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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 11 | Issue 1
Page Nos. 1-64

Online since Tuesday, February 1, 2022

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MESSAGE FROM EDITOR-IN-CHIEF  

Message from editor-in-chief Highly accessed article p. 1

DOI:10.4103/2277-4025.337048  
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EDITORIAL Top

Research in anatomy: Challenges and opportunities amid the COVID-19 pandemic p. 2
NB Pushpa, Srinivasan Viveka, Kumar Satish Ravi
DOI:10.4103/NJCA.NJCA_5_22  
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ORIGINAL ARTICLES Top

Localization of L5–S1 disc space by utilizing simple on table surface marking in posterior lumbar spine surgery without any radiological assistance: An observational study p. 5
Acharya Suryakanta Pattajoshi, Tushar Ranjan Dalei
DOI:10.4103/NJCA.NJCA_104_21  
Background: Localization of the spinal levels is an important task during any spinal surgery. The purpose of the study is to assess the accuracy and reliability in identifying L5–S1 disc space by surface localization using Venus of dimple as a landmark in posterior spinal surgery without undertaking any radiological assistance. Methodology: We prospectively analyzed 39 patients, who had undergone primary posterior spine surgery, especially for Prolapsed intervertebral disc mostly affecting the lumbosacral region. Following surface marking using Venus of dimple as a landmark, patients were subjected to surgery with or without prior X-ray evaluation solely on surface localization of L5–S1 disc space. Intraoperatively, the accuracy and reliability of the surface marking were determined. Results: Sixty-four percent of the patients had accurate L5–S1 spine level localization utilizing the above clinical palpatory methods, while 23% of the cases identified L5 spine intraoperatively. On analyzing this surface topographical method with that of X-ray in standing position, the sensitivity and specificity came to be 93.3% and 49%, respectively, with a positive predictive value of 77.8%. Conclusion: The method of localization of L5–S1 space described although cannot fully replace the role of fluoroscopic assistance during spinal surgery, still it is an important, simple, and reliable alternative method of localization which demands its application by the spine surgeons, especially in the beginning of their carrier and in certain specific situations.
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Sexual dimorphism and clinical importance of posterior condylar canal p. 10
Sushant Swaroop Das
DOI:10.4103/NJCA.NJCA_65_21  
Background: The posterior condylar canal (PCC) and its associated emissary vein are important anatomical landmarks for juxta-condylar approach and extreme lateral approach for exposing lesions in the region lateral to the foramen magnum. The study aimed to provide a complete gender-based assessment of the morphological characteristics of PCC in an adult central Indian population. Methodology: The study was conducted on 130 dry adult central Indian human skulls of known sex (81 males, 49 females). The presence of PCC on both sides, their patency, variations, and site of internal opening in relation to important anatomical landmarks, i.e., sigmoid sulcus, jugular foramen, and foramen magnum were assessed. Results: The PCC and probe patency were statistically more common bilaterally than unilateral. Females showed statistically significant higher incidence of bilateral PCC and bilateral probe patency than males. Three morphological variations in PCC were found, i.e., double condylar canal, septation, and spur. They showed no significant gender differences. In both sexes, bilateral intrasinus was the most common type of internal opening of PCC. Internal opening into jugular foramen, foramen magnum, and retro sinus was significantly more unilaterally than bilateral. Significant gender differences in unilateral intrasinus and unilateral retro sinus type of internal opening were noted. Conclusion: This study gives knowledge about the comparison of various morphological variations of PCC in both sexes of an adult central Indian population, and its clinical impact on the surgeries of this region.
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Semitendinosus tendon morphometry as a graft – A cadaver study p. 17
Balakrishna Shetty, Sweekritha Shetty, Prashanth Kasargod Umesh
DOI:10.4103/NJCA.NJCA_95_21  
