Impact of maternal topiramate ingestion on ossification of skull and appendicular bones in rat fetuses.

The skull and appendicular bones are derived from different embryological sources during their development. The impact of prenatal exposure of topiramate on ossification of these bones is not adequately studied. The goal of this study was to assess the ossification patterns of the craniofacial bones and bones of the forelimbs and hindlimbs in 20-day-old rat fetuses after maternal exposure to topiramate at doses equivalent to human therapeutic doses. Three groups of Sprague-Dawley pregnant rats were used: control, topiramate 50mg/kg/day (T50) and topiramate 100mg/kg/day (T100). Topiramate was given by oral gavage from day 6 to day19 of gestation. Ossification was evaluated in the bones of 20 days fetuses after staining with Alizarin red. Results showed a significant reduction in complete ossified centers of the metacarpal, metatarsal and craniofacial bones in topiramate-exposed fetuses at both doses when compared to the control group. Also, a significant decrease in the length of ossified part of the long bones of the forelimbs and hindlimbs in topiramate-exposed fetuses at both doses was noted when compared to the control group. Crown-rump length and fetal weight were significantly decreased in topiramate treated groups compared to the control group. In all examined groups, there was a positive correlation between the crown-rump length and the lengths of humerus and femur. No abnormalities in the ossified bones and no significant changes in their ossification pattern were observed between the treated groups. In conclusion, prenatal administration of topiramate in doses equivalent to human therapeutic doses delayed ossification and development of craniofacial and appendicular bones in rat fetuses and their effects are not dose dependent at doses investigated. The implications of these findings in women who require topiramate therapy in pregnancy merit further evaluation.

Checklist-based active learning in anatomy demonstration sessions during the COVID-19 pandemic: Perception of medical students.

Human anatomy is an essential component of the medical curricula. Anatomy education has been significantly affected during the COVID-19 pandemic. The aim of this study was to explore student's perceptions on a blended learning approach using Checklist-based Active Learning in Anatomy Demonstration Sessions (CALADS) as a method in comparison to the two previously used methods; namely face-to-face Structured Problem-Related Anatomy Demonstrations (SPRAD) and online anatomy learning. A comparative, cross-sectional, survey-based study was conducted. The survey was composed of 13 questions that explored preference of learning anatomy in demonstration sessions of 4th year pre-clerkship students who have had their anatomy learning through face-to-face SPRAD in year 2 (before the COVID-19 pandemic), online in year 3 (during the COVID-19 pandemic), and CALADS method in year 4. Descriptive statistics were used, and the level of significance was set at P<0.05. The survey exhibited high internal consistency (Cronbach's α=0.953). Validity of the survey was established through exploratory factor analysis. The preferred method for more than half of the students was the CALADS method. Face-to-face SPRAD came next and lastly came the online method. However, more students preferred the online method in comparison to face-to-face method for "learning radiological anatomy". There were no statistically significant differences between male and female students regarding any of the survey questions. CALADS method, as a hybrid, student-centered, interactive learning method of learning practical anatomy, was preferred by pre-clerkship students as a more effective method in understanding anatomy than face-to-face and online learning methods.

Learning anatomy before and during COVID-19 pandemic: Students' perceptions and exam performance.

The objective of our study was to explore the impact of COVID-19 pandemic on learning anatomy and to compare the students' perceptions of "face-to-face" and "online" anatomy teaching, and to assess their impact on student's performance. We used a descriptive, cross-sectional, questionnaire-based study that focused on a single cohort of undergraduate medial students who attended anatomy demonstrations, at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU), both pre-pandemic (face-to-face) during 2019-2020 and the pandemic (online) during 2020-2021. Students who participated in this study responded in favor of face-to-face demonstrations for better understanding of the spatial orientation of body organs and systems, the visualization of the anatomical relations between structures, understanding the difficult anatomical structures, understanding the clinical correlations, and making them more confident about their practical exams. On the other hand, students were in favor of online demonstrations for retaining key information, confidence levels on discussing anatomy learning needs, effective utilization of demonstration time, and lower stress associated with the online learning. Regarding anatomy exam scores, statistically significant difference was found between mean scores of online and onsite exams in one of the two analyzed multiple choice questions tests. However, there was a statistically significant difference between the mean scores of objective structured practical examination of online and onsite exams in the two analyzed tests. Furthermore, the majority of the students who participated in the survey prefer a mixture of both face-to-face and online anatomy demonstrations during the pandemic and also in the post-COVID-19 era.

A morphometric study on flexor carpi radialis muscle of the forearm: A cadaveric study.

