Radiographic Study of Distal Radius Parameters in Patients Visiting Tertiary Care Hospital.

Background The important morphological parameters of distal radius namely palmar tilt, radial inclination, radial height and ulnar variance are consequential in the evaluation and management of the distal radius fracture, distal radius plate design and kinesiology. Correction of these parameters in anatomical alignment is important to restore the normal biomechanics of the wrist joint. Objective To ascertain the distal radius parameters in the patients attending tertiary care hospital with regard to gender and age. Method The wrist radiographs (postero-anterior and lateral views) of 125 patients, from 16 to above 60 years of age were used to determine the four parameters of distal radius. The subjects were divided into gender and three different age groups (16-36 years, 37-57 years and > 57 years). Independent t-test and ANOVA test was used for statistical analysis with level of significance set at p ≤ 0.05. Result The mean palmar tilt was 15.69 ± 4.84° (p-value = 0.40). The mean radial inclination was 22.58 ± 2.82° (p-value = 0.88). The mean value of radial height was 10.31 ± 1.59 mm (p-value= 0.001). Positive ulnar variance were recorded in maximum of subjects (46.40%) and the least was neutral (16.80%). Conclusion The distal radius parameters of our population were similar to the Orthopedic Trauma Association standard reference value. And there was significant difference in radial height between males and females.

A Study on Variations of Branching Pattern of Hepatic Arteries with its Clinical Significance.

Background Variation of hepatic artery is very frequent and may predispose the patients to inadvertent injury to the vessels during hepato-billiary surgery. With the advancement of new diagnostic, therapeutic and operative techniques for abdomen, the sound knowledge of variations of hepatic arterial system have become increasingly important for dealing clinicians, surgeons and interventional radiologists. Objective To study the variations of hepatic artery and to evaluate the possible clinical significances. Method A total of 104 images of abdominal computed tomography scans were used for this study. The origin and branching patterns of hepatic artery were recorded. After collecting the data, statistical analysis was done. Result The present study concluded that normal branching pattern of hepatic artery was seen in 86.54% cases, whereas 13.46% cases showed different types of variations. Among them, type II and IV pattern were seen in 0.96% in each, type VI in 1.93%, type VII in 2.87% and the most common variation type IX was seen in 3.85%. There were not a single case of type III, V, VIII and X recorded in this study. Addition to these, one of the variants was common hepatic artery originating from abdominal aorta, was seen in 1.93% of cases while the other variant is unnamed artery arising from superior mesenteric artery, was seen in 0.96% of cases. Conclusion The knowledge of the branching pattern of hepatic artery might be helpful for clinicians to the better understanding of the arterial supply of the liver and may reduce the risk of complications.

A Study on Variations of Branching Pattern of Renal Artery with its Clinical Significance.

Background The kidneys are supplied by a single renal artery originating from abdominal aorta. However, recent literature reports great variations in renal blood supply. Hence, it becomes mandatory for the clinicians to understand the abnormality and variations in the renal vasculature. Objective To evaluate the branching pattern of renal artery and its variations. Method The study consisted of Computed Topographic images of 206 kidneys. Numbers and branching pattern of renal artery were recorded. The data was analyzed for presence or absence, source of origin and type of accessory renal artery. Result The present study revealed that 73.79% of kidneys were supplied by a single renal artery, 25.72% by double renal artery and 0.49% by triple renal artery. The hillar branching pattern was recorded in 38.83% and early branching pattern was in 34.95%. The presence of accessory renal artery was recorded in 26.21%. They were originated from abdominal aorta in 22.81% and 3.40% from main renal artery. The prevalence of superior polar artery was found in 6.79%, hilar in 10.19% and inferior polar in 9.22%. Conclusion The knowledge of variations of renal artery becomes essential for the clinician to plan the adequate surgical procedures and to avoid any vascular complication.

A Study on Variations of Nutrient Foramen of Humerus with its Clinical Implications.

