Indian Journal of Clinical Anatomy and Physiology

Page No. 1-3

Authors: Amruta S. Bennal, Varsha Chavan

Background: During reproductive life of women, menstrual cycle is a physiological phenomenon. Alteration in the concentration of hormones such as estrogen and progesterone influences its phases. Across normal menstrual cycle, fluctuating levels of sex steroids affect sensory- motor association of an individual. Aims and Objective: To study the nerve conduction velocity across the phases of menstrual cycle. Materials and Methods: In 50 female’s medical students with regular menstrual cycle belonging 19-25 years of age, a cross sectional study was conducted. Nerve conduction velocity was calculated by recording evoked electromyogram (EMG) by stimulating median nerve at elbow and at wrist. Results: There is no statistically significant change in nerve conduction velocity (measured in m/s) across the different phases of menstrual cycle, though slight decrease in secretory phase (57.96±2.99) comparing proliferative phase (57.99±3.83) and menstrual phase (58.37±2.92). Conclusion: NCV slightly decreases during secretory phase, may be due to the hormones estrogen and progesterone causing retention of salt and water, may be considered as physiological

Page No. 8-10

Authors: Barun K. Sharma, Rubi Dey, Sumit Kar, Varun Kumar Singh

Introduction: The termination of the spinal cord in human beings is cone shaped and is called the Conus Medullaris (CM). Thecal Sac (TS) is a membranous sac of dura mater containing the spinal cord, cauda equina and cerebrospinal fluid. The terminations of these vary in the population across the world, which carries therapeutic implications. Materials and Methods: A retrospective descriptive study was conducted on all patients above 18 years of age undergoing Magnetic resonance imaging (MRI) of lumbosacral spine for low backache using Achieva 1.5 Tesla MRI (Philips, Netherland) to localize the levels of conus medullaris and thecal sac. Results: The study population comprised of 91 individuals of which 63 individuals fulfilled the inclusion criteria. The position of conus medullaris varied between upper third of T12 vertebral body to L2- L3 disc level with a mean position at mid third of L1 vertebral body. The position of the thecal sac varied between upper third of S1 vertebral body to lower third of S3 vertebral body with the mean position at upper third of S2 vertebral body. Conclusions The mean level of termination of the conus medullaris in our study was at the level of middle third of L1 vertebral body and the mean level of thecal sac in our study was at the upper third of S2 vertebral body. Knowledge of the position of CM and TS, the distances between the two in various population groups will be of practical value in day to day clinical practice.

Page No. 16-19

Authors: D. NagaJyothi, S. Saritha, N. Hima Bindu, T. V. Ramani, Gayatri. P

Introduction: The Supra trochlear aperture is situated on thin transparent bony plate which separates the Olecranon fossa and Coronoid fossa of the humerus. The Supra trochlear foramen (STF) is relatively common, seen in some humerii. Materials and Methods: The current study was done in 108 dried humerii (right 45 and left 63) from the Anatomy Department, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Gandhi Medical College, Secunderabad and Osmania Medical College, Hyderabad. The presence of STF, its different shapes and the vertical and transverse diameter were observed. In bones w here the foramen was not present, translucency and opacity of Supra trochlear septum were noted. Results and Conclusion: The supra trochlear foramen was seen in 34 humerii (31.4%) and 74 humerii (68.5%) were without STF. Among 74 humerii, translucency Supra trochlear septum was seen in 23 (21.2%) and the rest opaque septum (normal) was seen in 51 humerii (47.2%). The supra trochlear aperture was more common on the left side about 23 in number (21.3%) than on the right side which was 11 in number ( 10.1%) . The different shapes like oval, round and triangular were also observed and most common shape is oval. We attempted to enlighten the knowledge of presence of Supra trochlear foramen and translucent supra trochlear septum in the dry humerii. These bony features are important for anatomists, orthopedicians and radiologists in their routine practical knowledge and interpretation in their respective areas.

Page No. 26-29

Authors: Ezhilarasan S., Jetanthi M., Muthuvel Vijayan K.

