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   Table of Contents - Current issue
July-September 2021
Volume 10 | Issue 3
Page Nos. 109-183

Online since Friday, July 30, 2021

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Anatomy education amid the second wave of COVID-19 pandemic: Challenges and solutions for instructional delivery p. 109
Apurba Patra, Ghulam Mohammad Bhat, Kumar Satish Ravi
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Rare anatomic variant: Celiac-mesenteric trunk in an Afro-Caribbean population Highly accessed article p. 112
Michael T Gardner, Shamir O Cawich, Ramanand Shetty, Patrick Lodenquai, Yuxue Zheng
Background: The celiac-mesenteric trunk is an anatomic variant where there is a common origin for the superior mesenteric artery and celiac trunk. We sought to determine the prevalence of this variation in an Afro-Caribbean population. Methodology: Anatomic dissections were observed over 5 years, and specimens with celiac-mesenteric trunks were identified for detailed investigation. We measured celiac-mesenteric trunk diameters at their origin from the aorta. Results: Dissections were performed in sixty-nine cadavers at a mean age of 68 years (range 55–85). Only one celiac-mesenteric trunk (1.5%) was encountered in an Afro-Caribbean male. This cadaver had no other morphologic anomalies. The celiac-mesenteric trunk had an internal diameter of 13.06 mm at its origin (55% aortic diameter). Conclusion: In this Afro-Caribbean population, a celiac-mesenteric trunk was found in 1.5% of unselected cadavers. This formidable vessel was 55% of the aortic diameter. Therefore, healthcare professionals must be aware of this variant to avoid inadvertent injury during clinical interventions.
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Comet parameters and plasma 8-Iso-prostaglandins F2α: Common markers of etiopathogenesis in major depression and indicators of antioxidant action of fluoxetine p. 118
Rajeev Panwar, M Sivakumar
Background: Major depression can be characterized by isolated episodes of disturbance in psychosomatic functions for a duration of at least two weeks along with intermediate non-symptomatic periods. The factors playing important role in the etiology of major depression were family history, genetic factors, decreased levels of serotonin and norepinephrine; increased levels of interleukins or any other medical illness having an increased cytokine production. The pathogenesis of major depression involves oxidative stress, which consists of synthesis of free radicals causing damage to nucleic acids, lipids, carbohydrates, and proteins present in the cells. Oxidative stress – induced DNA damage consists of numerous types of lesions which can be assessed by the comet assay method. Prostaglandin F2-alpha is produced because of oxidative stress-induced peroxidation of cell membrane lipids and has elevated plasma levels in patients with major depression. Fluoxetine is the drug of choice for major depression and found to have antioxidant properties. The present study was done to assess the correlation between plasma 8-iso-PGF2α levels and the comet parameters, namely comet length (CL), head diameter (HD), % of DNA in head (%DNA Head), tail length (TL) and % of DNA in tail (%DNA Tail), before starting and after finishing the eight-week fluoxetine therapy. Methodology: The prospective clinical study was conducted in the Department of Anatomy in collaboration at, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. The study group consisted of drug naïve, newly diagnosed major depression patients belonging to age-group of ≥ 18 to 50 years and followed up after eight weeks of fluoxetine therapy. Results: The correlation was found to be positive between the levels of 8-iso-PGF2α in the plasma and all the comet parameters except %DNA Tail, which showed a negative (inverse) relationship with the levels of 8-iso-PGF2α in the plasma. Conclusion: The current study suggested the role of oxidative stress in causing DNA damage and lipid peroxidation in major depression patients and the antioxidant role of fluoxetine in causing decrease in the levels of parameters of oxidative stress and subsequent DNA repair.
