Implementation of Pediatric Allergic Rhinitis Module as a Part of AETCOM among First-Year Medical Undergraduates: Mixed Methods Evaluation.

Background: Children suffering from allergic rhinitis (AR) in their earlier days of life, not receiving proper treatment, subsequently develop asthma. To sensitize the first-year medical undergraduates about AR by implementing pediatric allergic rhinitis (PAR) module as a part of their attitude, ethics, and communication (AETCOM) curriculum. Materials and Methods: Triangulation type of mixed method study was conducted from January 2021 to June 2021 among 125 first-year medical undergraduate students. The PAR module communication checklist was developed and validated by an interprofessional (IP) team. Twenty multiple-choice questions (MCQs) were framed for both pretest and posttest cognitive assessment of the students. The pretest assessment was done (first 15 min) followed by the teaching of the PAR module (30 min), and lastly the posttest assessment along with open-ended feedback (last 15 min). Objective Structured Clinical Examination (OSCE) communication checklist along with the guidelines was given to the observer during the student-patient encounter to score the learner and to assess the communication skill. Apart from descriptive analysis, paired t-test and content analysis were done. Results: A statistically significant difference in the mean scores before and after the PAR module and communication checklist (P < 0.001). Majority (78/81, 96%) of the students favored this module, while (28/81) 34.6% suggested modifications. Most of the parent's feedback was good about the student's communication skill in terms of empathy (118), behavior (107), and greet (125); however, 33 parents were about the opinion of difficulties in closing the session, 17 parents commented about student's language problem and 27 about feedback. Conclusion: The PAR module should be taught in the current medical curriculum as a part of AETCOM in the foundation course as early clinical exposure with some modifications in the existing module.

A Cadaveric Study about the Anomolous Origin of Testicular Arteries Arising from the Accessory Renal Arteries.

Testicular arteries are paired vessels, arising from the abdominal aorta, at the level of second lumbar vertebra. Variations in the origin of these vessels highlight a potential importance regarding the vascular supply to the gonads and kidneys. This study was designed to assess the variations in the origin, course, and distance about the point of origin of the testicular arteries. The posterior abdominal walls of 40 male cadavers were studied on either side, during routine dissection in the Department of Anatomy, Kasturba Medical College, Manipal. A majority had a normal course and the variations were reported as: a) Bilateral origin of gonadal arteries from accessory renal arteries, b) Unilateral origin of the gonadal artery from the left accessory renal artery, and c) Unique origin of the right testicular artery from the right inferior epigastric artery and left testicular artery from descending thoracic aorta above the aortic opening of the diaphragm. Due to the embryological attribution, these variations in the testicular arteries indicate an alarming threat to the radiologists and surgeons during renal transplants and nephrectomies, as these vessels monopolize the vascular supply to the gonads. This study was undertaken to document the incidence of testicular arteries originating from accessory renal arteries.

Morphometry of the deep muscles of the extensor compartment of the forearm and related variations

The architecture and dimensions of the muscle-tendon unit has a close relation with muscle performance. The aim of this study was to conduct morphometry and note the variations of the deep muscles of the extensor compartment of the forearm. The origin, insertion, anatomical variations, length of muscle belly and tendon of the deep extensors of the forearm, i.e. abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis were noted in 38 sides of 19 cadavers. Results were statistically analysed and tabulated. There were no extra bellies of any muscle, but one 60-year-old male cadaver showed a variant muscle extensor digitorum brevis manus with the absence of extensor indicis. The variant muscle did not have any extra tendon or extra muscle belly. It was excluded from statistical analysis. The average muscle length and tendon length of abductor pollicis longus were 15.37 cm & 6.2 cm respectively; those of the extensor pollicis brevis were 15.37cm & 9.07 cm respectively; those of the extensor pollicis longus were 12.47 cm & 12.88 cm respectively; and those of extensor indicis were 10.06 cm & 14.4 cm respectively. Tendons and muscles work together to absorb or generate tension in the system. Muscle and tendon length are involved in the amount of force production

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A rare finding of the superficial palmar arch-developmental and clinical significance.

