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  Most popular articles (Since August 28, 2020)

 
 
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EDITORIAL
Does the Corpse teach the living? - Anatomy in the era of COVID -19
NB Pushpa, Kumar Satish Ravi
July-September 2020, 9(3):79-81
DOI:10.4103/NJCA.NJCA_49_20  
  565 37 -
We have miles to go together: Message from New Editor in Chief
Kumar Satish Ravi
April 2020, 9(2):37-38
DOI:10.4103/NJCA.NJCA_11_20  
  533 49 -
ORIGINAL ARTICLES
Communication between the median nerve and the musculocutaneous nerve: Occurrence and significance
BN Shruthi, Shreya Krishnamurthy, K Ruthvik, B Rahul
April 2020, 9(2):66-71
DOI:10.4103/NJCA.NJCA_7_20  
Background: The median nerve and musculocutaneous nerve are nerves arising from the brachial plexus supplying the muscles of the arm and forearm. The communication between these nerves is of clinical importance in the traumatology of the shoulder joint and upper arm and in situations where a surgeon needs to isolate and trace the median and musculocutaneous nerves distally. Aims and objectives: The study was conducted to observe and discuss the communications between the median and musculocutaneous nerves. The data was statistically analysed. Materials and Methods: The present study was conducted on 60 cadaveric upper limbs (left: right=30:30) obtained from the department of Anatomy, Rajarajeswari Medical College and Hospital, Bengaluru. The brachial plexus was dissected according to standard dissection procedures and the median nerve and musculocutaneous nerve were exposed. Results: The musculocutaneous nerve did not pierce the coracobrachialis in 5 limbs. However, the nerve did supply the coracobrachialis muscle in all cases. In 5 upper limbs (8.3%), a single communicating nerve was observed between the median nerve and the musculocutaneous nerve. In one case (1.67%), two communicating nerves were observed between the median nerve and the musculocutaneous nerve. Conclusion: Variations in the formation and branching of the brachial plexus have been reported by several researchers. The anatomical variations of musculocutaneous nerve and median nerve are important to neurosurgeons ,orthopaedicians and general surgeons who deal with cases of neurofibromatosis and neurotization procedures. Surgeons must consider the possible presence of the communication between the median nerve and musculocutaneous nerve in such cases.
  399 30 -
Wash and wipe to win over COVID-19
Saha Susmita, Prachi Saffar Aneja, Bansal Savita, Vibhash Kumar Vaidya, Kumar Paras
April 2020, 9(2):48-53
DOI:10.4103/NJCA.NJCA_8_20  
Background and Objectives: The COVID-19 is a serious issue in every corner of the globe affecting frontline warriors and other individuals. Appropriate hand hygiene measures are considered to be the most basic but effective steps to control this disease. The objective of the study was to assess the knowledge, awareness, and proper practice of hand hygiene among university undergraduate medical and nonmedical students. Materials and Methods: The present cross-sectional survey was conducted on 703 university undergraduate medical students (MBBS, BDS, BPT, nursing, and allied) and nonmedical students (engineering, law, commerce, etc.) at Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, through the Google Forms by a prevalidated questionnaire to assess the knowledge and attitude regarding hand hygiene practices in this COVID-19 pandemic era. Results: The correct responses for questions based on recommended time of handwash (29.7%), minimum time required for alcohol-based hand rub to kill germs (70.1%), recommended concentration of hand rub (50.5%), and effective method of handwash (38.8%) were observed. Only 73% of the medical students and 58% of the nonmedical students knew exact steps of handwashing (as per the World Health Organization guidelines). Ninety-one percent of all the respondents agreed that they became more conscious about hand hygiene during COVID-19 pandemic. Eighty-two percent of the participants opined that the steps of hand hygiene must be included in routine curriculum. Conclusions: The results of the current survey presented an average score regarding hand hygiene knowledge and practices among university students for both medical and nonmedical streams in this COVID-19 pandemic era.