Background: Sports and games have become professional activities. The standard of fitness level is raised. Advancement in arthroscopic anterior cruciate ligament (ACL) reconstruction using free tendon graft is one of the key developments. Autograft with minimal donor site or functional morbidity is the key. The latest is the use of semitendinosus in ACL reconstruction. Preoperative knowledge of graft in terms of size is crucial. The present cadaveric study is an attempt to understand the morphology of the semitendinosus tendon (ST) as tendon graft in the local population. Methodology: A total of 50 male cadaver limbs embalmed with formalin were used for harvesting 50 STs. The exact age and height of the cadavers were not known. The femoral length was used as a measure of body height. Tendon length and quadruple diameters were measured. Anderson–Darling test was used for distribution analysis of all the data. Results: In our study, mean length of the tendon was 27.12 cm which is shorter than the required 28 cm for quadrupling the tendon. The average diameter was 8.14 mm which is slightly more than the minimum required thickness of 8 mm. These two findings suggest that tendons in the Indian population are not long enough for an ideal quadruple graft with more than 8 mm diameter. Conclusion: The result of our study is in conformation with the previous studies on the Indian population and also in the Western population. The height of the individual can be inferred from length of the femur; hence, height can be taken as a good predictor for the length of ST in the Indian population.
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Measurement of metric and nonmetric parameters for determining the gender of the human mandible p. 22
Anil Kumar, Penprapa S Klinkhachorn, Ciraj Ali Mohammed
DOI:10.4103/NJCA.NJCA_112_21  
Background: In humans, the mandible is the longest, densest, and most robust facial bone. It displays a high degree of phenotypic variation between sexes and is resistant to postmortem trauma. Measures of male and female mandibles were quantified in this study along with nonmetric and metric parameters to determine the gender. Methodology: In this retrospective observational study, 96 mandibles (55 males and 41 females) were evaluated for gender through the measurement of 15 metric and 5 nonmetric parameters. Results: A significant correlation between nonmetric variables of the squared chin (85.54%), prominent muscle markings (74.54%), everted gonial flares (94.54%), and triangular coronoid processes (81.81%) was found. Females, by contrast, tended to have a rounded chin (68.49%), a less prominent muscle marking (53.6%), an inverted gonial flare (95.54%), and a hooked shape coronoid process (80.48%). All metric mandible parameters were determined, evaluated, and statistically analyzed in SPSS to determine whether gender had a relationship with the mandibles. Conclusion: Various metric and nonmetric criteria, in addition to existing methods, can be used to determine the gender of a person's mandible.
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Attainment of Indian Medical Graduate (IMG) roles through the curriculum: The untold stakeholder perspective p. 30
TS Gugapriya, Sithikantha Banarjee, Meenakshi Girish, Sachin Damke, Shital Bhattad
DOI:10.4103/NJCA.NJCA_74_21  
Background: Graduate Medical Education Regulations 1997 and “Vision 2015” documents were the steps toward training a skilled and competent Indian Medical Graduate (IMG). To implement the changes in the curriculum and to achieve the IMG goal, a nation-wide faculty development program was started by the Medical Council of India in 2009. Even before the introduction of Competency-Based Medical Education (CBME) in 2019, the Indian medical curriculum imbibed and trained the Graduates in competencies relevant for an IMG. This research was to attempt to understand the stakeholder perspective of the contribution of the curriculum in attaining the IMG roles prior to 2019. Methodology: The present multicentric study was carried out among 450 interns belonging to batch 2018 in the state of Maharashtra. A self-administrated, online, structured questionnaire containing 27 items based on IMG roles was used as the study instrument. Descriptive analysis was performed to arrive at the perception of stakeholders. Results: Analysis of self-rating of the competency for IMG roles showed a 30.7% for the “leader and as a team member role”. A detailed analysis noted that the majority of the participants lacked confidence in the role of the “medical expert.” Competency in the psychomotor domain gained maximum self-rating in comparison to the affective domain. The overall rating about their undergraduate training toward five IMG roles had an unsatisfactory score of 56.3% for the “lifelong learner” role. Conclusion: The study highlighted the stakeholder perspective about curriculum equipping them in developing “leader and a team member” while failing with “lifelong learner” IMG role. The study also emphasized that the attitudinal domain needs addressing by the CBME curriculum.
