A histopathological observation made on cystic kidneys obtained from human cadavers

Introduction: Cysts in the kidneys have been described as being heterogeneous, and occur due to hereditary,developmental and acquired disorders. They account for 6-8% of diseases that go for dialysis. Evaluating cysticdiseases is important for pathological diagnosis and treatment procedures for the patient.Objective: Present study aimed at finding the types of cysts prevalent in human cadaveric kidneys by making ahistopathological observation. The study was made to review the incidence of cysts in kidneys and to find outwhat are the commonest types of cysts that are identified.Material and Methods: Thirty formalin fixed adult cadavers were used for the study. Twenty were male and tenwere female cadavers used for routine dissection and teaching purposes for the first year medical students in thedepartment of Anatomy, P.E.S Institute of Medical Sciences and Research. The kidneys were dissected out from thecadavers from both sides. The fat and fascia were removed carefully and first photographed for gross appearance,before handing the specimens to the department of pathology for further study by making sections.Results: Cystic kidneys were seen in seven cadavers out of the thirty cadavers. The other cadavers had no cystickidneys. The incidence of cysts has been calculated in this study as 23.3%. The normal kidneys were 76.6%. Inthree female cadavers unilateral cysts were seen in the right kidney. In male cadavers, one had unilateral cystand the remaining three presented with bilateral cystic kidneys. One among the four showed multiple bilateralcysts ranging from one to forty five cysts.Conclusion: From this study it is evident that cysts of the kidney may occur without disturbing the normalfunctioning of the kidneys. The incidence of multiple cysts was more in males than in females. No of cysts weremore in the right than in the left kidneys. For a person to lead a normal life one fifth of the kidney is sufficient ifit functions normally.

Where does the change begin?

The book Healers or Predators? Healthcare Corruption in India edited by Samiran Nundy, Keshav Desiraju and Sanjay Nagral is a compilation of 41 essays covering a broad array of topics of central concern to India’s health system. As the title of the book suggests, at the core is corruption in medical practice, defined by most authors as “abuse of entrusted power for private gain,” a concern that has been engaging attention in the media and public discourse, albeit in a limited manner.

Author's response: Need to make health central to the development dialogue

This is in reference to the book review “India’s health system: No lessons learned” by Sunil K Pandya, published online in IJME on August 30, 2017. Before responding to the review, a clarification may be in order. The book Do We Care? India’s Health System is not an autobiography. It neither lists out my achievements nor explains my failures. It only records my understanding of the evolution of India’s health system over the years and provides an insider’s perceptions on how policies are made in the corridors of power.

Morphological Study of Origin of Profunda Femoris Artery in Human Cadavers.

Background: Profunda femoris artery is an important and largest branch of femoral artery. It supplies all the compartments of the thigh as well as it supply the head and neck of femur and its branches form anastomosis around head of femur. So, the study of variation of profunda femoris artery is of great value for radiologist and surgeon during diagnostic and surgical intervention. Materials and Methods: The present study includes 102 lower limbs of adult formalin fixed human cadavers used for the routine dissection procedure for under graduate and post graduate students in the department of Anatomy of three medical college in Karnataka, India over a period of 3 years (2011-2014).The study was done by dissection method as per Cunningham’s manual of Practical Anatomy. Results: During the study, it was found that profunda femoris artery was originating abnormally from the femoral artery. Out of 102 limbs that were studied, 47 limbs (46.07%) originated from posterolateral aspect, 20 limbs (19.60%) on lateral aspect, 11 limbs (10.78%) on medial aspect, 24 limbs (23.52%) on posterior aspect of femoral artery. High origin of profunda femoris artery (0- 10 mm) from femoral artery (distance from the midpoint of inguinal ligament) was seen in 2 limbs. Conclusion: In the present study, we found the different types of variations in the origin of profunda femoris artery from femoral artery and also the variation in the distance of origin. Surgeon and radiologist should consider this variation in mind during vascular invasion and surgeries in femoral region.

Two-year treatment outcomes of patients enrolled in India’s national first-line antiretroviral therapy programme.

Background. We aimed to analyse treatment outcomes of patients receiving first-line antiretroviral therapy (ART) through the national AIDS control programme of India. Methods. Using routinely collected programme data, we analysed mortality, CD4 evolution and adherence outcomes over a 2-year period in 972 patients who received first-line ART between 1 October 2004 and 31 January 2005 at 3 government ART centres. Cox regression analysis was used to identify independent predictors of mortality. Results. Of the 972 patients (median age 35 years, 66% men), 71% received the stavudine/lamivudine/nevirapine regimen. The median CD4 count of enrolled patients was 119 cells/cmm (interquartile range [IQR] 50–200 cells/ cmm) at treatment initiation; 44% had baseline CD4 count <100 cells/cmm. Of the 927 patients for whom treatment outcomes were available, 71% were alive after 2 years of treatment. The median increase in CD4 count was 142 cells/ cmm (IQR 57–750 cells/cmm; n=616) at 6 months and 184 cells/cmm (IQR 102–299 cells/cmm; n=582) at 12 months after treatment. Over 2 years, 124 patients (13%) died; the majority of deaths (68%) occurred within the first 6 months of treatment. Those with baseline CD4 count <50 cells/cmm were significantly more likely to die (adjusted hazard ratio 2.5, 95% confidence interval 1.3–3.2) compared with patients who had baseline CD4 count >50 cells/cmm. Over the 2-year period, 323 patients (35%) missed picking up their monthly drugs at least once and 147 patients (16%) were lost to follow up. Conclusion. Survival rates of HIV-infected patients on first-line ART in India were comparable with those from other resource-limited countries. Most deaths occurred early and among patients who had advanced disease. Earlier initiation of HIV treatment and improving long term treatment adherence are key priorities for India’s ART programme.