Ultrasound for thigh muscle thickness is a valuable tool in the diagnosis of sarcopenia in Indian patients with predialysis chronic kidney disease

Objectives@#Patients with chronic kidney disease (CKD) are known to develop sarcopenia, an agingrelated disorder, with low muscle mass, strength and physical performance. Ultrasound-derived thigh muscle and rectus femoris thickness (TMT and RFT) can be measured easily in clinical practice, but need validation for use in predialysis CKD (stages III through V) for muscle mass estimation. The study aims to compare ultrasound-derived TMT and RFT with bioelectrical impedance analysis (BIA)-derived muscle mass estimation in the diagnosis of sarcopenia in predialysis CKD. @*Methods@#Patients with stable CKD stage III, IV, V and not yet on dialysis were recruited, and underwent anthropometric assessment, BIA and ultrasound examination of midthigh region. Appendicular skeletal muscle index (ASMI)/height2 derived from BIA was taken as a standard for the diagnosis of low muscle mass. Gait speed and handgrip were also measured. The Asian Working Group criteria were applied. Cutoff values for low muscle mass by TMT and RFT were obtained using receiver operator curve (ROC) analysis. @*Results@#Of the total of 117 enrolled study participants, 52 (45%) had low muscle mass, 34 (29%) had sarcopenia, of whom 79% were male, majority (38%) were CKD stage IV and had a mean age of 58 years. Using ROC analysis, TMT cutoffs of 19 mm in males and 17 mm in females were computed. Comparison of TMT cutoffs and ASMI/h2 showed good agreement between the 2 methods using Bland-Altman plots. @*Conclusions@#Ultrasound-derived TMT and RFT can be used for muscle mass estimation in the diagnosis of sarcopenia.

Needle guides enhance tissue adequacy and safety of ultrasound-guided renal biopsies

BACKGROUND: Needle guides have recently come into use for ultrasound-guided percutaneous renal biopsies; however, it is not yet clear if the use of needle guides leads to decreased post-biopsy complication rates and improved tissue yields. Thus, we conducted a retrospective single center study comparing biopsy yield, adequacy, and rates of complications before and after utilization of a needle guide device. METHODS: A retrospective analysis was performed on all native kidney biopsies performed before and after June 2015 corresponding to the start of needle guide use. All biopsies in the latter period of the study were performed by a single operator. We compared clinical characteristics, indications, type of investigation, tissue yield, adequacy of procedure, and rates of major and minor complications. RESULTS: A total of 343 biopsies were analyzed, 140 in the pre-needle guide use period (Period I) and 203 in the needle guide use period (Period II). Biopsy yields were similar, irrespective of the use of needle guides. Tissue adequacy was better in Period II (93.7% vs. 84%, P < 0.001, with respect to pathologist-reported inconclusive biopsies. There were no differences in terms of major complications (1.7%) for the two periods; however, the rate of minor complications (8.4%) was significantly reduced in Period II (P = 0.006). According to multiple logistic regression analysis, not using a needle guide (odds ratio, 3.70; P < 0.001) along with low hemoglobin level, higher pre-dialysis serum creatinine level, and high urinary red blood cell count were significant predictors of biopsy complications. CONCLUSION: Use of a needle guide improves biopsy adequacy and is associated with reduced rates of minor complications in native renal biopsies. Therefore, needle guides may be recommended in percutaneous renal biopsies, especially when transitioning to single-operator performed procedures.

Cheiloscopy as an additional forensic parameter : a review

@#Criminal activities involving human life always puts lives at stake. Newer advances in other fields especially medicine and dentistry is essential in solving the mysteries of death. Different disciplines insert a part of the puzzle until it is complete. Fingerprints, DNA profiling, Forensic anthropology are commonly employed in personnel identification, mass disasters and others. Investigators may also rely on lip prints to identify possible suspects or to support evidence gained in specific investigations. A lip print at scene of crime can be the basis for inference as to the number of people involved, gender, habits, occupational traits, and others, based on the pathological changes present. This review deals with lip prints and their possible acquisition and usage.