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Role of 4-methylimidazole in liver toxicity: A histomorphometric study in albino rats p. 37
Suman Yadav, Sunita Kalra, Surbhi Wadhwa, Pooja Rani
DOI:10.4103/NJCA.NJCA_126_21  
Background: These days, food products industry involves the commercial production and addition of food colors, which comprises many food dyes, including caramel colors. 4-methylimidazole (4-MEI) is a component of various caramel-colored food products such as bakery, beer, soft drinks, coffee and sauces, which are consumed daily. The most common route of exposure is ingestion and liver is the organ of detoxification. The histomorphometric observations in liver after 4-MEI consumption have not been reported to the best of our knowledge and so the present study have been designed to evaluate the same. Methodology: Adult male Wistar albino rats weighing 150–200 g were procured for the study and divided into the control and experimental groups. The experimental animals were given 4-MEI orally by gavage tube at a dose of 250 mg/kg body weight daily for 1 month, while the control animals received distilled water. At the end of experiment, all the animals were euthanized under ether anesthesia by perfusion with Formal saline. Dissection and histopathological processing of liver was done for the examination. Results: The histomorphometric observations of the liver in experimental rats revealed a significant increase in sinusoidal width indicative of sinusoidal dilatation and congestion. There was a significant increase in the size of hepatocytes while a decrease in the size of their nuclei was noted, suggestive of ballooning degeneration. Conclusion: The findings in the present study strongly suggest hepatocellular damage caused by ingestion of 4-MEI found in caramel color dyes used routinely in the food industry.
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Fetal gall bladder development: A histo-morphometric study p. 42
Anamika Jaiswal, Ankit Kaushik, AK Singh, DN Sinha
DOI:10.4103/NJCA.NJCA_89_21  
Background: The gall bladder development in fetal life is complex and starts as early as the 4th week of gestation; the abnormal development of the gall bladder is associated with various congenital abnormalities. The objective of the present study was to study fetal gall bladder development in relation to gestational age (GA) among fetuses. Methodology: In a cross-sectional observational study of 29 fetuses, the gall bladder parameters and histological changes are evaluated at different gestational age. The fetus was categorized based on GA into three categories of <20 weeks, 21–30 weeks, and 31 weeks and above. After dissection of the abdomen, the shape and location of the gall bladder were observed. The relationship of gall bladder with liver was observed. The gall bladder length (GBL) and gall bladder width (GBW) were measured. The histogenesis of the gall bladder was observed among all fetuses and developmental changes were noted. Results: The study included 29 fetuses, 14 males and 15 females. The first, second, and third groups comprised 5, 14, and 10 fetuses. The GA ranged from 13 to 35 weeks. The mean crown-rump length (CRL) of the fetuses was 19.34 ± 6.32 cm. The mean GBL was 2.06 ± 0.83 cm and the mean GBW was 0.77 ± 0.32 cm. The GBL and GBW increased with CRL, GA, and weight. The strong positive correlation was observed between GBL, GBW with GA and CRL. On microscopy, among the first group, fetal gall bladder at 13 weeks showed solid structure with obliterated lumen and area of early canalization. The muscular layer initially was very thin and comprised only few haphazardly arranged muscle fiber in the first group, the thickness was found to be more in the second group and a well-formed adult-like muscular layer was found in the third group. The loose connective tiisue, the outer most layer was pronounced in the third group. Conclusion: The fetal gall bladder parameters show linear increase with GA and CRL. The location, size, and relation of the fundus with margin of gall bladder in fetus undergo changes with the development of the fetus. The fetal gall bladder undergoes marked histological changes during development.
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Morphological study of rouviere's sulcus: An important landmark in laparoscopic cholecystectomy and right segmental liver resection p. 49
Pushpa Gowda, Suman Udupi
DOI:10.4103/NJCA.NJCA_121_21  
