Falx cerebelli and its associated occipital venous sinus: an anatomical study.

PURPOSE: This study presents the morphological variation of falx cerebelli, which helps to identify the possible variations in the presence of the occipital sinus in the posterior margin of the fold whose damage during midline incision of posterior cranial fossa surgeries may lead to internal hemorrhage. METHOD: The study was conducted on 48 cranial cavities exploring the falx cerebelli. Variations in the number of folds, its proximal and distal attachments, and the drainage pattern of the occipital sinus were evaluated by histological processing of the upper 1/3rd section of the falx fold. RESULTS: The variation in the number of folds recorded are single folds in 87.5%, double folded in 8.3%, and multiple folds (five and seven folded) in 4.2% of the cases. The variation in the proximal and distal attachments in single falx folds showed three combinations: Ramified triangular in 66.7%, both ramified type in 12.5%, and both triangular type in 8.3% of the cases. Double and multiple folds showed ramified and triangular types of variation in their attachments. Histological findings showed the presence of occipital venous sinuses in most of the single falx fold. Two aberrant venous sinuses were seen in a double and five-folded falx cerebelli. CONCLUSIONS: This study records the variations in the morphology of falx cerebelli. The histological data of this study sheds light on the drainage pattern of venous sinuses in the area whose negligence during midline incisions of brain surgeries may increase the possibility of hemorrhage.

A clinical perspective on the anatomical study of digastric muscle.

One of the suprahyoid muscles is the digastric muscle which comprises anterior and posterior bellies joined by an intermediate tendon. Because of its close relationship with the submandibular gland, lymph nodes, and chief vessels of the neck, detailed knowledge about the morphometry of the digastric muscle is essential. The objective of the current cross-sectional evaluative study is to record morphometry along with the digastric muscle's origin, insertion, and variability. Forty human cadavers (25 males and 15 females) were dissected, and the head and neck regions were studied in detail. The attachment of the digastric muscle anterior belly to the digastric fossa of the mandible was noted, and the distal attachment of the posterior belly to the mastoid notch was traced. The length of the anterior belly from the digastric fossa to its intermediate tendon and the length of the posterior belly from the intermediate tendon to its mastoid attachment were measured. There is a fair correlation between the length of the neck and the length of the anterior and posterior belly. The study also identified two cases of bilateral accessory bellies of the anterior belly of the digastric. Normal morphometric data is provided by this study on details of the digastric muscle. It is significant from a clinical and surgical point of view as the muscle lies in proximity to the important structures of the neck.

Effects of maternal vitamin deficiency on the microstructure of the maternal hippocampus and behavior in offspring.

Objectives: Nutrition plays a critical role in the brain's function and development. Vitamin B6 in the form of pyridoxal phosphate (PLP) is required for the biosynthesis of several neurotransmitters. As vitamin B6 is not endogenously synthesized, the availability of dietary sources becomes imperative. Due to its contribution to neurological functions, severe vitamin B6 deficiency leads to an increased risk of psychiatric disorders, dementia, and neurodevelopmental disorders. This study aimed to establish a vitamin B6-deficient model in experimental animals and assess the neurodevelopmental effects in their offspring. Methods: Two- to three-month-old female C57BL/6J mice were used in the study. They were randomly divided into control and vitamin B6-deficient groups. The control group was fed a regular diet containing 6 mg vitamin B6/kg and the vitamin B6-deficient group was fed a customized diet containing 0 mg vitamin B6/kg, for 5 weeks (n = 6). After 5 weeks, plasma PLP was assessed. The animals were bred to generate offspring. The dams were killed following weaning, and the hippocampal neurons were quantified using cresyl violet staining. The offspring were assigned the respective diet post-weaning up to 2 months of age. Learning and memory were assessed using the Morris water maze test. Results: The plasma PLP levels confirmed the deficiency in the deficient group compared to the control group. The viable pyramidal neurons in the cornu ammonis 3 (CA3) region of the hippocampus showed a significant difference between the control and deficient groups. Offspring born to deficient dams showed a substantial increase in latency to reach the target quadrant during the probe trial compared to the controls. Conclusion: Vitamin B6 deficiency reduces memory in dams and their offspring, suggesting the importance of vitamin B6 for both brain function and development.

