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   Table of Contents - Current issue
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October-December 2022
Volume 71 | Issue 4
Page Nos. 259-335

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EDITORIAL  

Philately, world postage stamps, history of medicine, and anatomists Highly accessed article p. 259
Vishram Singh, BV Murlimanju, Rajanigandha Vadgaonkar
DOI:10.4103/jasi.jasi_152_22  
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ORIGINAL ARTICLES Top

Morphologic and Morphometric Evaluation of the Carotid Artery Wall: A Cadaver-Based Light and Scanning Electron Microscopic Study p. 261
Hilal Nakkas, Ferda Topal Celikkan, Nihal Apaydın, Oya Evirgen
DOI:10.4103/jasi.jasi_168_21  
Introduction: A variety of changes occur on the elastic artery wall with age. Ultrastructural studies made in this area are mostly animal based. We aimed to evaluate wall changes and three-dimensional organization of the elastic lamellae with aging in humans. Material and Methods: Common carotid arteries were obtained from 17 human cadavers which were grouped as G1 (n = 6), 30–39 years; G2 (n = 5), 40–49 years; and G3 (n = 6), >50 years of age. Samples were evaluated under light and scanning electron microscopes. Results: Examination of G1 revealed intimal thickening and foamy cell infiltration. G2 and G3 had plaques bulging into the lumen and interlamellar space was widened. The lamellae were more straight. There was a positive correlation between intimal thickness and age. Elastic fiber content decreased with aging. Scanning electron microscopic analysis confirmed the findings. G1 and G2 had a smooth surfaced internal elastic lamina with uniform fenestrations whereas G3 contained numerous irregular fenestrae. Discussion and Conclusion: With this study, we showed some other wall structure changes beside plaque formation by aging. Which layer is affected the most was not clear at previous clinical studies because using ultrasonography (USG) cannot address the layer. Microscopic evaluation of this study revealed that when a wall thickening is detected by USG, it is due to intimal thickening. The specific vessel layer structural changes are important for proper treatment.
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Anatomical variations of the human ossicular chain in south indian population: morphometry and morphology p. 266
Giridhar Dasegowda, Padmalatha Kadirappa, Hema Nanjundaraju, Seema Shimoga Raja, Rachana Suresh
DOI:10.4103/jasi.jasi_192_21  
Introduction: The middle ear consists of the malleus, incus, and stapes. The otologic surgeons need to have a thorough knowledge of anatomical details and variations to provide better operative results and for surgical maneuvers. The present study aimed to analyze the morphological variation and morphometry of the ear ossicles and compare the parameters with those reported in previous studies. Material and Methods: The study was conducted on 28 mallei, 26 incus, and 20 stapes obtained from the cadavers allotted for dissection. Measurements were documented, and the morphological variations were analyzed. Results: The average of the parameters showed that the malleus was 7.59 mm in total length with an angle of 130°; the manubrium was 4.65 mm, the total length of the head and neck was 5.01 mm, and the average weight was 21.50 mg. The incus had a total length and width of 6.37 and 4.89 mm, respectively; a maximal distance of 5.97 mm between the tips with an angle of 101° and weighed an average of 23.81 mg. The stapes had a total length of 3.36 mm, with the stapedial base being 2.83 mm in length and 1.41 mm in width, and weighed an average of 3.16 mg. Discussion and Conclusion: The ossicular chain shows great variations in measurements and morphology. Hence, a thorough anatomical knowledge of the human ossicular chain is required for clinicians for surgical maneuvers and for designing prosthetics to replace the adult middle ear ossicles.