Background Nutrient foramen is an opening into shaft of humerus which gives passage to the blood vessels of medullary cavity. The knowledge of nutrient foramen is important in surgical procedures like bone grafting and more recently in microsurgical vascularized bone transplantation. Objective To determine the number, location and direction of nutrient foramen and whether the nutrient foramens obey the rule of ossification, that is directed away from the growing end of the bone or not. Method The present study consisted of 253 (108 right and 145 left) dried humeri excluding any fracture or pathological abnormalities during the period of 15th December 2014 - 14th February 2015. Number and direction of nutrient foramen was observed in each humerus. Location of nutrient foramen in relation with surfaces and zones of humeri was determined. Result It has been observed that 60.87% of the humeri had a single nutrient foramen, 28.85% double foramen, 6.32% triple foramen and 1.98% of humeri had four nutrient foramina where as 1.98% humeri did not have any nutrient foramina. It was concluded that the majority (88.86%) of the nutrient foramina were present on the antero-medial surface, 6.52% on the anterolateral surface and 4.62% on the posterior surface of the shaft of humeri. It was also concluded that most (94.84%) of the foramina present in the zone II followed by zone III (4.62%) then by zone I (0.54%). All foramina were directed toward the lower end of humeri. Conclusion By knowing the number and location of the nutrient foramina in humerus would be useful in preventing intra-operative injury of nutrient artery during orthopedic, plastic and reconstructive surgery and will also be relevant in medico legal practice.

A Study on Nutritional Status of Rural School going Children in Kavre District.

Background Childhood is a time of active growth in terms of physical size, mental, emotional and psychological development. Normal growth is dependent on adequate nutrition and encompasses major transformations from birth to adulthood. Nutrition is a focal point for health and well being; and has special significance in countries with disadvantages in socioeconomic and hygienic standards. Objective The objective of the present study was to assess the nutritional status in terms of prevalence of underweight, stunting and thinness among rural school going children. Method The present study was cross-sectional study, conducted on 438 rural school going children (169 male and 259 female) with the age group 4-16 years, during the period from April 2014 to July 2014. Age was recorded in year; height and weight were measured in centimeter and kilogram respectively. BMI was calculated by using standard equation. Result The present study concluded that the nutritional status in terms of prevalence of underweight, stunting and thinness were found to be 30.85%, 24.54% and 10.05% respectively among rural school going children of Kavre district. It was revealed that 37.87% was underweight, 29.59% was stunted and 11.25% was thinness among male children whereas in female children, 26.27% was underweight, 21.24% was stunted and 9.27% was thinness. Hence, high prevalence of underweight, stunting and thinness were observed in male than in female children. Conclusion The present study has successfully documented the nutritional status in terms of prevalence of underweight, stunting and thinness among the rural school going children of Kavre district. The results of the present study will be useful for policy makers in their endeavor to formulate various developmental and health care programs.

Use of head circumference as a predictor of height of individual.

BACKGROUND: Establishing personal identity is one of the main concerns in forensic investigations. In forensic anthropology, estimation of height from head circumference has a significant role in establishing personal identity. OBJECTIVE: The objective of the present study was an attempt to understand the relationship between height and head circumference of an individual and to derive regression formulae to estimate the height from the head circumference. METHOD: The present study consisted of 440 (258 male and 182 female) students of age group 17 to 25 years studying in Kathmandu University School of Medical Sciences, Dhulikhel, Nepal during the period from November 2012 to October 2013. Height and head circumference of an individual were measured in centimeter. Data were analyzed by using statistical software SPSS-16. RESULT: The findings of the present study were significant correlation between height and head circumference (r = 0.443, p < 0.01 for male, r = 0.302, p<0.01 for female, and r = 0. 398, p < 0.01 for combined (male and female). The regression equation for height and head circumference was found to be Y = 1.734X + 70.36 (R2 = 0.196) for male, Y = 0.916X + 106.8 (R2 = 0.091) for female, and Y = 1.648 X + 71.69 (R2 = 0.158) for combined (male and female), where Y is the height of Individual and X is the Head Circumference. CONCLUSION: Head circumference showed highly significant positive correlation with individual's height. Therefore, the present study will help in medico-legal cases in establishing the identity of an individual and this would also be useful for Anatomists and Anthropologists.

