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   Table of Contents - Current issue
January-March 2022
Volume 71 | Issue 1
Page Nos. 1-79

Online since Thursday, March 17, 2022

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Superspecializations in anatomy: A step forward in order to improve medical education and clinical practice Highly accessed article p. 1
Vishram Singh, Gaurav Singh
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Mutation analysis of severe acute respiratory syndrome coronavirus-2 genomic sequences in India and its geographical relations Highly accessed article p. 3
Pradip Rameshbhai Chauhan, Ashish J Rathva, Kinjal Jethva
Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has been spreading all over the world, including India; the virus has been classified in various clades (L, S, V, G, GH, GR, and others) on the base of mutations. India is vulnerable to the health and financial hazards of the SARS-CoV-2 infection. Even after four phases of lockdown, the number of SARS-CoV-2 infections has been increasing in India. Clinical trials for vaccine and ribonucleic acid (RNA)-dependent RNA polymerase inhibitor are going on. The study was conducted to analyze SARS-CoV-2 genomic sequences submitted from India to identify mutations and their geographical distribution. Material and Methods: Three hundred and sixty-three sequences submitted from India were archived (GISAID database), compared with reference sequence (Wuhan, China), and phylogenetic tree was prepared. Sequences with more than 1% nucleotide stretching were excluded for mutation analysis, and multiple sequence analysis for 317 sequences was done. Mutations were analyzed as per phases of lockdown and geographical distribution. Results: Clade “GH” appears in the second and third phases of lockdown; the clade “V” has not been reported after March 17, 2020, in India. Spike protein mutation D614G was found in 166 sequences, out of which 164 sequences show P323 L mutation of nonstructural protein 12 (nsp12). RNA-dependent RNA polymerase coding nsp12 shows 23 types of 364 amino acid mutations. Discussion and Conclusion: SARS-CoV-2 shows increasing mutations with the time and spread of the virus. The mutations in spike protein and nsp12 regions are critical for response to undergoing trials of vaccines and drugs.
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Level of variations of the aortic bifurcation and distance measurements between the aortic bifurcation and the common iliac bifurcations Highly accessed article p. 11
Arzu Ekingen, Mehmet Güli Çetinçakmak
Introduction: The purpose of the present study was to investigate the vertebral levels of the aortic bifurcation (AB) in patients with and without the abdominal aorta (AA) deviation and to measure the distances between the AB and the right-left common iliac bifurcations (CIBs) which are crucial anatomical information, especially for anterior lumbar interbody fusion surgery. Additionally, we made comparisons levels of the AB according to sex and examined whether the results were statistically significant, which we could not find other studies comparing gender in literature. Material and Methods: The images of 721 patients, undergoing angiography with multidetector computed tomography between January 2016 and October 2019, were reviewed retrospectively. The AB levels of the patients with and without the AA deviation were classified and evaluated separately. It was measured the distances between the level of the AB and the right and left CIBs with the 3-dimensional ruler technique in only 207 of 721 patients. Results: It was detected seven different vertebral levels of the AB among patients (116 patients) with the AA deviation, in which is the highest L4-upper (27.59%), and 11 different vertebral levels of the AB among patients (605 patients) without the AA deviation, in which is the highest L4-upper (22.48%). When comparing cases with and without AA deviation, a statistically significant difference was found between the sexes (P < 0.05). Discussion and Conclusion: The presented study demonstrates that there is a significant relationship between the genders at some levels. The preoperative information of the morphological variations of the AB may be very useful for laparoscopic, invasive procedures, and spinal surgery procedures. At the same time, these variation information reveals new information for anatomy.
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Ossification of calcaneal tendon: Plausible role of hypoxia-induced factor 1 alpha p. 18
Parul Kaushal, Tara Sankar Roy, Tony George Jacob, Deep N Srivastava, Chetan Sahni, Neerja Rani
Introduction: Tendons may rarely be ossified. The calcaneal tendon (CT) is the largest in the body. The incidence and mechanism of ossification of CT is not known. Material and Methods: We carried out a morphological, radiological, histological, and immunohistochemical study on the CT of 50 (30 – male and 20 – female) human cadavers. Results: The mean length (cm) of the CT was 27.60 ± 2.30 (right) and 27.51 ± 2.60 (left) in males and 25.43 ± 0.77 on both sides in females. The contribution to the formation of the CT from the two heads of gastrocnemius muscle was greater from medial head in 84%, lateral head in 12%, and equal in 4%. On screening the CT by C-arm radiography, slight opacification at the site of insertion of CT (bilaterally) was noted in an elderly male. Large, bilateral opacification was seen in another elderly male cadaver. Well-defined lamellar bone with osteocytes lying in lacunae and bone marrow amid the tendon collagenous tissue was noted in hematoxylin- and eosin-stained sections. The osteocytes expressed hypoxia-induced factor 1 alpha. Discussion and Conclusion: In this study, we confirmed that the radiological opacification in the CT was ossification that may have been triggered by hypoxia.
