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.

Kaposi's sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital

Abstract: Background: Kaposi's sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi's sarcoma epidemic has increased as co-infection with HIV. Objectives: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. Methods: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi's sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. Results: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. Study limitations: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. Conclusion: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.

Motivações e expectativas dos calouros de medicina / Motivations and expectations of first-year students of medicine

Objetivo: descrever os fatores envolvidos na escolha dos calouros de Medicina da Universidade Federal do Pará (UFPA) pelo curso e as suas expectativas. Método: realizado um estudo descritivo e transversal, através da aplicação de questionário a 107 calouros de 2013. Resultados: foi verificado o predomínio do sexo feminino (52,8%), com a média de idade de 19,6±0,2 anos, sendo que um percentual expressivo apresentava renda menor do que 5 salários-mínimos (40,1%). Dentre os fatores que motivaram os calouros a escolher o curso de Medicina, os mais citados foram o desejo de ?Cuidar do próximo? (89,7%) e a ?Admiração pela profissão? (86%). Sobre as expectativas dos calouros quanto ao curso, a maioria declarou querer se tornar um profissional competente (89,7%), capaz de tratar enfermidades (89,7%) e ajudar os necessitados (83,2%).Conclusão: fatores de ordem ética, solidária e humanitária correspondem a um percentual importante dentre os motivos aos quais os alunos atribuem seu ingresso no curso de Medicina da UFPA, porém, vários outros fatores foram, também, identificados entre as expectativas dos calouros, sejam de caráter financeiro, capacitação técnica ou mesmo, reconhecimento social.

Objective: this study describes the reasons why first-year students of the Federal University of Pará Medical School chose that course and their expectations. Methods: a descriptive and transversal study was conducted through the ap-plication of a questionnaire to the 107 first-year medical school students of 2013.Results: there was a predominance of female students (52.8%), with an average age of 19.6±0.2 years. A significant number of students had a household income lower than five minimum wages (40.1%). The reasons that led these students to choose medical school were mostly the ?desire to care for others? (89.7%) and ?admiration for the profession? (86%) Most of them declared that they expect to become competent professionals (89.7%), who are able to treat illnesses (89.7%) and care for the needy (83.2%). Conclusion: ethical and humanitarian reasons represent a significant percentage of the motives students at-tribute to their choice of course; however, several other factors were identified among their expectations, including financial compensation, technical skills and social standing.