ABSTRACT Backgrounds: Fortunately, much has been studied about COVID-19 in patients with inflammatory bowel diseases (IBD). Evidence suggests that these patients do not appear to be at increased risk of severe COVID-19. However, there are still some uncertainties regarding the clinical manifestations of COVID-19 in patients with immune-mediated diseases. Objective: This study aimed to describe the main symptoms of COVID-19 and their frequency in IBD patients and evaluate the impact of the IBD therapeutic drugs on clinical presentation of COVID-19 and to determine factors associated with COVID-19 in this population. Methods: Adult patients with IBD from three tertiary-care public, teaching hospitals in Ceará, Northeastern Brazil, were evaluated during one scheduled appointment from March to December 2020. Patients with possible or confirmed COVID-19 were compared with patients without COVID-19. Furthermore, incidences of each symptom were evaluated based on the use of IBD therapeutic drugs. Results: A total of 515 patients with IBD were included in the study: 234 with CD, and 281 with UC. Of these, 174 patients (34%) had possible/confirmed COVID-19 of whom 156 (90%) were symptomatic. Main symptoms were fever (65%) and headache (65%); gastrointestinal symptoms occurred in one third of patients and were higher than COVID-19 in general population. The factors associated with having COVID-19 were female gender (OR 1.71, 95%CI: 1.17-2.50); contact at home (OR 5.07, 95%CI: 3.31-7.78) and outside the home (OR 3.14, 95%CI: 2.10-4.71) with a case of COVID-19; work outside of the home (OR 1.87, 95%CI: 1.26-2.78); family history of COVID-19 (OR 2.29, 95%CI 1.58-3.33) use of salicylate (OR 1.71, 95%CI: 1.17-4.28); and asthma (OR 7.10, 95%CI: 1.46-34.57). Conclusion: IBD patients at high risk of COVID-19 infection may need to avoid salicylate therapy but further studies are necessary to confirm this association. Backgrounds Fortunately COVID19 COVID 19 COVID-1 IBD. . (IBD) COVID19. 19. However immunemediated immune mediated Objective population Methods tertiarycare tertiary care public Ceará Brazil 2020 Furthermore Results 51 23 CD 28 UC 17 34% 34 (34% possibleconfirmed 15 90% 90 (90% symptomatic 65% 65 (65% OR 171 1 71 1.71 95CI CI 95 1.172.50 117250 1.17 2.50 2 50 1.17-2.50) 507 5 07 5.07 3.317.78 331778 3.31 7.78 3 31 7 78 3.31-7.78 314 14 3.14 2.104.71 210471 2.10 4.71 10 4 2.10-4.71 187 87 1.87 1.262.78 126278 1.26 2.78 26 1.26-2.78) 229 29 2.29 1.583.33 158333 1.58 3.33 58 33 1.58-3.33 1.174.28 117428 4.28 1.17-4.28) 710 7.10 1.4634.57. 1463457 1.46 34.57 46 57 1.46-34.57) Conclusion association COVID1 COVID- (IBD 202 (34 9 (90 6 (65 1.7 172 1.172.5 11725 117 1.1 250 2.5 1.17-2.50 0 5.0 317 3.317.7 33177 331 3.3 778 7.7 3.31-7.7 3.1 104 2.104.7 21047 210 2.1 471 4.7 2.10-4.7 18 8 1.8 262 1.262.7 12627 126 1.2 278 2.7 1.26-2.78 22 2.2 583 1.583.3 15833 158 1.5 333 1.58-3.3 1.174.2 11742 428 4.2 1.17-4.28 7.1 4634 1.4634.57 146345 146 1.4 3457 34.5 1.46-34.57 20 (3 (9 (6 1. 1.172. 1172 11 25 2. 1.17-2.5 5. 3.317. 3317 3. 77 7. 3.31-7. 2.104. 2104 21 47 4. 2.10-4. 1.262. 1262 12 27 1.26-2.7 1.583. 1583 1.58-3. 1.174. 1174 42 1.17-4.2 463 1.4634.5 14634 345 34. 1.46-34.5 ( 1.172 1.17-2. 3.317 3.31-7 2.104 2.10-4 1.262 1.26-2. 1.583 1.58-3 1.174 1.17-4. 1.4634. 1463 1.46-34. 1.17-2 3.31- 2.10- 1.26-2 1.58- 1.17-4 1.4634 1.46-34 1.17- 1.26- 1.463 1.46-3 1.46-

