Indian Journal of Clinical Anatomy and Physiology

290-294

Authors: Anandi N. Bande, MA Doshi, RB Vaidya, PS Patil, NR Mudiraj.

The development of adrenal gland is complex and fascinating. The cortex shows migrating neuroblastic nodules derived from neural crest cells which are described in literature as “in situ neuroblastoma”. Aim: The present study was undertaken to highlight neuroblastic nodules and giant epithelial cells in fetal adrenal glands at different gestational weeks. Materials and Method: Adrenal glands were dissected in thirty spontaneously aborted normal human fetuses fixed in 10% formalin with gestational age ranging from 11 weeks to 35 weeks. After tissue processing, paraffin blocks were prepared and sections stained with Hematoxylin and Eosin. Multiple serial sections were observed to note average number of neuroblastic nodules per field, size, location and degenerative changes if any in the nodules. Observations and Results: The developing adrenal gland showed parenchyma with a thick fetal cortex showing migrating neuroblastic nodules and giant epithelial cells in the background. It was seen that they increased in number as the gestational age advanced but after 20- 21 weeks of gestation their number went on decreasing. Conclusion: Knowledge of the behaviour of neuroblastic nodules and their fate gives an additional dimension to the histogenesis of adrenal gland. The spontaneous regression of such nodule or persistence and progression to neuroblastoma may be of great clinical significance.

298-303

Authors: Dope Santoshkumar Ankushrao, Dattatray Digambarrao Dombe.

Scapula a bone of shoulder girdle is among the interesting bones of our body because of variations present in it. Its lateral angle becomes truncated and broadened that bears the glenoid cavity which articulates with the head of the humerus in the shoulder joint. The knowledge of the normal anatomical features and variations in shape and size of the glenoid fossa are required for better understanding of shoulder joint arthroplasty are prerequisites for complete understanding of the mechanics of shoulder joint. Materials and Method: Total 107 scapulae; 53right sided and 54 left sided were studied macroscopically and morphometrically. Superior-Inferior Glenoid Diameter (SI), Anterior-Posterior Glenoid Diameter-1 (AP-1), Anterior-Posterior Glenoid Diameter-2 (AP-2)were measured using Vernier sliding caliper and Glenoid cavity index (GCI) was calculated also Scapular length & Breadth measured .Data was analyzed using Microsoft excel. Results: In our morphological study the pear shaped glenoid cavity was most common type followed by inverted comma shaped and the oval glenoid cavity was least common type. Mean length and breadth of scapula was 136.07±14.1mm & 97.13 ± 10.63mm respectively. Mean SI diameter was 36.71±4.14 mm, mean diameter AP-1 was 24.85±3.50 mm, mean diameter AP-2 was 16.27±3.24 mm and GCI was 65.40±8.14%. Conclusion: Results of our study shows that there are variations in the shape of glenoid cavity and in Indian population pear shaped glenoid cavity is most common. There are minor differences in the dimensions of the glenoid cavity of right and left side but the differences are statistically insignificant.

308-311

Authors: Jyothi SR, Dakshayani KR.

Introduction: Third coronary artery supplies right ventricular outflow tract, arises from anterior aortic sinus. It is a source for collateral coronary blood flow forming a vascular anastomotic bridge between the right and left coronary systems. Objectives: To understand coronary artery disease and for successful planning of coronary angiogram the knowledge on third coronary artery is very much necessary. The purpose of the study was to know if the origin of third coronary artery is from a separate orifice or a branch of right coronary artery as right conus artery. Materials and Method: After an ethical approval, 49 formalin fixed human cadaveric hearts were collected from department of Anatomy and Forensic medicine, Mysore Medical College and Research Institute, Mysore, India and a study was done on the origin of third coronary artery in human cadavers by dissection method. The data was analysed using SPSS computer software. Results: It was observed that the incidence of third coronary artery was 10.2%. Conclusion: Complete knowledge on third coronary artery is essential to understand the advances made in coronary artery bypass surgeries and newer methods of myocardial revascularisation.

316-318

Authors: Rajad R, Rani Raphael M, Romi S.

Introduction: The human femoral third trochanter is described as a projection from the proximal aspect in the upper part of gluteal tuberosity. This projection could be in the form of an oblong, rounded or conical shape. This projection is called third trochanter with reference to the greater trochanter and lesser trochanter. Studies on the third trochanter are comparatively less in number. Materials and Method: 100 human femora of unknown sexes from the Department of Anatomy, Government T.D Medical College, Alappuzha, Kerala, were inspected to estimate the occurrence of third trochanter. Result: The third trochanter was present in 13 bones (13%). The frequency of occurrence was 13.46% in left and 12.5% in right. The mean vertical length was 15.81 mm and the mean breadth was 8.48 mm. Conclusion: The third trochanter of femur with an incidence of 13% in the present study might potentially influence the fracture line in pertrochanteric fracture. Its presence should be taken into consideration while modeling the pre contoured femoral plates.

