Variation in the formation of the retromandibular and the external jugular veins with embryological overview: A case report

Awareness of the formation and termination of the head & neck's superficial vein, such as jugular veins, are imperative for anatomists, surgeons, and radiologists during interventional procedures. We report an uncommon variation in the formation of the retromandibular vein and external jugular vein (EJV) in an embalmed male cadaver's right side. The joining of the facial vein and superficial temporal vein within the parotid gland formed the retromandibular vein (RMV). The anterior division joined with the submental vein forming an anomalous venous trunk. The anomalous vein united with the EJV forming a common trunk in the lower third of the neck and terminated into the subclavian vein. We compared the available literature and justified the embryological development of this rare variation.

Influence of pretesting and a near peer sharing real life experiences on CPR training outcomes in first year medical students: a non-randomized quasi-experimental study

BACKGROUND

Existing literature on cardiopulmonary resuscitation (CPR) training focuses on the knowledge and skill components while the attitudinal component is rarely addressed. There is a need to explore how peer interaction, learning atmosphere, and communication influence learning effectiveness during CPR training. Therefore, this study's objective was to evaluate how a senior student (near peer) sharing their real-life experience of performing CPR would influence medical students' learning and readiness to perform CPR.

METHODS

The present study involved 250 newly enrolled undergraduate medical students. The Solomon's four-group study design was used to evaluate the influence of both pretesting and peer interaction. Students belonging to two groups initially completed a pre-training knowledge test (pretest) and a questionnaire on readiness to perform CPR. Students from all four groups then participated in instructor-led hands-on skills training, after which the two intervention groups interacted with their senior, who shared their life experiences of performing CPR. Finally, all four groups underwent skills evaluation, immediate and delayed post-tests, and completed a questionnaire to assess readiness to perform CPR. The students also provided their feedback on the experience of interacting with a peer during the training.

RESULTS

Post-test scores were significantly higher than pretest scores (Kruskal-Wallis test, p < 0.05). Scores were significantly higher in pretested intervention groups than in the non-pretested non-intervention group (p < 0.05). Delayed post-test scores were slightly but not significantly lower than the immediate post-test scores with no significant difference observed in the scores among the groups. The pretested groups showed more readiness to perform CPR and the pretested intervention group were least concerned about acquiring infection during CPR. Students in all groups were confident of performing chest compressions correctly, and found it inspiring and motivating listening to and discussing real-life experiences with a near peer.

CONCLUSIONS

Hearing from peers about real-life CPR experience during CPR training sessions significantly impacted learning, enhanced student motivation to learn and may be an effective strategy to consider in routine CPR training. However, the positive effects of pretesting and peer interaction on knowledge were not sustained, highlighting a need for repeat training.

Diversity in approach to teaching and assessing ethics education for medical undergraduates: A scoping review

There are diverse methods to teach medical ethics, and there is no single accepted approach towards its learning and assessment. The authors aim to explore the various strategies practised to teach undergraduate medical students the fundamentals of medical ethics and their evaluation. The authors reviewed the articles published from January 2014 to September 2019. The authors searched PubMed for the relevant publications and extracted the information using a data extraction sheet. Twenty-nine articles were included for the review, which fulfilled the inclusion criteria. Case-based discussions were a widely accepted strategy to learn ethics. The studies highlighted a mixed teaching approach using multiple teaching tools. A qualitative approach was preferred for the assessment through reflections, simulated patient interactions, and development of portfolios. However, there are gaps in the existing literature on the assessment strategies for ethics education. Heterogeneity still exists in the planning of the curricula, teaching, and assessment methods. These curricula suit the cultural and religious set up of that particular country. Case-based discussion is a popular teaching strategy, and there exist numerous innovative and cost-effective active teaching strategies. There is a need for studies that are more rigorous to address the evaluation of the ethics curricula. This review would help educators to choose their preferred approach based on their teaching environment.

•

The major learning strategies were ‘Case-based,’ ‘video/movies,’ ‘role modelling,’ ‘lectures,’ and ‘patient interactions.

•

A mixture of learning methods have proven to be beneficial.

•

The assessment of ethics education is still a challenge, and there is a gap in the literature on their strategies.

•

Curricula are evaluated mainly by the student feedback using unstructured, open-ended questionnaires and reflections.

•

There is a need to have studies that are more rigorous to evaluate the long-term impact of the ethics curricula.

Morphology and innervation of brachioradialis and flexor carpi radialis and their utility in tendon transfer surgeries: A Cadaveric Study

INTRODUCTION

The Brachioradialis (BR) muscle flap is easy to harvest, provides a stable coverage to the cubital fossa as it is well vascularized. The BR andflexor carpi radialis (FCR) tendons are utilized in tendon transfer to restore the normal hand function. Therefore, the present study describes the morphology of the muscle bellies and the tendons of BR and FCR along with their pattern of innervation.

MATERIALS AND METHODS

The study was carried out on 27 upper limbs of formalin-fixed, adult human cadavers. Length and width of the bellies of BR and FCR were measured. The number of motor branches and their distances from the bi-epicondylar line was measured.

