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   Table of Contents - Current issue
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July-September 2020
Volume 9 | Issue 3
Page Nos. 79-131

Online since Thursday, October 15, 2020

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EDITORIAL  

Does the Corpse teach the living? - Anatomy in the era of COVID -19 Highly accessed article p. 79
NB Pushpa, Kumar Satish Ravi
DOI:10.4103/NJCA.NJCA_49_20  
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ORIGINAL ARTICLES Top

Axillary artery variation: The rule not the exception p. 82
Cameron M Thiele, Danielle A Thornburg, Sonya E Van Nuland, Natalie R Langley
DOI:10.4103/NJCA.NJCA_32_20  
Introduction: Anatomic morphology commonly depicted in atlases or textbooks is often emphasized in gross anatomy classrooms; however, considerable variation may be observed in cadavers during dissection, particularly in the vascular system. This study statistically assesses the frequency of the classic versus variant axillary artery branching pattern and compares these observations to the incidence of variation described in the literature. Material and Methods: Axillary artery branching pattern was studied in 62 cadaver limbs. A Chi square goodness of fit test with post hoc analyses on the adjusted standardized residuals was used to evaluate branching patterns. Results: A statistically significant difference existed between the observed and expected frequencies of the classic presentation (P < 0.001). The axillary artery branching pattern exhibited the classic presentation in 17.7% of this sample; 82.3% of the limbs displayed a variant in at least one major axillary artery branch. The lateral thoracic and posterior circumflex humeral arteries were significantly variable branches observed in their textbook locations in 40.3% and 61.3% of cases, respectively. The superior thoracic, thoracoacromial, and subscapular arteries were significantly conserved branches documented in their textbook locations in 97%, 98.3%, and 98.3% of cases, respectively. Discussion and Conclusion: While anatomy educators and students understand that anatomic structure has an inherent range of variability, the classic axillary artery branching pattern students expect to find in cadavers and patients rarely occurs. Educators must present a realistic picture of anatomic complexity and emphasize the clinical and surgical implications of anatomical variation.
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Study of effect of smoking on cytomorphometry of buccal mucosal cells among smokers in South Gujarat Region p. 90
Nisha D Parmar, Neeraj Master, Deepa S Gupta
DOI:10.4103/NJCA.NJCA_33_20  
Background: Tobacco consumption is the major cause of oral cancer. Early detection of cytomorphometrical changes in the buccal mucosa of smoker by the use of exfoliative cytology could help in picking early premalignant changes and thereby reduce morbidity in oral cancer patients. Aim: To assess and compare the cytomorphometrical changes in the buccal mucosa cells among smoker and nonsmoker group and assess these findings in smokers with a duration of exposure to smoking by dividing them as per pack year groups. Materials and Methods: This study was carried out on 51 male cases (Cigarette or Bidi smoking) and 51 controls as per the inclusion and exclusion criteria. For finding the effect of smoking exposure severity, smokers were divided into three groups based on pack year like Group 1 with pack year <5, Group 2 with pack year 5–10, and Group 3 with pack year >10. Sample was taken from the buccal mucosa and stained with Papnicoalaou stain. Images were analyzed by Image J software and nuclear area (NA), cytoplasmic area, and nuclear/cellular ratio (N/C ratio) data collected and analyzed. Results: There was a significant difference for the mean values of NA and N/C ratio in the buccal mucosa of smokers. Significantly increased NA and N/C ratio were found with increased pack year. Conclusion: Cytomorphometrical findings such as NA and N/C ratio are observed in increased severity in premalignant conditions such as leukoplakia. Hence, it is possible to pick up these findings earlier by noninvasive method such as exfoliative cytology, and it can be used as an adjunct tool for mass screening.
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The effectiveness of early clinical exposure in teaching anatomy: A study among 1st year medical students p. 97
Anita R Gune, Vasudha R Nikam, Vaishali V Gaikwad, Dhanaji T Wagh
DOI:10.4103/NJCA.NJCA_31_20  
Background and Objective: The new study model of the Medical Council of India 2015, suggested the introduction of a module of early clinical exposure (ECE) to 1st year medical students to improve their understanding of the subjects taught. Thus, the main objective of the study was to assess; how students respond to the modified curriculum of ECE in the 1st year. Methodology: Cross-sectional study was conducted among 1st year medical students (n = 140) and were brought to the hospital; followed by the demonstration of a visual relay of an appendectomy procedure, which in turn was followed by an interactive session with the facilitators. Following this, the students filled a questionnaire (designed as per the Likert scale) about their opinion of the module. In addition, a test was conducted before and after the module to assess the comprehension of the subject by the students. Statistical analysis was performed using descriptive statistics (for qualitative variables) and t-test, for determining the significance between pre- and post-test scores. Results: Ninety-five percent of the students responded extremely well to ECE and was appreciated by the students. This was clear through the positive feedback received on improvement in understanding and interest in the subject. The pre- and post-test evaluation also resulted in a significant increase in test scores, (P = 2.20e−16). Conclusion: ECE module significantly helped 1st year medical students to comprehend the topic better. It made learning interesting and helped those correlate basic sciences with their clinical applications and relevance in practical medicine.
