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.

Evaluation of Physiology Teaching Methods in Chandrapur Government Medical College

Background: The primary goal of medical education is to produce quality doctors and not just quantity. Heightened focus on the quality of teaching in the new medical college has led to increased use of student surveys as a means of evaluating teaching. Aim: This study was undertaken to evaluate various teaching methods and skills adopted by a teacher in Physiology lectures by first year MBBS students of two successive batches admitted in newly established Chandrapur Government Medical College. Methods: A pre-validated questionnaire consisting of 18 questions was given to 100 first year medical students of first two successive batches towards the end of their academic year and feedback was taken in the form of selecting the most appropriate option applicable (OPTION: A = Always, M = Most Often, S = Sometimes, N = Never). Total numbers of A, M, S and N were calculated and given 3, 2, 1 and 0 marks for every A, M, S and N circled respectively. Maximum possible score was 54. 45 to 54 marks – Exceptional teaching skills, 30 to 44 marks – Superior teaching skills, 15 to 29 marks – Average teaching skills, 0 to 14 marks – Room for improvement. Results: In the first batch, maximum score was given for having clarity with the concepts and being audible, using simple language and audio-visual aids and explaining them their errors and how better they can perform. In second batch, apart from this, maximum score was given for relating the topic with their lives, giving examples, summarizing the concepts, asking them to answer questions, applying information in solving problems, encouraging them to learn in different ways, listening their comments, giving them feedback and finding out frequently whether every student has learnt the skills. Conclusion: Every medical teacher who delivers a lecture should make teaching meaningful with clarity in the concepts and audibility, promoting active learning by the students, understanding the individual differences, giving feedback at regular intervals and ensuring mastery in the subject.

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.

Association of schizophrenia and mental retardation with facio-scapulohumeral muscular dystrophy.

Three members of an Indian family with facio scapulohumeral dystrophy (FSHD linked to chromosome 4q35 with short EcoR1 segment of 23 Kb are reported where two male adults had schizophrenia. One family member developed isolated facial weakness with mild mental retardation. This genetically proven FSHD family is reported because of its uncommon associations.