Plastination is a technique for preparing dry specimens, which can be used for demonstration as well as for mounting in museum Plastination technique was first developed by Gunther von Hagens in 1977. Till then Plastination has become the gold standard for preservation of biological specimens. Recently plastination of human organs with general purpose resin has been done in many Institutions of Anatomy in India. But general purpose resin has the property. To darken the colour of the specimens. So in the department of Anatomy, Government Theni Medical College we used a new type of commercially available Isopthalic polyester resin for plastination. In the past three years more than 30 specimens have been plastinated in our department by this technique. According to the standard plastination procedures, complete dehydration of formalin fixed specimens by acetone can normally be achieved at -25°C and the forced impregnation of specimens with silicone polymers or polyester resins can be done by applying vacuum.

Page No. 34-39

Authors: Gayatri Bora, G. K. Sudhir, K. N. Narasimha Swamy

Background: Overweight has a considerable impact on spirometry variables which are thought to be improvised by isotonic exercise and diet regime – though the combined effects have not been investigated and precisely proved as yet. We hypothesized that programmed exercise training improves the Peak expiratory flow rate in overweight, more so if there is associated weight loss. Objective: The objective was to investigate and evaluate the effect of dynamic exercise and dietary weight-loss program of 12 weeks on the Body mass index and Peak expiratory flow rate in overweight adolescents. Settings and Design: Adichunchanagiri Institute of Medical Sciences, Karnataka. A cross-sectional pilot study. Materials and Methods: Dynamic lung parameter, Peak expiratory flow rate, was measured in 20 overweight boys and in equal number of age and gender matched normal weight controls using computerized spirometer (BPL APREMIS 3.1). Statistical analysis used: Collected data were statistically treated using the SPSS software. Results – Body mass index and pre training baseline Peak expiratory flow rate revealed very significant difference (P< 0.001) between the two groups. Following 12 weeks of regular aerobic exercise combined with calorie restricted diet protocol, the experimental group showed a longer pulmonary endurance. Overall 19.6% improvement in Peak expiratory flow rate was observed in the high-BMI participants. The pre- and post-training changes in the Body mass index amongst the overweight, was statistically significant (P = 0.0350) with 25% i.e., five boys achieving healthy weight limit. Conclusion: Body mass index, restricted diet and exercise are concomitantly affecting Peak expiratory flow rate result. The results indicate that exercise training with a restricted diet not only improved respiratory fitness but more so the Body mass index in the overweight adolescents

Page No. 44-47

Authors: Manoj Borkute, K. Shyam Kishore

Introduction: Posterior condylar foramen is the most constantly present emissary foramen in human skull. It is also considered as largest emissary foramen present in humans. Of the two large emissary veins of posterior cranial fossa, one of them i.e. posterior condylar vein passes through posterior condylar foramen. Condylar veins are also important channels of venous drainage for posterior cranial fossa region. Emissary veins are important in equalising intracranial pressure. They can act as safety valves in cerebral congestion. Method: Material for this study consists of 100 dry adult skulls obtained from two teaching institutes in Maharashtra state. These skulls were carefully observed for posterior condylar foramen. Whether foramen was present unilaterally or bilaterally or was absent on both sides was noted. Result: Posterior condylar foramen was present on both sides (bilaterally) in 58 skulls. In 15 skulls it was present only on right side where as in 10 skulls it was present only on left side. Foramen was found to be absent on both sides in 17 skulls. When present unilaterally it was more common on right side than left. Conclusion: Posterior condylar foramen was not only important from anthropological point of view but also important for clinicians and surgeons who deal with posterior cranial fossa region. Condylar vein (posterior) and posterior condylar foramen (canal) both are important surgical landmarks for different skull base approaches described. Enlarged posterior condylar canal can be wrongly interpreted as pathological condition in certain radiological procedures like MRI.

Page No. 51-54

Authors: Rajput AS, Dwivedi SK, Agrawal AK, Goyal M

Background: The dynamic ventilatory tests actually depend upon the speed and efficiency with which filling and emptying of lungs take place and not upon the actual size or range of movements. Dynamic tests proved to be more informative than the static one. Objective: To compare the results of pulmonary function test among males and females. Methods: Present study was carried out on one hundred eighty five young adults of both sexes belonging to 17 to 22 years of age group. All sampled young adults were examined clinically carefully for all the systems especially respiratory. Mean values along with S.D. for all variables were analyzed. Statistical analysis was done using students “t” test and p value of less than 0.05 was considered as statistically significant. Results: All lung functions variables except FEV .5/FEV % and FEV1/FEV% were significantly higher in males in comparison to their female counterparts. Conclusion: M.V.V. is a good measure of the overall function of the lung especially as it is also related to the ability to increase the ventilation during exercise. The pulmonary function test values were significantly more among males as compared to females. There was an increase in all lung functions values in luteal phase.