324-328

Authors: Ankit Jain, Rashmi Jain, Sonia Baweja.

Introduction: Growth of the fetus is dependent on the development and function of the placenta. Therefore, any pathological condition which affects the function of placenta, will also affects the fetal outcomes. The aim of the present study was to assess the effects of non-central cord insertions on placental outcomes. Materials and Method: 120 placentae divided into sixty each of normotensive and pre-eclamptic pregnancies were studied. After delivery, the weight of the placenta was taken by using weighing machine. The shape of the placenta and umbilical cord insertion on placenta was observed. Results: In this study, abnormal cord insertions were found 2.57 times more in pre-eclamptic pregnancies as compared to normal pregnancies. Altered shaped placentae were found 2.6 times more in pre-eclamptic pregnancies as compared to normal pregnancies. We found that 28.57% and 55.56% placentae with abnormal cord insertion were associated with altered placental shapes in normal and pre-eclamptic pregnancies respectively. We also observed that 57.14% and 77.78% placentae with abnormal cord insertion were associated with low placental weight in normal and pre-eclamptic pregnancies respectively. Conclusion: The incidence of abnormal cord insertions were more in pre-eclamptic pregnancies and these abnormal cord insertions were significantly associated with altered shaped placentae and lower placental weight. Conclusively, placenta with abnormal cord insertion may be associated with alteration in the function of the placenta, which ultimately affects the fetal outcomes.

332-335

Authors: Deepali A, Shashiraj HK, Kavitha BS, Mahesh SH.

Introduction: Stress is defined as a force of deleterious nature external or internal, physical or mental that tends to disturb the organisms integrity or homeostasis. Medical education poses great amount of stress to the students, as the study of medicine is extensive and time consuming more so among the first year medical students. Aim and Objectives: The present study was conducted to identify the potential stressors among students and develop strategies to help students combat stress in an effective manner. Materials and Method: This cross sectional questionnaire based study was conducted among first year medical students belonging to 2015-2016 batch of Sri Siddhartha medical college, a composite college Sri Siddhartha academy of Higher Education a Deemed to be University at Tumkur. Results: A total of 130 students participated in the study and their questionnaire based responses were analyzed. 76.92% of students identified examination related issues and competition among peers (76.92%) as a major source of stress among them followed by loneliness 34.61%, apprehension about teachers 43.84%, as a possible source of stress Listening to music and watching movies were the medium through which of the students sought relief from the stressors followed by spiritual activity and sports. Conclusion: First year medical students are exposed to varying degrees of stress and identification of potential stressors with effective intervention by structured mentorship programs along with student counseling the students can be guided in a better way to perform well in their scholastics.

340-343

Authors: Kahkashan Azeez, Shivakumar Veeraiah.

Introduction: Hypertension is a major public health problem in India with a prevalence ranging between 20-40%. Chronically sustained high blood pressure is associated with a number of adverse health effects such as myocardial infarction, renal failure, stroke and may also lead to cognitive decline. The relationship between blood pressure and cognition has varied across studies; hence this study was taken up to evaluate the relationship between hypertension and cognitive performance. Hypothesis: Hypertension is associated with cognitive decline. Materials and Method: Study involved 30 hypertensive and 30 normotensive subjects. Hypertension was diagnosed based on JNC VII criteria. Both groups were matched for age and education. Potential alternative psychosocial causes of cognitive impairment such as depression, anxiety, stress were ruled out using DASS21. In both groups, cognitive functions in domains of psychomotor speed, sustained attention, executive functions, short and long term verbal memory were assessed using a battery of performance tests. Results were compiled and statically analyzed using Pearson’s Chi- square test, student-t test, odds ratio on SPSS software version 17. Results: A significant association was found between hypertension and psychomotor speed (p= <0.01), sustained attention (p= <0.01), short term and long term verbal memory (p= <0.05). No association was observed between hypertension and executive functions. Conclusion: Hypertensives performed poor in set of tasks that measure psychomotor speed, sustained attention, short and long term verbal memory probably because hypertension brings certain pathophysiological changes in brain such as vascular remodelling, impaired cerebral auto regulation, small lacunar infarcts, white matter lesion and amyloid angiopathy. Thus it is imperative to strictly control blood pressure in hypertensives to avoid deleterious effect of hypertension on cognition.

348-352

Authors: Manish Lamoria, Alkesh Vara, Soumi H Chaudhuri.