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Morphometric analysis of normal and variant anatomy of posterior cerebral artery and the incidence of fetal posterior cerebral artery in Uttar Pradesh region: A computed tomography angiographic study p. 24
Arvind Kumar Pankaj, Sarah Sko Sangma, Jyoti Chopra, Garima Sehgal
Introduction: The aim is to study morphometric analysis of normal and variant anatomy of posterior cerebral artery (PCA) and incidence of fetal PCA (FPCA) in Uttar Pradesh region. The PCA and its cortical branches supply blood to the occipital lobe, inferomedial temporal lobe, and portions of posterior inferior parietal lobe. Fetal-type PCA is a common anatomic variation of PCA that is closely associated with intracranial aneurysm. The present study provides the description of PCA regarding its normal morphology, morphometry, and variations in Uttar Pradesh region. Material and Methods: The study evaluated 100 computed tomography angiograms. Results: Among arteries that displayed normal anatomy, mean diameter of PCA was observed to be 4.29 ± 0.74 mm on the right side and 2.47 ± 0.74 mm on the left side. Mean diameter in males and in females was found to be 2.48 ± 0.73 mm and 2.47 ± 0.74 mm, respectively. In 56.5% of cases, the diameters of P1 segment of PCAs ranged from 2.1 to 3 mm whereas >3 mm diameter was observed in 18.5% cases. Nineteen percent cases showed 1.1–2 mm. In 6% cases, hypoplasia (≤1 mm) of PCA was observed. FPCA was observed in 26% cases. Unilateral observed in 17% cases and bilateral in 9% cases and the difference was statistically significant (P < 0.000). Discussion and Conclusion: Anomalies of PCA may assume considerable significance in surgeries of head and neck, which require ligation of internal carotid and common carotid artery. Awareness of these anatomical variations described shall prove to be useful for any cerebrovascular procedures.
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Estimation of length of femur from its distal segment p. 30
Aswathy Maria Oommen, Suja Robert Joseph Sarasammal, Sheena Kalyani Sukumaran
Introduction: The stature of an individual, one of the key elements of identification, can be calculated from the length of long bones in the body, of which the femur has the highest correlation with stature. Many a times, forensic anthropologists have to identify unknown dead bodies from fragments of bones that are available. Studies have proven that the total length of a bone can be estimated from fragments using population-specific regression equations. In the present study, the objective was to estimate the total length of the femur (TFL), in an Indian population, from measurements of its distal segment, using regression equations. Material and Methods: One hundred and twenty-one intact adult femurs were studied. The TFL and four variables from its distal segment were measured. Linear regression analysis was performed, and regression equations were derived to calculate the TFL from each of the variables. Results: The mean TFL was 41.9 ± 3.4 cm. All the four parameters of the distal segment showed a significant positive correlation with the total femoral length (P < 0.001), and of these, the width measured between the two epicondyles showed the maximum correlation. Multivariate and univariate regression equations were derived to estimate the TFL from these variables. Discussion and Conclusion: The TFL can be reliably calculated from the measurements of the distal fragments. These measurements can be used by forensic anthropologists for the estimation of the stature of an unknown individual.
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Effects of maternal iron deficiency anemia on placenta and cord blood iron status with specific reference to the iron transport protein ferroportin 1 p. 34
Shravanthi Gadhiraju, Thathapudi Sujatha, Uday Kumar Putcha, Mullapudi Venkata Surekha
Introduction: Iron deficiency anemia is the most prevalent nutritional deficiency disorder in pregnant women. During pregnancy, nutrients, including iron, are transferred from the mother to the fetus through the placenta, in which the placental transport protein Ferroportin1 (FPN1) plays a crucial role. It has been frequently observed that developing fetus is immune to anemia despite the presence of anemia in the mother, the mechanisms underlying which have not been identified. We, therefore, planned the present study to explore the effect of maternal iron deficiency anemia on the expression of FPN1 in the placenta. Material and Methods: Two hundred pregnant women recruited were divided into anemic and nonanemic groups based on their predelivery hemoglobin levels (<11 g/dl and ≥11 g/dl, respectively). After delivery, placental expression of FPN1 was studied by immunohistochemistry and mRNA analysis, and neonatal anthropometry was performed. Results: Of the 200 women, 59% were anemic. FPN1 protein immunohistochemical staining in placenta showed a statistically significant increase with increasing severity of anemia. Similarly, placental mRNA expression levels of the FPN1 gene were observed to be higher in anemic mothers when compared with nonanemic mothers. Discussion and Conclusion: Thus, our study for the first time shows that maternal iron deficiency increases placental FPN1 protein and mRNA expression, thereby probably facilitating increased transport of iron from the mother to the fetus.
