Short-term Outcome and Predictors of Survival Among Neonates With Moderate or Severe Hypoxic Ischemic Encephalopathy: Data From the Indian Neonatal Collaborative

Background: Among term and late preterm infants, hypoxic ischemic encephalopathy (HIE) is an important cause of mortality, and neurologic morbidity among survivors. Objective: The primary objective was to study the incidence of survival to discharge among late preterm and term infants with moderate or severe HIE. Secondary objectives were to explore variation in the management of HIE across participating sites and to identify the predictors of survival. Setting: Indian Neonatal Collaborative (INNC), a network of 28 neonatal units in India. Study design: Retrospective cohort. Participants: Late preterm (34-36 weeks) and term (37-42 weeks) infants with moderate to severe HIE from 2018-2019. Outcome: The primary outcome was survival to discharge (including discharged home and transfer to other hospital). A multivariate logistic regression model was constructed to identify the predictors of survival. Results: Of 352 infants with moderate or severe HIE, 59% received therapeutic hypothermia. Survival to discharge among infants with moderate or severe HIE was 82%. Severe HIE (aOR 0.04; 95% CI 0.02-0.10), persistent pulmonary hypertension (PPHN) (aOR 0.22; 95% CI 0.08-0.61) and requirement of epinephrine during resuscitation (aOR 0.21; 95% CI 0.05-0.84) were independently associated with decreased odds of survival to discharge. Conclusion: Survival to discharge among infants with moderate or severe HIE was 82%. Severe HIE, requirement of epinephrine during resuscitation and PPHN decreased the odds

South Asian Working Action Group on SARCOpenia (SWAG-SARCO) e A consensus document

The South Asian population is rapidly ageing and sarcopenia is likely to become a huge burden in this region if proper action is not taken in time. Several sarcopenia guidelines are available, from the western world and from East Asia. However, these guidelines are not fully relevant for the South Asian healthcare ecosystem. South Asia is ethnically, culturally, and phenotypically unique. Additionally, the region is seeing an increase in non-communicable lifestyle disease and obesity. Both these conditions can lead to sarcopenia. However, secondary sarcopenia and sarcopenic obesity are either not dealt with in detail or are missing in other guidelines. Hence, we present a consensus on the screening, diagnosis and management of sarcopenia, which addresses the gaps in the current guidelines. This South Asian consensus gives equal importance to muscle function, muscle strength, and muscle mass; provides cost-effective clinical and easy to implement solutions; highlights secondary sarcopenia and sarcopenic obesity; lists commonly used biomarkers; reminds us that osteo-arthro-muscular triad should be seen as a single entity to address sarcopenia; stresses on prevention over treatment; and prioritizes nonpharmacological over pharmacological management. As literature is scarce from this region, the authors call for more South Asian research guided interventions.

Incidental Detection of Ischemic Myocardium on 68 Ga-FAPI PET/CT / 대한핵의학회잡지

Recent studies using Ga-68-labeled fibroblast activation protein inhibitors (FAPI) PET have shown strong association between focal uptake of FAPI in myocardium and presence of coronary artery disease. We present an interesting case of a 76-year-old female with breast cancer with incidental uptake on FAPI PET in apex and septal wall of left ventricle myocardium correlating with findings of ischemia on dobutamine stress myocardial perfusion imaging and anatomical stenosis on coronary angiography.

Morphometric Study of Hypoglossal and Facial Nerves and its Significance in Hypoglossal-Facial Nerve Anastomosis.

Background: During the repairing of facial nerve injurymost common nerve used is the hypoglossal nerve. Aimand Objectives: To measure the distance between theanatomical landmarks, facial nerve and hypoglossalnerve which will be beneficial to locate the facial nerveand hypoglossal nerve more effortlessly and willdecrease the hazard of procedural problems. Materialand Methods: Thirty specimens were dissected.Measurements of the hypoglossal and facial nerveswere taken from various anatomical landmarks. Datawere analyzed using Statistical Package for SocialSciences 16 version. Results: The mean distance of theorigin of the facial nerve to the angle of mandible wascm, the mean distance of the origin of thefacial nerve to the tip of mastoid process wascm, the mean distance of common carotidbifurcation to the hypoglossal nerve where it crossesthe external carotid artery was cm, the meandistance of common carotid bifurcation to thehypoglossal nerve where it crosses the internal carotidartery was cm and the mean distance ofhypoglossal nerve to the tip of mastoid process wascm. Conclusion: The results of this studywill help and prevent any complication in identifyingthe hypoglossal nerve and facial nerve duringhypoglossal-facial nerve anastomosis.