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Stereological and comparative evaluation of the carpal tunnel in patients with carpal tunnel syndrome using magnetic resonance images p. 272
Gürsel A K. Güven, Mehmet Emirzeoglu, Murat Terzi, Mustafa Bekir Selçuk, Bünyamin Sahin
DOI:10.4103/jasi.jasi_71_21  
Introduction: In this study, the relation between carpal tunnel syndrome (CTS) severity and the carpal tunnel volume (CTV), volume and the volume fraction of the carpal tunnel contents on subjects with CTS and healthy individuals were examined. Material and Methods: 30 female patients diagnosed with CTS clinically and electrophysiologically and 16 healthy female patients were included in this study. In patient group, 50 and in control group 30 hand wrists were examined. CTS severity was ranked electrophysiologically. T1-weighted axial magnetic resonance images (MRIs) were examined by the Cavalieri principle. Results: CTV in the patient group (4.26 ± 0.57 cm3) was found to be lower than that of the control group (4.66 ± 0.73 cm3), while the volume (0.41 ± 0.07 cm3) of the median nerve (Vnm) in the patient group was found to be higher than the control group (P < 0.05). Besides, the volume and volume fraction of the median nerve increase when the CTS severity increases (r = 0.610; r = 0.778). Discussion and Conclusion: Our study has shown that stereological studies with MRI are successful in determining the CTV in differentiating patients and healthy people. In addition, the volume and volume fraction of the median nerve were found to be quite effective in differentiating the severity of CTS. It is anatomically confirmed that when the severity of CTS increases, the space volume fraction of the carpal tunnel decreases.
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Correlation of cephalo-facial parameters with body height in indian and african students of a university in North India p. 279
Sreekala C Nair, Prajna Paramita Samanta, Poonam Kharb
DOI:10.4103/jasi.jasi_1_21  
Introduction: In forensic anthropology, body height or stature estimation is important for identification of missing persons. Stature has a proportional relationship with different parts of the human body including cephalo-facial region. The cephalo-facial indices are different for different people. Therefore, they may help in stature reconstruction and identification of a person. The study was conducted to find out if there is any correlation between four cephalo-facial parameters and body height and to derive regression formulae in Indian and African students. Material and Methods: The present study was conducted on 170 students of a University in North India belonging to two different races, i.e., Indian (85) and African (85). Stature and four cephalo-facial dimensions, i.e., maximum head length (MHL), horizontal head circumference (HHC), morphological facial length (MFL) and bigonial diameter (BD) were measured. The data were analyzed using SPSS software version 15. Results: In both Indian and African students all the four cephalo-facial parameters, i.e., MHL, HHC, MFL, and BD showed a positive correlation with stature (P < 0.001). It was found that in Indians the strongest correlation of stature was with MHL and least correlation was with HHC. In Africans, the highest correlation was observed with MHL and lowest with BD. Discussion and Conclusion: In this study, it was found that among the cephalo-facial parameters, cephalic parameters are more reliable than facial parameters. Out of the two cephalic parameters HHC was found to be more reliable than MHL in the estimation of stature in both Indian and African students. The regression equations derived turned out to be population/race-specific and therefore, cannot be generalized for all population groups.
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Numerical chromosomal aberrations in acute lymphoblastic leukemia in North Indians p. 283
Indu Shri, Rakesh Kumar Verma, Archana Rani, Navneet Kumar
DOI:10.4103/jasi.jasi_97_21  
Introduction: Alterations in chromosome number have a strong impact on outcome in childhood ALL. Genetic findings may predict the prognosis and biologic properties of the leukemia more consistently than does morphology. To see the numerical aberrations in ALL in North Indian population Material and Methods: Culture and chromosome banding of bone marrow and blood sample of 51 North Indian patients of ALL (44 males and 7 females) from the age group of 2 to 42 years were done. Only 39 shows good chromosomal spread, so 39 karyograms were prepared and observed for the chromosomal gain or loss and their frequency. Results: Numerical abnormalities were observed in 14 patients (35.9%) of the 39 cytogenetically analysed cases. Trisomy 21 was found in 3 cases. Trisomy of chromosome number 13 and 14 were found in 5.12% cases. Trisomy of chromosome number 3, 4, 6, 8, 11, 15, 17 and 18 were present in 2.56% cases (Fig. 21, 30, 31, 34, 35, 42). Gain of chromosome X was seen in 5.12% cases while only in one case (2.56%) gain of chromosome Y was detected. Discussion and Conclusion: Numerical chromosomal abnormality in this study was 15.38% which was different from other population described in previous studies. Trisomy 21 is most common in this study. The findings of the present study may be useful for the clinician in predicting outcome, remission, survival and treatment response in ALL.