Introduction: Malaria is a troublesome protozoan disease to control in tropical and subtropical countries because of menace of mosquito vector and humans easily susceptible to its bite. It is estimated to infect 200 million people and 1-3 million deaths a year according to the WHO. Among them the virulence of Plasmodium falciparum malaria is the most by the virtue of rosetting. Rosetting means adherence between infected and uninfected RBCs, which together can hinder peripheral and terminal microvasculature circulation, thus, leading to most of the dreaded complications of this disease. Objectives: To study the distribution of blood groups in patients infected with Plasmodium falciparum malaria and to evaluate the complications and deaths associated with it in admitted patients of GMERS Medical College and Hospital, Patan, Gujarat. This study also includes corroborating the hypothesis whether O blood group confers any protection against dire complications of plasmodium falciparum infection as widely believed. Materials and Method: The study was conducted from February 2012 to February-2015 (3years) on 162 confirmed patients of falciparum malaria who were admitted in GMERS Medical College, Patan and were diagnosed by thin and thick peripheral blood smear examination. Patients of all age groups were included. Control group included 1660 healthy volunteers donating blood in blood bank of the hospital. Blood grouping was done by conventional agglutination test using Monoclonal Antisera A and B on porcelain tile. The following Investigations were also collected; serum hemoglobin, platelet count, serum bilirubin, serum creatinine, random blood sugar. Complications like coma, convulsion, hypoglycemia, anemia, thrombocytopenia, hepatic dysfunction, renal dysfunction, hypotension, shock, respiratory distress and cause of death if any occurred were duly noted. Results: Out of 162 diseased patients studied in 3 years duration, percentage of patients of each blood group were A:33.80%, B:30.64%, O:24.20%, AB:11.29% respectively with blood group A has highest relative risk of 1.38 of contracting the disease among all four groups. Total 15 of 162 patients died with 6 patients each belonging to group A and B and 3 patients of group AB. Conclusion: As per this study and statistics prevalence of plasmodium falciparum malaria was found to be more among blood group A and B, along with its complications. Although blood group O patients were also not found to be immune to the infection, the presence of complications and death were indeed next to nought in them.

356-360

Authors: Ritika Gaddewar, MM Meshram.

Estimation of the skeletal age of an individual by radiological observation of the time of fusion of the ossification centers is a subject matter of great medicolegal and academic interest to anatomists and forensic experts. Total 107 cases were studied for assessing epiphyseal fusion at Elbow joint. Epiphyseal fusion at Conjoint epiphysis of lower end of Humerus, Medial epicondyle of lower end of Humerus, Upper end of Radius are studied by radiography. It was observed that complete epiphyseal fusion of Composite epiphysis of Lower end of Humerus with shaft occurred at about 15 years in case of Males and 14 years in case of Females, epiphyseal fusion of the Medial epicondyle of Humerus with shaft at 20 years in case of Males and 19 years in case of Females and epiphyseal fusion of the Upper end of Radius with shaft occurred at about 16 years in case of Males and Females. Females showed early epiphyseal fusion than in males. Age of epiphyseal fusion was studied and compared with different studies carried out in different populations of India as well as other countries.

364-368

Authors: Sukanya Badami, Mahesh Baragundi.

Medical colleges in India have traditionally followed a curriculum stuffed with a large body of knowledge pertaining to basic sciences and clinical disciplines. With expanding body of knowledge, there is over-burdening of the student with content information. Unfortunately, heavy academic workloads in medical school make it difficult for medical students to maintain a regular exercise program. Research findings in the last three decades, have shown that physical inactivity and a negative life style has seriously threatened health and hastened the deterioration rate of human body. On the other hand Physical Education (PE) is the course that encourages psychomotor learning in a play or movement exploration setting. Physical education class provides a great variety of activities and high intensity exercises for students. It is well known that rigorous exercise training diminishes certain cardiovascular and hormonal responses to fixed amounts of exercise. Aerobic training is responsible for metabolic adaptations that allow more efficient adjustment of energy expenditure during exercise recovery

373-376

Authors: Umadevi B, Anitha DR, HM Kavyashree.

All health professionals face stress because of time pressure, workload, multiple roles and emotional issues. Stress and its psychological manifestations are a major concern in the modern-day society. Presence of psychological morbidity in medical undergraduate students has been reported from various countries across the world, Indian studies to document this burden are very few. Therefore, the present cross sectional study was taken to assess the stress parameters using previously validated and standardized instrument, Depression Anxiety Stress Scale (DASS 21) and the associations with their personal characteristics. Cognitive functions were assessed by visual and auditory reaction time and the effect of BMI on Visual and auditory reaction time was also assessed. Results: The mean depression score of the respondents is 14.11± 7.82 students showed moderate depression, mean anxiety score is15.33±7.57 showed severe anxiety and mean stress score is 17.83±7.33 experienced mild stress. Main source of stress is overloading of work around (108, 82%) and (62, 47%) of students go to sleep as their main stress coping method. Visual and auditory reaction time was increased in students during exams. Mean visual reaction time is 0.25±0.06 and auditory reaction time is 0.22±0.05. In students with high BMI (27±2.14) visual and auditory reaction time was high also students with high waist to hip ratio(0.81±0.13) showed high VRT and ART but is not statistically significant compared to students with normal BMI and waist to hip ratio.

