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   Table of Contents - Current issue
April-June 2021
Volume 10 | Issue 2
Page Nos. 55-107

Online since Saturday, April 10, 2021

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White coat ceremony: A felicitous ritual Highly accessed article p. 55
NB Pushpa, Kumar Satish Ravi
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Taxation of micronuclei frequency as a prognostic marker in oral and oropharyngeal carcinoma: A cytogenetic study p. 57
Kumar Satish Ravi, NB Pushpa, Sanjeev Kishore, Sohinder Kaur, Vandana Mehta, KS Reddy
Background: Oral and oropharyngeal carcinoma are one among the most common cancers in the world. India shares about one-fourth of incidences of oral and oropharyngeal cancers and death due to the same is also of significant number. Micronucleus resulting from aberrant mitosis, chromatin fragmentation, or aberrant chromosome is considered as a hall mark for genotoxicity, also oral cancer risk and is useful in chemopreventive studies. Hence, the determination of micronuclei frequency serves as better prognostic marker. Methodology: A total of 60 patients with a mean age of 53 (56 males and 4 females) years, who were histopathologically confirmed cases of oral and oropharyngeal carcinoma with different degree of differentiation were included in the study. Patients were solely treated by radiotherapy with radiation dose plan of 4 Gy, 14 Gy, 24 Gy, and 60 Gy on the 2nd, 7th, 12th, and 30th days, respectively. The mucosal scapings stained with Giemsa and May-Grunwald's stain were studied to assess the micronuclei at each interval. Results: Although there was no significant association between site of lesion and tumor differentiation with micronuclei index, there was statistically significant difference in the micronuclei index at each interval. Percentage of relative increment in micronuclei also showed promising significance. Conclusion: Hence, micronuclear assay could be used as an efficient tool to determine the radiosensitivity and prognosis in oral and oropharyngeal carcinoma patients treated by radiotherapy.
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Morphometry of sylvian fissure among Maharashtrian population p. 61
A Shinde Amol, KA Kushalini
Background: Various studies have documented asymmetry and sexual dimorphism in the Sylvian fissure (SF). The objective of the present study was to determine the morphometry of Sylvian fissure for sexual dimorphism and interhemispherical variations. Methodology: In a descriptive study at Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, morphometric evaluation of lateral sulcus was done from 50 cerebral hemispheres. SF and Sylvian point with its posterior limb, anterior limb, and ascending limb were demarcated after dissecting out the cerebral hemispheres from the cranial cavity. The length of posterior limb of SF, anterior limb, and ascending limb was noted separately for the left and right sides. The angle between the limbs was noted. Incidence of bifurcation into anterior and ascending limbs as V, U. or Y shape at anterior Sylvian point was noted. Results: The average length of SF (posterior, ascending, and anterior limbs) on the left hemispheres was significantly more than the right side. The length of SF was also significantly more in males in comparison with males. The most common branching pattern of anterior and ascending limbs was U shape (64%). The angle between posterior and ascending limbs on the left side was significantly higher in the left side (104°) than on the right side (98°). Conclusion: Posterior, anterior, and ascending limbs of SF were longer on the left side. Male brains had significantly longer SF than females. U-shaped branching was the most common shape bilaterally and in both sexes. The angle between ascending and anterior limbs was found more in females and on the left side, thus reflecting laterality and sexual dimorphism.
