Rocuronium-Induced Dilated Nonreactive Pupils in a Patient With Coronavirus Disease 2019: A Case Report.

We report the clinical case of a patient with coronavirus disease 2019 (COVID-19) who had recently undergone neurosurgery and presented with dilated nonreactive pupils during continuous rocuronium infusion, which was reversible with the suspension of the drug. Both the neurosurgical procedure and possible disruption of the blood-brain barrier due to COVID-19 infection may have led to the action of rocuronium in the central nervous system (CNS). Thus, clinicians must remember that neuromuscular blocking agents (NMBAs) can cause dilated nonreactive pupils in patients with COVID-19.

Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country.

BACKGROUND: Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). METHODS: This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. RESULTS: Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96). CONCLUSIONS: Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.

External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs.

BACKGROUND: The performance of severity-of-illness scores varies in different scenarios and must be validated prior of being used in a specific settings and geographic regions. Moreover, models' calibration may deteriorate overtime and performance of such instruments should be reassessed regularly. Therefore, we aimed at to validate the SAPS 3 in a large contemporary cohort of patients admitted to Brazilian ICUs. In addition, we also compared the performance of the SAPS 3 with the MPM0-III. METHODS: This is a retrospective cohort study in which 48,816 (medical admissions = 67.9%) adult patients are admitted to 72 Brazilian ICUs during 2013. We evaluated models' discrimination using the area under the receiver operating characteristic curve (AUROC). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration). RESULTS: Mean SAPS 3 score was 44.3 ± 15.4 points. ICU and hospital mortality rates were 11.0 and 16.5%. We estimated predicted mortality using both standard (SE) and Central and South American (CSA) customized equations. Predicted mortality rates were 16.4 ± 19.3% (SAPS 3-SE), 21.7 ± 23.2% (SAPS 3-CSA) and 14.3 ± 14.0% (MPM0-III). Standardized mortality ratios (SMR) obtained for each model were: 1.00 (95% CI, 0.98-0.102) for the SAPS 3-SE, 0.75 (0.74-0.77) for the SAPS 3-CSA and 1.15 (1.13-1.18) for the MPM0-III. Discrimination was better for SAPS 3 models (AUROC = 0.85) than for MPM0-III (AUROC = 0.80) (p < 0.001). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration): the SAPS 3-CSA overestimated mortality throughout all risk classes while the MPM0-III underestimated it uniformly. The SAPS 3-SE did not show relevant deviations from ideal calibration. CONCLUSIONS: In a large contemporary database, the SAPS 3-SE was accurate in predicting outcomes, supporting its use for performance evaluation and benchmarking in Brazilian ICUs.

[Prevalence of alcoholism in the profile of disability retirement among employees of a federal university]. / Prevalência de alcoolismo no perfil das aposentadorias por invalidez dentre trabalhadores de uma universidade federal.

This study aimed to describe the causes of morbidity among servers retired for disability in a federal university; identify the socio-demographic and occupational profile of the retired for disability in general and for alcoholism; and make an association between these causes. This was a retrospective cross-sectional descriptive study; the population consisted of all servers retired for disability registered at the university. The total disability retirees was of 553 servers, especially in cases of retirement for psychiatric disorders (35.6%) as the leading cause of disability, and alcoholism led to the retirement of 9% of retirees. It was concluded that the highest percentage of disability retirement was composed of workers concentrated in the university hospital.

Prevalência de alcoolismo no perfil das aposentadorias por invalidez dentre trabalhadores de uma universidade federal / Prevalence of alcoholism in the profile of disability retirement among employees of a federal university / Prevalencia del alcoholismo en el perfil de las jubilaciones por invalidez entre los empleados de una universidad federal

O presente estudo teve como objetivos descrever as causas da morbidade dos servidores aposentados por invalidez em uma universidade federal; identificar o perfil sociodemográfico e ocupacional dos aposentados por invalidez geral e pelo alcoolismo; e fazer uma associação entre essas causas. Tratou-se de um estudo descritivo seccional retrospectivo, cuja população foi composta por todos os servidores aposentados por invalidez registrados na universidade. O total de aposentados por invalidez foi de 553 servidores, com destaque para os casos de aposentadoria por transtornos psiquiátricos (35,6%) como primeira causa de invalidez, sendo que o alcoolismo motivou a aposentadoria de 9% do total de aposentados. Concluiu-se que o maior percentual de aposentadoria por invalidez foi composto por trabalhadores lotados no hospital universitário.

This study aimed to describe the causes of morbidity among servers retired for disability in a federal university; identify the socio-demographic and occupational profile of the retired for disability in general and for alcoholism; and make an association between these causes. This was a retrospective cross-sectional descriptive study; the population consisted of all servers retired for disability registered at the university. The total disability retirees was of 553 servers, especially in cases of retirement for psychiatric disorders (35.6%) as the leading cause of disability, and alcoholism led to the retirement of 9% of retirees. It was concluded that the highest percentage of disability retirement was composed of workers concentrated in the university hospital.

El presente estudio tuvo como objetivos: describir las causas de la morbilidad de los empleados jubilados por discapacidad en una universidad federal; identificar el perfil sociodemográfico y laboral de los jubilados por discapacidad general y por alcoholismo; y hacer una asociación entre esas causas. Fue un estudio descriptivo, seccional y retrospectivo cuya población consistió de todos los empleados jubilados por discapacidad, inscriptos en la universidad. El total de jubilados por discapacidad fue de 553 servidores, como la se destacan los casos de jubilación por los trastornos psiquiátricos (35,6%) como la primera causa de discapacidad de las morbilidades como la siendo que un 9% de estos fueron jubilados por el alcoholismo. Se concluyó que el mayor porcentaje de jubilación por discapacidad ocurrió en los trabajadores del hospital universitario.

Drogas antitiroideanas no tratamento da doença de Graves / Antithyroid agents in the treatment of Graves' disease

Quando prescritas corretamente, as tionamidas, que sao drogas antitiroideanas - no Brasil existem o propilitiouracil (PTU) e o metimazol (MMI) -, sao capazes de controlar o hipertiroidismo em praticamente todos os casos. Ultimamente vem se intensificando a discussao se o tratamento com tionamidas deve ser feito com baixas ou altas doses, levando-se em conta a taxa de remissao a longo prazo e os índices de efeitos colaterais. Contudo nao há consenso em relaçao a baixas e altas doses de tais medicaçoes, bem como a associaçao com hormônio tiroideano na tentativa de diminuir a recidiva da doença. Estes sao os aspectos discutidos no presente artigo.