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A new approach for medial longitudinal arch estimation by “foot print”: A comparative study p. 101
Vedi Neeraj, Dulloo Puja, Gandotra Achleshwar
DOI:10.4103/NJCA.NJCA_27_20  
Background: Medial longitudinal arch (MLA) is important as per the anatomical aspect of individual's foot. Its elastic properties reduce the risk of musculoskeletal wear and impairment. Various methods of its estimation have been presented by researchers. With this basis the aim of the study is to find the value of MLA by the devised mid-footprint planter angle method and compare it with the standard navicular height method. Methodology: Purposive analytical and comparative study done on 1st year health professional students of Sumandeep Vidyapeeth University (2015–2016 batch). MLA was estimated by the navicular height method and mid-footprint planter angle method on footprint after collecting their demographic and anthropometric data. The calculated values of MLA for both feet were compared by correlation coefficient by two different methods and Kruskal–Wallis test for the comparison as per body mass index (BMI) of participants. Results: Statistical significance was observed for right (−3.57 ± 0.85; P < 0.0001) and left (−6.4 ± 0.91; P < 0.0001) foot for MLA values by two methods, with higher level of Kappa agreement for right (0.755) and left (0.794) foot. Higher to middle level of correlation was observed for both the feet as per the two methods. Statistical significance as per gender was observed for left foot by navicular height method. While, no statistical significance was observed for MLA values as per BMI for both feet as per two methods. Conclusion: MLA values estimated by mid-footprint planter angle and compared by the standard navicular height method concludes that this method can be used in place of the gold standard in day-to-day basis, but extensive work needs to be done before considering it as a replacement, specifically in terms of sample size.
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Propylthiouracil-induced histological changes in the placenta of swiss albino mice p. 108
Samta Tiwari, SK Pandey
DOI:10.4103/NJCA.NJCA_34_20  
Introduction: Propylthiouracil, an antithyroid drug, is used to treat hyperthyroidism in early pregnancy as drug of choice. Maternal and fetal morbidities and mortalities occur, if hyperthyroidism is not treated during pregnancy. Aim: The teratogenic potential of propylthiouracil is studied by observing the placental changes in Swiss albino mice, in the light of present research. Materials and Methods: 100 mg/kg body weight/day of propylthiouracil was given orally to pregnant Swiss albino mice (treated group) during early gestational period (6, 7, and 8th days of gestation), while control pregnant mice were given the same volume of distilled water orally for the same duration. The pregnant mice of all groups were sacrificed on 18th day of gestation and placentae were collected. The placentae were grossly examined, formalin fixed, and processed for histological study with H and E staining. Results: Histological examination shows edematous spaces and degenerated normal architecture of the various zones, i.e., labyrinthine, junctional, and basal zones. There was increase in the thickness of chorioallantoic plate and degeneration of giant cell trophoblasts and sinusoids. Conclusion: It was found that the propylthiouracil had a teratogenic effect; therefore, it should be used cautiously during pregnancy to avoid risk of congenital malformations.
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Morphometry of nasopalatine line for transnasal endoscopic access to craniovertebral junction: A cadaveric study p. 111
D Bharathi, Deepali Deshatty, BN Shruthi
DOI:10.4103/NJCA.NJCA_29_20  
Background and Aims: Lesions in craniovertebral junction (CVJ) are approached either through transnasal or transoral route. Endoscopic transnasal route reduces significant morbidity, and nasopalatine line (NPL) predicts the inferior-most limit of surgical dissection. The purpose of the present study was to measure the NPL in the cadavers, which is beneficial for the endoscopic transnasal anterior approach to access odontoid process and anterior CVJ, especially in surgical decompression of medulla oblongata. Materials and Methods: The present study was done on forty midline sagittal head-and-neck specimens obtained from 10% formalin-fixed cadavers in the Department of Anatomy, Rajarajeswari Medical College and Hospital, Bangalore. Using slide calipers, the hard palate line (HPL), which extends from the anterior nasal spine of maxillary bone to the posterior nasal spine of palatine bone and NPL which extends from the inferior-most point of nasal bone to the posterior nasal spine were measured. In addition, HPL was extended to the lower limit of the anterior margin of the foramen magnum, and NPL was further extended posteriorly to the ventral surface of the second cervical vertebra to know the inferior limit of transnasal endoscopic access for surgeries on ventral skull base lesions. Results: The average of HPL and its extension to foramen magnum was found to be 45.83 mm and 40.97 mm respectively. The NPL and its extension to the ventral surface of C2 vertebra were found to be 58.22 mm and 37.18 mm, respectively. Conclusion: HPL & NPL provide useful information for the neurosurgeons to access the lesions in the ventral CVJ and to achieve a good outcome.
