PANORAMA DAS INTERNAÇÕES POR GASTROENTERITE AGUDA: UM PERFIL EPIDEMIOLÓGICO NO CONTEXTO BRASILEIRO

INTRODUCTION: Acute gastroenteritis represents a significant challenge for public health, given its high incidence and impact on the population's quality of life. Brazil reveals a worrying incidence of the disease, with significant regional variations and disproportionate impacts on certain population groups. OBJECTIVE: To evaluate the epidemiological profile in Brazil, from 2019 to 2024, according to the number of hospitalizations recorded per year, according to age, gender, age group, and list of morbidities. METHODOLOGY: This is a qualitative and quantitative study, of a cross-sectional and descriptive nature, of epidemiological data on hospitalizations for gastroenteritis, in Brazil from 2019 to 2024. The data were obtained through the SUS Information System (DATASUS).RESULTS: 426,736 hospitalizations for acute gastroenteritis were reported, with the highest rate in 2019, with (n=119,306) 27.9%, and the lowest rate in 2021 with (n=71411) 59%. The most affected region was the Northeast region with (218,794) 51% of cases and the least affected region was the Central-West region with (n=27,435) 6.4% of cases. Among the most registered infections caused by specific pathogens, amoebiasis is found (n=3881) 0.9%. The highest prevalence was in early childhood aged 1-4 years, (n=91,466) 21.4% and the lowest prevalence was in adolescence, aged 10-14 years, with (n=20,970) 4.9%. Furthermore, females represent (n=217,444) 50.9% of cases.CONCLUSION: Gastroenteritis is still a public health problem in Brazil, predominantly in the Northeast region, affecting more female children aged 1 to 4 years. Understanding these factors is essential to reduce the burden of gastroenteritis on the Brazilian healthcare system and improve the quality of life of the affected population.INTRODUCCIÓN: La gastroenteritis aguda representa un desafío importante para la salud pública, dada su alta incidencia e impacto en la calidad de vida de la población. Brasil revela una incidencia preocupante de la enfermedad, con importantes variaciones regionales e impactos desproporcionados en ciertos grupos de población. OBJETIVO: Evaluar el perfil epidemiológico en Brasil, de 2019 a 2024, según el número de hospitalizaciones registradas por año, según edad, sexo, grupo etario y listado de morbilidades. METODOLOGÍA: Se trata de un estudio cualitativo y cuantitativo, de carácter transversal y descriptivo, de datos epidemiológicos sobre hospitalizaciones por gastroenteritis, en Brasil, en el período de 2019 a 2024. Los datos fueron obtenidos a través del Sistema de Información SUS (DATASUS).RESULTADOS: Se reportaron 426.736 hospitalizaciones por gastroenteritis aguda, siendo la tasa más alta en 2019, con (n=119.306) 27,9%, y la tasa más baja en 2021 con (n=71411) 59%. La región más afectada fue la región Nordeste con (218.794) el 51% de los casos y la región menos afectada fue la región Centro-Oeste con (n=27.435) el 6,4% de los casos. Entre las infecciones más registradas causadas por patógenos específicos, se encuentra la amebiasis (n=3881) con un 0,9%. La mayor prevalencia fue en la primera infancia de 1 a 4 años, (n=91.466) 21,4% y la menor prevalencia fue en la adolescencia, de 10 a 14 años, con (n=20.970) 4,9%. Además, las mujeres representan (n=217.444) el 50,9% de los casos.CONCLUSIÓN: La gastroenteritis sigue siendo un problema de salud pública en Brasil, predominantemente en la región Nordeste, afectando más a niñas de 1 a 4 años. Comprender estos factores es esencial para reducir la carga de la gastroenteritis en el sistema de salud brasileño y mejorar la calidad de vida de la población afectada.INTRODUÇÃO: A gastroenterite aguda representa um desafio significativo para a saúde pública, dada sua alta incidência e impacto na qualidade de vida da população. O Brasil revela uma preocupante incidência da doença, com variações regionais significativas e impactos desproporcionais em determinados grupos populacionais. OBJETIVO: Avaliar o perfil epidemiológico no Brasil, de 2019 a 2024, de acordo com o número de internações registradas por ano, conforme idade, gênero, faixa etária, e lista de morbidades. METODOLOGIA: Trata-se de um estudo   qualitativo   e   quantitativo, de   caráter   transversal   e   descritivo,  dos   dados epidemiológicos  de internações por gastroenterite,  no Brasil de 2019 a 2024. Os  dados foram obtidos através do Sistema de Informática  do SUS (DATASUS). RESULTADOS: Foram notificadas 426.736 internações por gastroenterite aguda, com maior índice no ano de 2019, com (n=119.306) 27,9%, e menor índice em 2021 com (n=71411) 59%. A região mais acometida foi a região Nordeste com (218.794) 51% dos casos e a menos acometida região Centro-Oeste com (n=27.435) 6,4% dos casos. Das infecções por patógenos específicos mais registrados encontra-se a amebíase com (n=3881) 0,9%. A maior prevalência foi na primeira infância dos 1-4 anos, (n=91.466) 21,4% e a menor prevalência na adolescência, dos 10-14 anos, com (n=20.970) 4,9%. Ademais, o sexo feminino representa (n=217.444) 50,9% dos casos. CONCLUSÃO: A gastroenterite ainda é um problema de saúde pública no Brasil, predominantemente na região Nordeste, acometendo mais crianças de 1 a 4 anos, do sexo feminino. A compreensão desses fatores é essencial para reduzir a carga da gastroenterite no sistema de saúde brasileiro e melhorar a qualidade de vida da população afetada

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status