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The study of anatomy of tarsal tunnel in human fetuses by dissection method p. 66
BR Chaithra Rao, Sucharitha Annam, Sreepadma Sunkeswari, Sandeep Patil
Background: The flexor retinaculum of foot extends from the medial malleolus to the calcaneus to form the roof of tarsal tunnel. The structures passing through the tunnel are tendons of tibialis posterior, flexor digitorum longus & flexor hallucis longus, the tibial nerve & the posterior tibial artery with its venae comitantes. In order to understand the pathogenesis and improve the treatment of tarsal tunnel syndrome, we investigated the tarsal region of human foetuses anatomically. Methodology: The study was done on aborted/ stillborn foetuses in the Department of Anatomy of Sapthagiri Institute of Medical, Sciences, Bangalore. The structures passing under the flexor retinaculum of foot were dissected in 68 normal limbs of 34 foetuses of gestational age ranging from 10 weeks to term. Results: It was noted that the structures were arranged in two planes. Most commonly the superficial plane contained the tendon of tibialis posterior, posterior tibial artery & tibial nerve from medial to lateral side. In the deeper plane were the tendons of flexor digitorum longus medial to that of flexor hallucis longus. The bifurcation of tibial nerve mostly occurred under cover of flexor retinaculum and that of posterior tibial artery was distal to it. Conclusion: The understanding of arrangement of structures under cover of flexor retinaculum is important for diagnosis and treatment of tarsal tunnel syndrome in adults and also for the surgical correction of clubfoot, poliomyelitis & other deformities of foot in children.
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Morphometric study of the distal end of dry adult humerus of the South Indian population with its clinical applications p. 70
G Vinay, W Benjamin, Aditya K Das, KH Raviprasanna, D Sunil Kumar
Background: The arm bone is the largest and strongest bone of the superior extremity. Movement of the arm bone helps in essential activities like writing. lifting objects and throwing. Use of implants in communited cracks in the lower end of the humerus of an aged person may be needed to retain the mobility at the elbow joint. The present study was aimed at providing morphometry of the distal end of the arm bone for comparison with different populations. Materials and Methods: Eight morphometric parameters were evaluated from 200 dry adult humeral bones using the osteometric board and digital vernier calipers. Results: The average value of the maximal length of the arm bone in the present study was 306.3 ± 21.19 mm in the right humerus and 301.1 ± 22.4 mm in the left humerus. The transverse distance between the medial and lateral epicondyles was 57.4 ± 4.8 mm and 56.0 ± 4.7 mm in right and left humerus, respectively. The average distance between the capitulum and medial end of trochlea horizontally was 39.6 ± 3.4 and 39.5 ± 4.3 mm in right and left humerus, respectively. The average maximum transverse diameter of the trochlea was 24.4 ± 2.6 and 23.5 ± 2.6 mm in right and left humerus, respectively. The average anteroposterior diameter of the trochlea was 17.0 ± 3.9 and 16.3 ± 3.7 mm in right and left humerus, respectively. Conclusion: Eight morphometric parameters of 200 humeri presented. This information can be useful for surgeons in preparing implants and reconstruction of fractures of the distal end of the arm bone.
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A cadaveric study of anterior communicating artery p. 75
Sunitha Narayanan, GN Geetha
Background: Anterior communication artery is a collateral channel that connects the right and left anterior cerebral arteries in the circle of Willis. This helps in stabilizing the cerebral blood flow. Different types of variations of this artery were reported in the previous studies. The hemodynamic changes in the blood flow produced by variations induce strain at the sites of bifurcation, which may result in the formation of aneurysms. This commonly occurs at the meeting point of anterior communicating artery (ACoA) with the anterior cerebral artery. The anatomical variations in this portion may complicate the planning and performance of surgery which in turn will lead to postoperative complications. Materials and Methods: The study was conducted in 60 specimens of the brain in the department of anatomy, Government Medical college, Calicut. The artery was carefully dissected and observed. Photographs were taken. The observations were tabulated. Results: Variations were noted in 15 specimens (25%). Duplication of the artery was noted in 6 specimens (10%), hypoplasia in 3 specimens (5%), V-type artery in 1 specimen, and X-type in 6 specimens (10%). There was no triplication or plexiform type noted. An accessory anterior cerebral artery was noted in 3 specimens (5%). Conclusions: As the ACoA acts a collateral channel that stabilizes the cerebral blood flow, when there is any vascular occlusion in any components of the circle, the knowledge of these anatomical variations becomes significant. As the radiological and neurosurgical interventions are increasingly performed, nowadays, the surgeons and radiologists should be aware of these variations in the cerebral arteries.
