An Immunohistochemical Study of Proliferation of Human Fetal Heart Cardiomyocyte With Phospho-Histone H3 Antibody.

The rapid proliferation of cardiomyocytes in mammals occurs during fetal life. But in postnatal life, this capacity of proliferation is reduced or lost as they exit the cell cycle. However, the cardiomyocytes don't show the same activity for different species. In human fetuses or in adult life, the capacity of the proliferation of cardiomyocytes and their response to an injury are not understood yet. In this study, we have done an immunohistochemical study using phospho-histone H3 (PHH3) to observe human fetal cardiomyocytes' proliferative activity. The heart specimens from the fetal autopsy of spontaneously aborted and stillborn human fetuses were subjected to immunohistochemical study using PHH3 antibody, and comparison between the PHH3 index (number of PHH3 positive cells per 1000 number of cardiomyocytes/high power field [HPF]) of myocardial regions was done using appropriate statistical tests. A total of 17 fetal hearts were included in our study. In the left ventricle, right ventricle, right atrium, and interventricular septum, the PHH3 index of myocardium was significantly higher over the pericardial region (p-value 0.002, p-value <0.001, <0.001, and 0.009 respectively) as compared to the region of over the endocardium and the middle part of the myocardium. The PHH3 index of the pericardial region of the left ventricle was significantly correlated with the maximum thickness of the left ventricle.

The Impact of Periodic Formative Assessments on Learning Through the Lens of the Complex Adaptive System and Social Sustainability Principles.

PURPOSE: Medical institutions in India have employed different periodic formative assessment (FA) methods with variable impact. The formative evaluation must incorporate feedback to improve learning. Formative assessment has helped inexperienced students apprehend their weaknesses, make choices, prepare for summative exams, and allow teachers to identify regions wherein students may also need aid. This study attempts to quantify the impact of the weekly, monthly, and semester formative assessments and view it retrospectively through the lens of complex adaptive systems and social sustainability principles. METHODS: We used a post-exam survey and statistical analysis to compare the students' performance between the timely periodic formative assessments in a competency-based curriculum. The cohort consisted of 2018 (semester), 2019 (weekly), and 2020 (monthly) first-year medical students. Cronbach alpha, spearman's correlation coefficient, descriptive statistics, and repeated measure analysis of variance were used to explore the reliability and relationship between formative assessment and summative scores of each cohort and find any significant difference. The authors also analyzed the accordance between the FA exam performance and students' perceptions, deduced broad themes, and discussed the appropriateness and feasibility of students' suggestions for changes. RESULTS: A significant correlation was found only between the weekly formative assessment and summative scores (r=0.74, p=0.01). The analysis of variance established significant differences between all summative scores of respective periodic formative assessments. The weekly formative assessment showed the highest mean summative examination scores. This study helped comprehend preclinical students' apprehension after the intervention of periodic formative assessments. The students found this intervention helpful in driving and detecting gaps in learning but preferred focused feedback, clinically oriented practices, and countered mental health issues. CONCLUSION: The continuous periodic formative assessment model had a valid educational impact but was not sustainable according to social sustainability principles. A complex adaptive framework can be utilized to make it sustainable.

Epidemiological Characteristics and Role of Connexin-43 in Patients of Syndactyly Attending a Tertiary Care Center in Odisha, India.

BACKGROUND: Syndactyly is one of the most common hereditary limb malformations. Yet, epidemiological data in our state is not reported. The current study aims to understand the Connexin-43 expression in such patients. METHODOLOGY: A retrospective cohort study was done in the Department of Plastic surgery and Anatomy of All India Institute of Medical Sciences (AIIMS), Bhubaneswar. The study duration was three years, between 2019 and 2022. The total number of cases was 49 and included patients diagnosed with Syndactyly seeking surgical intervention. The demographic details and the personal and disease history were collected, analyzed, and interpreted. Immunohistochemistry study using Connexin-43. RESULTS: Out of the 49 patients, 26 (53.1%) were male, and 23 (46.9%) were female. Thirty nine (79.6%) had syndactyly, and 10 (20.4%) were diagnosed with syndactyly associated with another syndrome. Both complete and incomplete syndactyly was found. Strong membranous positivity of Connexin-43 was found in the keratinocytes of the stratum spinosum layer of the epidermis, while the stratum granulosum and stratum basale layer revealed negative staining. CONCLUSIONS: Syndactyly is mostly non-familial, sporadic with male preponderance affecting unilaterally and in incomplete form in our geographical location. We found an overt expression of Connexin-43 in these patients' stratum basale.