BACKGROUND: Flexor carpi radialis (FCR) is frequently used in reconstruction procedures involving the hand and wrist regions. Despite having tremendous clinical significance, very few studies have been conducted on the heterogeneity of the FCR. Its surgical importance in grafting techniques and tendon transfers prompted us to study the morphometry of FCR. MATERIALS AND METHODS: In this study, we used 37 upper limbs (25 right and 12 left sides) of formalin embalmed cadavers. FCR was neatly dissected in all upper limbs to measure its total length, muscle belly length, tendon length, width of muscle belly at proximal and distal ends, width of tendon at proximal and distal ends. RESULTS: Average total length of the muscle, muscle belly length, tendon length, width of muscle belly at the proximal end, width of muscle belly at the distal end, width of tendon at the proximal end, width of tendon at the distal end were 27.1 ± 2.13, 12.38 ± 2.23, 14.99 ± 2.36, 1.99 ± 0.72, 1.59 ± 0.48, 1.59 ± 0.48 and 0.42 ± 0.12 cm, respectively. Ratio of mean muscle length and tendon length, ratio of mean tendon length and total length were found to be 0.45 ± 0.07 and 0.55 ± 0.07, respectively. No noted variations were observed in the proximal and distal attachments of the FCR muscle. CONCLUSION: Morphometric data of FCR reported increases the existing knowledge on the heterogeneity of FCR morphology, and further forms an anatomic basis while designing/elevating the graft in certain surgical procedures in hand and wrist regions.

Effect of cyclophosphamide exposure on the migration of primordial germ cells in rat fetuses.

OBJECTIVES OF THE STUDY: Effect of a single dose of cyclophosphamide on migration of the primordial germ cells (PGC), when they are about to reach gonadal ridge was investigated histochemically by staining for alkaline phosphatase. This may throw some light on the fate of gonadal ridge when exposed to the drug itself or its breakdown products such as acrolein, which is present as an environmental pollutant. MATERIALS AND METHODS: Twelve pregnant Charles foster rats were divided in to control and treatment groups and kept in separate cages. In the experimental group, Cyclophosphamide 20 mg/kg/body weight was injected intraperitoneally on day 12 of gestation. Transverse sections of fetuses collected on day 16 of gestation were stained for alkaline phosphatase activity. Outcome of the study was analysed by scanning the photomicrographs and represented by photomicrographs. RESULTS: An unique finding in experimental group in the gonadal ridge consisted of homogeneously distributed pale staining cells. The gonadal ridge-mesonephros junction showed a single big cluster of the PGC. Under higher magnification, the PGC could be identified by oval or circular shape with well-defined cell membranes and very distinct dark brown staining. There were no signs of degeneration or disintegration of these cells. CONCLUSIONS: Cyclophosphamide exposure led to failure of PGC to spread inwards from the gonadal ridge-mesonephros junction giving rise to a situation so far not reported in literature. The presented phenomenon will result in improper development of the gonads leading to infertility in an affected individual in future generation (Fig. 4, Ref. 18).

Variations of the celiac trunk and its branches associated with the shift of vascular hilum (porta hepatis) of the liver.

The knowledge of vascular variations, like other anatomical variations, is important during the operative, diagnostic and endovascular procedures in abdomen. This report describes variations in the celiac trunk and abnormal entry of hepatic arteries into the liver as found during routine dissection in approximately 65 years old female cadaver. The celiac trunk was two inches long and gave 2 inferior phrenic arteries, a left gastric artery, and then bifurcated into a splenic and a common hepatic artery. The common hepatic artery gave rise to left hepatic artery, which entered the liver through fissure for ligamentum venosum. The common hepatic artery then divided into right hepatic and gastroduodenal arteries. The cystic artery was a branch of the left hepatic artery. The porta hepatis of the liver was situated on the right side of the caudate lobe.The knowledge of variation reported here is important during endovascular procedures, cholecystectomy and liver transplantation from the living donors (Fig. 2, Ref. 18).

Effect of Cissus quadrangularis Linn on the development of osteopenia induced by ovariectomy in rats.