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Aniline blue staining method for sperm DNA fragmentation index: A guide to sperm quality and infertility management – An observational study in males from South Maharashtra p. 126
Priya Santosh Patil, Nitin R Mudiraj, Vaibhav P Mane
Background: Infertility rate all over the globe is on the rise and semen analysis forms the only basic investigation for male infertility. The success of infertility treatment depends on many semen parameters. In this study, we focus on sperm DNA fragmentation (SDF) by the aniline blue staining method. The DNA fragmentation index (DFI) was correlated with other semen parameters. The semen parameters in low DFI and high DFI (HDFI) groups were compared to highlight the importance of DFI in infertility management. Methodology: The sample size was 60. The semen parameters were studied. The sperm chromatin integrity and DFI were calculated. Statistical analysis was performed by calculating mean, standard deviation, Spearman's correlation coefficient, and unpaired t-test. Results: DFI showed a significant negative correlation with sperm count, progressive motility of sperms, sperm vitality, and a positive correlation with sperm deformity index (SDI). The cases were grouped according to DFI and showed statistically significant differences in the two groups with respect to sperm count, motility, sperm vitality, and SDI indicating poor sperm quality. HDFI group underwent prolonged infertility treatment. Conclusion: Acidic aniline blue staining method is a feasible screening test for sperm DFI which correlates well with semen analysis parameters such as low sperm counts, low progressive motility, low sperm vitality, and high SDI. A high SDF has a negative impact on infertility management.
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Nonmetrical variants of the sigmoid sulcus: A study on dry human skulls p. 131
Rakesh Kumar Diwan, Rakesh Kumar Verma, Arvind Kumar Pankaj, Anita Rani, Navneet Kumar
Background: Sigmoid sinus is an area of interest for anatomists, neurosurgeons, and radiologists. Different procedures such as mastoidectomy, thrombectomy in the sigmoid, and transverse sinus thrombosis have realized the need of proper morphological knowledge of the sigmoid sinus and its variations and their important relations. Therefore, the present study was conducted to report the prevalence of various nonmetrical attributes of the sigmoid sulcus in dry human skulls in India. Methodology: This study was conducted on 224 human skulls in which sex and origin were not known and these were taken from the departmental osteology laboratory. Interior of the skull base at the area of the sigmoid sulcus was carefully observed for the presence of any osseous projection on its anterior or posterior lips such as crest, plate, or bars. Shape, position, and side of projection were noted and frequency was calculated in percentage. Results: Out of 224 skulls, 80% of the sigmoid sulci showed one or other form of bony features. A total prevalence of 43.08% was observed for crests, whereas plates showed lesser frequency (28.57%) on the anterior lip of the sigmoid sulcus. Bony bars were the least common (9.14%) features, but were characteristically located at the angle region of the sigmoid sulcus. In 16.74% of skulls, sigmoid sulcus was shallow. Conclusion: Occurrence of bony attributes in the form of plates, crests, and bridges along the course of the sigmoid sulcus is quite high and shows frequent variability in location and laterality, which may adversely affect the morphology of the sigmoid sinus.
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Branching pattern of terminal branches of the facial nerve: A cadaveric study p. 135
AK Sapna
Background: For a successful facial surgery, it is vital to have a good knowledge of the distribution of the facial nerve in the face. The aim of this study was to highlight the pattern in the branching of the end part of the facial nerve in adults and fetuses and to look for any anastomoses between them. The branching pattern in the two groups is compared for any significant association. Methodology: Cross sectional study done in cadavers and stillborn fetuses. Subjects and Methods: Done in 100 facial halves. Statistical Analysis Used: Chi square test is used to look for any significant association between the branching pattern and gender & side of the face. Results: The branching pattern was classified into six types as per Davis et al. classification in the two study groups – adults and fetuses. The frequencies of occurrence in the first group were Type I – 1%, Type II – 7%, Type III – 18%, Type IV – 17%, Type V – 4%, and Type VI – 3% and in the second group were Type I – 1%, Type II – 8%, Type III – 20%, Type IV – 15%, Type V – 5%, and Type VI – 1%. No significant association was found in the branching pattern with respect to gender and side of the face in the two groups of study. Conclusions: There are multiple anastomotic communications among the end branches of the facial nerve. More the anatomical knowledge of these communications, lesser will be any unwanted facial nerve injury.