Thickness and width of the menisci of adult knee joint: a descriptive cross-sectional observational study in cadavers.

Background: The goal was to determine the thickness and width of the knee joint meniscus at their different regions. The objective was to compare the dimensions at these regions and over the right- and left-sided specimens. Methods: The present study included 50 adult cadaveric knee joints, and 100 menisci (50 medial menisci and 50 lateral menisci) were studied. The meniscus was distributed into anterior, middle and posterior parts. Thickness and width at the mid-point of these three parts were determined by using the Vernier caliper. Results: The breadth of the medial meniscus was 8.38 ± 1.64 mm, 7.68 ± 1.92 mm and 13.93 ± 2.69 mm at the anterior, middle and posterior one-third regions. Same measurements for the lateral menisci at these regions were 9.84 ± 1.78 mm, 8.82 ± 2.01 mm and 10.18 ± 2.23 mm, respectively. The thickness of the medial meniscus was 4.49 ± 0.78 mm, 4.07 ± 0.81 mm and 4.79 ± 0.93 mm at these regions. The lateral meniscus thickness was 3.82 ± 0.69 mm, 4.43 ± 0.98 mm and 4.36 ± 0.8 mm, respectively. Conclusion: It is believed that this data is enlightening to the arthroscopic surgeon during the meniscus transplantation either by using synthetic material or allograft as the proper sizing of the meniscus is important to prevent complications due to inaccurate sizing.

Serendipitous Discovery of a Benign Obturator Nerve Schwannoma: Case report with a brief clinical review.

Schwannomas are typically benign tumours of the peripheral nerves. However, they seldom arise from the obturator nerve. We report a case of an uncommon swelling (2.5 × 3.5 cm) in a 65-year-old male cadaver, found during a routine dissection session for first Bachelor of Medicine and Surgery students in the Department of Anatomy, Kasturba Medical College, Manipal, India, in 2019. It was seen originating from the left obturator nerve in the pelvis at the level of the sacral promontory. Histopathological investigation revealed a schwannoma. The hypocellular tumour was arranged in a sweeping fascicle pattern with patches of myxoid degeneration. Obturator schwannomas, though rare, can exist in cadavers, as seen in the present case. Hence, it should be considered as a differential diagnosis for clinical cases of pelvic masses and eliminated only after thorough radiological examination. Knowledge about the existence of such schwannomas is therefore essential.

Lateral collateral ligament and anterolateral ligament of the knee - A morphological analysis with orthopedic significance.

BACKGROUND: The lateral collateral ligament (LCL) is the chief stabilizer of the lateral aspect of the knee to varus forces. Studies have confirmed the function of the anterolateral ligament (ALL), which improves the lateral knee stability by preventing excessive internal tibial rotation. Clinically, a persistent instability following anterior cruciate ligament reconstruction may be due to damage to the anterolateral structures. The finding has created a novel interest in anterolateral extra-articular operations. METHODS: This observational, cross-sectional study involved 42 dissected adult knees. The variations in morphology and morphometry of the LCL were identified and classified. The prevalence and the variabilities in the ALL were also noted. RESULTS: The variations in the shape of the LCL were classified into four types: (1) cord, (2) band, (3) mixed, and (4) inverted Y shaped, with a frequency of 69.04, 26.20, 2.38, and 2.38% of specimens, respectively. The cord type measured 50.4 ± 2.7 mm in length and 5 ± 0.9 mm in width. In comparison, the band type measured 50.1 ± 4.2 mm in length and 9 ± 1.6 mm in width. The ALL was identified in four (9%) of the specimens with a mean length of 35 ± 0.9 mm. Two types of ALL were observed, membranous wideband and distinct cord-like ALL. CONCLUSION: The anatomy of the lateral structures of the knee is inconsistent. The study has attempted to classify the different shapes of the LCL along with the frequency and prevalence of the ALL. Orthopedic surgeons and radiologists must note the LCL morphology and prevalence of the ALL due to their clinical implications.

Knowledge and Training of Primary School Teachers in First Aid - A Questionnaire Based Study.