Prakriti phenotypes as a stratifier of gut microbiome: A new frontier in personalized medicine?

Ayurveda has a rich history and its significance woven deeply in the Indian culture. The concept of prakriti (a person’s “nature” or constitutional type determined by the proportion of three doshas, namely - vata, pitta and kapha) in Ayurveda is deeply rooted in personalized health management. While the attributes of prakriti has been established to have a genomic basis, there is dearth of elaborate evidences linking prakriti with manifestation of diseases. Next generation sequencing studies have provided a causal link between variation in the gut microbiome and its effect on an individual’s fitness. Separately, reports have identified gut microbial patterns associated with several host variables such as geography, age, diet and extreme prakriti phenotypes. Recently, few reports have identified a “core gut microbiome” consisting of Bacteroides, Faecalibacterium, Prevotella and Ruminococcus prevalent across the Indian population; however, a few bacterial genera were specifically enriched in certain prakritis. Hence, in this review we aim to analyse the role of prakriti variations on dysbiosis of the gut microbiome and concomitantly its effect on human health. We suggest that prakriti phenotyping can function as a potential stratifier of the gut microbiome in a given population and may provide evidence for the conceptual framework of personalized medicine in Ayurvedic system of medicine.

The Approach of Anatomists towards Voluntary Body Donation: Inspiring or Dispiriting???

Background: Body donation is a noble act towardscontributing to medical education and research.Although anatomists encourage the general populationto donate bodies, the attitude of anatomists towarddonating their bodies is less discussed in the literature.Aim and Objectives: The present study was conductedto obtain the knowledge, attitude and practice ofanatomists towards voluntary body donation. Materialand Methods: The study was conducted among theanatomists of different Medical Colleges of SouthIndia. To assess the knowledge, attitude, and practicesof voluntary body donation, a semi-structuredquestionnaire was designed and distributed to theanatomists. Results: The study involved 102anatomists. The majority 58.3% stated that the primarysource of supply of cadavers was from the bodydonation program. When it came to voluntary bodydonation, only 32.4% of the anatomists were willing todonate their bodies. The facilitating factors forwillingness to donate were contributions to medicaleducation 60.3%, personal satisfaction 7.4%,motivation to the general public 4.4%, andencouragement from a close friend/ colleague 2.9%.The factors that abstained individuals from donatingwere: restriction from family members 30.9%, malhandling of the cadavers 29.4%, and ritual beliefs20.6%. Conclusion: The approach of anatomiststowards donating their bodies is not promising. It maydiscourage the general public from donating theirbodies. Therefore, it is equally important to inspire andencourage the anatomists towards body donation.

Anthropometric and Histologic Study of Liver and Kidney of Foetuses and Their Correlation With Gestational Age

@#Introduction: It is very important to accurately estimate the age of foetus for various medicolegal cases. This study is an attempt to establish a relationship between anthropometric measurements and histologic analysis of liver and kidney to identify gestational age of the foetus. Methods: The study was carried on 30 fetuses. Their anthropometric measurements were done using Vernier calipers. The data was statistically analyzed by computation to find out its normative value. Histologic analysis was done by preparing hematoxylin and eosin stained slides and looking under light microscope. The relationship between gestational age and data thus obtained was determined. Results: Size of liver and kidneys increased with every trimester. The kidney showed immature duct system and clustered glomeruli with lack of differentiation into cortex and medulla in first trimester. Tubular differentiation started in second trimester which finished in third trimester with formation of juxtaglomerular apparatus. Size of glomerulus was, however, maximum during second trimester, followed by first and third trimester. In liver, haemopoeisis was observed in first trimester which decreased with subsequent trimesters. Lobular differentiation increased with each trimester. However, full term liver did not have the classic lobular pattern. Size of sinusoids decreased with every trimester. Abundant fibrous tissue was observed around portal triad. Conclusion: There is a relationship between the gestational age and anthropometric measurements and histologic features of liver and kidney of the foetus. This will help in identifying foetal age as well as any congenital kidney and liver diseases.