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Carrying angle of the elbow joint in young caucasian and Indian American population: A descriptive cross-sectional study p. 42
Chakravarthy Marx Sadacharan, Sukaina B Alikhan, Vasanthakumar Packirisamy, BV Murlimanju
Introduction: To establish normative anthropometric data about the carrying angle, length of the forearm, hip circumference, and body height for young Indian American and Caucasian population and to test statistically the ethnic and gender differences. The objective was also to compare the right and left carrying angle in the ethnic groups. Material and Methods: The present study included 200 students from the American population. Among them, 100 were Caucasians (50 females and 50 males), and 100 were Indian Americans (50 females and 50 males). These participants were aged between 18 and 30 years. Goniometer was used to measure the carrying angle, the hip circumference, body height, and length of forearm were also determined. Results: The present study observed that there was no statistical significance for the carrying angle compared between sides and genders of both the ethnic groups (P > 0.05). The carrying angle was higher (P < 0.05) in Caucasians than in the Indian Americans, both over the right and left upper extremities. This was observed in both the genders. The comparison between genders showed that, carrying angle was higher for females (P < 0.05) than the males in both Caucasians and Indian Americans. Discussion and Conclusion: This investigation contributes the morphological database in Indian Americans and Caucasians for the carrying angle. The morphological findings of this study could be used as reference values for the clinical application and ergonomics. The knowledge about the carrying angle is imperative during the surgical procedures at the elbow joint.
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Retromolar canals and mandibular third molar position: Is there a possible connection? p. 47
Oguzhan Demire, Aslıhan Akbulut
Introduction: The retromolar canal (RMC) is an anatomical variation of the posterior part of the mandibular canal. It is thought that this variation is related to histological vestiges of the gubernacular canal and RMC presence may be associated with mandibular third molar (MTM) malposition. This study aims to investigate the relationship between MTM position and RMC existence. Material and Methods: Patients who had undergone cone-beam computed tomography examination for various purposes were included in the study. All of the patients had unilateral or bilateral MTM teeth. MTM impaction patterns were classified according to Winter and Pell-Gregory classifications. RMC existence, type, retromolar foramen (RMF) position, RMF dimensions, and distance from RMF to second and third molars were recorded. Results: Three hundred and forty-six retromolar areas with MTM of 244 patients were evaluated. RMCs were present in 11.5% of the patients. No statistically significant relationship between RMC and MTM impaction patterns was observed. A1-type RMC was found to be the most prevalent. The mean distance from RMF to the third molar was 6.09 ± 4.20 mm and was found to be higher in male patients. The mean distance from RMF to the second molar was 15.28 ± 4.73 mm. The average dimensions of the RMF were 1.4 ± 0.47 mm. Discussion and Conclusion: RMC is a relatively common anatomical variation of the mandibular canal. Although no correlation was observed between MTM impaction pattern and RMC existence, further research including more samples may be helpful to explain a possible correlation.
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Evaluation of pharyngeal airway by cone-beam computed tomography after mono- and bimaxillary orthognathic surgery p. 54
Merve Sari, Esengül Sen, Nihat Akbulut, Seval Bayrak, Osman Demir
Introduction: The aim of this study was to evaluate the changes of the pharyngeal airway obtained using mono-and bimaxillary orthognathic surgery in patients with skeletal malocclusion. Material and Methods: The analysis was conducted on cone-beam computed tomography images taken preoperatively and postoperatively of patients undergoing mono-or bimaxillary orthognathic surgery. The pharyngeal airway was divided into four airway volume segments and measured by planimetry. Results: The bimaxillary surgery group showed an increase in nasopharynx and velopharynx volumes and a decrease in glossopharynx and hypopharynx volumes (P < 0.05). The mandibular setback surgery group showed decreases in glossopharynx, hypopharynx, oropharynx, and pharynx volumes (P < 0.05). The mandibular advancement surgery group showed increases in glossopharynx, hypopharynx, oropharynx, and pharynx volumes (P < 0.05). The maxillary advancement surgery group showed increases in nasopharynx, velopharynx, and pharynx volumes (P < 0.05). Discussion and Conclusion: Mandibular setback surgery had a narrowing effect on the pharyngeal airway volume. Maxillary advancement surgery compensated for the constrictive effect of mandibular setback surgery on both the oropharynx and pharynx volumes. Although maxillary and mandibular advancement surgery affected different sites, these were the operations that contributed most to the increase in pharyngeal volume.