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A histological study on the developing adrenal gland in human fetuses p. 79
T Suresh Kumar, S Sathish Kumar, B Minu Rekha
Background: Adrenal gland has an outer cortex and inner medulla that vary structurally, functionally, and embryologically. The developing gland plays a major role in concordance development of various viscera of the fetus and in parturition. The fetal adrenal gland shows histological changes not only in the fetal cortex but also in capsule, permanent cortex, and medulla. The current study aims to look at the changes in the microstructure of the fetal adrenal glands at various gestational ages. Methodology: Forty adrenal specimens from dead fetuses of gestational age from 14 to 36 weeks were collected and processed for routine hematoxyline and eosin staining and studied under light microscope. The samples were grouped into I, II, and III based on their gestational age. The microscopic changes occurring in different gestational ages were studied and photographed. Results: The cortex become well defined by 18 weeks and increase in thickness till term. Blood vessels appear in the capsule as early as 15 weeks. The fetal cortex increases in thickness with increase in gestational age. Lymphocytic infiltrations were consistently noted in the permanent cortex. The neuroblastic nodules were noted in the medulla from 14 weeks and regressed with advancing gestational age. Conclusion: Increase in the size of the fetal adrenal gland is mainly due to the increase in the fetal cortex. The neuroblastic nodules were seen until 32 weeks of gestation. The lymphocytic infiltration in the fetal cortex opens a new avenue of research to study their role in mediating the cortical secretions in fetus.
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Osteological study of morphometric analysis of acromion process and its implication in impingement syndrome p. 84
Hamzah Muzammil Hafezji
Introduction: Acromial morphology along with its position (slope/tilt) has a role in shoulder impingement. Acromioplasty is an important step in rotator cuff repair. Thus, knowledge of morphometric variations of the acromion is necessary. The aim of the study was to determine acromion morphometry and to correlate the morphometry of acromion with the dimensions of the scapula. Materials and Methods: The study was performed on 150 dried adult human scapulae, for which age and sex were not known. The shape of the acromion was observed from posterior and lateral view and different dimensions were measured. Results: The acromial curvature (as per Bigliani classification) was found to be flat (Category I) in 23.33%, curved (Category II) in 49.33%, and hooked (Category III) in 27.34% of scapulae. The acromial shape (from posterior view) was found to be quadrangular in 22%, triangular in 31.33%, and tubular in 46.67% of scapulae. The mean values of length, breadth, and thickness of acromion were 41.14 mm, 24.89 mm, and 6.95 mm, respectively. The acromion thickness was <8 mm in 87.33% and >8 mm in 12.67%. The mean of acromion slope and tilt were 28.23° and 42.47°, respectively. Conclusions: From the study, it may be concluded that a small proportion of the population (12.67%) may be prone to develop impingement due to more acromial thickness (>8 mm). The acromion slope and tilt are larger in our population which suggests lesser predisposition to impingement syndrome.
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Correlational anatomy of biceps brachii muscle with its footprint and aponeurosis parameters p. 89
Suresh Narayanan
Background and Aims: The anatomy of the distal biceps tendon (DBT) and its insertional anatomy to radial tuberosity is important to understand the pathophysiology of tendon rupture and in surgical repair of the ruptured tendon. The present study aimed to evaluate the relationship between biceps brachii parameters with biceps footprint and lacertus fibrosus (LF) parameters. Materials and Methods: This was a cross-sectional observational study done on 23 cadavers. The biceps brachii perimeters, the length of the DBT, distance between the radial head and radial tuberosity, footprint length, footprint breadth, and LF width were noted (with measuring tape and digital vernier caliper. LF angle was measured using Image J software. Results: There was a weak positive correlation between biceps brachii perimeter and footprint length (r = 0.392), biceps brachii perimeter and footprint breadth (r = 0.341), biceps brachii perimeter and LF width (r = 0.300), and moderate positive correlation between footprint length and breadth (r = 0.686). Conclusion: The biceps brachii perimeter has a minimal role in influencing the footprint dimensions and LF morphology. The study has explored the biomechanical aspect of the biceps brachii insertional anatomy. The data on footprint dimension and aponeurosis could help the surgeons in the effective repair of the ruptured tendon and achieving a better postoperative outcome.