Page No. 59-62

Authors: Poornima B, Sampada P K, Mallikarjun M, Santosh B S

Background: One of the important foramen which connects the middle cranial fossa to the infratemporal fossa is the foramen ovale. Structures passing through this foramen are lesser petrosal nerve, mandibular nerve, accessory meningeal artery and an emissary vein which connects the pterygoid venous plexus in the infratemporal fossa to the cavernous sinus. Materials and Methods: This study was done by using 100 dry adult human skull bones taken from the Anatomy Department, V.I.M.S., Ballari, Karnataka, India. Anteroposterior and transverse diameters of the foramen ovale were measured. Different shapes of the foramina and any bony growth around its margins were noted. Duplication of the foramen was observed. Results: Out of 200 sides in 100 adult dry human skull, average transverse and anteroposterior diameters of foramen ovale was 3.50±0.842mm and 6.4±1.471mm on left side and on right side was 3.54±0.569mm and 6.5±1.398mm. Oval shaped foramina were 60%, almond shape were 25%, round shape were 13% and slit like foramina were 2%. 11% of foramina had spines, 5% had tubercles and 10% had a bony plate. Duplication of the foramen was seen in one skull on the right side. Conclusion: Our present study may be of immense importance in cases of neurovascular compression due to abnormal bony growth, fine needle aspiration technique in perineural spread of tumor and in trigeminal neuralgia.

Page No. 68-70

Authors: Archana Alzapur, Rajani S. Nagothu, Hima B. Nalluri

Background: “Cheiloscopy” is a technique that deals with lip prints. The pattern of fine creases on the lips are unique to the individual. They are similar to finger prints and useful in crime investigation. Aims and Objectives: To study the uniqueness, prevalence, and gender significance of lip print patterns in human subjects. Materials and Methods: The study was conducted on 100 randomly selected male and female undergraduate medical students. The lip print of each subject was obtained and its pattern was analyzed according to Suzuki and Tsuchihashi classification. Results: The study showed that Type I lip pattern was the commonest. Conclusion: Our study has added to confirmation of the distinctiveness of cheiloscopy, which can be used as an additional tool for identification. Studies on lip prints being very scanty, our findings add significantly to the meager literature on this subject. Further in-depth studies to establish prevalence of patterns in lip prints will certainly help as useful evidence in forensic investigations.

Page No. 74-76

Authors: Samata K. Padaki, Surekharani C., Anita H., Amrut A. Dambal

Background: Considerable variations in the P wave morphology are noted in association with obesity. Standard 12-lead ECG is still considered to be the initial screening test for non-invasive detection of cardiovascular changes. Objective: To study the duration of P wave (milliseconds), P wave amplitude (mV) and dispersion of P wave (milliseconds) in obese subjects and to compare them with apparently healthy normal subjects. Material and Method: Asymptomatic obese 150 young adults in the age group of 18– 39 years with BMI ≥ 30 kg/m2 , sex and age matched 150 healthy individuals with BMI less than or equal to 22 kg/m2 were considered as controls from the general population. A standard 12-lead ECG after 10 minutes of rest was taken and duration of P wave and amplitude was noted. Minimum (min) and maximum (max) duration of P wave and dispersion of P wave (the difference between the max and min P wave duration) were measured by transferring the 12-lead ECG to personal computer via scanner. It was magnified 400 times by Adobe Photoshop software to pick up the smallest changes. Data was analyzed in terms of mean ± SD. Unpaired ‘t’ test was used to study the changes in P wave. Results: P wave duration was statistically extremely significant (104.3 ± 8.2 vs 95.7 ± 79, P value < 0.0001) and dispersion of P wave was statistically extremely significant (21.1 ± 3.4 vs 14.6 ± 3.9, P value < 0.0001) in obese subjects. P wave amplitude was statistically not significant. Conclusion: Duration and dispersion of P wave was longer in asymptomatic obese individuals, increasing the risk of atrial flutter and fibrillation. Hence, a regular check on this parameter is needed to reduce its manifestation at a future date

