Qualitative and quantitative dermatoglyphics of chronic kidney disease of unknown origin (CKDu) in Sri Lanka.

BACKGROUND: Dermatoglyphics has been used widely in fields of medicine as a non-invasive diagnostic tool and an early assessment of risk for certain medical conditions. It reflects disturbances in fetal development during early prenatal weeks 14-22 when fingerprints develop. Dermatoglyphic asymmetry has been used to measure developmental instability during a specific period of human fetal development. Thus, the present study was planned to investigate whether digital and palmar dermatoglyphics of chronic kidney disease of unknown origin (CKDu) patients in Sri Lanka are different from healthy people. METHODS: A case control study was carried out among CKDu patients (90 males, 90 females) from a CKDu endemic area and gender-matched two control groups; one group from a CKDu endemic region (90 males, 90 females) and another group from a CKDu non-endemic region (90 males, 90 females). Dermatoglyphics were obtained using photographic methods. Both qualitative and quantitative dermatoglyphic variables were defined and analyzed according to standard criteria. Both directional (DA) and fluctuating asymmetry (FA) were assessed. RESULTS: Several qualitative dermatoglyphic variables had significant association with CKDu. The triradii a1 variable was less evident in palms of CKDu cases in both genders when compared to both control groups. The FA of pattern discordance (right vs left hands) between CKDu cases and control group were significant in several digits. The FA of the ridge count was found significant in several digits, and also significant for A-B ridge count and total ridge count. CONCLUSION: Based on these results, it is proposed that the mechanisms responsible for the development of CKDu might be associated with those responsible for FA observed in CKDu patients. Accordingly, a diagnostic tool based on FA could be developed for predicting risk prior to the development of CKDu.

Dermatoglyphics in kidney diseases: a review.

Kidney diseases are becoming a major cause of global burden with high mortality and morbidity. The origins of most kidney diseases are known, but for some the exact aetiology is not yet understood. Dermatoglyphics is the scientific study of epidermal ridge patterns and it has been used as a non-invasive diagnostic tool to detect or predict different medical conditions that have foetal origin. However, there have been a limited number of studies that have evaluated a dermatoglyphic relationship in different kidney diseases. The aim of this review was to systematically identify, review and appraise available literature that evaluated an association of different dermatoglyphic variables with kidney diseases. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The PubMed(®) (Medline), POPLINE, Cochrane Library and Trip Database and grey literature sources such as OpenGrey, Google Scholar, and Google were searched to earliest date to 17 April 2014. Of the 36 relevant publications, 15 were included in the review. Of these studies, there are five case reports, seven case series and three comparative studies. Possible association of dermatoglyphics with Wilms tumor (WT) had been evaluated in two comparative studies and one case series that found fewer whorls and a lower mean total ridge count (TRC). Another study evaluated adult polycystic kidney disease (APCD) type III that revealed lower TRC means in all cases. All other case series and case reports describe dermatoglyphics in various kidney disease such as acro-renal-ocular syndrome, potter syndrome, kabuki makeup syndrome, neurofaciodigitorenal syndrome, syndactyly type V, ring chromosome 13 syndrome, trisomy 13 syndrome and sirenomelia. It is evident that whorl pattern frequency and TRC have been used widely to investigate the uncertainty related to the origin of several kidney diseases such as WT and APCD type III. However, small sample sizes, possibly methodological issues, and discrepancy in the make up between cases and control groups limits interpretation of any significant findings. Future studies with proper protocol, adequate cases, and control groups may provide stronger evidence to resolve uncertainty related to the aetiology of kidney diseases.

Structural changes in pre-eclamptic and eclamptic placentas--an ultrastructural study.

OBJECTIVE: To determine the ultrastructural changes of the placenta in women with pre-eclampsia and eclampsia compared to the placenta of normotensive patients. STUDY DESIGN: Comparative descriptive study. PLACE AND DURATION OF STUDY: Obstetrics Unit of North Colombo Teaching Hospital, Ragama, Sri Lanka in 2004. METHODOLOGY: Placentae of 10 normotensive women and 10 hypertensive women with pre-eclampsia and eclampsia were studied. Morphological abnormalities in chorionic villi, cytotrophoblastic cells and basement membrane under electronmicroscope were detected. Findings were recorded and compared. RESULTS: Microvillous surface of many chorionic villi of hypertensive placentae showed a complex appearance with many distorted microvilli and frequent cytotrophoblast cells compared to normotensive placentae. The basement membrane of chorionic villi was more thickened in hypertensive placentae. Patchy necrosis with loss of microvilli and gross thinning of the syncytium with distorted microvilli were seen in terminal villi of placentae of women with eclampsia. In areas where the syncytium was absent, the cytotrophoblast cells showed numerous vacuolated mitochondria with loss of cristae, and few rough endoplasmic reticulum, lysosomes and glycogen deposits. An accumulation of electron dense amorphous substance and number of vacuolated mitochondria were concentrated in the cytoplasm of endothelial cells of fetal capillaries. CONCLUSION: Ultrastructural villous changes were found in the placentae of women with pre-eclampsia and eclampsia which are likely to influence adversely on placental function.