  335 23 -
Soft-fixed embalming: Our experiences
Navbir Pasricha, Eti Sthapak, R Bhatnagar, MS Siddiqui, Sonia Jaiswal
April 2020, 9(2):43-47
DOI:10.4103/NJCA.NJCA_2_20  
Background: There is an increased need for surgical skills training which does not involve patients in the first exposure. Clinicians and surgeons prefer honing their psychomotor skills on cadavers. Standard formalin embalming, however, does not provide a very realistic model, so an alternative approach needs to be sorted out in the form of soft-fixed embalmed cadavers to provide realistic model for such procedures. Aim: This study aimed to evolve new methods of soft embalming, which provide better cadavers for surgical training. Objectives: (1) To provide long-term structural preservation of tissues, viscera, and body and prevent fungal and bacterial growth. (2) To explore the use of glutaraldehyde solution for arterial embalming. (3) To obtain cadavers with soft consistency of muscle and tendon and maintain joint mobility. (4) To provide lifelike quality of soft-fixed cadavers for cadaveric surgical workshops. Materials and Methods: Only those bodies which were received within 12 h of death were used for soft embalming. The solution for soft embalming contained glutaraldehyde, glycerin, methanol, cetrimide, and eosin for arterial and formalin solution for cavity embalming. The cadavers were embalmed and then preserved in a deep freezer (−70°C to −80°C) for at least 30 days. After that, the cadavers were preserved in an immersion tank which contained 10% formalin diluted in water. Results: Soft-fixed embalmed cadavers were better for all aspects of training. Soft-fixed cadavers exhibited a greater degree of flexibility and color retention compared to that of traditional formalin-fixed cadavers. The preference was particularly pronounced in aspects that require flexibility of tissues such as for flap raising. Conclusions: Soft-embalmed cadavers provide a more realistic model for training of surgical skills.
  312 36 -
Teratogenic effects (resorptions and reduction in weight and crown rump length) of valproate on fetal mice
Pratibha Shakya, Neelesh Kumar Shakya, C Mohanty
April 2020, 9(2):39-42
DOI:10.4103/NJCA.NJCA_9_20  
Background and Aims: Teratology is the study of abnormal development in fetus. Teratology first came into existence in 1930 when a number of experiments were conducted. There are various causes of congenital anomalies such as genetic factors, environmental factors such as radiation, changes in temperature, hypoxia, chemical substances, drugs, and maternal infections. At present, valproic acid is the most widely used antiepileptic drug. Valproic acid is salt of dipropyl acetic acid. Most of the studies on the valproate were done at higher doses starting from 400 mg/kg. Hence, the present study was done to assess teratogenic effects at lower dose of valproate i.e., 200 mg/kg. Only few studies are conducted on fetal mice at Valproate dose of 200 mg/kg. The aim of the present study is to report the teratogenic effects of valproate at dose of 200 mg/kg on single gestational day (8th) and multiple gestational days (7th, 8th, and 9th) in fetal mice. Materials and Methods: Forty pregnant mice were taken in the present study, and these are distributed in three groups. Group A which was control group received normal saline. In Group B, Valproate was administered on single gestational day (8th). In Group C, Valproate was administered on multiple gestational days (7th, 8th, and 9th). Dose of valproate given in each group was 200 mg/kg intraperitoneally. On the 18th gestational day, fetuses were collected after uterotomy. The fetuses of all three groups were weighed by digital laboratory weighing scale. Crown rump length (CRL) of fetuses of all groups was documented by means of graph paper. Mean, standard deviation, and P value were calculated. Statistical analysis was done by the ANOVA one-way test. Results: Valproate administered groups showed resorptions. CRL and fetal weight reduction were found in treated groups. These findings were more found in Group C in comparison to Group B. Conclusion: Valproate is teratogenic drug at 200 mg/kg dose, so valproate should be prescribed at lowest efficacious dosage to minimize the teratogenic risk.
  297 37 -
Axillary artery variation: The rule not the exception
Cameron M Thiele, Danielle A Thornburg, Sonya E Van Nuland, Natalie R Langley
July-September 2020, 9(3):82-89
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.
  232 33 -
REVIEW ARTICLE
Revisiting the anatomy of rotator cuff relevant to rotator cuff injury
Adil Asghar, Sanjib Kumar Ghosh, Ravi Kant Narayan
January-March 2020, 9(1):1-6
DOI:10.1055/s-0040-1709029  
The rotator cuff is the prime stabilizer of the glenohumeral or shoulder joint. The last decade saw introduction of three components, namely, rotator cable, rotator crescent, and rotator interval of rotator cuff, which were being studied and published in dozen of literatures belonging to clinical specialties of orthopaedics and radiology. At times when these terms have helped the clinician to understand the biomechanics of the rotator cuff while improving the outcome of its repair, the knowledge of the same remains at large for the anatomists. The preoperative assessment of rotator cuff tear has helped surgeons to identify the structure and its functional deficits thereof. The rotator cable is a thick fibrous band that behaves like a suspension bridge. Tears of rotator cable result in partial loss of function or pseudoparalysis of shoulder joint. The rotator interval is a four-layered protective cover of ligaments and the capsule in the rotator cuff. The current knowledge of the rotator interval revealed that the minor underlying ligaments of the shoulder j’oint play a crucial role in maintaining the congruency of the rotator cuff. The rotator cuff inj’ury is often misdiagnosed due to a lack of knowledge and identification of its recently reported components. This review intends to sensitize the anatomists to investigate further about rotator cuff anatomy and biomechanics of the shoulder joint.
