Analysis of the epidemiological profile of patients actively registered in the ostomy care service in Juiz de Fora / Análise do perfil epidemiológico dos pacientes cadastrados ativamente no serviço de ostomias de Juiz de Fora

AIM: Population-based study on the profile of ostomized patients attended by a specialized service in the city of Juiz de Fora, Brazil. METHOD: This retrospective, cross-sectional study was based on a descriptive epidemiological model. A total of 2,406 medical records of patients registered between 1988 and 2016 were analyzed and only the records of active patients (alive, not having undergone reconstruction) were selected (507 cases). The analyzed variables were gender, age, type of stoma, and the disease that led to the need for a stoma. Statistical analyzes were performed using SPSS software, version 20.0. RESULTS: Stomata were observed in 265 male patients (52.3% of the cases). The age varied from a range of 0 to 98 years. The colostomy corresponded to 63.7% of the cases. Ileostomy was the second most common type of stoma (27%) and then the urostomy (6.5%) was the third. The main causes for stoma creation were colorectal cancer (CRC) with 59.8% of cases, bladder cancer (5.9%) and others less prevalent, such as intestinal obstruction, diverticular disease, volvulus, peritonitis, colorectal injury, and inflammatory bowel disease. CONCLUSION: Colostomy was the most frequent type and the highest prevalence of stomata that was observed in males. The age group of the most ostomized patients was between the fourth and eight decade. CRC was the main cause of a diverting stoma creation. The services of ostomized care with competent and efficient multidisciplinary teams play an important rolefor the user can overcome the possible limitations of an intestinal or urinary stoma.

CARACTERIZAÇÃO DA DEMANDA DE UMA UNIDADE DE SAÚDE ATRAVÉS DO AGENDAMENTO PROGRAMADO

Demanda programada (DP) é aquela agendada previamente, ou seja, toda ação requerida antes da consulta, sendo um importante instrumento quando se trata de um serviço que compõe a rede de Atenção Primária pautada em ações preventivas

Management of inflammatory bowel diseases in urgent and emergency scenario

Objective: To review the main acute complications of inflammatory bowel disease in order to present the state of the art of their respective diagnosis and treatment. Methods: A bibliographic search was conducted in Medline database using the following keywords: “inflammatory bowel disease”, “Colitis Ulcerative”, “Crohn Disease”, “emergency” among others that had their variation evaluated by the MESH. Articles from the last 10 years conducted with humans, written in Portuguese or English, and published in journals with impact factor greater than 1 were selected. Results: After carrying out the search phrase and selecting the filters, 20 articles were selected to be included in the research. The most common acute complications were evaluated, focusing on their current propaedeutic and management aspects. Conclusion: Most emergencies related to inflammatory bowel disease should be treated non-operatively firstly, prioritizing patient hemodynamic state. In selected cases of life-threatening complications emergent operative treatment are mandatory. The timing of procedure is the most important aspect. As general rule, in Crohn’s Disease, operative treatment should be postponed as much as possible and the resection as small as possible. In case of ulcerative rectocolitis, if the hemodynamic state of the patient allows, proctocolectomy should be expedited with curative intention. Resumo: Objetivo: Revisar as principais complicações agudas das doenças inflamatórias intestinais, a fim de apresentar o estado da arte de seus respectivos diagnósticos e tratamentos. Métodos: Foi realizada uma pesquisa bibliográfica no banco de dados Medline, utilizando as seguintes palavras-chave: “doença inflamatória intestinal”, “Colite Ulcerativa”, “Doença de Crohn”, “emergência” entre outras que tiveram sua variação avaliada pelo MESH. Artigos dos últimos 10 anos realizados com seres humanos, escritos em português ou inglês, e publicados em periódicos com fator de impacto maior que um foram selecionados. Resultados: Após a construção da frase de pesquisa e seleção dos filtros, 20 artigos foram selecionados para inclusão no estudo. As complicações agudas mais comuns foram avaliadas, enfocando seus atuais aspectos propedêuticos. Conclusão: A maioria das emergências relacionadas à doença inflamatória intestinal deve ser tratada primariamente de forma não cirúrgica, priorizando a hemodinâmica do paciente. Em casos selecionados de complicações potencialmente fatais, tratamento cirúrgico de emergência é mandatório. O momento do procedimento é o aspecto mais importante. Como regra geral, na Doença de Crohn, o tratamento cirúrgico deve ser adiado ao máximo com ressecção menor possível. No caso de retocolite ulcerativa, se o estado hemodinâmico do paciente permitir, a proctocolectomia deve ser realizada com intenção curativa. Keywords: Inflammatory bowel diseases, Emergencies, Complications, Palavras-chave: Doença inflamatória intestinal, Emergências, Complicaçõe