The use of serum alkaline phosphatase as a choledocholithiasis marker to mitigate the cost of magnetic resonance cholangiography.

OBJECTIVE: To assess the predictive value of preoperative serum laboratory test results for identifying choledocholithiasis and reduce the use of cholangioresonance and its inherent costs. METHODS: Patients aged 21-69 years who underwent preoperative cholangioresonance examination at our institute were included. Patients with a history of fluctuating jaundice or biliary pancreatitis, bile duct dilatation on ultrasonography, and elevated levels of canalicular enzymes (alkaline phosphatase >100U/L and gamma-glutamyl transferase >50U/L) underwent cholangioresonance-guided surgery. Cases of choledocholithiasis confirmed by cholangioresonance were compared with those without choledocholithiasis. Serum laboratory data were evaluated and the diagnostic capabilities of these examinations were analyzed. RESULTS: A total of 104 patients were included. For detecting choledocholithiasis using alkaline phosphatase, the cut-off point was 78U/L, sensitivity was 97.6% (95%CI: 87.4-99.9), and specificity was 72.6% (95%CI: 59.8-83.1). In the binary logistic regression analysis, age (OR= 0.92; 95%CI: 0.86-0.98) and alkaline phosphatase level (OR= 1.02; 95%CI: 1.01-1.05) were selected for the final model. CONCLUSION: Serum alkaline phosphatase levels may aid preoperative diagnosis of asymptomatic choledocholithiasis. After a global clinical assessment of the patient, serum laboratory findings may contribute to a reduction in cholangioresonance-related heathcare costs.

The use of serum alkaline phosphatase as a choledocholithiasis marker to mitigate the cost of magnetic resonance cholangiography

ABSTRACT Objective To assess the predictive value of preoperative serum laboratory test results for identifying choledocholithiasis and reduce the use of cholangioresonance and its inherent costs. Methods Patients aged 21-69 years who underwent preoperative cholangioresonance examination at our institute were included. Patients with a history of fluctuating jaundice or biliary pancreatitis, bile duct dilatation on ultrasonography, and elevated levels of canalicular enzymes (alkaline phosphatase >100U/L and gamma-glutamyl transferase >50U/L) underwent cholangioresonance-guided surgery. Cases of choledocholithiasis confirmed by cholangioresonance were compared with those without choledocholithiasis. Serum laboratory data were evaluated and the diagnostic capabilities of these examinations were analyzed. Results A total of 104 patients were included. For detecting choledocholithiasis using alkaline phosphatase, the cut-off point was 78U/L, sensitivity was 97.6% (95%CI: 87.4-99.9), and specificity was 72.6% (95%CI: 59.8-83.1). In the binary logistic regression analysis, age (OR= 0.92; 95%CI: 0.86-0.98) and alkaline phosphatase level (OR= 1.02; 95%CI: 1.01-1.05) were selected for the final model. Conclusion Serum alkaline phosphatase levels may aid preoperative diagnosis of asymptomatic choledocholithiasis. After a global clinical assessment of the patient, serum laboratory findings may contribute to a reduction in cholangioresonance-related heathcare costs.

Management of inflammatory bowel diseases in urgent and emergency scenario / Manejo das doenças inflamatórias intestinais na urgência e emergência

Abstract 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.

Análise das ligas acadêmicas de medicina sob a perspectiva dos alunos / Analysis of academic medical leagues from the students' perspective

Objetivo: analisar as ligas acadêmicas de medicina (LAM) estruturadas e em funcionamento em instituição de ensino superior como estratégias de ensino e aprendizagem, considerando o perfil e verificar se as atividades promovidas pelas LAM estão alinhadas com a medicina baseada em evidências. Métodos: estudo descritivo, do tipo transversal, aprovado pelo Comitê de Ética da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora. Participaram como sujeitos da pesquisa estudantes do último ano de medicina e médicos recém-formados no ano de 2018. Essa amostragem não probabilística teve como finalidade a avaliação da influência das LAM na formação médica. Resultados: oito (5,9%) entrevistados não participaram de qualquer LAM. Observou-se que 31 (24,2%), 49 (38,3%) e 38 (29,7%) participaram de uma, duas ou três LAM, respectivamente. A maioria participou de LAM do terceiro ao oitavo período, porém em todos os períodos houve participação de algum aluno. Para 50 (39,1%) entrevistados, as LAM ajudaram de alguma forma para confirmar a escolha da área da residência, já para 53 (41,4%) deles, elas ajudaram na exclusão da área para a residência. Nota-se, ainda, que 117 (91,4%) dos que participaram de LAM acharam a experiência válida para a formação acadêmica. Conclusões: a maior parte dos alunos atualmente participam de ligas; há enorme interesse em participar de diretoria de LAM e estágios extracurriculares; as LAM contribuem para a escolha da futura especialidade; os estudantes veem neces-sidade na regulamentação das LAM; a avaliação global é de que a experiência é válida para a formação médica. O tema ligas acadêmicas é de enorme relevância atualmente em virtude da extensa participação dos estudantes nessas atividades. A educação em saúde visa compreender a importância dessas entidades para garantir o maior êxito possível no ensino, na pesquisa e na extensão.