  210 27 -
ORIGINAL ARTICLES
Study of pattern of origin of central branches of middle cerebral artery by using 64-slice computed tomography angiography
Mahendra Kumar Pant, Jayanti Pant, SK Pandey, RC Shukla
April 2020, 9(2):54-58
DOI:10.4103/NJCA.NJCA_3_20  
Background and Aims: Middle cerebral artery (MCA), a branch of the internal carotid artery, is the most commonly affected vessel in cerebrovascular diseases. Various studies have reported for variations in the origin pattern of MCA. The detection of these variations is of clinical relevance for the clinicians for planning their line of treatment. The present study was performed to identify the variations using 64-slice computed tomography (CT) angiography. Materials and Methods: The present study was performed in 45 participants (32 males and 13 females). MCA was identified and observed for a different pattern of origin of the central (perforating) branches using 64-slice CT angiography. Results: The observations revealed that the M1 segment of MCA showed single, dual, or multiple origins of central branches. Single central branch of MCA originated in 8.88% of cases, double branches were observed in 11.11% of cases, whereas the multiple branches were found in 66.67% of cases and mix pattern was observed in 13.3% of cases. These central branches coursed through the anterior perforating substance to reach the basal area of the subcortical zone. Conclusions: The present study revealed the variations in origin of the central branches of MCA using 64-slice CT angiography and the knowledge of radiological identification of these variations can be of use for radiologists and neurosurgeons dealing with cerebrovascular diseases.
  209 25 -
A study of morphology of the chordae tendineae of the left ventricle in human cadaveric hearts of North West Indian population
Kirandeep Kaur Aulakh, Prachi Saffar Aneja, Shavi Garg
July-September 2020, 9(3):115-120
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.
  218 15 -
CASE REPORT
Presence of pericentric inversion in chromosome 9 in all family members
Anjali S Sabnis
April 2020, 9(2):75-78
DOI:10.4103/NJCA.NJCA_10_20  
Pericentric inversion is the most common type of inversion encountered in human beings. Although pericentric inversion in chromosome 9 is generally considered as normal variant without any phenotypic presentations, some conditions associated with it, like mental retardation. In the present case, we discuss a baby with mental retardation showing pericentric inversion of chromosome 9 and also parents showing the same type of inversion on chromosome 9 without any phenotypic presentations.
  210 15 -
ORIGINAL ARTICLES
Perceptions and attitudes of medical students toward the use of digital surgical operative video in lecture – A better anatomical understanding
Medora C Dsouza Dias, Rajesh T Patil
April 2020, 9(2):63-65
DOI:10.4103/NJCA.NJCA_6_20  
Background and Aims: There are numerous variations in the branching of the internal iliac artery (IIA), which are important during any pelvic surgery. An aberrant/accessory obturator vessel is the most common source of hemorrhage during pelvic surgery and to prevent this, one needs to have a good knowledge of pelvic vascular anatomy. Our aim was to enhance the learning process of the branching pattern of the IIA in MBBS students in order for them to better understand the concept of aberrant/accessory obturator artery (OA) and corona mortis (CM). Materials and Methods: First-year MBBS students after completing their routine dissection of branches of the IIA, were shown a video of laparoscopic femoral hernia reduction surgery and their feedback was taken. Results: Nearly 95.82% of the students agreed that they observed and understood aberrant OA, 99.16% of the students agreed that they observed and understood accessory OA, 98.33% of the students agreed that they observed and understood the CM concept, and 100% of the students felt that more such videos should be incorporated and discussed in future interactive lecture teaching. Conclusion: This study incorporates the levels of competency as per AET-COM teaching module in the knowledge domain, i.e., “Knows” and “Knows-How.” This study proves that learning anatomy can be made more interesting for and be better conceptualized, visualized, and understood by students by incorporation of relevant surgical/clinical video clips during conventional teaching.
