Variations in the Termination of the Popliteal Artery: A Multidetector Computed Tomography Angiography (CTA)-Based Retrospective Study.

BACKGROUND: Comprehension of the intrucate anatomy and variations in the termination of the popliteal artery (PA) is increasingly essential for endovascular interventionists, plastic surgeons, vascular surgeons, and orthopedic surgeons, due to the rise in procedures like embolectomy, vascular grafting, free fibular flap surgery, and high-tibial osteotomy. Few studies from India have reported on the variant anatomy of PA termination, and none have used 128-slice tomography. This study aimed to observe the terminal branching pattern of the PA and the morphology of its terminal branches using 128-slice computed tomography angiography (CTA) and to analyze its relation to gender and laterality. METHODOLOGY: A retrospective review of CTA images of 181 lower extremities from 100 patients (137 males and 44 females), aged five to 75 years, was conducted. RESULTS: The usual type I-A pattern was found in 75.69% of cases, while 24.31% exhibited variant patterns. Type III was the most common variation observed (19.34%), with type III-A being the most prevalent (11.05%). Types II-B and II-C were not observed. Among 84 bilaterally examined cases, 19.05% had unilateral variations and 15.48% had bilateral variations, with 8.33% showing bilaterally similar variations and 7.14% dissimilar variations. No significant difference in branching patterns was found between genders or sides. The mean length of the tibial-peroneal trunk (TPT) in the type I-A pattern was 3.00 ± 0.99 cm (right side: 3.21 ± 1.02 cm; left side: 2.82 ± 0.93 cm; males: 2.9 ± 1.00 cm; females: 3.37 ± 0.85 cm), with statistically significant differences between sides and genders. In the type II-A pattern, the mean TPT length was 7.16 ± 3.75 cm. An exceptionally long TPT (12.97 cm) was noted in one case of the III-B pattern. CONCLUSION: There is a high prevalence of variation in the termination pattern of the PA. Knowledge of these variations is crucial for any interventions in this region to avoid postoperative vascular complications and reduce patient suffering.

Transition from physical to virtual classroom amidst COVID-19 crisis: Analyzing students' perspective to drive improvement in the current online teaching methodology.

BACKGROUND: Among the COVID crisis, medical education is forced to shift to the virtual mode, for which neither the students nor the teachers are prepared. Currently, we replaced traditional classroom teaching (CT) by live online classes (LOC), power-point presentations with voiceovers (UPV), or only power point presentations (UP). Uncertainty of this situation necessitates analysis of the experiences of its stakeholders to improve the implemented online teaching methodologies in coming time. The present study aims to analyze and compare the effectiveness of online teaching methodologies among themselves and against traditional CT. MATERIALS AND METHODS: A cross-sectional, survey based, observational study was conducted on 250 MBBS first year students after 1 month of implementation of online teaching program. Responses were collected on Likert scaling from 1 to 5, and data were analyzed using the Kruskal-Wallis H-test, ANOVA with multiple comparisons post hoc Turkey test, and an independent t-test. RESULTS: The students perceived that the understanding, convenience for attending class, notes-taking, visibility, audibility, raising queries and overall experience was best in traditional setup. The understanding of the topic and overall experience of the students was not affected by gender. Internet connectivity problem popped up as the major issue that adversely affected the online teaching experience. CONCLUSIONS: Majority of students perceived that the traditional CT is best, but at the same time, they felt that a combination of live online classes and power point presentations with voice over can replace the traditional online classes.

Histological changes at the commissure of the lip on approaching from its cutaneous to the mucosa region in males.

INTRODUCTION: The morphology of the epithelium of the oral lips comprised keratinized external epithelium (anteriorly) and nonkeratinized or sometimes parakeratinized mucous membrane epithelium (posteriorly). Knowledge of morphometry of the lip lining helps in deciding the best site for choosing graft for its better uptake during several dermal grafting procedures following trauma or tumor excision following craniofacial cancers or cosmetic procedures. MATERIALS AND METHODS: Ten human male cadavers were procured at the Department of Anatomy King George's Medical University, Lucknow, Uttar Pradesh. The rectangle-shaped skin specimen through the right commissure of the lip which included the skin, mucocutaneous junction, and mucosa was stained with hematoxylin and eosin stain. A total of 30 slides were prepared. Thus, the readings were obtained for three regions, respectively, with the help of CAT-CAM E-series HD cameras which were installed in a light microscope. RESULTS: Thickness of skin (epidermis + dermis) of the lip ranged from 756 µm to 1068 µm among males. Epidermal thickness increases on moving from the cutaneous region to the mucosa region of the lip. The lowest contribution of the stratum corneum in thickness of the epidermis was observed in the vermillion region, while the highest contribution was observed in the skin region. It was found to be absent in the mucosa region of the lip. Rete pegs at the dermoepidermal junction was found to be maximum in the vermillion region and minimum in the skin region. Its depth increased as we move from the skin to the mucosa region of the lip. Depth of the dermis was found to be maximum in the skin region, while minimum in the vermillion region. It ranged between 291 µm and 693 µm. CONCLUSION: Care should be taken while using dermal fillers in lip augmentation surgeries, especially in the vermillion region due to its close proximity to musculature in the core of the lip.