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Typing and morphometric analysis of the pterion on human skull of central anatolia p. 61
Duygu Akin Saygın, Anıl Didem Aydin Kabakci, Şerife Alpa, Mustafa Buyukmumcu, Mehmet Tuğrul Yilmaz
Introduction: Pterion is seen in the norma lateralis of the skull and is shaped like the letter H. Pterional approach such as retro-orbital, sellar, sub-frontal, replate areas, anterior circulation, and olfactory meningiomas, tumors involving downstream of the frontal lobe such as the orbital, basilar artery aneurysm is a commonly preferred surgical approach. The present study focused on the typing of the pterion and morphometric measurements between the pterion and surrounding important anatomic spots. Material and Methods: The present study was performed with pterion typing of 107 skull (a total of 214 sides including the right and left sides) within Anatomy Laboratories of Necmettin Erbakan University, Meram Faculty of Medicine, and KTO Karatay University, Medicine Faculty. Distance between the pterion and some important (mid-point of the superior edge of the zygomatic arch, the anterior and posterior edge of the frontozygomatic suture, the tip of the mastoid process, and anterosuperior edge of suprameatal spine and asterion) spots were measured through a digital caliper in millimeter. In addition to the classification made by Murphy, three different classifications were made. The pterion was classified into seven types. Results: The rates of the types were sphenoparietal type by 55.60%, epipteric type by 3.73%, stellate type by 2.33%, frontotemporal type by 0.4%, wormian type by 5.14%, frontoparietal type by 8.87%, and frontoparietal sphenoidtype by 23.83%. Discussion and Conclusion: Morphometric characteristics of the pterion were detected in detail by the present study. Moreover, the knowledge of typing would serve as an important guide for surgical planning and procedures and may contribute to further anthropological studies. This study is aimed at the Central Anatolia population and can be conducted among other populations.
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A rare anomalous origin of the right vertebral artery from the right aortic arch with the left aberrant subclavian artery arising from kommerell's diverticulum p. 71
Gulay Acar, Mustafa Koplay
Right-sided aortic arch (RAA) with left aberrant subclavian artery (LASA) is a rare vascular variant due to the failure in regression process during embryologic development of the aortic arch. The prevalence of it ranges from 0.04% to 0.1% in radiology series. We report the case of a 44-year-old female shown to have the presence of a RAA with LASA arising from the Kommerell's diverticulum, and also in association with an aberrant aortic origin of the right vertebral artery using computed tomography angiography. Considering the diameter of the diverticulum <5 cm and the absence of severe external esophageal or tracheal compression, thoracic surgery was not indicated and it was decided to keep the patient under clinical follow-up at regular intervals. Based upon this present case and literature review, the knowledge of this anomalous anatomy and its embryologic basis appear to be important for diagnostic endovascular interventions and planning thoracic surgery.
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Unusual additional distal aponeurotic slips of biceps brachii: A rare variation p. 74
Ritu Singh, Pooja Singh, Ranjana Verma, Rakesh Kumar Diwan
Biceps brachii muscle is basically a powerful supinator. Although there is ample literature on variant origin of biceps brachii, variant insertion pattern was minimally reported. Here, we report a case, in which apart from usual insertion of biceps brachii, three distal accessory aponeurotic slips were found on the right arm of 55-year-old embalmed male cadaver. Two slips were arising from the lateral most part of bicipital aponeurosis traversing across the cubital fossa superficial to the brachial artery and median nerve and get attached to deep fascia covering the brachioradialis and pronator teres. Third accessory aponeurotic slip arises from the lateral side of biceps brachii muscle belly, traversing superficial to the musculocutaneous nerve and get attached to deep fascia covering the lateral border of brachioradialis and extensor carpi radialis longus. These extra slips may affect the kinematics of biceps brachii muscle and adds to the differential diagnosis of variety of clinical symptoms of neurovascular syndrome.
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Calcified brain metastasis from ovarian cancer: A case report and literature review p. 77
Jian-Hui Huang, Jian-Zeng Ma, Chun-Wei Xu, Xue-Ni Liu, Jian Lou, Yan-Ru Xie
The overall incidence of ovarian cancer with calcified brain metastasis is low. However, in the absence of edema, it is difficult to distinguish metastasis from isolated brain calcifications. Metastasis should be considered in any cancer patient who presents with brain calcification(s) and symptomatology of the nervous system. The authors report a case of advanced ovarian cancer with multiple calcifications in the brain and edema after multiline treatment, in which metastatic cystadenocarcinoma was confirmed by biopsy.
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