Anatomy and embryology of umbilicus in newborns: a review and clinical correlations

Umbilicus is considered a mirror of the abdomen in newborns. Despite its importance, the umbilicus has been stated in literature and textbooks as discrete subjects with many body systems, such as the urinary, digestive, and cardiovascular ones. This article aimed to address the basic knowledge of the umbilicus in relation to clinical disorders under one integrated topic to aid physicians and surgeons in assessing newborns and infants. The umbilicus appears as early as the fourth week of fetal life when the folding of the embryonic plate occurs. The umbilicus appears initially as a primitive umbilical ring on the ventral aspect of the body. The primitive umbilicus contains the connecting stalk, umbilical vessels, vitelline duct and vessels, allantois, and loop of the intestine. Changes occur to form the definitive cord, which contains three umbilical vessels, namely, "one vein and two arteries," embedded in Wharton's jelly. After birth, the umbilical vessels inside the body obliterate and gradually form ligaments. Congenital disorders at the umbilicus include herniation, bleeding, and discharge of mucous, urine, or feces. Some of these disorders necessitate emergent surgical interference, whereas others may be managed conservatively. The umbilicus has many embryological remnants. Thus, the umbilicus is prone to various clinical disorders. Detecting these disorders as early as possible is essential to prevent or minimize possible complications.

Talus bone: normal anatomy, anatomical variations and clinical correlations

Talus is a pivotal bone that assists in easy and correct locomotion and transfers body weight from the shin to the foot. Despite its small size, it is implicated in many clinical disorders. Familiarity with the anatomy of the talus and its anatomical variations is essential for the diagnosis of any disorder related to these variations. Furthermore, orthopedic surgeons must be fully aware by this anatomy during podiatry procedures. In this review, we attempt to present its anatomy in a simple, updated and comprehensive manner. We have also added the anatomical variations and some clinical points relevant to the unique and complex anatomy of talus. The talus has no muscle attachment. However, it does have many ligaments attached to it and others around it to keep it in place. Moreover, the bone plays a pig role in movements due to its involvement in many joints. Most of its surface is covered with articular cartilage. Therefore, its blood supply is relatively poor. This puts the talus at greater risk for poor healing as well as more complications in the event of injury than any other bone. We hope this review will make it easier for clinicians to pursue and understand the updated essential knowledge of one of the most complex bone anatomies that they need in their clinical practice.

A systematic review on normal and abnormal anatomy of coronary arteries

Coronary artery (CA) disorders are among the major causes of morbidity and mortality in humans. We attempt to explain CA anatomy and its variations in a simple, concise, and understandable way to help clinicians deal with the various disorders. There are two main arteries: right coronary artery (RCA) and left CA. The left bifurcates into two terminal branches: left anterior descending artery (LAD) and left circumflex artery (LCX). The commonest anatomical variant is trifurcation of left main coronary artery (LMCA) with presence of ramus intermedius artery (RIM), abnormal origin of LCX from RCA or right sinus of Valsalva, abnormal CA origin from unusual aortic sinus in-between aorta and pulmonary trunk, myocardial bridging, CA fistula and aneurysm. The RCA may arise abnormally from the left sinus of Valsalva rather than the usual origin from the right sinus. Furthermore, most cases of abnormal CA fistulas affect the RCA where the artery opens into the right heart chambers, pulmonary trunk, or coronary sinus. Although their incidence is relatively rare, coronary abnormalities are of critical importance in medical practice. Identification of normal and abnormal anatomy of CA is essential because not knowing one of the differences can lead to loss of a person’s life.

Is There any Mean to Postpone The Menopausal Ovarian Senescence?