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An observational study of human fetal acetabulum in Western Tamilnadu p. 140
Dharmalingam Mathivanan, Murugesan Nirmaladevi, Meenakshisundaram Jamuna
Background: Ten percent of congenital dislocation of hip (CDH) is familial. Many previous studies attribute shallow acetabular cavity (dysplasia trait) as the main reason. Anthropological studies revealed different observations of fetal acetabulum, regarding the side and gender involvement of CDH due to varied geographical conditions and genetical traits. With this backdrop, the study was designed to assess the morphological and morphometric parameters of fetal acetabulum in western Tamil Nadu population. Methodology: Thirty fetuses (15 males and 15 females) were obtained from the O and G Department of PSG Institute of Medical Sciences and Research. Fetuses were grouped into three groups under the age criteria as 12–20 weeks, 21–30 weeks, and 31–40 weeks. The diameter, depth, and shape of the acetabulum were observed and documented for gender and side variations. Results: In our study, there was a significant correlation between the parameters taken. With advance in the gestational, there was a significant increase in diameter of the acetabulum. The acetabular cavity had become shallower with an increase in age of the fetus. Conclusions: In our study, there were no significant differences observed in the morphology & morphometry of acetabulum wrt side and gender of the fetuses.
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The distribution of parafollicular cells (C cells) in adult cadaveric thyroid gland: An immunohistochemical study p. 144
Kafeel Hussain, V Sathialakshmi, Shaweez Fathima
Background: The population of parafollicular cells or C cells in the normal thyroid has subjective variation. These variations in cadaveric thyroid gland are primarily attributed to ethnicity, gender, underlying pathologies, and sampling technique or approach. The lack of homogenous C cell dispersal poses a challenge in the diagnosis and interpretation of C cell hyperplasia. The aim of the study is to analyze the C cell distribution in various parts of the cadaveric thyroid. Methodology: This study was performed with 56 thyroid glands acquired from adult human cadavers (37 males and 19 females). Calcitonin polyclonal antibody was employed to identify the C cells. C cells in tissue sections from the isthmus, upper, middle, and lower regions of the thyroid gland were examined. Results: The number of C cells in the section from the thyroid ranged between 0 and 5/low-power field (LPF) in the upper region, 0 and 12/LPF in the middle region, and 0 and 3/LPF in the lower region. The mean number of C cells displayed in the section from the upper third region of the thyroid was 9 ± 1.92 C cells (range 6–12 C cells). The mean number of C cells quantified in the section from the middle third region was 25 ± 3.34 cells (range 19–30 C cells). The mean number of C cells in the section from the lower third was 3 ± 1.88 C cells (range 0–6 C cells). Sexual dimorphism in the mean total number of C cells in the section from the midzone of the gland was statistically significant. Conclusion: The midzone of thyroid gland has more population of C cells than other region. A significantly higher number of C cells were observed in males. This nonuniform distribution of C cells could result in conflicting reports, especially during the assessment of C cell hyperplasia.
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Evaluation of neck–shaft angle of dry femora in the gangetic region of West Bengal p. 148
Barnali Mukherjee, Anirban Sadhu, Sudeshna Majumdar
Background: Femur being the strongest and longest bone of the skeleton plays a crucial role in maintaining the usual anatomy of the hip joint. The neck–shaft angle (NSA) contributes greatly to the daily activity of the hip joint and therefore is of considerable importance in planning a proper surgery. Knowledge of the usual range of NSA is, therefore, imperative in the proper treatment of patients who present with disease of the hip related to the NSA. The objective of the present study was to estimate the minimum, maximum, mean, median, and range of NSA and to determine the difference(s) between the right and left sides of dry adult femora in the Gangetic region of West Bengal. Methodology: The present study was conducted on 281 dry adult femora (144 on the left and 137 on the right sides). The femora were selected according to the inclusion and exclusion criteria. Measurements of NSA were based on the standard method. Results: The mean NSA of the total sample size was 124.12° ± 6.231°. The means for the left and right NSAs were 123.33° ± 6.47° and 124.91° ± 5.885°, respectively. The mean difference between the right and left femora was statistically significant. There was also a high degree of positive correlation between the NSAs of the left and right sides. Conclusion: This study establishes baseline data for the NSA of the Gangetic region of West Bengal, India. This will be helpful for orthopedic surgeons and implant makers to properly design and treat patients with problems of the NSA.