Course pattern of the muscular branch of the median nerve in Sri Lankans hand / Curso del patrón del ramo muscular del nervio mediano de la mano en sri lankenses

Transligamentous variant of the recurrent motor branch is having a higher risk of getting damage during both endoscopic and open carpal tunnel releases. The incidence of the transligamentous variant is about 7 percent to 80 percent world wide. This wide variation of the incidence could be due to the failure of identification of the distal edge of the flexor retinaculum from the obliquely oriented fascia that runs from the distal edge. We used two criteria to identify the distal edge; the abrupt change in the thickness of the flexor retinaculum and its colour change in cross section. The incidence of transligamentous variant is rare and the reported high incidence could be due to an error in identification of the distal edge of the flexor retinaculum as shown by Kosin (1998).

Las variantes transligamentosas del ramo motor recurrente tienen un mayor riesgo de recibir daños durante la endoscopía y liberación abierta del túnel carpiano. La incidencia de la variante transligamentosa es de, aproximadamente, 7 a 80 por ciento en todo el mundo. Esta amplia variación de la incidencia podría deberse a la falla en la identificación del borde distal del retináculo flexor de la fascia de orientación oblicua que va desde el borde distal. Hemos utilizado dos criterios para identificar el borde distal, el brusco cambio en el grosor del retináculo flexor y su cambio de color en la sección transversal. La incidencia de la variante transligamentosa fue rara y el informe de la alta incidencia podría deberse a un error en la identificación del borde distal del retináculo flexor, como lo demuestra Kosin (1998).

Microbiology of gallbladder bile in uncomplicated symptomatic cholelithiasis.

BACKGROUND: Few studies have assessed microflora and their antibiotic sensitivity in normal bile and lithogenic bile with different types of gallstones. METHODS: We performed a case control study of 70 bile samples (35 cholesterol and 35 pigment stones from 51 females and 19 males, aged 21-72 years with a median age of 37 years) from patients who underwent laparoscopic cholecystectomy for uncomplicated cholelithiasis, and 20 controls (14 females and 6 males, aged 33-70 years with a median age of 38 years) who underwent laparotomy and had no gallbladder stone shown by ultrasound scan. The bile samples were aerobically cultured to assess microflora and their antibiotic susceptibility. The procedures were undertaken under sterile conditions. RESULTS: Thirty-eight (54%) of the 70 patients with gallstones had bacterial isolates. Nine isolates (26%) were from cholesterol stone-containing bile and 29 isolates (82%) from pigment stone-containing bile (P=0.01, t test). Twenty-eight of these 38 (74%) bile samples were shown positive only after enrichment in brain heart infusion medium (BHI) (P=0.02, t test). The overall bacterial isolates from bile samples revealed E. coli predominantly, followed by P. aeruginosa, Enterococcus spp., Klebsiella spp. and S. epidermidis. There were no bacterial isolates in the bile of controls after either direct inoculation or enrichment in BHI. CONCLUSIONS: Bacterial isolates were found in pigment stone-containing bile. Non-lithogenic bile revealed no bacteria, showing an association between gallstone formation and the presence of bacteria in bile. Antibiotic sensitivity patterns of isolated organisms were similar irrespective of the type of stone.

Effects of placental infarctions on the fetal outcome in pregnancies complicated by hypertension.

OBJECTIVE: To determine the frequency of placental infarcts and its effects on the fetal outcome in pregnancies complicated by hypertension. STUDY DESIGN: Case control. PLACE AND DURATION OF STUDY: Obstetrics Unit of North Colombo Teaching Hospital, Ragama, Sri Lanka, from January 2003 to January 2004. PATIENTS AND METHODS: Placentae of 150 normotensive women and 200 hypertensive women were studied to detect the number of placentae with infarctions. Apgar score, birth weight and the head circumference of the newborns were measured and analyzed. RESULTS: The frequency of placental infarcts was significantly higher in hypertensive group (30%) compared to normotensive group (18.7%). An association between placental infarction and low Apgar score of the newborn was seen in the hypertensive group (p<0.001). The difference in the birth weight of the newborns in hypertensive and normotensive groups in relation to placental infarction was statistically significant (2.2 vs. 3.1 kg, p<0.001). A highly significant difference was observed in the head circumference of the newborns of hypertensive group compared to normotensive group in relation to placental infarctions (30.7 cm vs. 32.3 cm, p<0.001). CONCLUSION: The frequency of placental infarcts was higher in hypertensive women when compared to normotensives. Placental infarctions had an adverse effect on growth and development of the newborns. This information can be useful in planning and management of future pregnancies.

Hepaticocystic duct and a rare extra-hepatic "cruciate" arterial anastomosis: a case report.

INTRODUCTION: The variations in the morphological characteristics of the extra-hepatic biliary system are interesting. CASE PRESENTATION: During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis. CONCLUSION: Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.

A rare variant of the superficial ulnar artery, and its clinical implications: a case report.

The superficial ulnar artery is a rare variation of the upper limb arterial system that arises from the brachial or axillary artery and runs superficial to the muscles arising from the medial epicondyle 123. The incidence is about 0.7 to 7% 145. In our routine dissections we found a superficial ulnar artery, which crossed the cubital fossa superficial to the bicipital aponeurosis making it highly vulnerable to intra-arterial injection. This is a rare variation that every medical and nursing staff member should know about.