A study on eclampsia and its maternal and perinatal outcome

Background: Eclampsia is one of the major causes of maternal and perinatal mortality in India. Here authors present a prospective study which was conducted in a tertiary health centre to study the cases of eclampsia, the mode of presentation and the maternal and perinatal outcomes.Methods: A total 95 women were diagnosed as eclampsia during the period of 2 years. Various parameters and their effects on maternal and perinatal morbidity and mortality were studied. Maternal outcomes were assessed based on parameters like antenatal care received, mode of delivery, complications associated with eclampsia. Perinatal outcomes were noted depending upon the period of gestation, NICU admission, stillbirths and neonatal deaths.Results: Authors found the incidence of eclampsia to be 0.9%. 52.7% women had irregular antenatal follow up at any nearby health centre. A total 76.8% women had antepartum eclampsia. 56.8% delivered by caesarean section while 7.4% required operative vaginal delivery. 61.1% women delivered within 10 hours of onset of convulsion. Authors had 02 deaths in the study group, one due to ARDS with DIC and the other attributed to pulmonary oedema. There were 51.6% preterm deliveries. 21 neonates required NICU admission with 5 neonatal deaths and 11 stillbirths.Conclusions: Due to inadequate antenatal care, most of the cases of pre-eclampsia go unnoticed increasing the referrals to tertiary care centre for intensive care. Thus, it is necessary to emphasise on timely interventions and availability of blood bank, ICU and NICU facilities at the closest referral centre for better maternal and perinatal outcome.

Macromolecular properties and partial amino acid sequence of a Kunitz-type protease inhibitor from okra (Abelmoschus esculentus) seeds

A Kunitz-type protease inhibitor (OPI, okra protease inhibitor) has been purified from okra (Abelmoschus esculentus) seedsby a combination of ammonium sulfate precipitation, anion-exchange chromatography and reverse-phase high-performanceliquid chromatography. The protein shows an apparent mass of 21 kDa on sodium dodecyl sulfate-polyacrylamide gelelectrophoresis under reducing condition. OPI exhibits inhibitory activity against trypsin. Analysis of the far-UV circulardichroism spectrum showed that the protein contains *39% b-sheets but only *5% a-helices. The protein is thermallyquite stable, and exhibits a cooperative thermal unfolding transition at *70C, as determined by circular dichroismspectroscopy and differential scanning fluorimetry. De novo sequencing of OPI by nanoESI-Q-ToF mass spectrometry (MS)allowed the assignment of about 83% of its primary structure, which indicated that the protein shares 43% sequence identitywith a putative 21 kDa trypsin inhibitor from Theobroma bicolor. An intramolecular disulfide linkage between Cys149 andCys156 was also detected. The protein showed *24 and *25% sequence identity with a-amylase/subtilisin inhibitor frombarley and soybean (Kunitz) trypsin inhibitor, respectively. Comparative structure modeling of OPI revealed a structuralfold similar to other Kunitz-type TIs. The presence of Cys149–Cys156 disulfide bond as detected by MS and a seconddisulfide bond connecting Cys44–Cys91, conserved in all Kunitz-type TIs, is also identified in the model.

Incidence and risk factors of gestational diabetes mellitus in antenatal mothers in Goa, India

Background: Gestational Diabetes Mellitus (GDM) accounts for almost 90% of all pregnancies complicated by diabetes. Its prevalence in the Indian population ranges from 5.5% to 11.5 %.Methods: The present study was undertaken to assess the incidence of GDM among antenatal mothers admitted in Goa Medical College for a period of 18 months and also to study the risk factors associated with GDM amongst such cases.Results: Present study revealed that among 7717 antenatal mothers who were admitted and delivered in our Hospital, 424 women were diagnosed with GDM. Of these women diagnosed with GDM, almost one third were in the age group of 31- 35 years (35.8%); 56.2 % of these women were multigravidas. Advancing maternal age, rising parity, obesity, family history of Diabetes Mellitus (DM) and past history of GDM were among the risk factors found to be significantly associated with GDM.Conclusions: The incidence of GDM in present study population was 5.49%. Advancing maternal age, maternal obesity, family history of DM and past history of GDM were found to be important determinants of GDM.