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Anthropometric parameters of idiopathic familial short stature females and its correlation with height and comparison with the control group p. 288
Karishma Sharma, Rishita Chandra, Brijendra Singh, Shashi Ranjan Mani Yadav, Manisha Naithani, Surekha Kishore, Vivek Mishra, Kriti Mohan, Prashant Kumar Verma
DOI:10.4103/jasi.jasi_182_21  
Introduction: Familial Short stature is considered one of the most common causes of Short Stature along with the constitutional delay in growth and puberty (CDGP) from which it can easily be distinguish. The core parameters of anthropometry represent diagnostic criteria for obesity and other non-communicable diseases. To measure the anthropometric parameters in the patients with idiopathic clinically non-syndromic familial short-stature and to correlate those parameters with their height and compare them with the control group. Material and Methods: A cross-sectional study was conducted among Familial Short Stature females of 5-18 years age group referred from Paediatric and Genetic OPD of AIIMS, Rishkesh. Non-parametric tests were applied for comparing the variables and correlation coefficients were obtained. Results: There was a significant difference between the groups in terms of Standing Height (cm) (W = 376.000, P = <0.001), BMI (Kg/m2) (W = 1128.500, P = 0.002), with the median BMI (Kg/m2) and Waist/Height Ratio (W = 1164.500, P = <0.001), with the median Waist/Height Ratio being highest in the Short-Stature group. There was moderate to strong positive correlation between standing height and other anthropometric parameters. The mean waist to height ratio of 0.6 among short stature and 0.5 among the control group, with short stature having more odds of getting overweight and also shows a greater predilection of short-stature group for developing Cardio-vascular diseases. Discussion and Conclusion: Familial short stature though being a manifestation of some underlying cause, can fall in a non-syndromic group until further studies including karyotyping, next-generation sequencing etc. Extensive research for appropriate categorization and how this can effectively help combat the burden of malnutrition and non-communicable diseases should be done.
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Evaluation of the Brain Indexes of Subjects with and without Brain Atrophy Using Computed Tomography p. 295
Mahmut Öksüzler, Sema Polat, Mahmut Tunc, Duygu Vuralli, Pinar Göker
DOI:10.4103/jasi.jasi_20_22  
Introduction: This study was undertaken to determine the values of brain indexes using computed tomography (CT) in our population. Material and Methods: This study was carried out on the 520 senior subjects (196 subjects having brain atrophy and 324 subjects having no brain atrophy) aged 60–90 years. Measurements of the brain indexes were taken from subjects having axial brain CT image in the radiology department. Furthermore, the data were analyzed according to age and gender. Results: The means and standard deviations of the measurements were as follows: the maximum distance between anterior horns, 37.35 ± 3.76 mm; minimum bicaudate nuclei distance, 20.76 ± 3.78 mm; maximum internal skull diameter, 135.66 ± 6.51 mm; maximum internal diameter of the frontal bone, 103.23 ± 6.23; internal skull diameter measured along the same line, 116.28 ± 6.60 mm; maximum external diameter of the skull, 144.08 ± 5.93 mm; and cella media width, 35.88 ± 6.93 mm; and the indices were calculated and found as follows: Huckman number, 58.11 ± 6.99 mm; bifrontal index, 0.36 ± 0.03; bicaudate frontal index, 0.55 ± 0.07; bicaudate index, 0.18 ± 0.03; bicaudate temporal index, 0.15 ± 0.03; and Schiersmann's index (SI), 4.22 ± 1.16 in subjects having brain atrophy. The same values were measured as 32.28 ± 3.19 mm; 15.32 ± 3.05 mm; 133.67 ± 6.71 mm; 102.05 ± 6.13 mm; 113.12 ± 6.04 mm; 141.14 ± 6.12 mm; 28.92 ± 5.79 mm; 47.59 ± 5.63 mm; 0.32 ± 0.03; 0.47 ± 0.08; 0.14 ± 0.03; 0.11 ± 0.02; and 5.09 ± 1.13 in healthy elderly subjects, respectively. There was a significant difference in all measurements (except SI) (P < 0.05). Discussion and Conclusion: The brain index dimensions of Turkish population provide important and useful knowledge for the clinicians in terms of comparison of abnormalities and atrophy of the brain.