Variations in total facial index among students of Kathmandu University School of Medical Sciences.

The total facial index exhibits sexual differences and different shapes of face. Facial anthropometry has its well known implications for forensic scientists, anatomists, human biologists, criminologists and physical anthropologists. Facial index is the ratio of the morphological facial height to facial width and multiplied by 100. The present study aimed to examine the facial length, facial width, facial index and to find out the facial type in students of Kathmandu University School of Medical Sciences. The present study was conducted on 300 medical, dental and human biology students of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Of the total 300 students 150 students were male and 150 students were female and were between the age group 18-25 years. The study had been approved by the Institutional review committee of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The study result showed that the mean facial index of Nepalese students was 87.01. The mean facial index of Nepalese male was found to be 87.20 and female was found to be 86.81. The dominant facial type in students of Kathmandu University School of Medical Sciences was found to be mesoproscopic and least common was hyperleptoproscopic. The dominant facial type in male was euriproscopic and the dominant type in female face was mesoproscopic.

Variation of carrying angle with age, sex, height and special reference to side.

BACKGROUND: The carrying angle is defined as the acute angle made by the median axis of arm and median axis of forearm in full extension and supination. This angle permits the forearms to clear the hips in swinging movements during walking and is important when carrying objects. OBJECTIVE: The purpose of this study was to determine the values of carrying angle in both the sexes according to the age group in relation with height and special reference to side. METHODS: To evaluate the elbow carrying angle in normal children between 5-15 years by a manual goniometer, measurements were performed in 532 children (Male- 335, Female- 197), with the elbow in full extension and forearm in supination. Carrying angle was measured on right and left upper limbs to find out the difference on both the limbs. Their height, ages and sexes are also recorded. Bicipital groove, biceps brachii tendon at its insertion and palmaris longus tendon at the wrist were palpated and marked as anatomical landmarks to demarcate the median axes of arm and forearm respectively. RESULTS: The mean carrying angle of male on the left limb was 7.0359° and the female was 7.8030° and the mean carrying angle of male on the right limb was 4.5509° and the female was 4.9545°. We observed the greater carrying angle in non-dominant limb than the dominant limbs. There was significant positive correlation between height of students and carrying angle left (r =0.0866, p= 0.048<0.05), negative correlation between height and carrying angle right (r= -0.082, p= 0.058 >0.05). CONCLUSION: The present study showed that the carrying angle was greater in female than in male and was greater in non-dominant arm than in dominant arm and the carrying angle was not inversely related to the height of the person.

Morphometry of acromion process of human scapulae and its clinical importance amongst Nepalese population.

BACKGROUND: Morphometry of the acromion process of the scapula is an important factor implicated in impingement syndrome of the shoulder joint. Authors who have studied this process have tried to classify it according to the standard Bigliani classification viz., type 1, 2 and 3. OBJECTIVES: To analyze and classify the acromion process of human scapulae. METHODS: The present study was observational, cross-sectional and descriptive in nature. The present study was conducted on 68 adult human scapulae (30 right and 38 left) of unknown age and sex in the Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The length and breadth of the acromion process and the distances from the tip of the acromion process to the uppermost point of the glenoid cavity and to the tip of the corocoid process were measured with a help of caliper and measuring tape. RESULTS: The average length of acromion process on the right and left scapulae were 46.46 ± 5 SD mm and 45.57 ± 5.21 SD mm respectively. The average breadth of acromion process of right and left scapulae were 26.63 ± 3.55 SD mm and 27.23 ± 3.06 SD mm respectively. The acromio-coracoid distance on the right and left side were 39.03 + 6.20 mm and 39.39 +5.32 mm respectively. The acromio-glenoid distance was also measured which was 31.83 +3.66 mm and 31.97 +3.96 mm on right and left side respectively. The acromion process was classified in the present study into 3 types, based on the shape as: Triangular - 36.76%, Quadrangular - 52.94% and Tubular - 10.29%. CONCLUSIONS: Knowing the data on the shape and various distances of acromion may not only help the orthopaedicians during surgical repair around the shoulder joint but also may be of interest to the anthropologists when studying about the evolution of the bipedal gait. The morphometric analysis of the acromion should be used like an auxiliary to promote a better knowledge about the disease that appears in this area.