Recurrent Arterial Thrombosis as a Presenting Feature of a Variant M3-Acute Promyelocytic Leukemia

Acute limb ischemia (ALI) is a common vascular emergency. Hematologic malignancies are commonly associated with derangement of normal hemostasis and thrombo-hemorrhagic symptoms during the course of the disease are common. However, ALI as an initial presenting feature of acute leukemia is rare. Due to the rarity of this presentation, there is a scarcity of prospective randomized data to optimally guide the management of these patients. Current knowledge is mainly based on isolated cases. We report our experience managing a patient who presented with ALI and was found to have occult leukemia. A review of all cases with ALI as a presenting feature of acute leukemia is also presented.

A peculiar liver with surgically and radiologically important variations: a case report / 대한해부학회지

A peculiar liver was found in an adult male cadaver during a dissection class for undergraduate medical students. The quadrate lobe and fissure for the ligamentum teres were totally absent. Thus, the cystic notch on the inferior border was very broad and deep, and the fundus and body of the gall bladder popped out through this notch. The cystic duct terminated into the right hepatic duct at the porta hepatis instead of terminating into the common hepatic duct. Awareness of variations of the lobes and fissures may minimize a misdiagnosis of liver problems. The aim of the current study was to alert radiologists and surgeons about possible variations in the external appearance and anomalies of the lobes and fissures of the liver.

Rare Presentation of a Rare Disease (Erdheim-Chester disease): A Case Report

Erdheim-Chester disease (ECD) was first reported by J. Erdheim and W. Chester, in 1930. There are less than 250 reported cases till date. We report a case of ECD in a 16- year-old Malay male, who initially presented with elusive anemic symptoms with more specific symptoms of bony pain, cardiorespiratory and hepatic involvement evolving as the disease progressed.

Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated?

The objective of this study was to estimate the incidence of the Meckel's diverticulum [MD] and to study its clinical profile and surgical outcome, as well as to check whether diverticulectomy is indicated for asymptomatic MD in adults. This is a prospective study of 1332 patients who were operated upon for acute abdomen during the period August 1999 to July 2009 in a single surgical unit. Preoperative abdominal ultrasonography and plain x-ray abdomen [erect] were done depending on the necessity. These patients were subjected to laparotomy/ appendicectomy depending on the case. A search for MD was done, and if found, surgical resection and analysis by histopathological confirmation of the resected MD were performed. During the operation, this study detected 15 [1.13%] patients with MD. In none of these cases, preoperative diagnosis of Meckel's diverticulitis was made. The age of the patients ranged from 18 to 68 years [mean age, 32.9 years]. Out of 15 patients, 0 [60%] were males; 6 [40%] were females. Seven [46.7%] cases were symptomatic due to MD and 8 [53.3%] were asymptomatic. One patient presented with hematochezia; 2, with intestinal obstruction due to gangrene of the MD; and 4, with Meckel's diverticulitis. One patient had duplication of [double] Meckel's diverticulum without any inflammation in both the diverticulae. Histopathological examination of these specimens confirmed 4 cases with inflammation; 2, with gangrene; and 1, with ulcerated gastric mucosa in the MD. Among these, in 2 [13.3%] cases there was heterotopic epithelium [ulcerated gastric mucosa- 1, colonic mucosa- 1]. We recommend that a search for MD in every case of appendicectomy / laparotomy done for acute abdomen should be conducted, and if found, Meckel's diverticulectomy or resection should be performed to avoid secondary complications arising from it