Association of lipid profile test values, type-2 diabetes mellitus, and periodontitis.

OBJECTIVE: A two-way relationship between diabetes and periodontal disease has been suggested; whereas obesity and impaired lipid profile are risk factors for type-2 diabetes mellitus. This study examined the relationship between lipid profile, oral glucose tolerance test (OGTT) with periodontal health/disease dependent variables in healthy, diabetic and impaired glucose tolerance subjects. MATERIALS AND METHODS: 120 patients were selected for the study and were determined to be periodontally healthy or diseased. All these patients underwent biochemical tests for OGTT and Lipid profile analysis and data was compared using Z-test. RESULTS: The OGTT results deteriorated with deteriorating periodontal condition. A similar correlation was also observed between worsening lipid profile test values, OGTT score, and periodontal condition. CONCLUSION: This study indicates that hyperlipidemia may be one of the factors associated with periodontitis and that periodontitis may itself lead to abnormal serum lipid levels. Therefore, in addition to effects on diabetes, periodontitis may contribute to elevated serum lipid levels and therefore potentially to systemic disease arising from chronic hyperlipidemia.

Re-evaluation of superficial fascia of anterior abdominal wall: a computed tomographic study.

PURPOSE: Understanding the topographic anatomy of the membranous layer of superficial fascia of anterior abdominal wall may help in explaining the body contour deformities and provide the anatomic basis for surgical corrections. Existing controversies in the presence and extent of membranous layer of the superficial fascia of anterior abdominal wall among anatomists and misinterpretation of its anatomical description by clinicians provoked us to re-evaluate the superficial fascia of anterior abdominal wall. METHOD: Fifty CT scans of abdominal region of either sex were studied to see the vertical and horizontal extent of membranous layer. RESULTS: The membranous layer was clearly seen in whole of the anterior abdominal wall except for few cases where either it was not clear superiorly in zone 1 (16%) or inferiorly in zone 3 (6%). On combining the horizontal and vertical extent of membranous layer in each and every individual, altogether eight types of patterns were obtained. Out of these patterns, four were present in females and all the eight types in males. CONCLUSION: The membranous layer is present in whole of the anterior abdominal wall and it divides the superficial fascia into three layers: superficial fatty layer, intermediate membranous layer, and deep fatty layer. If membranous layer is not clear in CT scan the reason could be the absence of deposition of fat in deep compartment.

Anomalous formation of external jugular vein and its clinical implication.

INTRODUCTION: The superficial veins, especially the external jugular vein (EJV), are increasingly being utilized for cannulation to conduct diagnostic procedures or intravenous therapies. EJV is also used in microsurgical procedures,used as a recipient for the free flaps. MATERIALS AND METHODS: During routine dissection a variation was observed in the formation of EJV unilaterally on the left side. RESULT: In the anterior triangle of the neck submandibular vein joined with the anterior jugular vein to form a large venous trunk (V1). Facial vein joined this venous trunk (V1) to form another common channel (V2). The retromandibular vein divided into unusually long anterior and posterior divisions. Anterior division did not join the facial vein but drained into the common channel V2.The posterior division of retromandibular vein also drained into V2 which further continued as EJV and drained into the subclavian vein. CONCLUSION: The knowledge of variations in the patterns of superficial veins is important for the surgeons to avoid any intraoperative error which might lead to unnecessary bleeding.

Coracoclavicular and costoclavicular joints at a common juncture: a rare phenomenon / Articulaciones coracoclavicular y costoclavicular en una unión común: un raro fenómeno

Movements at the human shoulder girdle are the result of complex interplay of glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic articulations. Clavicle apart from articulating with the scapula and sternum is also connected with first rib by costoclavicular ligament and with coracoid process by coracoclavicular ligament. At times the area of attachment of these ligaments on clavicle, first rib and scapula show faceted apophysis suggesting the presence of additional diarthrodial articulations. Costoclavicular joint exists between clavicle and first rib and coracoclavicular joint between clavicle and coracoids process. Both these joints are described in the literature, but the concurrent occurrence of them in the same bone has not been reported yet. We found two clavicles, one of right and other of left side, both of them showed faceted apophysis for costoclavicular and coracoclavicular joint simultaneously, which is rare phenomenon.

Los movimientos de la cintura escapular humana son el resultado de la interacción compleja de las articulaciones glenohumeral, acromioclavicular, esternoclavicular y escapulotorácica. La clavícula, aparte de la articulación con la escápula y el esternón también está conectada con la primera costilla por el ligamento costoclavicular y con el proceso coracoides por el ligamento coracoclavicular. A veces la zona de unión de estos ligamentos de la clavícula, la primera costilla y la escápula muestran procesos facetarios que sugieren la presencia de nuevas articulaciones diartrodiales. La articulación costoclavicular existe entre la primera costilla y la clavícula y la articulación coracoclavicular entre la clavícula y proceso coracoides. Ambas articulaciones están descritas en la literatura, pero la aparición simultánea de ellas en el mismo hueso no se ha informado aún. Se encontraron dos clavículas, uno del lado derecho y otra del lado izquierdo, las dos presentaron procesos facetarios para las articulaciones costoclavicular y coracoclavicular simultáneamente, lo cual es un fenómeno raro.