The ovarian reserve (OR) gradually decreases throughout the female fertile life. This continuous depletion in OR is irreversible. This occurs through a programmed cell death, known as apoptosis. Some factors hasten such depletion, such as chemo- and radio-therapy. Others have been investigated in trials to preserve the OR including gonadotropins, cytokines, growth hormones, nitric oxide and reorganization of the actin cytoskeleton. Loss of OR occurs normally at the menopausal age, a stage called menopausal ovarian senescence. At some periods, there are other sources for ovarian hormones that are away from the ovary, like during use of contraceptive pills and at pregnancy after formation of placenta. Future trials to preserve ovarian follicles at these periods might postpone the onset of menopause and hence lengthen the fertile female age.

Possible role of selenium in ameliorating lead-induced neurotoxicity in the cerebrum of adult male rats: an experimental study

Chronic lead (Pb) poisoning is one of the greatest public health risks. The nervous system is the primary and most vulnerable target of Pb poisoning. Selenium (Se) has been shown to be a potential protection against heavy metal toxicity through anti-inflammatory and antioxidant properties. Therefore, the present study aimed to elucidate the possible protective role of Se in ameliorating the effects of Pb on rat cerebral structure by examining oxidative stress and markers of apoptosis. The rats were divided into 6 groups: control group, Se group, low Pb group, high Pb group, low Pb + Se group, high Pb + Se group. After the 4-week experiment period, cerebral samples were examined using biochemical and histological techniques. Pb ingestion especially when administered in high doses resulted in cerebral injury manifested by a significant increase in glial fibrillary acidic protein, malondialdehyde (MDA) marker of brain oxidation and DNA fragmentation. Moreover, Pb produced alteration of the normal cerebral structure and cellular degeneration with a significant reduction in the total number of neurons and thickness of the frontal cortex with separation of meninges from the cerebral surface. There was also a decrease in total antioxidant capacity. All these changes are greatly improved by adding Se especially in the low Pb + Se group. The cerebral structure showed a relatively normal histological appearance with normally attached pia and an improvement in neuronal structure. There was also a decrease in MDA and DNA fragmentation and an increase TAC. Selenium is suggested to reduce Pb-induced neurotoxicity due to its modulation of oxidative stress and apoptosis.

A new hypothesis may explain human parthenogenesis and ovarian teratoma: A review study

Parthenogenesis (PG) is a rare phenomenon occurring in humans, and understanding this may help us develop an explanation for such occurrences. Moreover, it may help reveal the cause of idiopathic ovarian teratoma (OT). We aim to explain the occurrence of PG and OT in humans based on a new hypothesis. Previous literature has been searched through relevant scientific websites and international journals on the causes and mechanisms of PG and OT in humans. The previous literature on human PG was sparse and mostly contained case reports. It appears that human PG is not as rare as previously reported but may occur spontaneously, resulting in OT formation. The difference between PG and sexual reproduction is that PG has no embryonic diversity. The biopsied embryonic samples in the PG correspond exclusively to those of the maternal side. Spontaneous PG in humans often degrades or leads to formation of OT. The cause and mechanism of spontaneous PG remain unclear in the available literature. Here, we hypothesized that in some cases the secondary oocyte and first polar body enclosed in the zona pellucida may fuse together to form a single cell that restores the diploid number of chromosomes and initiates cell division to form PG. It may go unnoticed or be represented by the OT. Future studies are recommended to investigate this hypothesis.

Myocardial Infarction: Risk Factors, Pathophysiology, Classification, Assessment and Management

Myocardial infarction is a serious health problem affecting populations worldwide. Proper and prompt diagnosis and management is critical to achieving good prognosis and avoiding or reducing morbidity and mortality. It is essential for clinicians to be aware of the risks, diagnosis and treatment. In this review we aim to update and discuss knowledge of myocardial infarction with respect to risk factors, pathophysiology, types or classification, clinical manifestations, diagnosis and treatment in a concise and simplified manner in order to define a simple comprehensive guide for clinicians. The available literature has been searched, reviewed, studied, analyzed, written in a simple understanding method, discussed and concluded. For prophylaxis, it has been found that moderate muscular exercise, regular consumption of fresh vegetables and fruits, avoidance of smoking and stress, and low consumption of fat are associated with reduced risk of coronary heart disease in populations of all age groups worldwide. The diagnosis of myocardial infarction is based primarily on evaluations of clinical features, typical abnormalities in ST-segment and T wave of ECG findings and rise in cardiac enzymes or biomarkers such as plasma troponin. At the same time, the key to treatment is reperfusion of the myocardium and restoration of coronary blood flow.