Comparative Morphometry of the Sacrum and Its Clinical Implications: A Retrospective Study of Osteometry in Dry Bones and CT Scan Images in Patients Presenting With Lumbosacral Pathologies.

Background Morphometric measurement of the sacrum is crucial due to its active involvement in the instrumentation for lumbar pathologies. From screw placement to stabilization procedures for the spine, the sacrum remains a site of surgical importance. Thus, the purpose of this study was to generate baseline data by comparing two techniques, namely, osteometry in dry bones and CT scan imaging. Methodology In this study, 30 dry, fully ossified, disarticulated sacra were studied for osteometry, and 60 CT scan reports of patients with lumbar pathologies were retrospectively evaluated. In both cases, similar parameters were measured. The mean values were determined, the two methods were compared, and statistical analysis was performed. Results Among the 30 dry bone samples, 33.3% (10 out of 30) were males, while 55% of the CT scan group were males. Correlation between the different measurements in the CT scan group suggested that the vertebral body maximum width of S1 had a significant positive correlation with the vertebral body height of S1, sacral height, sacral breadth, transverse diameter of auricular surface, and vertical diameter of auricular surface. Statistically significant higher values (P < 0.001) were observed for the vertebral body mid diameter of S1, vertebral body height of S1, pedicle width, and pedicle depth measurements in the dry bone group compared to the CT scan group. Conclusions The efficiency of anaesthetic blocks can be increased if the parameters are evaluated beforehand. Moreover, sexual dimorphism of the bone can account for the varied results of the parameters, indicating the necessity to conduct gender-based studies in a wider population.

Impact of Cardiovascular Factors on Pulse Wave Velocity and T otal Vascular Resistance in Different Age Group Patients with Cardiovascular Disorders.

BACKGROUND: Pulse Wave Velocity (PWV) is the propagation speed of the wave-induced along the aorta and arterial tree, each time the heart beats. PWV increases with increased arterial stiffness, thus establishing it as a reliable prognostic marker for cardiovascular morbidity and mortality. On the other hand, Total Vascular Resistance (TVR) is the overall resistance offered by systemic circulation and pulmonary circulation. This resistance needs to be overcome in order to create the flow of blood through the circulatory system. The goal of this study was to investigate the influence of different cardiovascular factors on arterial stiffness and vascular resistance in CVD patient from eastern India population. METHODS: Total of 782 patients with Cardiovascular Disease (CVD) like hypertension, Ischemic heart disease, Congestive cardiac failure and peripheral arterial disease were included to evaluate the cardiovascular hemodynamic and non-hemodynamic parameter by oscillometric method and investigated those factors on PWV and TVR in subjects of both sexes aged between 15 to 87 years. RESULTS: The old age (> 55 years) was found to have greatest impact on PWV as compared with younger age group. Systolic Blood Pressure (SBP), Heart Rate (HR), augmentation pressure and Body Surface Area (BSA) had a positive association with the PWV. Augmentation Index and Body Mass Index (BMI) had a negative impact on the PWV. CONCLUSION: Despite the limitations, like unequal number of male and female participants, wide variation of the age of the subjects and analyzing association of many factors at a time, our large and community-based study show individual blood pressure and pulse pressure depending on complex interaction between large arteries and arterioles. This study sheds light on the relationship between proximal and distal part (PWV and TVR) of the arterial tree as well as their association with different hemodynamic and non-hemodynamic parameters.

Sternalis Muscle: An Unexpected Finding during Mastectomy.