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Morphological variations of the cystic duct and its clinical significance: A cadaveric study p. 155
Sumathi Shanmugam, Kalaiyarasi Subbiah, Sivakami Thiagarajan
Background: Anatomical variations of the cystic duct (CD) are common with an incidence of 18%–23% and are commonly encountered during cholecystectomy. The prevalence of such variations in our region is recorded so as to create awareness to avoid significant ductal injury in biliary surgery. Methodology: This observational cross-sectional study was undertaken on one hundred specimens of liver with extrahepatic biliary apparatus available in the department of anatomy. The morphology of CD was studied with respect to its length, course, mode, and level of union. Descriptive statistical analysis was done. Results: The range of length of the CD varied between 0.6 and 5.5 cm. The mean length of the CD was 2.06 ± 1.142 cm. 15% were short CDs and 3% had long CDs. The CD opened into the right hepatic duct in 2% and there was a triple confluence in 1%. There was a high union of CD with common hepatic duct (CHD) in 7.2% and a low union in 3.1%. The CD joined the CHD at an acute angle in 82.47% laterally and medially in 1.03%, paralleled in 11.3% of which 9.3% had a short parallel course, and 2% had a long parallel course and spiralled either anteriorly or posteriorly in 5.2%. Conclusion: These variations of CD have surgical significance in order to avoid damage to the ducts during surgical procedures, especially with increasing laparoscopic cholecystectomies. Hence, an awareness to look for these variations in preoperative radiological imaging is essential for the surgeons to avoid catastrophes.
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Variations in nutrient foramina of clavicle – A descriptive study p. 160
Prerana Aggarwal, Sumi Ghorai
Background: Human clavicle, an important bone of the pectoral girdle connects the upper appendicular skeleton to the axial skeleton. The nutrition and growth of the bone depend mainly on the nutrient artery. It enters the bone through the nutrient foramen. Hence this study aimed to study the number, position, location, direction, and distance of nutrient foramina of the clavicle from the sternal end. Methodology: In a descriptive study 79 dry adult human clavicles (40 right, 39 left) were studied, and mean foramen index (FI) was calculated. The data obtained were tabulated, results obtained and the inference was drawn. Results: The mean length of clavicles studied was 141.36 ± 11.11 mm (right 140.51 ± 11.10 mm, left 142.36 ± 11.14 mm). The average distance of foramina (DNF) from the sternal end was 61.48 ± 15.82 mm (right 62.88 ± 16.28 mm, left 59.96 ± 15.12 mm). Nutrient foramen was found in all the studied bones. The total foramina observed are 120. Forty-four bones have single (55.70%), 29 double (36.71%), and 6 triple (7.59%) foramina. Foramina were distributed on all four surfaces of the clavicle, predominantly on the posterior surface (52.50%). Most foramina were present on the middle third (67.50%) with an average FI% of 43.82 ± 11.85 (right 44.99 ± 12.09, left 42.43 ± 11.41). The foramina were directed toward the acromial end in all cases. Conclusion: The nutrient artery of the clavicle needs to be preserved for maintaining its vitality. Hence, the morphometric and topographic knowledge related to nutrient foramen and its variations is of immense importance to orthopedic surgeons and radiotherapists while treating clavicular pathologies.