Treatment outcome of multiple myeloma (MM) based on cytogenetic risk stratification: a single institute experience from south India

Background: To study the epidemiology, incidence and the clinical outcome of multiple myeloma (MM) among the patients based on the cytogenetic risk stratification.Methods: Author retrospectively analysed 50 patients of Multiple Myeloma (MM) with conventional cytogenetics and interphase Fluorescence In-Situ Hybridization (FISH) method and author classified the risk on the mSMART classification. Treatment and outcome were evaluated separately based on the cytogenetic risk stratification for three arms of treatment- Bortezomib, Thalidomide and Dexamethasone (BTD), Thalidomide and Dexamethasone (TD) and Lenalidomide and Dexamethasone (LD).Results: The median age of the patients was 61years (48-74years) and ratio between male to female was 1.5:1. The overall response (OR) rate among high risk patients treated with Bortezomib, Thalidomide and Dexamethasone (BTD) was 100% with Complete Response (CR) being 26.7%. The OR rate and CR rates among standard risk treated with Thalidomide and Dexamethasone (TD) and Lenalidomide and Dexamethasone (LD) were 61%, 11% and 76%, 18% respectively. The two years overall survival (OS) was 53.3% in high risk and 66.7% with Thalidomide and Dexamethasone (TD) and 76.5% with Lenalidomide and Dexamethasone (LD) in low risk group.Conclusions: The present study showed that the high-risk features of cytogenetics portend poor outcome among MM patients. Bortezomib, Thalidomide and Dexamethasone (BTD) based therapy have improved the Overall Response (OR) rate and Complete Response (CR) rates in high risk MM, however overall survival (OS) is poor in this risk strata. The study also showed that cytogenetic risk stratification and the outcome of myeloma do correlated with each other.

Iron Overload in Children with Leukemia Receiving Multiple Blood Transfusions

Objective: To find out prevalence of iron overload in children with leukemia at the end oftreatment, and to identify factors affecting iron overload. Methods: Children (age-1-14 y)treated for Leukemia of our center who completed treatment between January and August2016 were included in the study. Serum ferritin and iron were measured at completion oftreatment and total blood transfusion received throughout treatment was quantified. Serumferritin >1000 ng/mL was considered as marker of transfusional iron overload. Results: Outof 66 participants, 55 (83.3%) received red cell transfusions. Average transfused volumewas 48 mL/kg, and patients with high-risk leukemia received more transfusions thanstandard-risk patients. 16 patients (24.2%) demonstrated transfusional iron overload. Totaltransfused volume and treatment intensity were significant factors associated with ironoverload, and total transfused volume of >100 mL/kg (approximately 10 transfusions) wasthe most important determinant of transfusional iron burden. Conclusion: One-fourth ofpediatric leukemia patients demonstrated iron overload at the end of treatment. Thesepatients need to be monitored and followed-up after treatment to assess need for laterchelation therapy.

Effect of nonsurgical periodontal therapy on interleukin-34 levels in periodontal health and disease

Interleukin-34 (IL-34) is a recently identified alternative ligand for colony-stimulating factor-1 receptor plays an important role in osteoclastogenesis. The aim of this study was to evaluate the IL-34 levels in gingival crevicular fluid (GCF) and plasma in subjects with chronic periodontitis and to evaluate the effect of nonsurgical periodontal therapy on the GCF and plasma IL-34 levels. Materials and Methods: Thirty individuals (age range: 30–56 years) were selected and divided into groups based on the gingival index, probing pocket depth, clinical attachment level, and radiologic parameters (bone loss): Group I (15 individuals with healthy periodontium), Group II (15 individuals with chronic generalized periodontitis) while Group II patients after 8 weeks of the treatment (scaling and root planning) constituted Group III. GCF samples and plasma samples were collected to estimate the levels of IL-34 using enzyme-linked immunosorbent assay kit. Results: The mean IL-34 concentration in GCF and plasma was highest for Group II compared to Group I and decreased after nonsurgical periodontal therapy in chronic generalized periodontitis group. The difference between them was statistically significant (P < 0.05). Conclusion: IL-34 can be considered as an “inflammatory marker” of periodontal disease and can be explored in the future as a potential therapeutic target in the treatment of periodontal disease.