Changes in Adult Rats’ Testis structure Induced by Hypothyroidism and Alleviating Role of L-Carnitine

Background Hypothyroidism is a metabolic disorder affecting the functions of many tissues in the body including the testis. Testis is rich in the polyunsaturated fatty acids content and lacks strong intrinsic antioxidant system making it prone to such oxidative stress. L-carnitine (LC) regulates long chain fatty acids metabolism; and is considered a valuable antioxidant factor. Aim It was to evaluate the effect of hypothyroidism induced by propylthiouracil (PTU) on rats’ testes and the possible protective role of LC. Methods Forty-eight adult male albino rats were used in this work. The animals were divided into three groups with sixteen animals in each. Group 1 (Control): Animals were kept without medications. Group 2 (PTU-treated): was subjected to administration of PTU; while group 3 (PTU and LC) received both PTU and LC. By the end of the experiment “30 days”, blood samples were taken for hormonal assay; then animals were anaesthetized and sacrificed. Specimens were homogenized for biochemical analysis; epididymal content of each rat was obtained immediately for semen analysis. Testes’ specimens were harvested, prepared and examined by light microscope examination. Results Induced hypothyroidism was noticed to cause histopathological, morphometric and biochemical changes in rat’s testes. LC protected the testicular specimens against such changes; it also improved the seminal quality and quantity as well as testicular structure and biochemistry. Conclusion Hypothyroidism could result in hazards to the structure of testis. Fortunately co-administration of LC might reduce such hazards.

A new look at the theoretical causes of endometriosis: Narrative review

Endometriosis is a major health concern in women who have it. Unfortunately, there is no definitive cure except panhysterectomy with its sequelae including induction of premature menopause due to loss of ovaries. Therefore, revealing the causes of this puzzling disease is necessary to avoid contracting it, and to spare women the health disorders resulting from it and the difficulties of treating it. We aimed to study endometriosis with a focus on its theoretical causes. Its classification reports and theories of pathogenesis were identified and studied from available database searches. The causes of endometriosis remain mysterious. Many theories have been proposed to explain the etiology, but retrograde menstruation (RM) remains the closest in this regard. Although this theory is the most accepted in the pathogenesis of endometriosis, its causes are still a matter of debate, especially in women who do not suffer from obstructions to menstrual outflows, such as cases of congenital cervical stenosis and imperforate hymen. It is suggested in some studies that there may be a relationship between women who engage in sexual activity during menstruation and the development of endometriosis. It is concluded that endometriosis is a painful and debilitating disease. Identifying its causes is essential to control the disease and avoid any burdens on health. RM is the main theory for its pathogenesis but its causes are still uncertain. Sexual activity during menstruation may be a possible cause of RM but needs more evidence. Future studies are recommended to reveal all aspects of the pathogenesis of endometriosis.

Is There any Mean to Postpone The Menopausal Ovarian Senescence?

The ovarian reserve (OR) gradually decreases throughout the female fertile life. This continuous depletion in OR is irreversible. This occurs through a programmed cell death, known as apoptosis. Some factors hasten such depletion, such as chemo- and radio-therapy. Others have been investigated in trials to preserve the OR including gonadotropins, cytokines, growth hormones, nitric oxide and reorganization of the actin cytoskeleton. Loss of OR occurs normally at the menopausal age, a stage called menopausal ovarian senescence. At some periods, there are other sources for ovarian hormones that are away from the ovary, like during use of contraceptive pills and at pregnancy after formation of placenta. Future trials to preserve ovarian follicles at these periods might postpone the onset of menopause and hence lengthen the fertile female age.