Aims: the objective was to analyze the structured and functioning of academic medical leagues (AML) in higher education institution as teaching and learning strategies, considering the profile and to verify if the activities promoted by the AML are aligned with the evidence-based medicine. Methods: descriptive, cross-sectional study, approved by the Ethics Committee of the Faculty of Medical and Health Sciences of Juiz de Fora. Medical students and newly graduated physicians participated in the research in 2018. This non-probabilistic sampling aimed to evaluate the influence of AML on medical education. Results: eight respondents did not participate in AML (5.9% of the sample). 31 (24.2%), 49 (38.3%) and 38 (29.7%) participated in one, two or three AML, respectively. Most participated in AML from the third to the eighth period, but in all periods, there was participation. For 50 (39.1%) of respondents, the AML helped in some way to confirm the choice of area of residence, while for 53 (41.4%) of them, AML helped to exclude the area for residence. It is also noted that 117 (91.4%) of those who participated in AML found the experience valid for academic education. Conclusions: thus, most students currently participate in leagues; There is tremendous interest in attending AML board and extracurricular internships; AML contribute to the choice of future specialty; Students needs AML regulation; The overall assessment is that experience is valid for medical education. The academic leagues theme is of enormous relevance today because of the extensive participation of students in these activities. Health education aims to understand the importance of these entities to ensure the greatest possible success in teaching, research, and extension.

Dyslipidemia in Adolescents Seen in a University Hospital in the city of Rio de Janeiro/Brazil: Prevalence and Association / Dislipidemia em Adolescentes Atendidos em um Hospital Universitário no Rio de Janeiro/Brasil: Prevalência e Associação

Abstract Background: Early exposure to obesity favors greater risks of cardiovascular factors such as dyslipidemia. Objectives: To establish the prevalence of dyslipidemia, and to evaluate its association with nutritional status of the adolescents attended at the ambulatory of the Adolescent Health Studies Center of the University Hospital Pedro Ernesto. Methods: This is a cross-sectional, observational study, the sample of which was of convenience, consisting of adolescents from 12 to 18 years old of both genders. The lipid profile was evaluated, along with its association with the anthropometric indicators: body mass index and waist circumference. For statistical analysis, a significance level of 5% was used. Results: A total of 239 adolescents, 104 boys (43.5%) and 135 girls (56.5%) were evaluated and, of these, 52 (21.8%) were eutrophic, 60 (25.1%) overweight, and 127 (53.1%) obese. Obeseadolescents had significantly lower mean values of HDL-cholesterol (44.7 mg/dl vs 53.9 mg/dl; p < 0.001) and higher triglycerides (109.6 mg/dl vs 87.3 mg/dl; p = 0.01). The changes with higher prevalence were low HDL-cholesterol (50.6%), hypercholesterolemia (35.1%), and hypertriglyceridemia (18.4%). A negative association of HDL-cholesterol with body mass index and a positive association of triglycerides with body mass index could be observed, even after adjustment for gender and skin color. Conclusion: This study demonstrated high prevalence of dyslipidemia among adolescents. In view of the significant association between lower levels of HDL-cholesterol and increased triglycerides with overweight, the control of these factors should receive attention, with the precocious diagnosis of the dyslipidemia being important, mainly if it is associated with another cardiovascular risk, to develop effective intervention strategies.