The ulnar artery provides a major blood supply to the hand in the form of the superficial palmar arch, with the assistance of the radial artery. A rare pattern of the superficial palmar arch was observed in a formalin fixed, male cadaveric left hand. The ulnar artery was only involved in the formation of this arch, which provided three common palmar digital arteries which ran into the second, third and the fourth spaces between the corresponding digits and one proper palmar digital artery which ran along the ulnar side of the little finger. The main trunk of the ulnar artery bifurcated to supply the thumb and the index finger. The superficial branch of the radial artery did not participate in the arch formation. The arch was completed by the radial artery proper on the dorsolateral surface of the hand, after joining the point of bifuracation of the ulnar artery.

Morphometry and CT measurements of useful bony landmarks of skull base.

OBJECTIVE: Aim of this study was to determine the distance between Henle's spine (HS) on the temporal bone to the clinically important bony landmarks on the dry skulls that will act as a guide in various surgical procedures on skull base. Distances from the head of malleus (HOM) to surgically relevant landmarks were also studied on CT images. MATERIALS AND METHODS: Thirty-nine adult preserved dry skulls were studied bilaterally. The parapetrosal triangle bounded by spinopterygoidal, bispinal and the midsagittal lines was identified. The location of the HS and its distance from the various important anatomical structures were measured. In addition, five CT images, where distances from the HOM to various anatomical landmarks were measured. RESULTS: The mean and range of distances from the HS to various important anatomical landmarks on the spinopterygoidal line, bispinal line and in the parapetrosal triangle were tabulated. The mean and range of CT-based measurements of distances from HOM to other anatomical landmarks were also noted. CONCLUSIONS: The knowledge of unvarying relationship of the HS and the HOM to the various structures of the skull would assume significance while planning surgeries around the temporal bone by guiding the direction and degree of bone removal. Statistical differences between the two genders showed significant difference only in the distance between the HS to the medial margin of the external orifice of carotid canal. Therefore, these landmarks can also be applied as references for various surgeries of middle cranial fossa, as well as transpetrosal and transmastoid approaches.

Morphological variants of lateral meniscus of the knee: a cadaveric study in South Indian human fetuses.

In the present study, the objectives were to study the morphology of the lateral menisci (LMs) in human fetuses from a South Indian population and to verify the developmental etiology of the discoid lateral meniscus (DLM). The study included 106 fetal knee joints which were fixed in 10% formalin. After dissecting the joints, the morphological variants of the shapes of the LMs were macroscopically noted and classified as discoid and nondiscoid. The nondiscoids were subdivided into C-shaped and crescentic. The discoid lateral menisci (DLMs) were divided into complete and incomplete discoid. From our observations, 82.1% of the LMs were found to be nondiscoid. Among them, 62.3% were C-shaped and 19.8% were crescentic. The remaining 17.9% of the LMs had a discoid shape, and among these, 14.1% were incomplete discoid and 3.8% were completely discoid. Bilaterality of the discoid shape was observed in 26.6% of the cases. There was a female preponderance (11:8) among LMs with discoid morphology. In conclusion, the prevalence of DLM according to the present study was estimated as 17.9%. Our findings favor Kaplan's theory, as the majority of the fetuses of various gestational ages had nondiscoid LMs. Even the youngest fetus (CRL 88 mm, 14 weeks of gestation) exhibited a lateral tibial plateau that was incompletely covered by the meniscus, which did not exhibit a discoid shape. We believe that the DLM is anomalous and arises through variant morphogenesis.

Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance.

The lateral femoral cutaneous nerve (LFCN), a branch from the lumbar plexus, may come to the clinician's or surgeon's attention. We studied this nerve to determine its location and its relationship with neighboring structures around the anterior superior iliac spine (ASIS) and the inguinal ligament (IL). Additionally, cross-sectional microanatomy of the LFCN at the IL was studied. The LFCN was dissected in 47 lower limbs from formalin-fixed cadavers. The distances from the ASIS to the point where the LFCN crossed the IL and the lateral border of the sartorius were measured. The distance between the ASIS and the point it pierced the deep fascia was also measured. Twelve nerve specimens at the IL were collected for histological sectioning and were stained with hematoxylin and eosin. On examination of the cross-sectional area, the nonfascicular area was wider than the fascicular area because of an increased amount of thick collagen fibers. This study may be of help to clinicians managing meralgia paresthetica and may also assist in defining a safe area for surgical intervention on the anterolateral aspect of the thigh.