Sternalis muscle also called rectus sternalis, rectus thoracis, or episternalis is an anomalous muscle of the anterior chest wall with unknown anatomical function. It is regularly observed in lower animal but infrequently in humans. Presence of this muscle can create confusion with tumours of the anterior chest wall during routine mammography. Although less is known about its origin and innervations, knowledge about this muscle can have many clinical implications. A case of unilateral sternalis muscle detected during mastectomy, in a female with carcinoma of the right breast, is being reported with a brief review of the literature and highlighting its clinical significance.

Clinical analysis of hypertension in children: an urban Indian study.

Hypertension in children, although an uncommon entity, is associated with end-organ damage. We tried to study the clinical profile of hypertension in children presented to our hospital. The medical records from January 1990 to December 2010 of all children aged 18 years and younger with hypertension were studied. The patients were divided into four age groups (infants, pre-school age, school age and adolescents) Presenting symptoms and other clinical parameters were thoroughly evaluated. The results were compared with previous studies on hypertension in children. A total of 135 patients were selected (male:female 103:32), with mean age of 0.4 ± 2.1 years (range: six months to 17 years). The most common age group affected was the adolescents group (42.9%). The most common clinical feature at presentation was dizziness (30.3%), followed by headache and chest discomfort (22.9%). Transient hypertension was detected in 34 patients (25.2%), and was most common in the adolescent age group, whereas sustained hypertension was noticed in 101 patients (74.8%) and was the most common in the school age group (36/45, 80%). Forty-two patients (31.1%) presented with hypertensive crisis. Nine patients were considered to have essential hypertension. The chief causes included chronic glomerulonephritis in 56 (41.5%), endocrine disorders in 21 (15.5%), obstructive uropathy in 16 (11.8%), reflux nephropathy in 12 (8.8%) and renovascular disease in 5 (3.7%). Takayasu's disease was the most common cause of renovascular hypertension. Coarctation of aorta was the most common cause of hypertension in infancy, being present in 40% of the cases. Hypertension in children may be easily underestimated but is a potentially life-threatening problem. Most of them are asymptomatic and a large chunk has an underlying etiology. Primary care clinicians should promptly identify patients with hypertension and treat them immediately and appropriately to prevent damage to the cardiovascular organs.

Reversible mitral and aortic regurgitation due to pioglitazone.

OBJECTIVE: To report the occurrence of pioglitazone-induced reversible valvular regurgitant lesions. METHODS: Clinical, laboratory, and imaging data are reported on a patient with known type 2 diabetes mellitus, who was prescribed pioglitazone to achieve better glycemic control. RESULTS: We present a case report of a 50-year-old woman, in whom diabetes had been diagnosed 5 years previously, who developed severe mitral and aortic regurgitation during 5 months of treatment with pioglitazone along with clinical and laboratory indications of fluid retention. Echocardiography 5 months after discontinued use of pioglitazone showed regression of regurgitant lesions and normalization of pertinent laboratory variables. CONCLUSION: Five months of treatment with pioglitazone could potentially induce major cardiac valvular dysfunction, which was reversible in our patient. This report emphasizes the importance of carefully monitoring patients during treatment with thiazolidinediones.

Pheochromocytoma with renal artery stenosis: A case-based review of literature.

Pheochromocytomas have been described to be associated with rare vascular abnormalities, most common of them being renal artery stenosis. A 45-year-old woman was admitted to our hospital with complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and severe hypertension. Hypertension was confirmed to result from both excess catecholamine production and hyperreninemia of left kidney. The technical images (abdominal CT and renal arteriography) revealed the presence of a left adrenal pheochromocytoma and stenosis of the renal artery. Surgical removal of pheochromocytoma and correction of renal artery stenosis restored the postoperative plasma catecholamine, renin and blood pressure to normal. To our belief, this is the first such case report from India citing this rare association. We conclude that when the two diseases occur simultaneously, both must be diagnosed accurately and treated in a different manner. We also hereby review the existing literature.