Resumo Fundamentos: Exposição precoce à obesidade favorece maiores riscos de fatores cardiovasculares como dislipidemias. Objetivos: Estabelecer a prevalência de dislipidemia e avaliar sua associação com o estado nutricional de adolescentes atendidos no ambulatório de atenção secundária do Núcleo de Estudos da Saúde do Adolescente do Hospital Universitário Pedro Ernesto. Métodos: Estudo transversal observacional, cuja amostra foi de conveniência e compreendeu adolescentes de 12 a 18 anos de ambos os sexos. Avaliado o perfil lipídico e sua associação com os indicadores antropométricos: índice de massa corporal e circunferência da cintura. Para as análises estatísticas foi utilizado nível de significância de 5%. Resultados: Foram avaliados 239 adolescentes, 104 meninos (43,5%) e 135 meninas (56,5%) e destes, 52 (21,8%) apresentaram eutrofia, 60 (25,1%) sobrepeso e 127 (53,1%) obesidade. Os adolescentes com obesidade apresentaram valores médios de HDL-colesterol significativamente menores (44,7 mg/dl vs. 53,9 mg/dl; p < 0,001) e triglicerídeos maiores (109,6 mg/dl vs. 87,3 mg/dl; p = 0,01). As alterações com maior prevalência foram HDL-colesterol baixo (50,6%), hipercolesterolemia (35,1%) e hipertrigliceridemia (18,4%). Foi possível observar associação negativa do HDL-colesterol com o índice de massa corporal e associação positiva dos triglicerídeos com o índice de massa corporal, mesmo após ajuste para gênero e cor da pele. Conclusão: Este estudo demonstrou alta prevalência de dislipidemia entre os adolescentes. Tendo em vista a associação significativa entre baixos níveis de HDL-colesterol e triglicerídeos aumentados com excesso de peso, o controle destes fatores deve receber atenção, sendo importante o diagnóstico precoce da dislipidemia principalmente se associada a outro risco cardiovascular, para desenvolvimento de estratégias de intervenção.

Ligas acadêmicas na educação médica: uma análise institucional sob a visão dos orientadores / Academic leagues in medical education: an institutional analysis under the guiding view

Introdução: As ligas acadêmicas de medicina (LAM) surgiram no Brasil no início do século XX como reuniões de alunos, na necessidade de combate à alta prevalência dos agravos de saúde pela tuberculose e pela hanseníase. Na década de 90, a criação de novas LAMs permitiu um ambiente de discussão e prática de atividades em área de saúde de interesse de um conjunto de alunos e foi, assim, ganhando cada vez mais espaço na formação médica. Todavia, ainda são poucas as evidências científicas que discutem as finalidades e contribuições das LAMs durante a graduação, seja do ponto de vista do aluno ou do orientador. Objetivo: Estudar o perfil das ligas acadêmicas do curso de medicina de uma instituição de ensino da cidade de Juiz de Fora ­ MG. Material e Métodos: Trabalho de natureza descritiva e transversal que teve como instrumento de pesquisa questionário estruturado com 12 perguntas fechadas, previamente definidas, que foi respondido pelos orientadores das LAMs. Resultados: Em 2018, havia na instituição 36 ligas oficialmente constituídas com 37 orientadores. Quanto a frequência de encontros, os mesmos são majoritariamente mensais (78,4%) e 78,4% contam com a participação dos orientadores. Quanto à participação científica, 70,3% fazem discussão de artigos científicos, 62,2% possuem práticas extra-curriculares, 10,8% realizaram projetos de extensão e 13,5% têm trabalhos vinculados ao Programa de Iniciação Científica. Ressalta-se que a percepção dos orientadores é que 56,8% dos alunos participam para pontuação em programas de residência médica. Finalmente, 89,2% consideram o modelo de gestão adequado. Conclusão: A percepção dos orientadores é importante para a análise das ligas de forma a garantir melhorias principalmente para a educação e extensão. Somente com a descrição e estudo da situação atual será possível imprimir sugestões e avanços nessa questão, que já é tema central dentro da educação médica.

Introduction: The academic leagues of medicine (LAM) emerged in Brazil at the beginning of the twentieth century as student meetings, in order to combat the high prevalence of health problems caused by tuberculosis and leprosy. In the 1990s, the creation of new LAMs allowed for an environment of discussion and practice of health activities of interest to a group of students and was thus gaining more and more space in medical education. However, there is still little scientific evidence to discuss the purposes and contributions of LAMs during undergraduate studies, either from the student's or the advisor's point of view. Objective: To investigate the profile of academic leagues by the medical course of an educational institution in the city of Juiz de Fora - MG. Material and Methods: This study has a descriptive and cross-sectional nature and had as its instrument a structured questionnaire with 12 previously defined closed questions, which was answered by the LAM advisors. Results: In 2018 there were 36 officially constituted leagues in the institution with 37 mentors. As for the frequency of meetings, they are mostly monthly (78.4%), and 78.4% have the participation of counselors. As for scientific participation, 70.3% discuss scientific articles, 62.2% have extra-curricular practices, 10.8% have Extension Projects and 13.5% have papers linked to the Scientific Initiation Program. It is noteworthy that the perception of counselors is that 56.8% participate for scoring in medical residency programs. Finally, 89.2% consider the management model appropriate. Conclusion: Guidance perception is important for league analysis in order to ensure improvements especially for education and extension. Only with the description and study of the current situation will it be possible to print suggestions and advances in this issue, which is already a central theme within medical education.