Radiographic study of carrying angle and morphometry of skeletal elements of human elbow.

Lateral obliquity of the forearm from the arm when the forearm is supinated and extended is called carrying angle. In this study carrying angle was measured using radiographs of adult individuals and morphometry was done on dry bones taking part in formation of human elbow (on lower end of humerus-trochlear angle and inclination angle of olecranon fossa, on upper end of ulna-olecranon-coronoid angle and length and width of inferior medial trochlear notch). On radiographs, the difference between male and female carrying angle and difference between carrying angle of right and left limbs (in both sexes together as well as in same sex) was statistically not significant. All the morphometric parameters measured in this study did not show any significant sexual dimorphism or difference between right and left side except the inclination angle of olecranon fossa, which was significantly more on right side. Different findings of carrying angle as reported by various authors could be due to racial difference or due to different methods used to measure carrying angle. Morphometric parameters were similar to findings of radiographic method of measuring carrying angle. These factors should also be considered in construction of elbow prosthesis as well as use of carrying angle in identification of skeletal remains.

Unusual communication between the lingual nerve and mylohyoid nerves in a South Indian male cadaver: its clinical significance.

It is well known that variations in the branching pattern of the mandibular nerve frequently account for the failure to obtain adequate local anesthesia in routine oral and dental procedures, and also for the unexpected injury to branches of the nerves during surgery. During our routine dissection, we found the presence of a communicating branch between the mylohyoid and lingual nerves in a middle aged male cadaver. We also discussed its clinical and surgical implications in this report.

Anomalous azygos venous system in a south Indian cadaver: a case report.

INTRODUCTION: The posterior thoracic wall, an area drained by the azygos venous system, is a common site for surgical intervention. Since the venous part of the cardiovascular system is subject to most common variation, abnormalities in the azygos venous system are often reported. CASE PRESENTATION: During routine dissection classes for undergraduate medical students, we encountered a variation in the azygos venous system in a 65 years old south Indian male cadaver. We observed that there was no accessory azygos vein, and left 4th, 5th, 6th and 7th posterior intercostal veins terminated directly into azygos vein. CONCLUSION: Identifying these types of variations is important during imaging this region and surgical operations of mediastinum.

Metrical and non-metrical study of anterior clinoid process in South Indian adult skulls.

BACKGROUND: The complex architecture of the anterior clinoid process (ACP), which is usually removed during the surgical elimination of tumors or aneurysms of sellar region, has surgical importance. For effective clinoidectomy, a neurosurgeon must have the prior knowledge of anatmoical variations of ACP. The purpose of this study was to investigate the dimensions and variation in the shape of ACP in dry adult skulls of South Indian origin. METHODS: The study was conducted on 25 dry adult South Indian skulls of either sex. Basal width, length and thickness of ACP were measured on both the sides using Vernier caliper. Non-metrical parameters such as shape, direction of ACP were recorded. RESULTS: ACP exhibited different anatomical variations with respect to their shape and direction. Triangular, pentagonal, nipple shaped, J-shaped and finger like ACP's were observed in these skulls. Bilaterally triangular ACP was the most common type observed (64%). ACP was bilaterally straight in 68% of the skulls and bilaterally curved in 16% of the skulls. ACP with blunt end and pointed end was observed bilaterally in 52 and 24% of the skulls, respectively. The average length, basal width and thickness of ACP on right side was 10.68 +/- 1.90, 12.4 +/- 2.58 and 6.88 +/- 1.09 mm, respectively, and on the left side it was 9.96 +/- 1.71, 11.12 +/- 1.81 and 6.52 +/- 0.96 mm, respectively. CONCLUSIONS: The result of the present investigation suggests that ACPs of South Indian skulls are highly variable and, are marginally larger and thicker than ACPs of Nepalese and Korean origin.

Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal.