BACKGROUND: Students at schools may need first aid due to illness or accident. Therefore, teachers at school should know first aid measures and be able to put them into practice. The aim of this study is to assess awareness regarding first aid training among primary school teachers. METHODS: Subjects were 150 primary school teachers from nine schools in the Udupi district of Karnataka. They were assessed by predesigned questionnaire proforma, after which each teacher was interviewed and responses were discussed separately in smaller groups. RESULTS: Of the subjects, 11.3% felt that first aid is important and 87.7% said that it is very important and wanted to learn first aid. About a third (30.2%) of the teachers knew some basic treatments for minor emergencies but they didn't recognize such treatments were called first aid. Most of the subjects (69.8%) were unfamiliar with the expression "first aid". CONCLUSION: First aid training should be included in the teacher training curriculum, and such training should be updated regularly.

Anatomical variations in the cutaneous innervation on the dorsum of the foot.

Generally among the branches of common peroneal nerve, the superficial peroneal nerve provides cutaneous innervation to major part of the dorsum of the foot whereas the deep peroneal nerve innervates the skin over the first interdigital cleft region. The sural and saphenous nerves supplies the smaller lateral and medial margins of the dorsum respectively. The present study has been taken to classify the patterns of innervations of the nerves on the dorsum of the foot in South Indian population. A total of 40 formalin fixed lower limbs from 20 adult cadavers (15 males, 5 females) aged between 35 to 60 years were dissected and the branching patterns of nerves on the dorsum of the foot were noted and specimens were photographed. Gross anatomical variations were noted in the branching pattern of superficial peroneal, deep peroneal and sural nerve on the dorsum of foot. Results obtained in our study were classified into four groups. The cutaneous nerves are at risk of iatrogenic injuries during surgeries involving ankle, open reduction and internal fixation of fracture, arthroscopy etc. Knowledge of such anatomical variations of the nerves provides information to clinicians to avoid injury to them in real clinical situations.

Effect of Diabetes on the Male Reproductive System­A Histomorphological Study

Introduction Type 1 diabetes is an autoimmune disorder characterized by lack of insulin production by the ß cells of the pancreas. This lack of insulin causes a variety of systemic effects on the metabolism of the body, one of which is reproductive dysfunction. The present study investigates the effects of diabetes on the male reproductive system of streptozotocin (STZ)-induced diabetic rats. Material and Methods A total of 18 adult male Wistar rats weighing between 250 and 300 g were included in the present study. The animals were divided into normal and diabetic groups. The diabetic group was further subdivided into 2 subgroups with durations of 24 and 48 days. A single dose of STZ (40 mg/kg body weight) was administrated intraperitoneally to the animals of the diabetic group. After the planned duration, the testes and epididymides were dissected, and their gross weight was measured. The tissues were then processed for histological study. Results The gross weight of the testes and epididymides in diabetic rats at 24 and 48 days showed a decrease in comparison to the control. (p < 0.01 for testes and epididymides). Diabetic animals presented a significant decrease in the diameter of the seminiferous tubules compared with the control group (p < 0.01). The epididymides in the diabetic groups showed a considerable reduction in the tubular surface area compared with the control group (p < 0.01). There was also a reduction in the mean diameter, which was measured using the maximum and minimum diameter of the tubules (p < 0.01). Conclusion The present study is an insight into the adverse effects that diabetes can have on the tissue structure of the testes, of the epididymides, and ultimately on the process of spermatogenesis.

Combined simultaneous arginine clonidine stimulation test: Timing of peak growth hormone (GH) concentration and correlation with clinical indices of GH status.

BACKGROUND: The aims of this study were to determine if it is possible to truncate a combined simultaneous arginine clonidine stimulation test, and to correlate the outcome of the test with clinical indices of GH status. METHODS: Charts of subjects who underwent a combined simultaneous arginine clonidine stimulation test between January 1, 2007 and August 31, 2016 were reviewed. RESULTS: 131/203 (64.5%) tests performed in children with growth failure demonstrated a peak GH ≥ 10 ng/ml. 6/7 (85.7%) tests performed in adolescents at the end of GH treatment had a peak GH ≥ 5 ng/ml. Among these negative tests, 97.8% had a passing GH by 120 min. 58/98 (59.1%) tests that had a sample at 150 min were negative. 3/58 (5.2%) had a passing GH level only at 150 min. Therefore, if the test were shortened to 120 min, 5.2% of normal responders would be missed. There was a weak correlation of peak GH with baseline growth velocity and serum IGF-1 z-score. A trend towards an inverse correlation between peak GH level and change in growth velocity pre- and post-GH was seen. CONCLUSIONS: If the combined simultaneous arginine clonidine test were shortened to 120 min, 5.2% of normal responders would be missed. Although this test has not been compared to any "gold standard" GH stimulation test, the outcome of this test does correlate weakly with clinical indices of GH status and spares patients the inconvenience of sequential testing.