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Ambiguity of the radiographs around the elbow joint: Anatomical variant versus degenerative changes p. 303
Vojtech Kunc, Vladimir Kunc, Katerina Kuncova, David Kachlik, Lubomir Kopp
DOI:10.4103/jasi.jasi_80_21  
Introduction: Interpretation of traumatological radiographs of the region of the elbow joint may come with many challenges. Aside from traumatological avulsions and fractures, we can also identify other entities such as persistent epiphysis, aseptic necrosis, osteochondritis dissecans, calcific bursitis, synovial chondromatosis, and other degenerative changes. It is also necessary for all these pathological conditions to be differentiated from the anatomical variants. Material and Methods: We performed a retrospective analysis of patients admitted to our clinic between 2010 and 2020 for arthroscopic treatment of chronic elbow joint stiffness. We evaluated the radiographs of their elbow joints for the presence of accessory ossification. If present, these cases were then sorted by previously defined criteria into groups according to the kind of anatomical variant and degenerative changes. On the basis of these data, we performed a statistical analysis. Results: We analyzed 39 limbs in 39 patients (12 women and 27 men). The average age was 40.9 years (span 16–74). The exclusion criteria did not exclude any patient. Accessory ossifications were present in 78.4% (29/37) of patients, and all three criteria for accessory bone were fulfilled by two patients. Discussion and Conclusion: This sample of patients suffering from joint stiffness due to degenerative changes around the elbow joint enabled us to prove the usefulness of the criteria for differentiating degenerative changes from accessory bones. We were also able to validate the hypothesis that in a sample of patients suffering from elbow stiffness, the dominant cause of the stiffness should be the degenerative changes, while the accessory bones prevalence should not differ significantly from their prevalence in the healthy population. Our analysis showed that the seemingly ovoid intra-articular loose bodies do not appear on the radiographs as regularly shaped and can be differentiated from accessory bones. In order to avoid the wrong interpretation of elbow radiographs, it is necessary to be aware of this issue. Our study validates the three previously defined criteria as means to diagnose accessory bones with a high specificity. The intra-articular loose bodies macroscopically seemed ovoid and regular. Nevertheless, they do not appear as regularly shaped on radiographs and do not, therefore, fulfill the criteria of accessory bones.
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Effect of different doses of aluminum chloride on neurodegeneration in hippocampus region of the rat brain p. 307
Amit Massand, Mallika Basera, Sonal Grace, Reshma Kumarachandra, K Sudha, Rajalakshmi Rai, BV Murlimanju, K Sowndarya
DOI:10.4103/jasi.jasi_39_22  
Introduction: Aluminum (AL) compounds are widely used as food additives, cosmetics, antacids, and buffered aspirins. Chronic consumption of AL may lead to its accumulation in tissues causing AL toxicity. The study aims to investigate the toxic effect of AlCl3 on hippocampus region of rat brain by qualitative and quantitative analysis of neurons. Material and Methods: Adult male albino Wistar rats were divided into three groups with six rats in each group. Group 1 was the control, Group 2 rats received 100 mg/kg b. w, and Group 3 received 300 mg/kg b. w of AlCl3 orally for 30 days. The neuronal count was done at the CA1, CA2, CA3, and CA4 regions of hippocampus by staining with cresyl violet stain. Neuronal damage in the AlCl3 groups was compared with the control group. Results: A significant damage was observed in all the regions of hippocampus both in Groups 2 and 3 compared to the control group (P < 0.00001). Further higher dose of AL caused marked neuronal damage in CA1 (P < 0.03) and CA3 (P < 0.05) regions compared to the lower dose of AL. The neurons in the CA3 and CA1 regions were most vulnerable to AL toxicity and the CA2 region of the hippocampus had a maximum number of viable neurons indicative of resistance to AL toxicosis. Discussion and Conclusion: Consumption of higher dose of AL even for a short term could have variable degrees of deleterious effects on different regions of the rat brain. This study sets a background for an in-depth exploration on toxicology of AL compounds on human participants which could be of public health importance.