Serum paraoxonase 1 activity status in patients with liver disorders

Paraoxonase 1 [PON1] is an esterase, exclusively synthesized by liver. The present study has two objectives: to determine the PON1 activity status in various disorders associated with hepatocellular damage and to correlate the changes of PON1 activity with the standard liver function and fasting lipid profile tests in these disorders. The study groups consisted of 95 patients with liver diseases including acute viral hepatitis [14], cirrhosis with portal hypertension [33], leptospirosis [14], sepsis and multi organ failure [15], left ventricular failure [9], and falciparum malaria [10]; and 53 healthy controls. Serum PON1 activity was measured manually using spectrophotometer. Liver function test parameters and fasting lipid profile were performed in clinical chemistry auto analyzer [HITACHI 912]. The serum PON1 activity in patients with acute viral hepatitis and sepsis decreased significantly [P<0.001] and moderately in falciparum malaria [P<0.05]. However, in patients with cirrhosis, leptospirosis and left ventricular patients, its activity did not change significantly. On applying Pearson correlation, serum PON1 activity correlated positively with high-density lipoprotein-cholesterol [HDL-C] in patients with sepsis [r=0.633, P<0.05], left ventricular failure patients [r=0.814, P<0.05] and negatively with acute viral hepatitis patients [r=-0.528, P<0.05]. PON1 activity has decreased significantly in acute viral hepatitis, sepsis with multi organ failure and falciparum malaria patients. Determination of PON1 activity may serve as a useful additional test in assessing these conditions

Transfer of moisture through the unsaturated zone in the tropical forest using the neutron probe

Knowledge of moisture content is crucial in assessing spatial and temporal movement of water through the unsaturated zone. Moisture storage is also important for monitoring the soil water balance and for validation of water balance models. The purpose of this work was to determine and analyse moisture content profiles at point locations in the unsaturated zone of a lateritic soil around Nsimi, south of Cameroon. Neutron probe has been connected to a set of tensiometers in an area of 60 ha. A comparative study between a site covered with vegetation and a site uncovered was conducted to assess the influence of vegetation in the process of moisture transfers. The results showed that the spatial distribution of moisture profiles varied according to the site and the texture of the soil, with in general increasing of moisture from the surface horizon toward the deeper layers. The mean values of moisture varied from theta m= 0,397 cm[3]/cm[3] on barren site, against theta m= 0,429 cm[3]/cm[3] in vegetation. Values of suction were generally strong in surface and at depth, but weak in the intermediate layers

Treatment with Centalla asiatica [Linn] fresh leaf extract enhances learning ability and memory retention power in rats

To investigate the role of Centella asiatica [CeA] fresh leaf extract treatment on the behavior, especially learning and memory, of adult rats. Adult rats [2.5 months old] were fed with 2, 4, and 6 ml/kg body of fresh leaf extract of CeA for 2, 4, and 6 weeks. After the treatment period the rats were subjected to spatial learning [T-Maze] and passive avoidance tests along with age matched normal and saline control rats. The data were compared with those of age matched control rats. The study was conducted at the Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India between December 2001 and February 2005. The rats treated with a higher dose [6 ml] of CeA showed improvement in spatial learning performance, namely, increased [p<0.001] number of alternations and decreased [p<0.001] percentage bias during spontaneous alternation test and increased [p<0.001] percentage bias during rewarded alternation test. They also showed enhanced memory retention power, namely, less [p<0.001] time spent in the small compartment during the retention period of passive avoidance test. This indicates that treatment with higher doses of CeA fresh leaf extract enhances learning ability and memory retention power in adult rats

Biliary Ascariasis

Ascariasis is a common parasitic infestation, it is usually asymptomatic, and is diagnosed either by accidental finding of ascaris eggs on stool examination, or by the patient reporting passage of pencil like structures with stool, but sometimes it might present with more sinister problems like intestinal obstruction, in heavy infestation, biliary involvement with related complications like obstructive jaundice, cholecystitis or cholangitis. In this article we report a case of biliary ascariasis presented as a case of chronic abdominal pain