Background: Rouviere's sulcus (RS) is a cleft, on the inferior surface of the liver, extending from the caudate process to the right lobe for a variable distance. Cystic duct and artery lie anterosuperior while the common bile duct lies anterior to this sulcus, making it an important landmark in laparoscopic cholecystectomy. Being situated anterior to segment I of liver and having the right posterior portal pedicle as its frequent content, it is an important guide in right segmental liver resection. This study intends to study the anatomy of the RS. Methodology: The present study was done by analyzing 60 formalin-fixed adult livers, for the presence/absence of RS, its morphology and morphometry. Results: RS was present in 49 (81.66%) specimens, it was oblique in 26 (43.33%), transverse in 23 (38.33%) and absent in 11 (18.33%) specimens, RS was classified into three different types - type 1, type 2, and type 3 based on its degree of penetration into the substance of the liver. Type 1, defined as a deep sulcus was present in 37 (61.66%) specimens. Type 2, a slit-like shallow sulcus was observed in 7 (11.66%) and type 3, scar-like sulcus was observed in 5 (8.33%) of specimens. The average length of RS was 2.84 cm, breadth was 0.18 cm and the average depth of the RS was 0.62 cm. Conclusion: RS is an important extra-biliary landmark of the liver, that could easily be visualized during laparoscopic hepatobiliary surgeries and its identification could definitely reduce the risk of bile duct and vascular injuries during these surgeries. Hence, the in-depth knowledge about the anatomy of RS which is less studied and not included in anatomy literature is essential.
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Face to face versus virtual assessment - A survey on Indian medical students' perception during COVID-19 pandemic: A cross-sectional study p. 54
Anasuya Ghosh, Satabdi Sarkar, Biswabina Ray, Arpita Sarkar, Anirban Dasgupta
DOI:10.4103/NJCA.NJCA_102_21  
Background: Assessment has a very important role in curricular development by motivating students and target setting, providing appropriate feedback and quality assurance. During COVID-19 pandemic-induced lockdown, most of the medical schools throughout the world including India had to undergo a paradigm shift from face to face to online mode in medical education and assessment. This study was planned to assess and analyze the perception and opinion of 1st-year medical students from all over the country regarding the online assessment (OA) process that emerged during the COVID 19 pandemic. We also tried to find out the preferred resources that the students wanted to access via online mode and any major hindrance they faced. Methodology: It was a cross-sectional, Internet based, online survey conducted on 1st year medical students from all over India. Result: Students preferred the traditional (face to face) examinations over the OA in terms of usefulness, motivation, answering long answer questions, adequacy of allotted time, and ease of performance. However, they favored OA in terms of examination anxiety, examiner bias, and answering the objective type of questions. The lack of good Internet connectivity was considered a major hindrance. Conclusion: This information might be helpful for respective authorities to establish an effective online platform which could deliver an authentic and valid OA in future during any crisis.
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CASE REPORT Top

Hepato-duodeno-colic fold and sessile sigmoid colon – Rare peritoneal bands in abdomen p. 60
V Dinesh Kumar, R Rajprasath, Magi Murugan
DOI:10.4103/NJCA.NJCA_138_21  
The presence of aberrant peritoneal folds is one of the differential diagnoses of intestinal obstruction in the pediatric population. Therefore, knowing the variations in the attachment pattern of peritoneum and its folds is essential. In this context, we report a rare peritoneal fold found during the routine human cadaveric dissection of the abdomen, which is attached superiorly to the liver including the gallbladder and inferiorly extended as a bilaminar fold with one attaching to duodenum and other to transverse colon. In addition, the sigmoid colon was completely plastered to the posterior pelvic wall. This variant peritoneal fold is named as hepato-duodeno-colic ligament and is described in detail with its clinical context. The knowledge regarding this abnormal peritoneal fold would be highly useful for surgeons while planning laparoscopic procedures in the upper quadrant of the abdomen.
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REVIEWERS Top

Reviewers of 2021 (Volume 10) p. 64
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