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The Relationship between Isolated Unilateral Concha Bullosa and Mastoid Air Cell Volumes p. 311
Fatih Yuksel, Mehmet Erkan Kahraman, Isa Deniz
DOI:10.4103/jasi.jasi_164_21  
Introduction: The purpose of this study was to investigate the relationship between the pneumatization of mastoid air cells (MACs) and isolated unilateral concha bullosa (CB) using computed tomography (CT) scans of the paranasal sinuses (PNS). Material and Methods: A retrospective review of PNS CT scans from 53 patients was performed. Cases with nasal septum angulation >5° were excluded from the study. CT evaluations were made with a 128-slice multislice CT scanner in two projections, axial and coronal. Slice thickness was taken as 1 mm for volumetric analysis. Volume measurements were calculated using the syngo.via software program by selecting the relevant anatomical region and using step-by-step addition and expansion processes. Volumes of the MACs (right and left) and isolated unilateral CB (right and left) were obtained and compared using statistical analysis. Results: The volume of MACs and isolated unilateral CB did not change with age; however, the volumes of male participants were larger than that of women. It was observed that the pneumatization of MACs on the side with isolated unilateral CB was significantly greater than for opposing MACs. Discussion and Conclusion: In our study, it was concluded that the isolated unilateral CB caused a significant increase in the MACs volume on the same side of CB.
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CASE REPORTS Top

Unusual Multiple Arterial Variations of the Upper Limb p. 317
Buse Naz Candir, Latif Sağlam, İlke Ali Gürses, Özcan Gayretli
DOI:10.4103/jasi.jasi_208_21  
During routine dissection of a 64-year-old male cadaver, multiple variations were observed in the arteries of the upper extremities. The first part of the axillary artery did not give any branches. The second part, after giving superior thoracic and thoracoacromial arteries divided into deep and superficial brachial arteries. Superficial brachial artery gave lateral thoracic artery and continued into the arm. After giving anterior circumflex humeral artery, the deep brachial artery trifurcated into the subscapular artery, posterior circumflex humeral artery, and profunda brachii artery. Understanding upper limb arterial variations are important for performing safer clinical procedures.
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Milder and Later Presentation of Trisomy 13: A Case Report and Literature Review p. 321
N Rashmi, HS Kiran, HS Rajani
DOI:10.4103/jasi.jasi_149_21  
Patau syndrome or Trisomy 13 is the least common and most severe of the viable autosomal trisomies. The frequent clinical features include holoprosencephaly, polydactyly, flexion of the fingers, rocker-bottom feet, cleft lip and palate, neural tube defects, and heart defects, with neurological involvement being the most consistent one. It is usually recognized at birth by the typical birth defects with poor neurologic performance. About 85%‒90% of cases die during infancy, with only 5% to 10% of patients alive beyond 1 year. Patients surviving beyond 1 year have a severe developmental handicap. We present here an infant who came with a relatively milder form of Patau syndrome and was confirmed by karyotyping.
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Case report of persistent left superior vena cava with absent papillary muscle – Unusual coexistence p. 324
Divya Umamaheswaran, Jayagandhi Sakkarai, Rema Devi
DOI:10.4103/jasi.jasi_81_22  
Persistent left superior vena cava (PLSVC) is uncommon with an incidence of 0.3%–1.3%. The incidence of absent papillary muscle is unknown. Congenital anomalies of a thoracic venous system associated with absent papillary muscle are very rare. During dissection of a 55-year-old male cadaver, PLSVC with absent papillary muscle was found. Although these congenital anomalies are incidentally found, it is worthwhile following such patients to look for the evolution of any cardiac symptoms. Sound knowledge and awareness of such congenital anomalies are required for radiologists, cardiothoracic surgeons, and critical care physicians.
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INSTRUCTIONS TO AUTHOR Top

Instructions to Author p. 329

DOI:10.4103/0003-2778.362558  
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