CLINICAL AND EPIDEMIOLOGICAL EVALUATION OF COMPLICATIONS ASSOCIATED WITH GALLSTONES IN A TERTIARY HOSPITAL.

BACKGROUND: Gallstones are the presence of bile clay in the gallbladder or bile ducts. The disease can be asymptomatic or symptomatic and can lead to complications and consequently a worse prognosis, such as acute cholecystitis, choledocholithiasis, cholangitis, and acute pancreatitis. The risk of complications increases after the first episode of biliary colic. OBJECTIVE: A clinical-epidemiological evaluation of patients admitted to a gastroenterology ward of a tertiary care hospital with gallstone-related complications. METHODS: We evaluated 158 patients admitted through discharge reports and medical records analysis from January 1, 2013, to February 24, 2021. RESULTS: The female sex was predominant (76.6%), and the mean age of patients was 51.6 years. Men were significantly older than women (P=0.005). Most (57.6%) had some comorbidity, the most frequent being systemic arterial hypertension, diabetes mellitus, and obesity. The mean hospitalization time was 24 days, significantly longer in men (P=0.046) but without a direct relationship with age (P=0.414). The most frequent complication was choledocholithiasis, and 55.7% of patients without previous cholecystectomy had a report of biliary colic before admission, on average 1.5 years previously. A history of a prior cholecystectomy was present in 17.1% of those evaluated. Abdominal ultrasonography followed by magnetic resonance cholangiography was the most frequently performed exam for diagnostic definition. Regarding therapeutic measures, endoscopic retrograde cholangiopancreatography was necessary for 47.3% of patients without previous cholecystectomy and 81.4% of patients who have already had a cholecystectomy. Among patients not yet cholecystectomized, 84% underwent the procedure before discharge. CONCLUSION: The female patients were predominant. Men were significantly older than women and had more extended hospital stays. The most frequent complication was choledocholithiasis, and around half of the patients reported previous biliary colic. endoscopic retrograde cholangiopancreatography has been necessary for the majority of the patients.

Avaliação clínica-epidemiológica de complicações associadas à litíase biliar em um hospital terciário / Clinical and epidemiological evaluation of complications associated with gallstones in a tertiary hospital

ABSTRACT Background: Gallstones are the presence of bile clay in the gallbladder or bile ducts. The disease can be asymptomatic or symptomatic and can lead to complications and consequently a worse prognosis, such as acute cholecystitis, choledocholithiasis, cholangitis, and acute pancreatitis. The risk of complications increases after the first episode of biliary colic. Objective: A clinical-epidemiological evaluation of patients admitted to a gastroenterology ward of a tertiary care hospital with gallstone-related complications. Methods: We evaluated 158 patients admitted through discharge reports and medical records analysis from January 1, 2013, to February 24, 2021. Results: The female sex was predominant (76.6%), and the mean age of patients was 51.6 years. Men were significantly older than women (P=0.005). Most (57.6%) had some comorbidity, the most frequent being systemic arterial hypertension, diabetes mellitus, and obesity. The mean hospitalization time was 24 days, significantly longer in men (P=0.046) but without a direct relationship with age (P=0.414). The most frequent complication was choledocholithiasis, and 55.7% of patients without previous cholecystectomy had a report of biliary colic before admission, on average 1.5 years previously. A history of a prior cholecystectomy was present in 17.1% of those evaluated. Abdominal ultrasonography followed by magnetic resonance cholangiography was the most frequently performed exam for diagnostic definition. Regarding therapeutic measures, endoscopic retrograde cholangiopancreatography was necessary for 47.3% of patients without previous cholecystectomy and 81.4% of patients who have already had a cholecystectomy. Among patients not yet cholecystectomized, 84% underwent the procedure before discharge. Conclusion: The female patients were predominant. Men were significantly older than women and had more extended hospital stays. The most frequent complication was choledocholithiasis, and around half of the patients reported previous biliary colic. endoscopic retrograde cholangiopancreatography has been necessary for the majority of the patients.