Toxic Effects of Different Doses of Cyclophosphamide on Liver and Kidney Tissue in Swiss Albino Mice: A Histopathological Study.

BACKGROUND: Cyclophosphamide (CPA) is an anti-cancer drug, used in chemotherapy. This is a toxic drug which targets the cancer cells and also the normal cells of the body. The original compound is inactive in vitro and exercises its biologic action through metabolites, chiefly phosphoramide mustard. The objective is to study the harmful effects of this drug on liver and kidney tissues. METHODS: To study the effect of cyclophosphamide on histology of liver and kidney, 40 adult male mice were taken and divided into two groups: control and test. Those in the test group were injected with the drug at doses of 100, 200, 250 mg/kg body weight. They were then sacrificed on day 7, 28 and 42. The liver and kidney tissue was processed, sectioned and stained with Haematoxylin and Eosin. RESULTS: Pathological changes were seen in the tissue within 7 days in high doses and after 28 days in low doses. As the dosage and the days administered increased, the changes were prominently seen and widespread. Pathology ranging from mild infiltration to necrosis and finally cytolysis were seen in liver and kidney tissue. CONCLUSION: Our study has demonstrated the effect of a progressive increase in dosage of cyclophosphamide in albino mice, and pathological alterations were observed in histology of liver and kidney by sequentially increasing both the dosage and duration of treatment. Subsequently, regular monitoring of liver and kidney function tests in patients undergoing chemotherapeutic regimen with administration of ahepato and nephroprotective agent becomes vital.

Indian propolis ameliorates the mitomycin C-induced testicular toxicity by reducing DNA damage and elevating the antioxidant activity.

Development of excellent curative therapy for most of the malignancies has resulted in a growing population of cancer survivors who are at increased risk for a variety of health problems including infertility. Therefore, fertility preservation has become an important issue during cancer treatment in recent years. Combination therapy with natural agents such as vitamins, antioxidants, dietary supplements, and plant products are considered as an attractive option to mitigate normal tissue toxicity imparted by chemotherapy. The aim of the present study was to explore the beneficial effect of hydroethanolic extract of Indian propolis (HEIP) on mitigating mitomycin C (MMC)-induced testicular damage and its mechanism of action. Healthy adult male mice were injected intraperitoneally with saline, MMC, HEIP and HEIP followed by MMC after 1h. The animals were dissected at 35days after various treatments to analyze testicular function. MMC administration resulted in significant reduction in testicular function in a dose-dependent manner at 35days after treatment which significantly improved by HEIP pre-treatment. At 24h after treatment, MMC induced significant increase in oxidative stress, γ-H2AX foci and expression of RAD51 and KU80 in testicular cells. Prior treatment with HEIP decreased the oxidative stress, reduced DNA damage and restored the testicular testosterone and inhibin B level. In conclusion, co-administration of Indian propolis extract may play a promising beneficial role in fertility preservation of males undergoing chemotherapy.

Opioid-induced hyponatremia in a patient with central diabetes insipidus: independence from ADH.

Hyponatremia can be a complication of opioid therapy, which has been postulated to occur secondary to inappropriate antidiuretic hormone secretion (syndrome of inappropriate antidiuretic hormone secretion [SIADH]). We report severe hyponatremia following wisdom teeth extraction with opioid analgesia in a 19-year-old female with diabetes insipidus (DI) and acquired panhypopituitarism that challenges this theory. As this patient has DI, we believe opioid treatment caused severe hyponatremia by the following mechanisms: (1) Opioids have a direct antidiuretic effect independent of changes in ADH, as demonstrated in Brattleboro rats with central DI. (2) Hydrocodone may have stimulated this patient's thirst center contributing to hyponatremia, as demonstrated in animal studies. Opioid use can cause hyponatremia in patients independent of ADH. It is important for clinicians to be aware of this so that patients can be appropriately counseled.