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A study of morphology of the chordae tendineae of the left ventricle in human cadaveric hearts of North West Indian population p. 115
Kirandeep Kaur Aulakh, Prachi Saffar Aneja, Shavi Garg
DOI:10.4103/NJCA.NJCA_13_20  
The chordae tendineae form an important part of atrioventricular apparatus connecting papillary muscles to the valve leaflets. Gross morphology of the chordae tendineae of the left ventricle was studied, and any gender differences were noted. Material and methods: 30 grossly normal cadaveric fixed in 10% formalin were studied. An incision was given along left border of heart to open the left ventricle. Gross morphology of chordae tendineae were studied. Statistical analysis: In the anterior leaflet, two strut chordae were found in both males and females in all the cases. The posterior leaflet of mitral valve showed the presence of rough zone, cleft, and basal chordae. Cleft and basal chordae were seen only in the posterior leaflet of mitral valve and not in the anterior leaflet. The number of rough zone chordae was more in the posterior leaflet than other types of chordae, and they were always present. The extent of the spread of anterolateral commissural chorda was mainly to commissural 1/3 of valve leaflet. In males, the chorda spread to commissural 1/3 of leaflet in all the cases, while in females, it was so in 86.7% of cases only. Posteromedial commissural chorda was present in 96.7% of cases.
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Primary amenorrhea in North Kerala: A cytogenetic study p. 121
KS Lekha, N Seena, Lola Das, V Bhagyam
DOI:10.4103/NJCA.NJCA_44_20  
Background and Objectives: Primary amenorrhea (PA) is a major cause of female infertility. PA with the absence of secondary sexual characters is usually due to endocrine or chromosome abnormalities. The purpose of the present study is to estimate the frequency and type of chromosomal anomalies (CAs) in patients with PA, referred for karyotyping, mainly from the gynecology and endocrinology departments. Materials and Methods: In this cross-sectional study, the cytogenetic analysis was carried out in 53 patients with PA from North Kerala. Based on the standard protocol, peripheral blood lymphocyte culture was done. Chromosomal analysis was done with the help of an automated karyotyping system, after G-banding of chromosomes. In each case, 30 metaphase spreads were analyzed to detect CAs. When mosaicism was suspected, at least 50 metaphase spreads were examined. Results: Out of the 53 patients with PA studied, 67.92% (n = 36) showed normal female karyotype (46, XX). Abnormal karyotype was detected in 32.08% of cases (n = 17). CAs can be grouped into the following four types: (1) The most frequent anomaly was aneuploidy of X chromosome 64.7% (n = 11). (2) Structural anomalies of the X chromosome were detected in 11.76% (n = 2). (3) Mosaicism of X chromosome aneuploidy with a structural anomaly of the X chromosome was found in 11.76% (n = 2). (4) Male karyotype 46, XY was present in 11.76% (n = 2). Conclusion: This study emphasizes the importance of karyotyping in the diagnosis and management of patients with PA as it reveals the incidence of a significantly high number of cases of CAs.
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Variations in the branching pattern of the tibial nerve in the posterior compartment of the leg p. 127
SA Premchand, W Benjamin
DOI:10.4103/NJCA.NJCA_25_20  
Background: Tibial nerve is the largest branch of sciatic nerve. It innervates muscles of the posterior compartment of the leg. Knowledge of the variations in motor branching pattern may help the surgeons when certain procedures are done for calf reduction and also for spastic equinus foot where selective neurectomy is required. It is also required for anesthetists for inducing neurolytic blocks. The aim of the present study was to study the variations in its branching pattern of the tibial nerve in the posterior compartment of the leg. Materials and Methods: The study was done by dissecting forty formalin-fixed lower limbs from twenty adult human cadavers. The origin of tibial nerve, variations, branching pattern, number of muscular branches and termination of the tibial nerve were studied. The level of origin of these nerves was taken in relation to the apex of head of fibula. Results: 57.5% showed that the origin was <12 cm and 42.5% were between 12 and 24 cm above the level of apex of head of fibula. The flexor hallucis longus received one branch in 70% and two branches in 30% of the specimens. Forty percent of the branches showed two or three divisions. The flexor digitorum longus received one branch in 95% and two branches in 5% of the specimens. Eighty percent of the branches of the muscle showed 2–4 divisions. 82.5% of nerve to soleus muscle had one branch and 17.5% had two branches. In 17.5% of the specimens, nerve to soleus originated from the nerve to the lateral head of gastrocnemius. Thirty percent of the branches showed 2–3 divisions. All specimens had one branch which supplied the tibialis posterior muscle and 47.5% of the branches showed 2–3 divisions. In 77.5% of the specimens, the termination occurred above the malleolar calcaneal axis. Conclusion: The flexor hallucis longus, flexor digitorum longus, and soleus muscle had one or two branches from tibial nerve. Single branch innervates tibialis posterior. Nerves to flexor hallucis longus, tibialis posterior, and the soleus had up to three divisions and nerve to flexor digitorum longus had up to four divisions.
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