Page No. 81-83

Authors: Sanjay Vikani, Pankaj Maheria, Satish Patel, Kuldeep Suthar

Introduction: Each kidney is irrigated by single renal artery, which is direct lateral branch of abdominal aorta. It is very important to understand the arterial pattern of kidney because it has much morphological variation, and there is many intervention procedure and surgeries carried out in kidney. Method: This study was done on 30 cadavers of different medical colleges of Gujarat. During routine abdominal region dissection of UG students, precisely dissect Kidneys and its arterial supply, note the pattern and variation if present in artery. Result: Sixty specimens of 30 Cadavers were dissected carefully and 60 specimen of kidneys observed and we found Double Renal Artery in 2(3.3%) specimens, Accessory renal artery in 13 specimen out of this 7(11.6%) on right side, 4(6.6%) on left side, 2(3.3%)Bilateral. 5 (8.3%)specimens had renal artery lies anterior to renal vein at hilum. Conclusion: Knowledge of this type of renal artery variation is useful in clinical practise to minimise the complication during surgery and radiological procedure.

Page No. 87-91

Authors: Sudakshina Chakrabrati, Shilpakala L. B., Gunapriya Raghunath, P. K. Sankaran

Introduction: Anatomy forms the backbone of medical education for first year MBBS with maximum number of teaching hours allotted to this subject. Invariably Anatomy is best taught in dissection halls with the specimens but due to reduction in course duration of first MBBS to 1 year and limited number of cadavers available in present time’s demands more innovative techniques to be utilized for teaching Anatomy. The lecture classes as perceived by most of students as boring does not under rule its importance. The adjustments and modifications made by the teachers of Anatomy to impart overall appropriate knowledge of the subject to the first MBBS student as per their requirements needs to be evaluated and assessed at regular intervals for best results. Objectives: To evaluate the teaching and learning methodologies practiced in Department of Anatomy by feedback analysis from 1 st MBBS students. Material and Method: 147 first MBBS students were included in the study. Informed consent was taken and they were asked to answer a semi structured questionnaire previously prepared and verified. The questionnaires were collected back from them after 30 minutes. The response was analyzed thoroughly over a period of 6 months and represented in percentages. Results: The responses of students were represented in graphs with percentages. Almost 42% of students preferred PowerPoint teaching and another 39% of students preferred both PowerPoint and chalk and board teaching of theory lectures whereas old conventional method of teaching with chalk and board was preferred by only 4% of students. Almost 64% of students preferred receiving handout of lectures before the class and ultra-small group teaching and demonstrations was favoured strongly for osteology rather than lectures for osteology. For effective learning methodologies almost 54% students preferred student’s subject seminars at end of each region and 71% of students preferred judicious use of audiovisual aids in form of animation ,dissection videos, and museum models for demonstration other than regular dissection hall teaching. Students felt clinical anatomy was not sufficiently taught and more emphasis should be given to applied aspects. Conclusion: This study was an extremely useful tool for evaluating student’s preferences for teaching and learning methodologies and thus a self-evaluation for the teachers and thus corrective measures can be taken in future batches.

Page No. 97-99

Authors: Suja Purushothaman, Deepalaxmi salmani, Somashekhar S., K. I. King, Santhi Reghunath, Bishara Pushka

Background: The medical curriculum doesn’t sensitize the students about medical ethics. The Indian Medical Graduates (IMGs), once they finish their internship and come out for clinical practice, often end up in dilemma when they encounter cases with ethical issues. Objectives: This study aims to assess the knowledge and attitudes of MBBS students to health care ethics. Materials and Methods: A self-administered structured questionnaire was distributed to third and fourth year MBBS students. Out of 300, a total of 270 questionnaires were completely filled and returned. The proposal was approved by the institute’s ethics committee and written consent was obtained from each participant. The questionnaires were analyzed using SPSS version 20. Descriptive analysis was carried out for all the data. Results: There was grossly insufficient knowledge about bioethics in majority of IMGs. There was also inadequate information regarding ethics administration with 50% being unaware about the existence of ethics committee in the institute. Majority were unaware about the procedural codes to be used in ethical issues. Conclusions: The IMGs knowledge about health ethics and its implications are poor and insufficient. It is therefore imperative to include health care ethics in a structured way into the current medical curriculum.