OBJECTIVE: The aim of our study was to see the efficacy of petroleum ether extract of Cissus quadrangularis (CQ) on development of osteopenia in ovariectomy induced Wistar rats. MATERIALS AND METHODS: The female Wistar rats were ovariectomized or Sham operated. The rats were anesthetized with pentobarbital sodium (40 mg/ kg b.w, i.p.), the ovaries were removed bilaterally. Sham-operation was performed in the same manner but only exposing the ovaries (sham operated (SHAM) group). A day later, the ovariectomized rats were randomly divided into four groups of eight animals each. The groups are 1. Sham operated (SHAM), 2. Ovariectomized (OVX), 3. Ovariectomized and treated with 25 mg/kg b.w of raloxifene (OVX+RAL), 4. Ovariectomized and treated with 500 mg/kg b.w of petroleum ether extract of CQ (OVX+CQ). The treatment continued for 30 days. At the end of the treatment, rats in all groups were sacrificed by cervical dislocation. Before sacrifice, blood was collected for the estimation of serum ALP, TRAP, Calcium and hydroxyproline; where as the left femur was used for histomorphometrical analysis. RESULTS: The findings assessed on the basis of animal weight, morphology of femur, histomorphometry and biochemical analysis. As compared to SHAM group, OVX group animals showed a significant rise in serum ALP, TRAP and hydroxyproline levels at the end of 1 month following ovariectomy while no significant change was seen in the serum calcium levels. ALP and TRAP levels of OVX + RAL and OVX + CQ groups showed a further increase following administration of raloxifene and Cissus quadrangularis. The serum hydroxyproline content was found to be increased in the OVX + CQ compared to SHAM group. CQ significantly increased the thickness of both cortical (p <0.001) and trabecular bone (p <0.001).This action of CQ is comparable to action of Raloxifene. )These data suggest a strong anti-osteoporotic activity of CQ. CONCLUSION: The results confirm, at least in part, for the use of Cissus quadrangularis in folk medicine to treat osteoporosis.

A preliminary survey of the median artery in human cadavers of South Indian origin.

BACKGROUND: The median artery is a transitory vessel that represents the arterial axis of the forearm during early embryonic life. It normally regresses in the second embryonic month. Its persistence in the human adult has been recorded in 2 different patterns: as a large, long vessel (palmar type) which reaches the hand; or as a small and short vessel (antebrachial type) which ends before reaching the wrist joint. The palmar type is of major clinical significance. OBJECTIVE: This study was undertaken to investigate the incidence and course of the palmar type of the median artery in South Indian cadavers. MATERIAL AND METHODS: 25 upper limbs of South Indian cadavers were taken to study the median artery. RESULTS: The occurrence of median artery was 8%; of which 4% was on the right side and the other 4% was on the left side. On both sides, the artery originated from the ulnar artery. On the right side, the artery was involved in the formation of superficial palmar arch, whereas the artery on the left side did not join the arch; it terminated as 1st and 2nd common palmar digital arteries. CONCLUSION: Persistent median artery is closely related to the anterior interosseous nerve, it is possible that the artery may compress the anterior interosseous nerve and cause the anterior interosseous nerve syndrome (Fig. 2, Ref. 17).

Ovarian folliculogenesis: detrimental effect of prenatal exposure to cyclophosphamide: a preliminary study.

AIM: To investigate whether cyclophosphamide interferes with ovarian folliculogenesis. METHODS: In this experiment, pregnant rats (n=12) were randomly assigned into two groups, control group (n=6) and cyclophosphamide treatment group (n=6). In the cyclophosphamide treatment group cyclophosphamide was injected intraperitoneally from day 10 of gestation till 20th day, at 2 mg/kg of body weight. The pregnant rats were sacrificed on gestation day 20 and the fetus was collected. The collected fetuses were processed for sectioning and stained with haematoxyline and eosin for microscopic observation of the ovaries. RESULTS: A meshwork-like appearance of mesenchyme with decreased number of somatic cells and absence of the majority of the germ cells in the ovarian follicles were found in treated fetus. Non-availability of primordial germ cells stopped the interaction between primordial germ cells and somatic supporting cells leading to nonproliferation and degeneration of somatic cells and fluid-filled vacant spaces in the meshwork -like arrangement of mesenchymal cells. CONCLUSION: We conclude that cyclophosphamide exposure prevents folliculogenesis by causing anovulation and results in infertility. The same detrimental effect might be seen in human fertility with environmental pollutants which are also metabolites of the drug (Fig. 2, Ref. 25).

Anatomy of plantaris muscle: a study in adult Indians.

AIM: The plantaris muscle (PM) and its tendon is subject to considerable variation in both the points of origin and of insertion. The present study was carried out to fi nd the different types of origin, insertion and possible variations of the PM in the population of southern costal region of India. MATERIALS AND METHODS: 52 embalmed (Formalin fixed) cadaver lower limbs of 26 males (age ranged 48-79 years, mean age 68 years) were dissected, to study the origin and insertion of PM. Various dimensions (length and width) of plantaris muscle belly and its tendon were also measured. RESULTS: Three types of origin and equal number of insertion were noticed in the present study. The PM took origin from type I: Lateral Supracondylar ridge, Capsule of Knee joint and Lateral head of gastrocnemius in 73.07% cases; type II: Capsule of Knee joint and Lateral head of gastronemius in 5.76% cases; type III: Lateral Supracondylar ridge , Capsule of Knee joint , Lateral head of gastrocnemius and fibular collateral ligament in 13.46% cases. The plantaris tendon was inserted into type I: to the flexor retinaculum of foot in 28.84% cases; type II: independently to the os calcaneum in 36.53% cases; type III: to the tendocalcaneus at various levels in 26.92% cases. In four lower limbs (7.69%) the plantaris muscle was completely absent. Additionally the length and width of the plantaris muscle and its tendon were measured to know any side difference. There were no statistically significant differences between the measurements of left and right side (p>0.05). CONCLUSION: Present study will help the surgeons while attempting various surgical procedures in and around the posterior aspect of knee involving plantaris.