Additional Muscle Slip of Bicipital Aponeurosis and its Anomalous Relationship with the Median Cubital Vein.

The cubital region of the arm is a common site for recording blood pressure, taking blood for analysis and administering intravenous therapy and blood transfusions. During the routine dissection of a 70-year-old male cadaver at the Kasturba Medical College, Manipal, Karnataka, India, in 2015, it was observed that the aponeurotic insertion of the biceps brachii muscle divided into two slips. The medial slip fused normally with the deep fascia of the forearm, while flexor carpi radialis muscle fibres originated from the lateral slip. There was also a single vein in the forearm, the cephalic vein, which bifurcated to form the median cubital vein and the cephalic vein proper. The median cubital vein, further reinforced by the radial vein, passed deep to the two slips of the bicipital aponeurosis and then continued as the basilic vein. During venepuncture, medical practitioners should be aware of potential cubital fossa variations which could lead to nerve entrapment syndromes.

Cadaveric Study on Morphology of Dorsal Interossei of Hand and its Anatomical Variation.

INTRODUCTION: The dorsal interossei are the abductors of the fingers and the knowledge of its variation help the surgeon in treatment of fractures, claw hand and compartment syndromes. AIM: To note the origin, insertion, pattern of muscle fibres and tendon length of all the dorsal interossei of hand. MATERIALS AND METHODS: Routinely dissected 30 formalin fixed hand in the Department of Anatomy, KMC, Manipal, were observed for origin, insertion and tendon length and muscle pattern of dorsal interossei. RESULTS: Out of 30 hands, presence of supernumerary muscle was observed in three hands. Presence of three heads of dorsal interossei was noted in one hand. CONCLUSION: The finding of present study is of importance to surgeons and orthopaedicians during conservative and surgical management of hand deformity. Adequate knowledge of these muscular variations is also important in treatment of fractures, stiff hand, claw hand or tendon transfer.

Superficial Ulnar Artery: A Case Report of its Unusual Course.

After arising from the brachial artery in the cubital fossa the ulnar artery usually passes deep into the superficial flexor muscles of the forearm. In the lower two-thirds, it typically follows a sub-fascial course. In the present case, during a routine undergraduate course dissection of a cadaver, it was found that the ulnar artery arose normally as a terminal branch of the brachial artery in the cubital fossa, followed a sub-fascial course by lying superficial to the flexor muscles then completed the superficial palmar arch in hand. This artery gave only minute muscular branches in the forearm. Moreover, the main branches that usually arise from the ulnar artery were given off by the radial artery. This type of variation is of importance for both the clinicians and surgeons due to its vulnerability to injuries and of academic interest for anatomists.

Bone and vitamin D metabolism in HIV.

Human immunodeficiency virus (HIV) infection has progressed to a chronic disease and HIV positive individuals are living longer lives. This has lead to an increase in morbidity and mortality due to secondary issues, one being HIV bone disease. HIV infected pediatric and adult populations have a greater incidence in reduction of BMD as compared to the controls. Osteoporosis has been reported to be present in up to 15 % of HIV positive patients. We are starting to understand the mechanism behind the changes in HIV bone disease. Viral proteins interfere with osteoblastic activity either by direct interaction or by the inflammatory process that they induce. Anti-viral management, including highly active antiretroviral therapy (HAART), protease inhibitors, and nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) also are involved in disrupting proper bone metabolism. Vitamin D levels have strong correlation with bone disease in HIV patients, and are dependent not only to chronic disease state, but interaction of pharmacologic management and inflammatory process as well. Work up of the secondary causes of osteopenia and osteoporosis should be undertaken in all patients. DEXA scan is recommended in all post-menopausal women with HIV, all HIV infected men 50 years of age or older and in those with a history of fragility fractures regardless of age or gender. Preventive measures include adequate nutrition, calcium and Vitamin D intake daily, muscle strengthening and balance exercises to increase BMD and reduce fractures. Bisphosphonates are considered to be the first line for the treatment of HIV associated bone disease. This review will describe how the balanced mechanism of bone metabolism is interrupted by the HIV infection itself, the complications that arise from HIV/AIDS, and its treatment options.