Risk factors of acute watery diarrhea

This was aprospective, descriptive sutdy conducted at the pediatrics Unit of the Civil Hospital, Karachi. The period of the study was from October 1,1995 to July 30, 1997. The objective was to determine the risk factors in acute watery diarrhea, which led to persistent diarrhea. 50 children with compaints of acute watery diarrhea of less than 15 days duration, coming to the pediatrics Out Patient Department and Emergency between 2 months and 5 years of age were enrolled in one group. 50 children with watery diarrhea of 15 days or more were enrolled in the second group. The various factors were studies/d in both the groups. Results show that children with persistent diarrhea were younger than children with acute diarrhea. [Mean values of 14.7 months as compared to 20.18 months]. The male to female distribution was almost the same in both the groups. There was past history of measles in 10 as compared to 4 children, use of non-human milk in 5:4 children and recent introduction of this milk with in the last 3 months in 23 as compared to 6 children in the group with persistent diarrhea as compared to acute diarrhea. Patients with severe dehydration, PCM and post-diarrhea distention are more likely to develop persistent diarrhea

Balloon valvuloplasty and angioplasty for congenital and acquired heart defects in children

Rubio and Limon Lason described a technique of dilatation of stenotic pulmonary and tricuspid valves in 1954; a decade later, Dotter and Judkins described a technique of balloon dilatation of atherosclerotic lesions. Balloon dilatation techniques were revived in the mid-1970s when Gruntzig and associates dilated coronary artery stenosis. Similar techniques have also been used in dilating stenotic lesions in renal, iliac, and femoral arteries. More recently, balloon dilatation techniques have been applied in infants and children to relieve congenital, acquired, and postoperative stenotic lesions. Although the initial description of balloon valvuloplasty is by a pullback or dynamic technique as suggested by Rubio and Limon Lason in 1954 and by Semb and his associates in 1979, a static dilatation technique, as described by Kan and her associates, is commonly used. The purpose of this review is to present the state-of-the-art of balloon dilatation of stenotic lesions in infants, children, and adolescents; personal experience with balloon dilatation in approximately 150 infants, children, and adolescents, including our previous publications and that reported in literature will be utilized as supportive material

Pregnancy and sickle cell haemoglobinopathies in Bahrain

In order to determine the significant factors which may contribute to complications in pregnant Bahraini mothers with sickle cell haemoglobinopathy, a study was conducted in 100 consecutive unselected mothers [35 SS and 65 AS] and the results were compared with 200 control women with a normal haemoglobin electrophoretic pattern. The incidence of vaso-occlusive crisis was significant in mothers with sickle cell disease belonging to low socioeconomic groups. Furthermore, it was observed that high levels of fetal haemoglobin did not have any beneficial effect in patients with sickle cell disease during the vaso-occlusive episodes

Relief of coarctation of the aorta without thoracotomy: the experience with percutaneous balloon angioplasty

The purpose of this paper is to present our experience with percutaneous balloon angioplasty [PBA] for coarctation of the aorta [COA]. The children between the ages of one month and 11 years [mean age 18 months] underwent PBA during an eight-month period ending September 1985. Numbers 5 to 9 French catheters with 5-to 15-mm balloons were used, depending upon the size of the angiographically measured coarcted segment and the aorta proximal to COA. The peak inflation pressure used in the balloons varied from 4 to 8 atmospheres of pressure and the duration of inflation was 8 to 15 seconds. At least four balloon dilatations were performed in every case. Following PBA for COA, descending aortic pressure rose from 86.4 +/- 17.7 to 107.8 +/- 20 [p< 0.02] and the peak systolic pressure gradient across the COA fell from 44.1 +/- 19.1 to 8.5 +/- [p< 0.001]. Increase in the angiographically measured coarcted segment, decrease in Doppler estimate of coarctation gradient, and improvement in the femoral pulses also occurred. No significant complications were encountered. PBA for COA is a safe and effective alternative to surgical coarcttectomy. It may become the procedure of choice for treatment of coarctation of the aorta favorable long-term results are documented