Page No. 106-111

Authors: Swathi, Geetha G. N., Sunita Athavale, Vidyashambhava Pare, Sheela G. Nayak

Introduction: Extensor digitorum brevis (EDB) is a small muscle present on the dorsum of the foot assisting in the extension of toes. The use of EDB in various plastic surgery procedures has renewed interest of clinicians to study the variations in EDB, its arterial supply and nerve supply. However, a review of literature highlights the paucity of anatomical studies comprehensively describing the morphology of EDB and its variations. The aim was to study the origin, insertion and morphological variants of EDB with emphasis on its arterial supply in embalmed human cadavers, which may have bearing on the use of EDB in various reconstructive surgical procedures. Methods: EDB muscle was carefully dissected to display the attachments, arterial supply and nerve supply, by retracting the tendons of extensor digitorum longus and peroneus tertius muscles. Results: EDB demonstrated many variations in its origin and insertion, had additional bellies and also had additional tendinous slips connecting its muscle bellies and having attachment over fascia covering the dorsal interossei and the metatarsals. Extensor hallucis brevis was the most prominent belly. In 13 cases, two lateral tarsal arteries supplied the muscle. Variations in the origin of dorsalis pedis artery were also observed. Accessory deep peroneal nerve was found to supply the muscle in addition to the lateral terminal branch of deep peroneal nerve in three specimens. In view of wide usage of EDB for clinical procedures, the knowledge of variations in its morphology, especially arterial supply and nerve supply is essential.

Page No. 118-122

Authors: Kishor D. Khushale, Yuvaraj J. Bhosale, K. Shyamkishore

Introduction: The students opined that they don’t have guidance regarding drawing of Histology diagrams in the journals, which is important for the practical as well as the theory evaluations. Aims and Objectives: To improve the understanding of histology in students. To augment the students ability for drawing good histology diagrams. To enhance the performance of the students in evaluation of histology. Material and Method: To prepare the charts rough histological diagram were drawn with H & E pencil and it is validated by the senior teachers in the department of Anatomy. The charts were displayed on the notice board. Questionnaire was distributed to all the first MBBS students, postgraduate students and teaching faculty from department of Anatomy to get the feedback. Result and Discussion: 1) 81 % first MBBS students, 100 % PG students and 100% teachers felt that histology charts make learning more interesting. 2) 83 % first MBBS students, 87% PG students and 80% teachers felt that histology charts develops the presentation skills in the students. 3) 67 % first MBBS students, 74% PG students and 60% teachers felt that histology charts improves the thinking ability. 4) 93 % first MBBS students, 100% PG students and 80% teachers felt that the department should provide the handbook of histology diagrams from the charts to the students. Conclusions: The histology charts must be developed by each department of Anatomy for enhancing the drawing skills of the students improves understanding the subject, thinking ability and reduces the mistakes committed by the students and less time is required to draw the diagram

Page No. 127-129

Authors: Rajarshi Roy, Rajib Kundu, Panchali Som

Introduction: Knowledge of presence of supernumerary renal arteries with anomalous origin of gonadal arteries are important with increased use of laparoscopic renal surgeries and donor nephrectomy. Transplantation of kidney may be jeopardized with aberrant renal and gonadal arteries. Therefore this case report will help surgeons to understand the possible abnormalities which are very important clinically. Methods: During routine dissection of abdomen of an embalmed female cadaver of about 70years of age, the renal and gonadal vascular abnormalities have been noted in the Dept. of Anatomy, IPGMER, Kolkata, India. Results: Bilateral four renal arteries were found, in right side the ovarian artery originated from third renal artery from above and in left side from the lower most one. In right side all the renal arteries originated from abdominal aorta separately, three arose above the superior mesenteric artery and one below. The upper three renal arteries entered through renal hilum, crossing the inferior vena cava (IVC) from behind but the fourth one entered through the lower pole after crossing the IVC anteriorly. In left side the upper three arose from a common arterial trunk from abdominal aorta as early division of main renal artery and the fourth one originated separately from abdominal aorta. The first one entered the left kidney through upper pole while the rest through hilum. Conclusions: Though the variations of renal and gonadal vessels may be silent/undiagnosed throughout the life, their presence may result in vascular injury of any additional vessels during renal /retroperitoneal surgery.