BACKGROUND: In recent years there has been a growing appreciation of the issues of quality of life and stresses involved medical training as this may affect their learning and academic performance. However, such studies are lacking in medical schools of Nepal. Therefore, we carried out this study to assess the prevalence of psychological morbidity, sources and severity of stress and coping strategies among medical students in our integrated problem-stimulated undergraduate medical curriculum. METHODS: A cross-sectional, questionnaire-based survey was carried out among the undergraduate medical students of Manipal College of Medical Sciences, Pokhara, Nepal during the time period August, 2005 to December, 2006. The psychological morbidity was assessed using General Health Questionnaire. A 24-item questionnaire was used to assess sources of stress and their severity. Coping strategies adopted was assessed using brief COPE inventory. RESULTS: The overall response rate was 75.8% (407 out of 525 students). The overall prevalence of psychological morbidity was 20.9% and was higher among students of basic sciences, Indian nationality and whose parents were medical doctors. By logistic regression analysis, GHQ-caseness was associated with occurrence of academic and health-related stressors. The most common sources of stress were related to academic and psychosocial concerns. The most important and severe sources of stress were staying in hostel, high parental expectations, vastness of syllabus, tests/exams, lack of time and facilities for entertainment. The students generally used active coping strategies and alcohol/drug was a least used coping strategy. The coping strategies commonly used by students in our institution were positive reframing, planning, acceptance, active coping, self-distraction and emotional support. The coping strategies showed variation by GHQ-caseness, year of study, gender and parents' occupation. CONCLUSION: The higher level of psychological morbidity warrants need for interventions like social and psychological support to improve the quality of life for these medical students. Student advisors and counselors may train students about stress management. There is also need to bring about academic changes in quality of teaching and evaluation system. A prospective study is necessary to study the association of psychological morbidity with demographic variables, sources of stress and coping strategies.

A study on anterior clinoid process and optic strut with emphasis on variations of caroticoclinoid foramen.

This study presents the incidence of carotico-clinoid foramen, dimensions of the anterior clinoid process and optic strut in dry skulls to provide a guide to neurosurgeons in surgical approach especially to anterior part of cavernous sinus. Thirty-five dry skulls were used. Basal width, length, thickness of anterior clinoid process and thickness of optic strut was measured. Morphology of carotico-clinoid foramen was also studied. The average length, basal width and thickness of the anterior clinoid process on right side were 10.74 +/- 2.37 mm, 10.83 +/- 1.20 mm, 5.13 +/- 1.03 mm and left side were 9.91 +/- 1.50 mm, 11.0 +/- 1.12, 5.33 +/- 0.96 mm. Average thickness of optic strut was 3.79 +/- 0.88 mm on right side and 3.61 +/- 0.78 mm on left side. Out of 70 sides in thirty five skulls examined, carotico-clinoid foramen was observed in 14 (20.0%) cases. Out of which complete foramen was in 3 (right side, 4.3%), partial in 8 (6 right, 2 left, 11.4%) and contact in 3 (left side, 4.3%) respectively. Comparison with other races and differences between right and left sides were also discussed. The present study was done to obtain dimensions of anterior clinoid, optic strut, their anatomical variants and incidence of caroticoclinoid foramen in location population. This study will help the surgeons to plan their approach to this area and thus will make the surgical procedure safer

Renal dimensions in Nepalese population: a preliminary study.

Kidney dimensions have been measured in various parts of the world ultrasonographically and morphometrically though never in Nepal. Prior knowledge of kidney dimensions in Nepalese population would be of immense help to ultrasonologists planning to scan kidney. Forty normal-appearing formalin-preserved adult kidneys of unknown age and sex were measured using a sliding caliper for maximum length, width and thickness. Weight of kidney was measured by a "micro" weighing balance. Student's t test was applied for statistical significance. Right kidney was 85.25 +/- 10.7mm. long, 50.65 +/- 5.8mm. wide and 34.6 +/- 5.1 mm. thick. Left kidney was 91.65 +/- 9.2mm. long, 53.65 +/- 5.2mm. wide and 38.5 +/- 4.1 mm. thick. Weight of right kidney was 84.16 +/- 28.4 gm. and left kidney was 111.1 +/- 28.9 gm. Kidneys of Nepalese population were shorter and lighter than people living in other parts of the world. Difference between length, thickness and weight of left and right kidney was statistically significant but difference in width was not. Variation from other population is racial. Difference in left and right kidney dimensions is reported in various earlier literatures; therefore, Nepalese population is no exception.