  206 15 -
A study on morphology of suprascapular notch with specific emphasis on type-VI of rengachary classification
Tushar V Nayak, Subhash M Gujar
April 2020, 9(2):72-74
DOI:10.4103/NJCA.NJCA_5_20  
Background and Aim: Superior border is shortest border of scapula which is marked by suprascapular notch bridged by transverse suprascapular ligament. Beneath this ligament passes the suprascapular nerve. Narrow notch and Type-VI suprascapular notch are one of the risk factors for suprascapular neuropathy. This study is done to study morphological variation of suprascapular notch. Knowledge of various types of suprascapular notch will help the clinician in early diagnosis and surgical treatment. Materials and Methods: A total of 525 human scapulae were taken to study morphology of suprascapular notch at the Anatomy Department, GMERS Medical College, Vadnagar and at B. J. Medical College, Ahmedabad. Age and sex of scapulae were not established. Digital camera is used to take photos of different suprascapular notch and classified as per Rengachary classification. Results: As per Rengachary classification in our study, of 525 scapulae most common suprascapular notch type is Type-III 47.1%, least common is Type-V 1.9%, and incidence of Type-VI is 8.9%. Conclusion: A study of different types of suprascapular notch can help the physician in screening high risk patient as well as diagnosis and treatment of suprascapular neuropathy disorder.
  188 25 -
A new approach for medial longitudinal arch estimation by “foot print”: A comparative study
Vedi Neeraj, Dulloo Puja, Gandotra Achleshwar
July-September 2020, 9(3):101-107
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.
  171 24 -
Morphometric study of uncinate process of cervical vertebra and its surgical importance
P Durga, KR Dakshayani
April 2020, 9(2):59-62
DOI:10.4103/NJCA.NJCA_4_20  
Introduction: Uncinate process (UP) is a projection on the posterolateral margins of the superior surface of the body of the cervical vertebra. They are involved in the uncovertabral (Luschka's) joints, with intervertebral foramen in between, which is related to vertebral artery and spinal nerve roots. Osteophytes of UP cause narrowing of intervertebral foramen, resulting in cervical spondylotic radiculopathy. Objectives: (1) To measure the morphometric parameters of UP of the cervical vertebra. (2) To classify the cervical vertebra on the basis of the encroachment of UP on the adjacent intervertebral foramen. Materials and Methods: One hundred dry cervical vertebrae were obtained from regions in and around Mysore, Karnataka, India. Measurements were taken using digital Vernier calipers. Results: Mean average values of the parameters are: width – 3.389 ± 0.83 mm (right), 3.389 ± 0.86 mm (left); length – 10.42 ± 1.46 mm (right), 10.64 ± 1.88 mm (left); and height – 5.32 ± 1.36 mm (right), 5.21 ± 1.16 mm (left). Classification of UP according to its encroachment on intervertebral foramen which is traversed by neurovascular structures, which may be compressed. Conclusion: Comparing the results of te present study with previous studies in different regions will help neurosurgeons to determine the boundaries of UP and allow adequate decompression of neural elements with reduced risk of neurovascular structures during anterior decompression of the spine.
  174 19 -
The effectiveness of early clinical exposure in teaching anatomy: A study among 1st year medical students
Anita R Gune, Vasudha R Nikam, Vaishali V Gaikwad, Dhanaji T Wagh
July-September 2020, 9(3):97-100
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.
  169 18 -
Propylthiouracil-induced histological changes in the placenta of swiss albino mice
Samta Tiwari, SK Pandey
July-September 2020, 9(3):108-110
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.
  172 10 -
Primary amenorrhea in North Kerala: A cytogenetic study
KS Lekha, N Seena, Lola Das, V Bhagyam
July-September 2020, 9(3):121-126
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.
  168 12 -
Morphometry of nasopalatine line for transnasal endoscopic access to craniovertebral junction: A cadaveric study
D Bharathi, Deepali Deshatty, BN Shruthi
July-September 2020, 9(3):111-114
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.
  160 13 -
Variations in the branching pattern of the tibial nerve in the posterior compartment of the leg
SA Premchand, W Benjamin
July-September 2020, 9(3):127-131
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.
  157 13 -
Study of effect of smoking on cytomorphometry of buccal mucosal cells among smokers in South Gujarat Region
Nisha D Parmar, Neeraj Master, Deepa S Gupta
July-September 2020, 9(3):90-96
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.
  140 16 -
Estimation of gestational age using fetal liver morphometry
D Agnihotri, SL Jethani, A Dubey, D Singh
July-September 2018, 7(3):134-138
Background and Aim: The liver is a large organ in the body. Its various parameters can be utilized in determining the gestational age of the fetus and also in diagnosing pathologies affecting liver growth. The aim is to measure the various liver parameters in non deformed fetuses and to develop regression equations between the liver parameters and the gestational age. Materials and methods: The study was done on 30 aborted fetuses with varying gestational age from 13 to 32 weeks. Fetuses with any gross abnormalities were excluded. The crown rump length was measured for all. Dissection was done and the livers were removed weighed, length of right border, length of the border, width of superior surface, distance of porta hepatis to the right and left border were recorded using manual vernier caliper. Result: The various parameters of the liver showed a strong correlation with the CRL and hence the gestational age. Conclusion: The determination of the gestational age of the fetus using the correlation between the crown rump length and the liver morphometry can be done accurately.