Chondrohumeralis and axillary arch of Langer: a rare combination of variant muscles with unique insertion.

During routine dissection, we found a rare case of an aberrant muscular slip originating from the pectoralis major called as the "chondroepitrochlearis / thoracoepicondylaris / costohumeralis" and an anomalous slip from the latissimus dorsi called as "axillary arch of Langer / musculus dorsoepitrochlearis" in the same axilla. Interestingly, these two slips found to have a common insertion after arching superficial to the axillary neurovascular bundle, into the fascia covering the biceps brachi and to the lateral lip of the intertubercular sulcus of the humerus. Presence of combination of these two rare variant muscles and their unique insertion pattern has not been reported earlier. The knowledge of these muscle variations is important for the clinicians and physiotherapist for better diagnosis and treatment. Here in this report, in addition to the case presentation, we also discuss their clinical significance and the review of literature in detail.

An anomalous belly of sternothyroid muscle and its significance.

The sternothyroid muscle and other infrahyoid muscles play a vital role in the process of vocalization, swallowing and mastication by mobilizing the hyoid bone and thyroid cartilage. During routine dissection of a 70-year-old male cadaver, we observed an anomalous sternothyroid muscle. It was arising from the posterior surface of the manubrium sterni and partly from the cartilage of the first rib. After a distance of 3.3 cm, the belly of sternothyroid muscle was divided into lateral and medial fibers. The lateral belly was inserted above the oblique line on the lamina of the thyroid cartilage, but the medial additional belly turned into a tendon, which was crossing over the thyroid artery and inserted to the hyoid bone and intermediate tendon of digastric muscles. The superior thyroid artery was below the above tendon on its way to the thyroid gland. The muscle was innervated by a branch from the ansa cervicalis.

High origin of ulnar artery in South Indian male cadaver: a case report.

Superficial ulnar artery, a rare variation may arise from axillary or brachial artery. Here we report a case of high origin of superficial ulnar artery from the axillary artery. Superficial ulnar artery, after running under the bicipital aponeurosis in the cubital fossa, it terminated as superficial palmar arch in the hand. We also discuss its clinical and embryological relevance.

Twisted renal vessels producing an abnormal shape of the right kidney.

The kidneys and the renal vessels are subject to a wide variety of variations. We report a rare variation of the right kidney and right renal vessels in a 60-year-old male cadaver. The right kidney was pyramidal in shape and the hilum was directed anteriorly. The right renal vessels were twisted against each other, and the inferior vena cava had a kink to the right side. Knowledge of this variation may be useful for the nephrologists, radiologists and surgeons.

Multiple accessory structures in the upper limb of a single cadaver.

The arterial and muscular variations of the upper limbs are common but important with regard to surgical approaches. Even though anomalies of the coracobrachialis muscle are rare, anatomical variations of the biceps brachii, existence of the accessory muscles in the forearm and persistent median artery are known and well documented. During routine dissection, we observed some important anatomical variations in a 50-year-old male cadaver. The variations were unilateral. The anomalies were: third head for biceps brachii muscle, an accessory belly for coracobrachialis muscle crossing the median nerve and brachial vessels and continuing with the medial head of triceps brachii muscle to be inserted to the olecranon process (coracoulnaris), a persistent median artery and an additional muscle in the anterior compartment of forearm. Although there are individual reports about these variations, the combination of these variations in one cadaver has not previously been described in the literature. Awareness of these variations is necessary to avoid complications during radiodiagnostic procedures or surgeries in the upper limb.

Anomalous origin of the lumbrical muscles: a study on South Indian cadavers.

Although variations in the attachments of the lumbrical muscles have been commonly reported, these have been seen mainly in the Caucasian population. The present study has been undertaken in South Indian population. The upper extremities of 24 South Indian (20 male and four female) cadavers were examined. Three instances of variant origins of the lumbrical muscles (two instances of the second and one of the first lumbrical) were seen. The muscles were unusually long extending to the level of the proximal border of the flexor retinaculum and in two of the cases it was taking origin from the flexor digitorum profundus tendon and its accessory belly. In one case it was taking origin from the flexor digitorum profundus and superficialis tendons. An anomalous origin of the lumbrical from muscles in the forearm has the potential to cause compression of the median nerve in the carpal tunnel.