (NNT) of 16.3 patients to prevent an episode from IDH intervention and 14.2 patients to prevent an episode from intradialytic symptoms. Conclusion: This study suggests that the use of sertraline may be beneficial to reduce the number of symptoms and ID interventions, although there was no statistically significant difference in the blood pressure levels.

Resumo Justificativa e objetivos: Os pacientes testemunhas de Jeová recusam transfusão sanguínea por motivos religiosos. O anestesiologista deve dominar conhecimentos jurídicos específicos para atender esses pacientes. Entender como o direito e o Conselho Federal de Medicina tratam essa questão é fundamental para saber agir dentro desse contexto. O objetivo deste artigo foi estabelecer um protocolo de atendimento do paciente testemunha de Jeová com ênfase no dever ético e legal do anestesiologista. Conteúdo: O artigo analisa a Constituição, o Código Penal, resoluções do Conselho Federal de Medicina (CFM), pareceres e jurisprudência para entender os limites do conflito entre a autonomia de vontade da testemunha de Jeová em recusar transfusão e a obrigação do médico em transfundir. Baseado nessas evidências um protocolo de atendimento é sugerido. Conclusões: A resolução do CFM 1021/1980, o Código Penal no artigo 135, que classifica como crime a omissão de socorro, e a decisão do Supremo Tribunal de Justiça sobre o processo HC 268.459/SP impõem ao médico a obrigação de transfusão quando houver risco de vida. Não é necessário concordância do paciente ou de seu responsável, pois não é proibida a manifestação de vontade do paciente testemunha de Jeová ao recusar transfusão sanguínea para si e seus dependentes, mesmo em emergências.

Abstract Background and objectives: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. Content: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. Conclusions: The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden.

Objetivo Avaliar a provisão de duas configuracōes do Labirinto Elevado em Cruz (LEC) através do comportamento exploratório de ratas Wistar em diferentes fases do ciclo estral (CE) em LEC com diferentes gradientes de luminosidade entre os braços aberto e fechado (A/F∆Lux).Método Ratas Wistar foram tratadas com Midazolam (MDZ, 1.0 mg.kg-1) e foram testadas no LEC 10 A/F∆Lux ou LEC 96 A/F∆Lux.Resultados A análise de regressão múltipla indicou que o A/F∆Lux está negativamente associado com a % de entrada no braço aberto e % de tempo no braço aberto, sugerindo que no aumento do A/F∆Lux, a exploração do braço aberto diminui. A fase do CE não influenciou a exploração do braço aberto no LEC. A ansiólise induzida pelo MDZ foi demonstrada no 96 LEC A/F∆Lux em todas as fases do CE.Discussão Estes resultados sugerem a importância do A/F∆Lux para estabelecer a preferência da exploração do LEC e preservar a validade do LEC.

Objective This study evaluated the provision of two configuration of the Elevated Pluz-Maze (EPM) by analizing the exploratory behaviour of female Wistar rats in different phases of the estrous cycle in EPMs with different gradients of luminosity between the open and enclosed arms (O/E∆Lux).Methods Female Wistar rats were treated with Midazolam (MDZ, 1.0 mg.kg-1) and were tested for their exploratory behaviour in either the EPM 10 O/E∆Lux or EPM 96 O/E∆Lux.Results A multiple regression analysis indicated that the O/E∆Lux is negatively associated with the %Open arm entries and %Open arm time, suggesting that as O/E∆Lux increases, the open arm exploration decreases. The estrous cycle phase did not influence the open-arm exploration in either EPM. MDZ- induced anxiolysis was detected in 96 O/E∆Lux EPM in all phases of the EC.Discussion Results of this study suggest the importance of the O/E∆Lux to establish the arm preference in the EPM, and to preserve the predictive validity of the EPM.

A avaliação cervical e intracraniana é uma etapa importante no AVC isquêmico (AVCi) agudo. Objetivo Comparar o uso do ultrassom neurovascular (USNV) com técnica padronizada e a angiografia digital (AD) em paciente com AVCi agudo no diagnóstico de doença arterial significativa extra e/ou intracraniana. Método Pacientes com AVCi e AIT admitidos em até 12 horas do início dos sintomas foram retrospectivamente avaliados. Todos os pacientes foram submetidos a USNV e AD padronizado em até 120 horas da admissão. Resultados Vinte e quatro pacientes foram incluídos no estudo. Em comparação com a AD, o USNV apresentou sensibilidade de 94,7% e especificidade de 100% para o diagnóstico de doença arterial significativa extra e/ou intracraniana. Conclusão O uso de técnica padronizada de USNV demonstrou elevada sensibilidade e especificidade para o diagnóstico de doença arterial significativa extra e intracraniana quando comparado a AD.

Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS). Objective Compare the use of the neurovascular ultrasound examination (NVUE) to digital subtraction angiography (DSA) in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy. Method Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission. Results Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy. Conclusion The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients.