381-385

Authors: PSL Saravanan, S. Anu.

In recent times the incidence of tumors of breast is quite alarming all over the world. In 2012, nearly 1.7 million new cases of breast cancer is reported worldwide. The occurrence of breast tumors is considered to be due to very many risk factors. Based on epidemiological data, risk factors for breast cancer fall in 3 main groups: Genetic, endocrine and environmental. Each may be of major, intermediate or minor importance. Major risk factors include 1. Female gender 2. Increasing age 3. History of previous breast cancer 4. Family history 5. Genetic factors (mutation of BRCA 1 or BRLA 2), appear to account for over half of all the identifiable breast cancer families. Intermediate risk factors include alcohol, diet, nulliparity, early menarche, late menopause, oral contraceptives, hormone replacement therapies, benign proliferative breast disease, irradiation etc

389-391

Authors: Vaishnavi Devi, Nawin Suriya, R. Shanmuga Sundaram, G. Sumitra, PA Kumar.

Introduction: Information regarding conduct and evaluation of Early Clinical Exposure (ECE) which has been mandated by Medical Council of India, is scarce and the present study is an attempt to highlight the significance of this very innovative program. Regulatory authorities have left the designing and the mode of implementation of the ECE program to the discretion of individual colleges to decide. Materials and Method: As a part of the program of ECE, 150 first year MBBS students were posted in cardiac catheterization laboratory of PSG Hospitals for part of the day. Students in small batches of 10 each had the opportunity of visualizing the activities in this department and could witness the procedure of angiography, which enhanced their knowledge of basic sciences of cardiac anatomy, coronary vasculature and its clinical significance. They also interacted with some of the patients and their attendants. Result: The evaluation of the program through a survey, in the form of a questionnaire (pre-post intervention) revealed that ECE had a positive impact on the appreciation of the relevance of basic sciences they learn during the preclinical years with clinical medicine. The open-ended comments from the participants revealed that the participants rated the program very high and considered it a memorable experience. Interaction with the interventional cardiologists and the patients and their attenders provided them an insight into the uniqueness of medical profession, in general and interventional cardiology in particular. Conclusion: ECE, if properly designed provides avenues of enhancing students’ learning in cognitive, psychomotor and affective domain.

396-399

Authors: Sudakshina Chakrabarti, Gunapriya Raghunath, Vijayalakshmi S, Shilpakala LB.

Introduction: The placenta is a fetal organ with important metabolic, endocrine and immunologic functions besides being responsible for nutrition, respiration and excretion for the fetus. With advances in grey scale and Doppler sonography presently the most effective method to date pregnancy is by ultrasound. Placental thickness measured at the level of insertion of umbilical cord can be used as a parameter to estimate gestational age. The thickness, diameter and volume of the placenta appears to be of prognostic value in identifying the subsequent occurrence of fetal growth restriction. Aim: To determine gestational age of fetus by using placental thickness as sonographic parameter and determine the correlation of the placental thickness to gestational age. Objectives: To use placental thickness as a parameter to determine gestational age. To correlate the placental thickness to the LMP derived and ultrasound derived gestational age using fetal parameters. To determine subnormal placental thickness for the corresponding gestational age. Materials and Method: 250 singleton normal pregnant women (10-40weeks of gestation) attending antenatal OPD whose gestational age was determined by LMP method were included in this study. On ultrasound examination the placental thickness was measured at insertion of umbilical cord. The data were collected and tabulated for analysis. Results: The gestational age increased by 1.054 week per unit increase in the placental thickness. Based on correlation coefficient it was determined that nearly 94% of change in GA was determined by the placental thickness. This study showed a strong and significant positive correlation between placental thickness and gestational age. Correlation coefficient between PT and GA overall in 3 trimesters is 0.96. Conclusion: Placental thickness can be considered as an important sonographic parameter to determine gestational age as concluded by this study.

404-406

Authors: Gyanendra Singh, Richa Chauhan, Upendra Prasad Singh.

Gall bladder disease and cancer is a common finding and is highly prevalent along the plains of river Ganga in parts of northern India. Surgical interventional is routinely required in the management of many of such cases. So, the clinicians treating these patients must have a thorough knowledge of both the normal and aberrant anatomy of the gall bladder and surrounding extra biliary structures. Though very rare, aberrations in the embryonic development may present as an absent or hypoplastic non - functional gall bladder. These patients may become symptomatic and present with biliary colic. In the given case report, we present the case of a 52year old lady, who presented with pain abdomen and jaundice. Her pre-operative work up showed a severely contracted and dysmorphic gall bladder which during surgery was found to be a rudimentary hypoplastic gall bladder.