Estimation of stature from foot length in adult Nepalese population and its clinical relevance.

BACKGROUND: Stature is the height of the person in the upright posture. It is an important measure of physical identity. Interrelationships among different body measurements may be used to estimate one from another in case of missing body parts. OBJECTIVE: Stature is an important indicator for identification. There are numerous means to establish stature and their significance lies in the simplicity of measurement, applicability and accuracy in prediction. The current study dealt with developing a regression equation for stature estimation from foot length and to find out the correlation between body height and foot length of Nepalese people. METHODS: The present study was carried out to establish the regression equation and correlation coefficient between individual height and mean foot length. It was conducted on 440 students of age group 17 to 25 years studying in Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Body height and foot length were measured in centimeter. RESULTS: There was significant correlation between height and foot length (r = 0. 703, p < 0.01).The regression equation for height and foot length was found to be Y = 3.179 X + 87.65, where X is the foot length and Y the height. CONCLUSIONS: This study will help in medico-legal cases in establishing identity of an individual and this would be useful for Anatomists and Anthropologists to calculate stature of adult Nepalese based on foot length.

Bilateral high-orgin anterior tibial arteries and its clinical importance.

Reported here is a case of bilateral high - origin anterior tibial arteries as detected during routine dissection of a 40 years old male cadaver at the Kathmandu University School of Medical Sciences, Kavre District, Nepal. The aim of the present study was to underline the clinical importance of high origin of anterior tibial artery from the popliteal artery.The high origin anterior tibial artery from the popliteal artery and its relations with the popliteus muscle is an important anatomical variation which should be paid attention during knee joint surgery, total knee arthroplasty and angiographic evaluations.

Problem based learning in medical education.

Problem based learning, originally introduced in the Medical School at Mc-Master University in Canada in the late 1960s, and is now being used as a learning method in many medical schools in the United Kingdom and worldwide. Problem based learning have been adapted in many medical colleges of Nepal be used either as the mainstay of an entire curriculum or for the delivery of individual courses. Institution of Medicine, Tribhuvan University in 1980, BP Koirala Institute of Health Sciences at Dharan in 1999, KUSMS with the great support of faculties from Harvard University in 2001, Patan Academy of Health Sciences (PAHS), and lately all the affiliated medical colleges of Kathmandu University have adapted Problem based learning.

Study on curvatures of clavicle with its clinical importance.

BACKGROUND: The clavicle is the most frequently fractured bone of the human skeleton. Most of fractures occur at the middle third of the shaft of the bone. Anatomical variations in the clavicle of relevance to form intramedullary fixation. OBJECTIVES: The purpose of this study was attempted to know about comparative differences between curvatures of the right and left clavicles, from certain metrical parameters. METHODS: The materials for the present study consisted of 257 (135 right and 122 left) adult clavicles, which were collected from the Department of Anatomy and from the students of the first year M.B.B.S during the period 2010 - 2011, Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The deepest points of the curvatures of the clavicle, where the convexities were the maximum. These angles were measured with the help of a protractor. The sum of the two angles constituted the total curvature of the bone. RESULTS: The average medial angle, lateral angle and sum of the two angles of right side were 150.97 ± 6.16 SD, 139.76 ± 7.55 SD and 290.73 ± 11.14 respectively and that of the left side were 151.50 ± 5.67SD, 141.73 ± 8.44 SD and 293.23 ± 11.69SD respectively. The present study revealed that the medial and lateral angles of the left clavicle were greater than that of the right clavicle and medial curvature was more than the lateral curvature of the same clavicle. CONCLUSION: It is important to recognize anatomical variations in the curvatures of clavicle when considering intramedullary nailing techniques. It also helps anthropologists in their study of evolution.