RESULTS

The mean lengths of BR and FCR bellies were 21.22±2.18cm and 16.15±2.39cm, and the lengths of their tendons were, 12.67±1.13cm and 12.48±1.72cm respectively. BR received a single motor branch in 19 upper limbs. However, FCR received single motor branch in 25 limbs as a common trunk. One upper limb received three motor branches to BR, and two upper limbs received two motor branches to FCR. The most proximal and distal branches to the BR were ranged between 6.3-2.2cm proximal to the bi-epicondylar line. Those to the FCR were ranged between 3.5-6.9cm distal to the bi-epicondylar line.

CONCLUSION

The motor branches to the BR and FCR are variable in their origin, and the knowledge of such variations is essential for identifying them while performing selective neurotomy surgeries.

Development of the Gall Bladder, and Caudate and Quadrate Lobes of the Liver: A Fetal Morphometric Study

INTRODUCTION

The gall bladder (GB) is a storage reservoir that allows bile acids to be delivered in a high concentration. The quadrate (QL) and caudate lobes (CL) are functional parts of the liver. The knowledge of the gross and developmental anatomy of GB and CL and QL of liver is important for surgeons who operate in this region. The present study was conducted to examine the developmental sequence and morphometry of the GB, and CL and QL of liver.

MATERIALS AND METHODS

In the present cross sectional study the parameters measured were length of GB from the neck to the lowest point on the fundus, and the length and width of QL and CL measured at the midpoint. The data was analyzed statistically and the various parameters were correlated using Pearson's correlation.

RESULTS

There was a statistically significant correlation indicating that the growth of GB, QL and CL was proportional to the gestational age (GA). The variations in the morphology of the GB were also noted. In two specimens it was found that the GB was embedded partially in the substance of the liver and failed to reach the inferior border of the liver.

CONCLUSION

The regression equations calculated in the study provide a tool to estimate the lengths of GB, QL and CL prenatally.

Histological and biochemical study of the superficial abdominal fascia and its implication in obesity

The advancement of liposculpturing and fascial flaps in reconstructive surgery has renewed interest in the superficial fascia of abdomen. Its histological and biochemical composition may play a vital role in maintaining strength and elasticity of the fascia. Hence, study of abdominal fascia for the elastic, collagen, and hydroxyproline contents is desirable to understand asymmetrical bulges and skin folds and in improving surgical treatment of obesity. Samples of superficial fascia were collected from of upper and lower abdomen from 21 fresh cadavers (15 males and 6 females). Samples were stained using Verhoeff–Van Gieson stain. Digital images of superficial fascia were analyzed using TissueQuant software. The samples were also subjected to hydroxyproline estimation. The superficial fascia was formed by loosely packed collagen fibers mixed with abundant elastic fibers and adipose tissue. Elastic contents and collagen contents of superficial fascia were significantly more in the upper abdomen than that in the lower abdomen in males. Hydroxyproline content of superficial fascia of upper abdomen was significantly more than that of lower abdomen in both males and females. The elastic, collagen and hydroxyproline contents of superficial fascia of upper abdomen were higher compared to the lower abdomen. This may be a reason for asymmetric bulging over abdomen and more sagging fold of skin in the lower abdomen than in the upper abdomen. This study may therefore be helpful in finding new ways to manage obesity and other body contour deformities.

A Study of Physicochemical Properties of Subcutaneous Fat of the Abdomen and its Implication in Abdominal Obesity

INTRODUCTION

The lower abdominal obesity is more resistant to absorption as compared to that of upper abdomen. Differences in the physicochemical properties of the subcutaneous fat of the upper and lower abdomen may be responsible for this variation. There is paucity of the scientific literature on the physicochemical properties of the subcutaneous fat of abdomen.

AIM

The present study was undertaken to create a database of physicochemical properties of abdominal subcutaneous fat.

MATERIALS AND METHODS

The samples of subcutaneous fat from upper and lower abdomen were collected from 40 fresh autopsied bodies (males 33, females 7). The samples were prepared for physicochemical analysis using organic and inorganic solvents. Various physicochemical properties of the fat samples analysed were surface tension, viscosity, specific gravity, specific conductivity, iodine value and thermal properties. Data was analysed by paired and independent sample t-tests.

RESULTS

There was a statistically significant difference in all the physicochemical parameters between males and females except surface tension (organic) and surface tension (inorganic) of upper abdominal fat, and surface tension (organic) of lower abdominal fat. In males, viscosity of upper abdominal fat was more compared to that of lower abdomen (both organic and inorganic) unlike the specific conductivity that was higher for the lower abdominal fat as compared to that of the upper abdomen. In females there were statistically significant higher values of surface tension (inorganic) and specific gravity (organic) of the upper abdomen fat as compared to that of lower abdomen. The initial and final weight loss of the lower abdominal fat as indicated by Thermo Gravimetric Analysis was significantly more in males than in female.

CONCLUSION

The difference in the physicochemical properties of subcutaneous fat between upper and lower abdomen and between males and females could be responsible for the variant behaviour of subcutaneous abdominal fat towards resorption.

Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages

Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. The present study was undertaken on 48 fetal femurs to calculate the NSA and FNA in fetuses digitally. End on images of upper end of the femurs were taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t test showed the FNA and NSA of femur did not vary significantly during the third trimester.

Cytokinesis blocked micronucleus assay of peripheral lymphocytes revealing the genotoxic effect of formaldehyde exposure

Formaldehyde (FA), which is said to be a carcinogenic agent, is commonly used in anatomy laboratories. This study used the cytokinesis blocked micronucleus assay (CBMN) to assess DNA damage due to FA exposure by measuring the frequency of micronuclei (MN) in lymphocytes. The extent of DNA damage was assessed with respect to the duration of exposure. Thirty male anatomy laboratory workers from various medical colleges involved with storing specimens and embalming were included in the study. Thirty males who were not exposed to FA were included as a comparison group. Blood samples were collected after informed consent was given. Information regarding age, duration of FA exposure and smoking habits was obtained by a questionnaire. The CBMN assay was conducted on cultured isolated lymphocytes stained with Giemsa. MN were counted in a total of 1000 binucleated lymphocytes. The effect of smoking was assessed using appropriate statistical tests. The frequency of MN in lymphocytes was significantly higher in the exposed group (P < 0.001). The duration of exposure correlated positively with the frequency of MN (r = 0.5, P = 0.02). Neither aging nor smoking correlated significantly with the formation of MN. The present study highlights significant DNA damage in people exposed to FA. The extent of damage was directly proportional to the duration of exposure.

In situ atomic force microscopy tip-induced deformations and Raman spectroscopy characterization of single-wall carbon nanotubes

In this work, an atomic force microscope (AFM) is combined with a confocal Raman spectroscopy setup to follow in situ the evolution of the G-band feature of isolated single-wall carbon nanotubes (SWNTs) under transverse deformation. The SWNTs are pressed by a gold AFM tip against the substrate where they are sitting. From eight deformed SWNTs, five exhibit an overall decrease in the Raman signal intensity, while three exhibit vibrational changes related to the circumferential symmetry breaking. Our results reveal chirality dependent effects, which are averaged out in SWNT bundle measurements, including a previously elusive mode symmetry breaking that is here explored using molecular dynamics calculations.

Long-term monitoring and proposed diffuse pollution control of a tropical reservoir

This paper presents the results of 30 years of water quality monitoring in a tropical water supply reservoir (Vargem das Flores, Brazil). This water body is subjected to eutrophication problems caused by point sources (discharge of untreated sewage) and diffuse pollution (agricultural use in the drainage basin). Emphasis is given here on the estimation of nutrient loads and on the study of the N/P ratio in the water body. In spite of the prevalence of high N/P values, there is a clear trend in the dominance of cyanobacteria in the phytoplankton, which contradicts results from research in temperate aquatic environments. Some restoration measures for Vargem das Flores Reservoir are currently being implemented: construction of wastewater treatment plants, control of recreational activities, erosion control by hydroseeding and use of natural wetlands. Finally some management strategies in order to prevent algae input in the water abstraction system are discussed. Examples of these techniques are the installation of plastic barriers and the construction of an air curtain device.

Digital image processing measurement of the upper eyelid contour in Graves disease and congenital blepharoptosis

OBJECTIVE

This study used image processing techniques to quantify the upper eyelid contour of patients with Graves upper eyelid retraction and congenital blepharoptosis.

DESIGN

The study design was a cross-sectional study.

PARTICIPANTS

A total of 29 patients with Graves disease, 22 patients with congenital blepharoptosis, and 50 patients with no history of eye disease participated.

INTERVENTION

The images of the palpebral fissure of all participants were transferred to a personal computer and processed with NIH Image 1.55 software.

MAIN OUTCOME MEASURES

The following parameters were analyzed: the curvature of the upper eyelid contour, the position of the contour peak relative to the midline, and the ratio between the temporal and nasal upper quadrant areas of the palpebral fissure.

RESULTS

All upper eyelid contours could be fitted with second-degree polynomial functions. The mean temporal/nasal area ratio was 1.33 mm in patients with Graves disease, 0.92 mm in patients with blepharoptosis, and 1.04 mm in control subjects. The peak of the upper eyelid contour was found to be lateral to the midline in control subjects (1.05 mm) and in patients with Graves disease (2.09 mm). In patients with blepharoptosis, the peak was 0.69 mm medial to the midline. Overall, the distance between the midpupil and the upper eyelid margin was correlated with several factors: the degree of curvature, the position of the peak of the eyelid contour, and the temporal/nasal area ratio.

CONCLUSIONS

In Graves eyelid retraction, the curvature of the upper eyelid is enhanced, the peak of the contour is displaced laterally, and the temporal upper quadrant area is increased. Conversely, in congenital blepharoptosis, the eyelid is almost flat, the peak of the contour is displaced medially, and the upper quadrant area is diminished. The lateral segment of the upper eyelid is more involved than the nasal segment in both Graves upper eyelid retraction and congenital blepharoptosis.