Development of the Fetal Ureter: A Fetal Metric and Histological Study

@#Introduction: This study provides a description of development of various components of the human ureter at different gestational ages. Methods:Measurements of the length of the ureter from pelvi-ureteric junction to vesico-ureteric junction, length of its intravesicular portion and angle made by the ureter at the entry into the bladder with respect to the internal ureteric orifice were taken. Transverse sections of the ureter were taken at the upper end, close to the pelvi-ureteric junction, and at the midpoint between the pelvis of the kidney and the vesico-ureteric junction. These were subjected for processing and stained with Haematoxylin Eosin and Masson’s Trichrome. They were then studied under the light microscope. Results: The length of the ureter from the pelvi-ureteric junction to the vesico-ureteric junction showed a highly positive correlation with the gestational age (GA). The angle of entry of the ureter to the bladder decreased as the GA increased. The microstructure of the ureter in both the sections showed development of transitional epithelium with an increase in layers by 33 weeks. At 18 weeks, the smooth muscle layer was in a single layer with an abundance of interspersed collagen fibers. By 33 weeks, the thickness of the wall increased significantly with a decrease in collagen. There was no trace of longitudinal muscle fibers even upto 33 weeks. Conclusion: Epithelial, muscular and connective tissue components displayed significant changes during intra uterine development.

Cost-effectiveness of indacaterol/glycopyrronium in comparison with salmeterol/fluticasone combination for patients with moderate-to-severe chronic obstructive pulmonary disease: a LANTERN population analysis from Singapore

<p><b>INTRODUCTION</b>In light of the growing evidence base for better clinical results with the use of the dual bronchodilator indacaterol/glycopyrronium (IND/GLY) over inhaled corticosteroid-containing salmeterol/fluticasone combination (SFC), this study aimed to evaluate the cost-effectiveness of IND/GLY over SFC in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) who are at low risk of exacerbations, in the Singapore healthcare setting.</p><p><b>METHODS</b>A previously published patient-level simulation model was adapted for use in Singapore by applying local unit costs. The model was populated with clinical data from the LANTERN and ECLIPSE studies. Both costs and health outcomes were predicted for the lifetime horizon from a payer's perspective and were discounted at 3% per annum. Costs were expressed in 2015 USD exchange rates. Uncertainty was assessed through probabilistic sensitivity analysis.</p><p><b>RESULTS</b>Compared to SFC, use of IND/GLY increased mean life expectancy by 0.316 years and mean quality-adjusted life years (QALYs) by 0.246 years, and decreased mean total treatment costs (drug costs and management of associated events) by USD 1,474 over the entire lifetime horizon. IND/GLY was considered to be 100% cost-effective at a threshold of 1 × gross domestic product per capita. The cost-effectiveness acceptability curve showed that IND/GLY was 100% cost-effective at a willingness-to-pay threshold of USD 0 (additional cost) when compared to SFC.</p><p><b>CONCLUSION</b>IND/GLY was estimated to be highly cost-effective compared to SFC in patients with moderate-to-severe COPD who are not at high risk of exacerbations in the Singapore healthcare setting.</p>

FloTrac/EV1000 guided management of amlodipine induced refractory hypotension during renal transplantation

Patients scheduled to undergo renal transplantation are often the most complex ones that an anaesthesiologist may encounter, as intraoperative hemodynamic instability can adversely affect the outcome of renal transplantation. Amlodipine is the commonly prescribed drug to patients with end stage renal disease [ESRD] for control of hypertension. Preoperative use of amlodipine may rarely present as intraoperative hypotension. Amlodipine induced hypotension is usually refractory to commonly used vasopressors. Combination of calcium, different sympathomimetic agents and fluids with minimal invasive monitoring with FloTrac/EV 1000 can be helpful in this situation. It is important to titrate antihypertensive medications in perioperative period to prevent intraoperative hemodynamic instability during renal transplantation as it can affect the graft function. We report a case of successful management of intraoperative refractory hypotension after therapeutic dose of amlodipine during renal transplantation

A cadaveric study of the testicular artery and its clinical significance / Um estudo da artéria testicular em cadáveres e sua relevância clínica

Abstract Background Knowledge of testicular artery variations is vital to ensure that they are not neglected during a variety of different operative techniques, since damage can cause testicular atrophy. Objectives The present study was therefore intended to identify variants in the origin and course of the testicular arteries. An attempt was made to classify the arteries based on their various origins. Methods This study examined 42 formalin-fixed cadavers of 40 to 70-year-old adult males. Variant origins of the testicular artery were identified and classified. Variations in the origin and course of the artery were colored, photographed, and documented. The distances between the origins of the testicular arteries and the mid-points of the origins of the renal arteries were measured. Results Testicular arteries were classified into four categories on the basis of origin. This variability was defined in relation to the renal and inferior mesenteric arteries. The mean distance between the origin of the testicular artery and the mid-point of the origin of the renal artery were 3.08 and 3.47 cm, on the right and left sides respectively. Variations were almost exclusively found on the left side. The variations observed included multiple arterial twigs forming the testicular artery, suprarenal arteries arising from the testicular artery, and testicular artery duplication. Conclusion This study provides an insight into variations in the testicular artery and proposes a classification which could help surgeons during a variety of procedures on the male abdomen and pelvis.