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An anatomical study of vascular foramina of radius and its clinical insinuation p. 93
Pramod Pundalik Rangasubhe, PS Bhusaraddi, Pratik Pradeep Khona, Pavan Prahlad Havaldar
Introduction: Different segments of radius present numerous vascular foramina (VF). The objective of the study was to quantify VF and note their size and direction. Methodology: One hundred dry human radii bones in our anatomy department were divided into various segments for studying VF. The number and direction of VF were evaluated in upper end (UE), shaft, and lower end (LE) separately. VF were categorized into three groups based on size, namely small (which admitted 25-gauge needle): 0.5–0.7 mm, medium (22-gauge needle): 0.71 mm to 1.10 mm, and large (19-gauge needle): >1.10 mm. The direction of foramina in each segment was noted. They were categorized into three types: horizontal, upper oblique, and lower oblique. Results: Significantly, a greater number of VF in the UE of radius were observed in the neck (average: 9.3 foramina) than in the radial tuberosity (average: 1.3 foramina). In the shaft, the maximum number of VF was observed in the anterior surface and minimum was found in the lateral surface. In the LE, the maximum number of VF was observed in the posterior surface (average 7.2 foramina) and minimum was found in the medial surface (average 1.6 foramina). In the UE of radius, 81.8% of VF were small sized. In the UE of radius, 62.8% of VF were directed horizontally. In the shaft, almost all (99%) VF were directed upper oblique. Conclusion: The present study concludes that different segments of radius have different densities of VF. The LE of radius has got more VF compared to UE indicating its rich vascularity.
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Assessing the outcome of implementation of jigsaw technique as a learning tool and its effect on performance of 1st year medical students in anatomy p. 97
Monika Lalit, Sanjay Piplani
Introduction: Multiple factors in the contemporaneous trends in curriculum and medical education demand changes in teaching–learning methods with a dramatic change in the paradigm of teacher-centered teaching methods to student-centered learning methods. The jigsaw technique is an active learning methodology that involves active participation by the students in the learning process where they learn by teaching one another. It is an excellent potential tool to grasp an outsized load of information in a brief period or shorter time frame. The objective of the present study was to assess the effectiveness of the implementation of the jigsaw method as a learning tool during a graduate medical education setting. Methodology: The study was conducted among 150 phase I MBBS students during dissection in the department of anatomy. Two topics were decided and taught by didactic lecture. After taking the pretest, the topics were again taught by the jigsaw technique. After completion of the topic with this technique, students' knowledge regarding the topics was judged by taking a posttest. Pre- and postjigsaw technique assessment scores were calculated. The difference in the mean of pre- and posttests was estimated and compared by applying a paired-t-test to know the effectiveness of teaching methods. Results: The difference in the performance of the students in pre- and postjigsaw technique assessment scores test was calculated by applying paired-t-test which was found to be statistically significant (P < 0.001). About 100% of faculty members readily accepted the suggestion of implementing the jigsaw method. About 88% (132) of students showed enthusiasm and interest to take up the activity. Conclusion: There was an eloquent difference in the performance of the students in pretest and posttest knowledge scores. The results indicate a better performance by the students when they are involved actively in learning and found this method very helpful, interesting, and motivating.
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Anatomy teaching in medical education p. 103
DN Sinha
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A lesson on ‘Cardiac tamponade’ from the cadaver p. 105
Doris George Yohannan, Thomas Varghese Attumalil, Komalavallyamma Chandrakumari
While dissecting the thorax, when the pericardium was opened, massive clots were seen, concealing the heart. The experience was used to teach about pericardial pericardial tamponade, which most probably caused the death of the “patient.” The concept of how the intrapericardial pressure builds up to compromise cardiac hemodynamics, how it can be clinically suspected, rapidly investigated, and managed as a medical emergency, was taught. This incident was an eye-opener that the time-tested cadaveric dissection should never be entirely replaced by alternatives though they may be wisely and effectively used to complement dissection.
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