OBJETIVO: Avaliar o tamanho do efeito do tratamento com prednisona oral na bronquite eosinofílica na asma por meio de revisão sistemática e meta-análise. MÉTODOS: Revisão sistemática de artigos nas bases de dados do Medline, Cochrane Controlled Trials Register, EMBASE e LILACS. Foram selecionados estudos que preencheram os seguintes critérios: comparar ao menos dois grupos ou dois momentos (prednisona vs. controle, prednisona vs. outra droga ou pré vs. pós-tratamento com prednisona) e avaliar parâmetros antes e depois do uso de prednisona, incluindo eosinófilos, proteína catiônica eosinofílica (PCE) e IL-5 no escarro - com ou sem valores de VEF1 pós-broncodilatador - com os IC95% correspondentes ou com dados suficientes para calculá-los. As variáveis independentes foram uso e dose de prednisona e duração do tratamento. Os desfechos avaliados foram eosinófilos, IL-5 e PCE no escarro, bem como VEF1 pós-broncodilatador. RESULTADOS: A análise conjunta dos dados de pré e pós-tratamento revelou uma redução significativa nas médias de eosinófilos no escarro (↓8,18%; IC95%: 7,69-8,67; p < 0,001), IL-5 no escarro (↓83,64 pg/mL; IC95%: 52,45-114,83; p < 0,001), PCE no escarro (↓267,60 μg/L; IC95%: 244,57-290,93; p < 0,001), assim como um aumento significativo na média de VEF1 pós-broncodilatador (↑8,09%; IC95%: 5,35-10,83; p < 0,001). CONCLUSÕES: Em pacientes com bronquite eosinofílica de moderada a grave, o tratamento com prednisona determinou uma redução significativa nos níveis de eosinófilos no escarro, assim como nos níveis de IL-5 e PCE no escarro. Essa redução na resposta inflamatória foi acompanhada de um aumento significativo do VEF1 pós-broncodilatador.

OBJECTIVE: To evaluate the effect size of oral corticosteroid treatment on eosinophilic bronchitis in asthma, through systematic review and meta-analysis. METHODS: We systematically reviewed articles in the Medline, Cochrane Controlled Trials Register, EMBASE, and LILACS databases. We selected studies meeting the following criteria: comparing at least two groups or time points (prednisone vs. control, prednisone vs. another drug, or pre- vs. post-treatment with prednisone); and evaluating parameters before and after prednisone use, including values for sputum eosinophils, sputum eosinophil cationic protein (ECP), and sputum IL-5-with or without values for post-bronchodilator FEV1-with corresponding 95% CIs or with sufficient data for calculation. The independent variables were the use, dose, and duration of prednisone treatment. The outcomes evaluated were sputum eosinophils, IL-5, and ECP, as well as post-bronchodilator FEV1. RESULTS: The pooled analysis of the pre- vs. post-treatment data revealed a significant mean reduction in sputum eosinophils (↓8.18%; 95% CI: 7.69-8.67; p < 0.001), sputum IL-5 (↓83.64 pg/mL; 95% CI: 52.45-114.83; p < 0.001), and sputum ECP (↓267.60 µg/L; 95% CI: 244.57-290.63; p < 0.0001), as well as a significant mean increase in post-bronchodilator FEV1 (↑8.09%; 95% CI: 5.35-10.83; p < 0.001). CONCLUSIONS: In patients with moderate-to-severe eosinophilic bronchitis, treatment with prednisone caused a significant reduction in sputum eosinophil counts, as well as in the sputum levels of IL-5 and ECP. This reduction in the inflammatory response was accompanied by a significant increase in post-bronchodilator FEV1.

OBJETIVO: Examinar a relação entre refluxo gastroesofágico (RGE) e exacerbações da DPOC. MÉTODOS: Foi realizada uma revisão sistemática de artigos publicados até dezembro de 2012 utilizando várias bases de dados. Os critérios de elegibilidade incluíram estudos sobre DPOC, exacerbações da DPOC e RGE que comparavam ao menos dois grupos (DPOC vs. controle ou RGE vs. controle) e descrevendo riscos relativos (RRs), razões de prevalência ou ORs e respectivos IC95% (ou com dados que permitissem o seu cálculo) para a associação entre RGE e DPOC, assim como taxas de exacerbações. Os dados foram coletados com um formulário padronizado que incluía o tipo de estudo; critérios para diagnóstico de RGE; idade e gênero dos participantes; número de participantes; método de randomização; escores de gravidade; métodos de avaliação dos sintomas de RGE; critérios de definição de exacerbação; taxa de exacerbações (hospitalizações, visitas à emergência, consultas não programadas, uso de prednisona e uso de antibióticos); sintomas de RGE no grupo DPOC vs. controles; média de exacerbações da DPOC (com sintomas vs. sem sintomas); frequência anual de exacerbações; tratamento para RGE; e gravidade da obstrução. RESULTADOS: O RGE foi claramente identificado como um fator de risco para exacerbações da DPOC (RR = 7,57; IC95%: 3,84-14,94), com um aumento na média de exacerbações por ano (diferença média: 0,79; IC95%: 0,22-1,36). Houve uma prevalência significativamente maior de RGE em pacientes com DPOC do que naqueles sem DPOC (RR = 13,06; IC95%: 3,64-46,87; p < 0,001). CONCLUSÕES: O RGE é um fator de risco para exacerbações da DPOC. O papel do RGE no manejo da DPOC deve ser mais profundamente investigado.

OBJECTIVE: To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations. METHODS: We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction. RESULTS: Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001). CONCLUSIONS: GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.