Epidemiological profile of elderly patients treated in the emergency room of a university hospital in Brazil

This study aims to describe demographic characteristics, hospitalization information and medical history, as well as to trace the epidemiological profile of elderly patients treated in the Emergency Room (ER) of the Hospital das Clínicas – UFG (HCUFG). It is a cross-sectional and descriptive study. Through the analysis of medical records, from January 2015 to July 2016, patients aged 60 years or more who remained in the ER for over 24 hours or died during this period were selected. Based on the medical records, the following variables were searched: sociodemographic aspects, symptomatic complaints, causes of hospital admission, complications during hospital stay, medical history (comorbidities and medications in use) and discharge conditions. From the 743 adult patients seen in the period, 29.87% were elderly, totaling 222 patients studied. The median age of the elderly assisted was 69 years old, with the majority being male. The main complaints referred to in the screening process were nausea and vomiting. Infection was the most frequent cause of hospitalization, and most of the patients evolved without complications. Hypertension and diabetes mellitus were the most prevalent comorbidities (65,77% e 43,24%, respectively). Approximately 41, 89% of the patients presented polypharmacy. The mean length of hospital stay was 4.9 days. During the period, 18, 47% died and 71.17% were discharged with improvement of their clinical condition. In general, the results were compatible with the literature. It is expected that this data contribute to national knowledge about elderly patients seen in the emergency medical services, which is important to develop more directed and resolutive clinical approaches.Este estudo objetiva descrever características demográficas, informações sobre internação e antecedentes médicos, bem como traçar o perfil epidemiológico de idosos atendidos no Pronto-Socorro (PS) do Hospital das Clínicas – UFG (HCUFG). Trata-se de um estudo transversal e descritivo. Através da análise de prontuários, de janeiro de 2015 a julho de 2016, foram selecionados pacientes com 60 anos ou mais, que permaneceram no PS por mais de 24 horas ou vieram à óbito neste período. Baseado nos prontuários, foram pesquisadas as seguintes variáveis: aspectos sociodemográficos, queixas sintomáticas, causas de internação, complicações durante a internação, antecedentes (comorbidades e medicamentos em uso) e condições de alta. Dos 743 pacientes adultos atendidos no período, 29,87% eram idosos, totalizando 222 pacientes estudados. A mediana de idade foi 69 anos, sendo a maioria do sexo masculino. As principais queixas referidas no processo de triagem foram náuseas e vômitos. Infecção foi a causa de internação mais frequente e a maioria dos pacientes evoluiu sem complicações. Hipertensão e diabetes mellitus foram as comorbidades mais prevalentes (65,77% e 43,24%, respectivamente). Aproximadamente 41, 89% dos pacientes apresentavam polifarmácia. A duração média da permanência no hospital foi 4,9 dias. No período, 18, 47% vieram a óbito e 71,17% receberam alta com melhora do quadro clínico. Em geral, os resultados do estudo foram compatíveis com a literatura. Espera-se que os dados desse estudo contribuam para o conhecimento nacional sobre pacientes idosos atendidos em serviços médicos de emergência, importante para o desenvolvimento de abordagens clínicas mais direcionadas e resolutiva

Hepatic alterations in severely obese patients: clinical-laboratory and histopatological evaluations before surgical treatment of obesity

A doença hepática gordurosa não-alcoólica (DHGNA) e a esteatohepatite (EHNA) são freqüentes nos obesos. O objetivo foi determinar a prevalência de DHGNA/EHNA e Síndrome Metabólica (SM) nos grandes obesos; definir preditores de EHNA; estabelecer critérios histológicos para o diagnóstico da EHNA. Avaliados 325 pacientes encaminhados à cirurgia bariátrica (IMC = 35 kg/m2), dos quais 146 foram submetidos à análise histológica; as variáveis clínicas e bioquímicas analisadas e correlacionadas com a histologia. A DHGNA ocorreu em 111 (76%) pacientes e a prevalência de EHNA, conforme critério histológico usado, em 25,3% a 55,5%; SM ocorreu em 57,2%. Os preditores da EHNA foram: SM; alterações glicêmicas; hipertrigliceridemia e HAS. Foram preditores de fibrose: idade acima de 30 anos e AST elevadaNonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) has been associated with obesity. Determine prevalence of NAFLD/NASH and metabolic syndrome (MS) in severe obesity; define clinical predictor of steatohepatitis; establish histological criteria necessary to diagnose NASH. Evaluation of 325 patients submitted to bariatric surgery (BMI = 35 kg/m2), among which 146 were submitted to histological analysis; variables clinical and biochemical were analyzed and correlated to histological characteristics. NAFLD occurred in 111 (76%) patients and NASH, according to histological criteria used, in 25.3% to 55.5%; MS was present in 57.2%. Predictors of NASH: MS; glycaemic alterations; hypertriglyceridaemia and high blood pressure (HBP). Predictors of fibrosis: age above 30 years and high AS