RESUMO Contexto: Felizmente, muito se tem estudado sobre a COVID-19 em pacientes com doenças inflamatórias intestinais (DII). As evidências sugerem que esses pacientes não parecem ter risco aumentado de COVID-19 grave. Mas ainda se tem algumas incertezas com relação às manifestações clínicas da COVID-19 em portadores de doenças imunomediadas. Objetivo: Este estudo teve como objetivo descrever os principais sintomas da COVID-19 e sua frequência em pacientes com DII e avaliar o impacto dos medicamentos utilizados no tratamento das DII na apresentação clínica da COVID-19. Métodos: Pacientes adultos com DII de três hospitais públicos terciários de ensino do Ceará, Nordeste do Brasil, foram avaliados em consulta ambulatorial no período de março a dezembro de 2020. Pacientes com COVID-19 possível ou confirmada foram comparados com pacientes sem COVID-19. Além disso, as incidências de cada sintoma foram avaliadas com base no uso de medicamentos utilizados para tratamento da DII. Resultados: Foram incluídos no estudo 515 pacientes com DII: 234 com DC e 281 com RCU. Destes, 174 pacientes (34%) tinham COVID-19 possível/confirmado, dos quais 156 (90%) eram sintomáticos. Os principais sintomas foram febre (65%) e dor de cabeça (65%); sintomas gastrointestinais ocorreram em um terço dos pacientes, sendo mais frequentes do que na população geral com COVID-19. Os fatores associados a ter COVID-19 foram sexo feminino (OR 1,71, IC95%: 1,17-2,50); ter contato com caso de COVID-19, tanto intradomiciliar (OR 5,07; IC95%: 3,31-7,78) como fora do domicílio (OR 3,14; IC95%: 2,10-4,71); trabalhar fora de casa (OR 1,87; IC95%: 1,26-2,78); história familiar de COVID-19 (OR 2,29, IC95% 1,58-3,33), uso de salicilato (OR 1,71, IC95%: 1,17-4,28) e asma (OR 7,10; IC95%: 1,46-34,57). Conclusão: Pacientes com DII com alto risco de infecção por COVID-19 podem precisar evitar a terapia com salicilatos, mas mais estudos são necessários para confirmar esta associação. Contexto Felizmente COVID19 COVID 19 COVID-1 . (DII) grave imunomediadas Objetivo COVID19. 19. Métodos Ceará Brasil 2020 disso Resultados 51 23 28 RCU Destes 17 34% 34 (34% possívelconfirmado confirmado possível/confirmado 15 90% 90 (90% sintomáticos 65% 65 (65% OR 171 1 71 1,71 IC95 IC 1,172,50 117250 1,17 2,50 2 50 1,17-2,50) COVID19, 19, 5,07 507 5 07 3,317,78 331778 3,31 7,78 3 31 7 78 3,31-7,78 3,14 314 14 2,104,71 210471 2,10 4,71 10 4 2,10-4,71) 1,87 187 87 1,262,78 126278 1,26 2,78 26 1,26-2,78) 229 29 2,29 1,583,33, 158333 1,58 3,33 , 58 33 1,58-3,33) 1,174,28 117428 4,28 1,17-4,28 7,10 710 1,4634,57. 1463457 1,46 34,57 46 57 1,46-34,57) Conclusão salicilatos associação COVID1 COVID- (DII 202 (34 9 (90 6 (65 1,7 IC9 172 1,172,5 11725 117 1,1 250 2,5 1,17-2,50 5,0 0 317 3,317,7 33177 331 3,3 778 7,7 3,31-7,7 3,1 104 2,104,7 21047 210 2,1 471 4,7 2,10-4,71 1,8 18 8 262 1,262,7 12627 126 1,2 278 2,7 1,26-2,78 22 2,2 583 1,583,33 15833 158 1,5 333 1,58-3,33 1,174,2 11742 428 4,2 1,17-4,2 7,1 4634 1,4634,57 146345 146 1,4 3457 34,5 1,46-34,57 20 (3 (9 (6 1, 1,172, 1172 11 25 2, 1,17-2,5 5, 3,317, 3317 3, 77 7, 3,31-7, 2,104, 2104 21 47 4, 2,10-4,7 1,262, 1262 12 27 1,26-2,7 1,583,3 1583 1,58-3,3 1,174, 1174 42 1,17-4, 463 1,4634,5 14634 345 34, 1,46-34,5 ( 1,172 1,17-2, 3,317 3,31-7 2,104 2,10-4, 1,262 1,26-2, 1,583, 1,58-3, 1,174 1,17-4 1,4634, 1463 1,46-34, 1,17-2 3,31- 2,10-4 1,26-2 1,583 1,58-3 1,17- 1,4634 1,46-34 2,10- 1,26- 1,58- 1,463 1,46-3 1,46-

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.

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.

Abstract INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.