RESUMO Contexto: A litíase biliar pode ser definida como a presença de cálculo ou barro biliar na vesícula e/ou nos ductos biliares. A doença pode ser assintomática ou sintomática, podendo levar a complicações e, consequentemente, a um pior prognóstico, como colecistite aguda, coledocolitíase, colangite e pancreatite aguda. O risco de complicações aumenta após o primeiro episódio de cólica biliar. Objetivo: Avaliação clínica-epidemiológica dos pacientes internados em enfermaria de gastroenterologia de um hospital terciário, com complicações relacionadas à litíase biliar. Métodos: Foram avaliados 158 pacientes internados no período de 1º de janeiro de 2013 a 24 de fevereiro de 2021, por meio de análise de relatório de alta e prontuário. Resultados: Houve uma predominância do sexo feminino (76,6%), e a média de idade dos pacientes foi de 51,6 anos. Homens eram significativamente mais velhos que as mulheres (P=0,005). A maioria (57,6%) apresentava alguma comorbidade, sendo as mais frequentes: hipertensão arterial sistêmica, diabetes mellitus e obesidade. A média de tempo de internação foi de 24 dias, sendo significativamente maior para os homens (P=0,046), mas sem relação direta com a idade (P=0,414). A complicação mais frequente foi a coledocolitíase, e 55,7% dos pacientes sem colecistectomia prévia apresentaram relato de cólica biliar antes da internação, em média, 1,5 anos antes. Histórico de colecistectomia prévia estava presente em 17,1% dos avaliados. Ultrassonografia abdominal, seguida de colangiorressonância magnética foram os exames complementares mais frequentemente realizados para definição diagnóstica. Em relação às medidas terapêuticas, a colangiopancreatografia endoscópica retrógrada (CPRE) foi necessária em 47,3% dos pacientes sem colecistectomia prévia e 81,4% dos pacientes com colecistectomia prévia. Dos pacientes ainda não colecistectomizados, 84% deles puderam ser submetidos ao procedimento antes da alta. Conclusão: Houve predomínio do sexo feminino. Os homens foram significativamente mais velhos do que as mulheres e tiveram uma permanência hospitalar consideravelmente mais longa. A complicação mais frequente foi a coledocolitíase, e cerca de metade dos pacientes relatou cólica biliar prévia. A CPRE foi necessária para a maioria dos pacientes.

Epidemiology of corneal transplantation before achieving the Zero Queue / Epidemiologia do transplante de córnea antes de atingir a Fila Zero

ABSTRACT Objective: To outline the epidemiological profile of cornea donors and recipients before reaching queue zero. Methods: Epidemiological study, of quantitative approach, with transversal, analytical design, analyzing database records from the Health Secretary of the State of Ceará, from 2013 to 2015. Results: We obtained 1,558 cornea donors and 2,287 cornea recipients from 2013 to 2015. Most donors were male, capital residents, from 21 to 40 years old. Of donated eyeballs, 14.52% were disposed, due to poor condition, infiltration or positive serology. The recipients were predominantly women over 60 years old. The procedures were mostly elective, due to bullous keratopathy (28%). Regarding emergency transplants, ulcer (38.51%) and retransplant (35.14%) were most prevalent. Predominantly, transplants were funded by the Unified Health System. Conclusion: The majority of patients who were submitted to corneal transplantation are senile, especially females, therefore should be cautiously observed. On the other hand, donors are mainly male and young, reflecting the high number of tragic accidents. The surgery for bullous keratopathy is the most frequent among elective transplants, while the ulcer surgery is the main cause of emergency procedures. The fact that most surgeries were financed by the Unified Health System reflects the importance of this system.

RESUMO Objetivo: Traçar o perfil epidemiológico dos doadores e receptores de córnea antes de atingir a Fila Zero. Métodos: Estudo epidemiológico, de abordagem quantitativa, com delineamento transversal e analítico, analisando registros da base de dados da Secretaria de Saúde do Estado do Ceará, de 2013 a 2015. Resultados: Foram obtidos 1.558 doadores de córnea e 2.287 receptores de córnea, de 2013 a 2015. A maioria dos doadores era homem, procedente da capital, de 21 a 40 anos. Dentre os globos oculares doados, 14,52% foram descartados por má condição, infiltração ou sorologia positiva. Os receptores eram predominantemente mulheres acima de 60 anos de idade. Os procedimentos foram majoritariamente eletivos, devido à ceratopatia bolhosa (28%). Já para transplantes de emergência, a úlcera (38,51%) e o retransplante (35,14%) foram os mais prevalentes. Em geral, os transplantes foram custeados pelo Sistema Único de Saúde. Conclusão: A maioria dos pacientes submetidos a transplantes de córnea foram do grupo etário senil, principalmente do sexo feminino, devendo esse grupo ser observado com cautela. Em contrapartida, os doadores eram, principalmente, homens e jovens, refletindo o alto número de pessoas que morrem devido a acidentes trágicos. A cirurgia de ceratopatia bolhosa foi a mais frequente dentre os transplantes eletivos; já a de úlcera foi a principal causa dos procedimentos de emergência. O fato de a maioria das cirurgias ter sido financiada pelo Sistema Único de Saúde reflete a importância desse sistema.