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The prevalence and distribution of the variants of pectoralis minor in cadaveric studies: A systematic review and meta-analysis of 32 observational studies p. 164
Adil Asghar, Shagufta Naaz, Sunita Naya
Introduction: Pectoralis minor (PMi) is used as a vascularized and innervated free-muscle graft in the reconstructive surgical procedure. The present review aims to provide insights to the surgeons regarding the variants of PMi in terms of costal attachment, insertion, nerve supply and arterial supply. Methodology: Three major databases (PubMed, EMBASE, and Google Scholar) were thoroughly searched along with the full text of journals. Results: Seven studies (n = 1787) were analysed for the evaluation of costal attachment. PMi arise from 3rd to 5th rib in 33% (95% confidence interval [CI], 30–37%), but the most common variants II-5 ribs was observed in 36%, which was higher than normal. Eighteen studies (n = 2424) reported details of insertion. The variant insertion of PMi was observed in 21% (15–28; 95% CI). Seven studies reported nerve supply. Both medial pectoral nerve (MPN) and lateral pectoral nerve (LPN) innervates PMi in 93% and MPN absent in 7%. Only two studies reported arterial supply. The PMi was vascularized by single dominant artery in 77% (68–85; 95% CI) or two arteries in 19% (13–29; 95% CI) or three arteries 2% (2–8; 95% CI) or even four arteries in 1% (0–7; 95% CI). Conclusion: PMi has a constant costal attachment to the 3rd and 4th ribs. Origin of PMi from 5th rib is reported with a pooled prevalence of 73.3% and from 2nd rib is reported in 61.5%. PMi inserts to the superomedial boundary of the coracoid process in 79% only.
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Accessory nutrient foramen in the mandibular ramus p. 174
Haley L Nation, Kevin P Adams, Chinonye C Agu-Udemba
While numerous anatomical variations in the osteology of the mandible have been reported, the current case describes a unique nutrient foramen in terms of its location and function. During an anatomical dissection of the infratemporal fossa, an accessory nutrient foramen was found in the mandibular ramus of a 93-year-old male dentulous cadaver. An anomalous vein draining the masseter muscle traversed the foramen. This venous structure was traced into a nutrient canal located anterior to the mandibular canal. To our knowledge, the location and function of the accessory nutrient foramen and anomalous vein have never been previously reported. These unique characteristics make this accessory nutrient foramen clinically relevant. Knowledge of accessory foramen in the mandibular ramus and similar anatomical variations may reduce the risk of injury to traversing structures during numerous surgical procedures.
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Proning: Its anatomical basis and effect on oxygen saturation in COVID patients p. 178
NB Pushpa, S Viveka, KS Ravi, Vishwambar Vallabhaneni
Proning is the process of turning the patient from their supine (lying on their back) position to lying on their abdomen. It is a medically accepted position for improving oxygenation while breathing. Respiration in supine position, compresses the posterior surface of the lung preventing normal distension of the alveoli. This results in suboptimal oxygenation of the blood circulating in the lobes of the lung, particularly lower lobes. Lowered V/Q ratio from these regions of the lung contributes to the venous admixture. In the prone position, the heart with its pericardial chamber, occupies anterior dependent portion of the mediastinum, resulting in better expansion of the alveoli. This leads to improved V/Q ratio from these regions and lowers the physiological shunt effect on the oxygen saturation.
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Advancing anatomy teaching by incorporating the neurophysiological concepts of learning p. 181
Vijaya Kumar Konuri, Abu Ubaida Siddiqui
Gross anatomy is staring at a challenge either to transform or to disappear, if not as a science may be as a faculty, in the present era of ever-evolving medical education systems. It is a well-understood fact that retention of anatomical information is not an easy job. It is also worthwhile to mention here that technology is a great contributor in the elaborate process of teaching and learning, but a logical methodology for delivering knowledge must gain precedence over any means of technology. A scientific approach in the acquisition of knowledge shall always enhance the sensory input in the brains of the learners. The knowledge disseminated should be delivered for a larger purpose to make it useful for the humankind. The scientific methodology of knowledge acquisition implies that documented sensory input shall not be automatically converted into a repertory of facts and figures. To make the process interesting and active, the need of the hour is to develop ordered arrays of data deliverance. All modalities of scientific teaching should move ahead through interconnected phases of knowledge. The delivery of sheer facts as a description is many a times entering the brain as a mere theoretical fact with not deductive results. The accumulated facts need to be correlated with the various facts that are being thrown open by the relevant other branches to discern the underlying patterns. Each organ is to a great extent the product of the function it performs, in the present as well as in the past. We have tried to summarize the above concept, thus trying to establish the fact that “the structure is a function in space and function is a structure in time.” The neuroanatomic-physiologic approaches should play the leading role in the development of the concepts of learning of anatomy.
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