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Morphological variations of biceps brachii muscle in eastern indian population: A cadaveric study
Praveen Kumar Ravi, Manisha Rajanand Gaikwad, Amit P Tirpude, Madhusmita Panda, Pravash Ranjan Mishra
January-March 2020, 9(1):31-35
DOI:10.1055/s-0040-1708923  
Background and Aims: Biceps brachii (BB) is the commonest muscle in the upper limb showing variations. Supernumerary heads of biceps brachii have been frequently reported in literature. The aim of the present study is to report the occurrence and detailed anatomy of the supernumerary heads of biceps brachii, including its nerve supply among the Eastern Indian population. Materials and Methods: A total of 50 upper limbs (25 right and 25 left upper limbs) of embalmed cadavers were dissected and examined for the variation in the origin of BB. Observations: Out of 50 upper limbs, five upper limbs (10%) showed supernumerary heads of BB. Inferomedial humeral type of supernumerary head was predominant. A significant percentage (80%) of the supernumerary heads were associated with the nervous variation. Conclusion: Biceps muscle is well-known for variation in its origin. Anomalous muscle tear may present as shoulder pain in these patients, magnetic resonance imaging (MRI) may be diagnostic. Detailed anatomy of supernumerary heads serves as a potential tool for graft or flap surgeries with preservation of the function of superior extremities. The awareness of supernumerary heads of biceps brachii in relation to adjacent neurovascular bundles is necessary for modern-day imaging techniques and surgeries.
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CASE REPORTS
Midgut malrotation with volvulus - a case report
Pradipta Ray Choudhury, Prasant Sarda, Shobhit Singh, Prabahita Baruah, KL Talukdar
April-June 2013, 2(2):82-85
Midgut malrotation is a rare anatomic anomaly that complicates the diagnosis and management of acute abdominal pain. It is a congenital anomaly that arises from incomplete rotation or abnormal position of the midgut during embryonic development. A two years old boy was brought with recurrent abdominal pain and vomiting. On ultrasonography, the intestinal malrotation was suspected and thus contrast enhanced computed tomography (CECT) was done. On CECT, abnormal relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV), colon on the left side of the abdominal cavity, ‘Whirlpool sign’ etc., were found. All findings were suggestive of midgut malrotation with volvulus. Detection of uncomplicated malrotation should not be trivialized because such patients might experience a future complication.
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REVIEW ARTICLE
Evaluation of pattern and duration of university question papers in anatomy
S Viveka, MJ Sudha
July-September 2018, 7(3):160-166
Background and objectives: Assessment drives learning. Theory summative assessment must be aligned to curricular goals. There is wide disparity in the total marks for which the examination is conducted and total duration of time of examination. The main objective of this study is to report differences in summative assessments in anatomy subject conducted by universities with respect to maximum time, maximum marks, syllabus distribution of papers, assessment of diagram drawing abilities and emphasis on clinical anatomy. Methodology: During August 2018, an extensive search for the syllabus/curriculum document will was in the internet. In the respective university websites, the document with names ‘MBBS syllabus’ or possible documents with syllabus details of medical undergraduate anatomy subject were searched. Results: Information from 25 different universities conducting undergraduate MBBS degree programs were evaluated. Out of these universities, sixteen universities conduct summative exam for 3 hours. Eight universities conduct exams for 2.5 hours. State universities of Punjab, Gujarat, Madhya Pradesh, Kerala and Tamil Nadu conduct anatomy exams for 50 marks with 3 hour duration. Whereas, state universities of Andhra Pradesh, Maharashtra, Assam and Odisha conduct exams for 50 marks in 2 hours. JIPMER, Pondicherry has two-hour exam for fifty marks. Only Karnataka universities [including Rajiv Gandhi University of Health Sciences and three other deemed to be universities] and All India Institute of Medical Sciences, Rishikesh conduct exams for 100 marks in 3 hours. Twenty-one universities have above diaphragm syllabus in paper 1 and below diaphragm in paper 2. Conclusion: It is the need of the hour to have a uniform, structured, objective and rationale summative assessments in anatomy
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