Examining the robustness of the obesity paradox in maintenance hemodialysis patients: a marginal structural model analysis.

BACKGROUND: The inverse association between body mass index (BMI) and mortality observed in patients treated with maintenance hemodialysis (MHD), also known as the obesity paradox, may be a result of residual confounding. Marginal structural model (MSM) analysis, a technique that accounts for time-varying confounders, may be more appropriate to investigate this association. We hypothesize that after applying MSM, the inverse association between BMI and mortality in MHD patients is attenuated. METHODS: We examined the associations between BMI and all-cause mortality among 123 624 adult MHD patients treated during 2001-6. We examined baseline and time-varying BMI using Cox proportional hazards models and MSM while considering baseline and time-varying covariates, including demographics, comorbidities and markers of malnutrition and inflammation. RESULTS: The patients included 45% women and 32% African Americans with a mean age of 61(SD 15) years. In all models, BMI showed a linear incremental inverse association with mortality. Compared with the reference (BMI 25 to <27.5 kg/m(2)), a BMI of <18 kg/m(2) was associated with a 3.2-fold higher death risk [hazard ratio (HR) 3.17 (95% CI 3.05-3.29)], and mortality risks declined with increasing BMI with the greatest survival advantage of 31% lower risk [HR 0.69 (95% CI 0.64-0.75)] observed with a BMI of 40 to <45 kg/m(2). CONCLUSIONS: The linear inverse relationship between BMI and mortality is robust across models including MSM analyses that more completely account for time-varying confounders and biases.

Assessment of Morphological Variations in Human Liver in Tertiary Healthcare Institute: A Cross Sectional Study in Maharashtra

Introduction: Liver is the largest gland of the body. Itis situatedunder the right dome of the diaphragm andmainlyoccupies the right hypochondriac and epigastricregions. In man, the liver is essentialfor survival since there iscurrently no artificial organ orequipment that has the capacityto compensate for theabsence of liver function. Henceknowledge of variation in liver anatomy is required for goodsurgical outcome, diagnostic imaging and minimally invasivesurgical procedures.Material and Methods: The present study was conducted in160 human livers from embalmed cadavers in the Departmentof Anatomy, KIMS, Karad, during the study duration of July2017 to August 2018. The liver specimens were removed fromadult human cadavers during routine dissection for medicalundergraduate students and then preserved in 10% of formalin.Results: We analyzed 160 livers, with its morphologicalcharacteristics and structural variations. Mean weight ofthe liver was reported to be 1.05 Kg (Minimum 0.461 andMaximum 2.137 Kg) with SD of 0.34 Kg. Mean breadth ofliver was reported to be 18.44 cm (Maximum 25.5 cm andMinimum 2.4 cm) with SD of 2.45 cm. Mean thickness of liverwas reported to be 10.52cm (Maximum 18.3 and Minimum3.4) with SD of 1.82 cm.Conclusion: The present study focuses upon the frequentoccurrence of morphological variations on the surface of theliver.

A Review of Programs, Components and Outcomes in Biomedical Research Faculty Development.

BACKGROUND/OBJECTIVE: To review, compare and synthesize current faculty development programs and components. Findings are expected to facilitate research that will increase the competency and competitiveness of less-established biomedical research faculty. METHODS: We reviewed the current literature on research faculty development programs, and report on their type, components, outcomes and limitations. RESULTS: Nineteen articles met inclusion criteria. There were no prospective studies; most were observational and all lacked a control group. Mentoring was the most successful program type, and guided and participatory learning the most successful enabling mechanism, in achieving stated program goals. CONCLUSIONS: Our findings are limited by the small number of current studies, wide variation in implementation, study design, and populations, and the lack of uniform metrics. However, results suggest that future prospective, randomized studies should employ quantitative criteria, and examine individual, human factors that predict "success."

Study of the fingertip pattern as a tool for the identification of the dermatoglyphic trait in bronchial asthma.

INTRODUCTION: Bronchial Asthma is one of the most extensively studied respiratory diseases and its genetic basis is well established. Dermatoglyphic traits are formed under genetic control early in development but may be affected by environmental factors during first trimester of pregnancy. These patterns may represent the genetic makeup of an individual and therefore his/her predisposition to certain diseases. Patterns of dermatoglyphics have been studied in various congenital disorders like Down's syndrome, Klinefelter's syndrome and also in chronic diseases like Hypertension, Diabetes Mellitus etc. Epidermal ridge patterns of finger tips in bronchial asthma patients were studied to find out fingertip pattern as Dermatoglyphic features in patients of Bronchial Asthma; it's comparison and association if exists between normal and bronchial asthma patients and also to find use of fingertip pattern in early childhood as non-invasive anatomical marker for bronchial asthma in adulthood. METHODS: The study was conducted on clinically diagnosed all bronchial asthma patients attending OPD of Dr Ulhas Patil Medical College, Jalgaon. Matched controls were selected without any respiratory problem or any symptoms related to asthma from medical students, staff members and paramedical staff of hospital after taking the informed consent and permission from the institutional ethical committee. Data collection and fingertip prints were taken by ink and rolling finger method. Prints taken were analysed and tabulated; data was analysed by using statistical tests. RESULTS: Study shows that decrease in number of arches, increase in AFRC in patients as compared with controls. Also there were increased ulnar loops in male patients and increased Whorls and radial loops in female patients. CONCLUSION: The fingerprints can represent a non-invasive anatomical marker of bronchial asthma risk and facilitate early detection and effective management which is vital for selecting appropriate agents for treating infections.

Multiple Morphological Variations in the Thyroid Gland: Report of two Cases.

The variety of multiple morphological variations in the thyroid gland is found as a result of disturbed organogenesis in humans as agenesis, hypoplasia, accessory, ectopy and hemiagenesis. In the routine undergraduate dissection of the thyroid gland, multiple anomalies of the thyroid gland were encountered in 50 and 60 years old female and male cadaver respectively. These were in form of absent isthmus with accessory thyroid lobe in between two lateral lobes, pyramidal lobe arising from left lobe of thyroid with levator glandulae thyroidae in first case. Second case showed narrow isthmus related to first tracheal ring and levator glandulae thyroidae arising from left lobe. In these case studies, we highlight various developmental anomalies of the thyroid gland as absent isthmus, pyramidal lobe and accessory lobe with levator glandulae thyroidae. Hence a thorough knowledge of such morphological variations of thyroid gland helps the surgeons in better planning of safe, effective and uncomplicated operative procedures in resection of thyroid and tracheotomy procedures.

The foramen meningo-orbital in Indian dry skulls.

Background & objective: Foramen meningo-orbital is present in greater wing of sphenoid bone close to superior orbital fissure. It provide route for an anastomosis between the orbital branch of the middle meningeal artery and recurrent meningeal branch of ophthalmic artery. Basic textbooks of anatomy stated that it was a rare occurrence but some recent studies indicate a more frequent incidence of this which shows side and gender variation. These discrepancies were verified in our research work. Methods: We studied 150 dried human skulls (100 male and 50 female) of known sex. Only patent foramina were included in the observation. Results: Incidence of foramen as whole was 44.33% (male- 37.5% and female- 58%). In 4%, it was present bilaterally. Average distance between lateral end of superior orbital fissure and foramen was 6.22 mm. Conclusion: Our study indicates that a foramen meningo-orbital is present as often as, mostly unilaterally and multiple foramina may exist and also it shows side and genders variation. Knowledge of it may be of surgical significance to ophthalmologist and neurosurgeons and for radiologist because it masquerading as an intraocular foreign body. Further detail study on this topic in other populations from different areas is required.