Changes in histological criteria lead to different prevalences of nonalcoholic steatohepatitis in severe obesity

The worldwide obesity epidemic contributes to the increasing incidence of a number of diseases, as nonalcoholic fatty-liver disease (NAFLD) and its most severe form, the nonalcoholic steatohepatitis (NASH). Data on the prevalence of NASH has varied from 18.5%4 to 69%43 in obesity, an unacceptable wide range. The aim of our study was to evaluate how prevalence of NASH is influenced by the different diagnostic histological criteria. Consecutive assessment of 325 obese patients referred for bariatric surgery (BMI ≥ 35 kg/m2), 146 of whose were submitted to histological analysis of the liver allowed the evaluation of the prevalence of NAFLD. Steatohepatitis was diagnosed histologically using 3 types of criteria: a) broad criteria, where steatosis was associated with at least 2 of the following parameters: any degree of lobular inflammatory infiltrate, hepatocellular ballooning and perisinusoidal/ perivenular fibrosis; b) restricted criteria, where the hepatocellular ballooning was of moderate or severe intensity; c) ultrarestricted criteria, which required perisinusoidal and/or perivenular fibrosis. NAFLD was present in 111 (76%) of the patients, and the prevalence of NASH was 25.3% when ultrarestricted criteria were used, 41.1% with restricted criteria and 55.5% with broad criteria. In conclusion, more accurate definition of the criteria for histological diagnosis of NASH should be required, so that further clinico-pathological studies may define the long-term progression of the disease and evaluate therapeutic strategies

Lipoma of the right atrium

The patient is a 54-year-old asymptomatic male with a tumor in the right atrium that was diagnosed on transesophageal echocardiography and confirmed as a lipoma of the right atrium on computerized tomography. The patient underwent surgical repair with extracorporeal circulation. The tumor was resected, and its base of implantation in the atrium was repaired with a flap of bovine pericardium. The diagnosis of lipoma was confirmed on histopathological examination. Locating of the tumor with the aid of transesophageal echocardiography was very useful in the strategy of cannulation of the venae cava for installation of the circuit of extracorporeal circulation. The patient had a good postoperative evolution

Encefalopatia hepática: relatório da 1º reunião monotemática da Sociedade Brasileira de Hepatologia

Hepatic encephalopathy (HE) is a functional disorder of the central nervous system (CNS) associated with liver failure, either end-stage chronic liver disease or fulminant hepatic failure. Its pathogenesis remains complex and poorly understood. In view of recent advances in the management of HE, the Brazilian Society of Hepatology endorsed a monothematic meeting regarding HE in order to gather experts in the field to discuss related data and to draw evidence-based recommendations concerning: management of HE and intracranial hypertension in FHF, treatment of episodic HE in cirrhosis, controversies in the management of EH including difficult to treat cases and diagnostic and treatment challenges for minimal HE. The purpose of this review is to summarize the lectures and recommendations made by the panel of experts of the Brazilian Society of Hepatology.A encefalopatia hepática (EH) é um distúrbio funcional do sistema nervoso central (SNC) associado à insuficiência hepática, de fisiopatologia multifatorial e complexa. Devido aos avanços no conhecimento sobre o manejo da EH na cirrose e na insuficiência hepática aguda (IHA), a diretoria da Sociedade Brasileira de Hepatologia (SBH) promoveu uma reunião monotemática acerca da fisiopatologia, diagnóstico e tratamento da EH, abordando aspectos controversos relacionados ao tema. Com a utilização de sistemática da medicina baseada em evidências, foram abordados o manejo da EH e da hipertensão intracraniana na IHA, o manejo da EH episódica na cirrose, as controvérsias no manejo da EH e a abordagem da EH mínima. O objetivo desta revisão é resumir os principais tópicos discutidos na reunião monotemática e apresentar recomendações sobre o manejo da síndrome votadas pelo painel de expertos da SBH