Resumo Contexto O conhecimento de variações da artéria testicular é vital para assegurar que essas artérias não serão negligenciadas durante a realização de diferentes técnicas operatórias, já que qualquer dano poderia causar atrofia testicular. Objetivos Este estudo teve como objetivo identificar variações na origem e no trajeto das artérias testiculares. Foi feita uma tentativa de classificar as artérias com base em suas diferentes origens. Métodos Este estudo examinou 42 cadáveres de adultos do sexo masculino com idade entre 40 e 70 anos preservados em formol. As diferentes origens da artéria testicular foram identificadas e classificadas. Variações na origem e no trajeto da artérias foram coloridas, fotografadas e documentadas. Foram medidas as distâncias entre a origem das artérias testiculares e o ponto médio da origem das artérias renais. Resultados As artérias testiculares foram classificadas em quatro categorias com base em sua origem. Essa variabilidade foi definida com relação às artérias renal e mesentérica inferior. A distância média entre a origem da artéria testicular e o ponto médio da origem da artéria renal foi de 3,08 e 3,47 cm nos lados direito e esquerdo, respectivamente. As variações foram encontradas quase exclusivamente no lado esquerdo. As variações observadas incluíram múltiplos ramúsculos formando a artéria testicular, artérias suprarrenais surgindo a partir da artéria testicular, e duplicação da artéria testicular. Conclusão Este estudo traz informações sobre variações da artéria testicular e propõe uma classificação que poderia ajudar os cirurgiões durante diferentes procedimentos realizados no abdome e na pelve de pacientes do sexo masculino.

Evaluation of effects of porcelain firing on the marginal fit changes of porcelain­ fused-to- metal crown fabricated utilizing two different margin designs and two commercially available base metal alloys

Aim: To find the marginal fit of the porcelain fused to metal crowns by two different margin designs (shoulder and chamfer) and two commercially available base metal alloys. Material and Methods: Tooth preparation of first central incisor for porcelain-fused-to-metal crown with shoulder margin and second incisor for porcelain-fused-to-metal crown with chamfer margin was done. Wax pattern of the same was prepared. Impression of both prepared ivorine incisors was made by light body impression material and poured with pattern resin. Both the patterns were invested and casted with cobalt chromium alloy for making master dies. Two wax patterns of unprepared central incisors were fabricated, one with shoulder margin and another with chamfer margin. These patterns were then cut back to the size of the coping. Four rings were invested. In each ring ten patterns, five with shoulder margin and five with deep chamfer margin were sprued together to ensure that each group would pass through the same investing and casting procedure, followed by ceramic firing and measurement. Results: Marginal fit change or marginal discrepancy (before and after firing) between the groups was highly significant. Conclusions: Veneered crowns exhibited highly significant marginal distortion than non- veneered copings after porcelain firing. Shoulder margin is better in minimizing marginal discrepancy compared to deep chamfer margin. Marginal discrepancy is less when cerabond base metal alloy is used with shoulder margin as compared to commend base metal alloy used for shoulder margin.

Rare variations in the Origin, Branching Pattern and Course of the Celiac Trunk: Report of Two Cases

Multiple anomalies in the celiac arterial system presents as rare vascular malformations, depicting deviations of the normal vascular developmental pattern. We found a common left gastro-phrenic trunk and a hepato-spleno-mesenteric trunk arising separately from the abdominal aorta in one cadaver. We also found a common hepatic artery and a gastro-splenic trunk arising individually from the abdominal aorta in another cadaver. Even though many variations in the celiac trunk have been described earlier, the complex variations described here are not mentioned and classified by earlier literature. Knowledge of such variations has signifi cance in the surgical and invasive arterial radiological procedures in the upper abdomen.