A comprehensive study and extensive review of morphological variations of liver with new insights.

PURPOSE: Liver is divided into four anatomical lobes presenting minor fissures and invisible major fissures. The prevalence of Accessory Fissures in liver ranges widely from 6 to 94%. The morphometric analysis of individual lobes is also scarce in literature. There have been instances where the surgeon has experienced some of these variations as a surprise during surgery as the existing data on the surface variations of liver is still contradictory. A sound knowledge of these variations would aid the surgeons and radiologists to circumvent the misdiagnosis and complications during surgeries. METHODS: The study was conducted in 93 cadaveric livers. Minor liver fissures, Accessory fissures and lobes were noted and measured. The livers were classified according to the Netter's classification. The morphology of caudate and quadrate lobes was studied. Any other variations in the appearance of groove for Inferior vena cava, gall bladder and its fossa were also studied. The results are tabulated. RESULTS: The study revealed several variations in the morphological features of liver. Accessory fissures were noted in 51.61% of livers, distributed on various liver surfaces. Accessory lobes were noted in 27.9%. Pons hepatis was present in 22.5%. Gall bladder variations that were noted include the Hartmann's pouch (n = 14; 15.05%) and the Phrygian cap (n = 2; 2.15%). 65.6% livers (n = 61) had the sulcus of the caudate process or fissure of Gans or Rouviere sulcus which is a normal fissure present in majority of normal healthy livers. CONCLUSION: The current study provides a complete understanding and a thorough knowledge of surface morphological variations in liver. We hope that this will be greatly helpful for surgeons and radiologists to avoid possible errors in interpretations, to plan appropriately and assist during liver surgeries and to do radiological interventions.

Perceptions of Medical Undergraduate Students on Curricular Changes in Anatomy: An Embedded Design Mixed Method Study.

INTRODUCTION: Implementation of competency-based medical education (CBME) offers challenges to the faculty and students. As a part of the new curriculum by the National Medical Council of India, we introduced certain teaching and assessment modifications in anatomy. There are few studies on the actual implementation of CBME. The current study aimed to assess the perceived usefulness of the teaching, learning, and assessment methodology (TLAM) based on written feedback from students. METHODS: All the 147 first MBBS students of the batch who had undergone the new teaching learning methodology answered the questionnaire on usefulness of the various TLAMs on a 3-point Likert scale which was taken as quantitative data. They were also asked to pen down their opinions and suggestions about the TLAM which was thematically analysed and considered as qualitative data. Face and content validity was assessed prior to administration of the questionnaire. Descriptive statistics were used for quantitative variables. Qualitative data were analysed by thematic analysis. RESULTS: 100% of the students found vertical integration and small group teaching as useful. Seminars and quizzes were reported as useful to extremely useful by 75.5% of the students. Self-directed learning and near-peer teaching was also appreciated well by 78% of students. In Embryology and Neuroanatomy, these active learning methods were not found to be useful as these topics were difficult to understand. Overall, the new TLAM introduced as per the new medical curriculum was found useful for the majority of students. CONCLUSION: This study provides valuable insights on the teaching, learning, and assessment methods as formulated by the competency-based medical curriculum. Though active learning methods are the integral principles of andragogy, the concepts which are difficult to understand need to be taught using the traditional teaching methodology.

Are Footedness and Lateral Postures Better Predictors of Hemispheric Dominance Than Handedness: A Cross-sectional Questionnaire-Based Clinical and Pedigree Study.

Objective Approximately 9 out of 10 individuals show right-hand dominance. The remaining 10% include left-hand dominant and mixed handed/ambidextrous individuals. Laterality, lateral postures or lateral preference is defined by various authors as the most comfortable posture that an individual prefers to assume. The current study aims at finding the distribution of these lateral postures and their correlation with handedness/dominant side. Materials and Methods The study was done in medical and nursing students in the age group 18 to 22 years. The patients were asked to fill a self-assessment questionnaire to determine handedness and footedness. The laterality traits were observed by asking the patients to do by themselves after an untailored demonstration. Statistical Analysis The relationship between study parameters was assessed using Chi-square test. Pearson's correlation test was done to assess the strength of association between comfort ratings of the various laterality postures. Results In our study, 96.5% were right handed and 79.9% of patients were right footed. Also, 50.8% preferred right-hand clasping, 53.9% preferred left-arm folding, and 60.6% preferred right-leg folding. A statistically significant correlation was seen between foot preference and lateral postures and arm folding and hand clasping (p < 0.05). A significant association was also found between handedness and positive history of retraining. Sidedness did not follow any Mendelian pattern of inheritance. Conclusions Handedness is affected by genetic and environmental factors. Since cultural and traditional practices can affect the lateral postures and handedness, it is important to know the relationship between laterality postures and sidedness and the impact of retraining on them. These postures are measures of cerebral dominance and are clinically important.