Human Anatomy & Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt, Hegazy AA, Medical Biotechnology Department, College of Biotechnology, Misr University for Science and Technology (MUST), 6th of October City, Egypt, Qenawy NM, Human Anatomy & Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt, Aziz NMA, Human Anatomy & Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt, El-Bestawy EM, Human Anatomy & Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt. Effect of high fat diet on structure of liver and gallbladder of adult male mice – an experimental study

Introduction. High fat diet (HFD) intake induces obesity and adversely affects different body organs including liver and gallbladder. Aim. It was to clarify the effects of HFD on the liver and gallbladder structure using light microscopic (LM) examination. Material and methods. 16 healthy adult male mice were equally divided into 2 groups. Control group mice were fed normal diet. HFD group was fed using HFD. At the end of the 8-week experiment, mice were anesthetized. Liver and gallbladder were removed and prepared to histological processing. Sections were stained with hematoxylin and eosin (H&E) and immunostaining for cyclooxygenase-2 (COX-2) cellular localization. Oil Red O (ORO)-stained frozen liver sections were prepared. Results. H&E-stained sections of HFD group revealed rounded swollen hepatic cells with pale cytoplasm suggesting cellular ballooning. Dilated congested sinusoids and portal vein, cellular degeneration and collection of inflammatory cells were observed between hepatic cells and in portal region. Gallbladder sections showed epithelial stratification and cellular vacuolation. Strong immunoexpression of COX-2 was observed in Kupffer and hepatic cells of the liver and gallbladder mucosal epithelial cells. Conclusion. HFD is suggested to alter the normal histological features of liver and gallbladder represented by fatty liver and gallbladder epithelial hyperplasia and inflammatory reaction.

Evaluation of Nonculprit Coronary Artery Lesions in Patients with Acute ST-Segment Elevation Myocardial Infarction

Background:

Multivessel coronary artery disease is a common finding during the primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction (STEMI). It might be a cause for recurrent attacks. This study aimed to evaluate nonculprit lesions (NCLs) encountered in the three major epicardial coronary arteries.

Methods:

Patients with STEMI who underwent PPCI and matched the study inclusion criteria were enrolled. They were evaluated clinically, biomedically, and coronary angiographically. The coronary angiography analysis was examined by four cardiologists using the Quantitative Coronary Artery Analysis software. The data was analyzed statistically.

Results:

Of the 154 patients included in the study, 130 (84.4%) were males and 24 (15.6%) were females, with a mean age of 52.92 ± 13.14 years. Five hundred seventy-four NCLs were found in 132 (85.7%) patients. Nonobstructive lesions with stenosis less than 70% of vessel diameter were more frequent than obstructive lesions. The left circumflex coronary artery (LCX) was the first one of the three major arteries to be affected by obstructive NCLs. The obstructive NCLs were 128 in number; found in 78 (50.4%) patients; 65 (50.8%) of them were in LCX; 32 (25%) were in left anterior descending (25%); and 31 (24.2%) were in right coronary artery.

Conclusions:

NCLs are common among STEMI patients. LCX obstructive NCLs are comparable to those in the other two major epicardial coronary arteries, with respect to frequency and severity of luminal stenosis.

Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City 44519, Egypt., Hegazy MA, Khairy HM, Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City 44519, Egypt., Awad Hegazy A, Basic Medical Science Department, Faculty of Dentistry, Zarqa University, Zarqa City 13110, Jordan., Human Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City 44519, Egypt., Sebaei MAEF, Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City 44519, Egypt., Sadek SI, Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City 44519, Egypt.. Congenital Vertical Talus: A Review of Anatomy and Clinical Correlation

Congenital vertebral talus (CVT) is a rare anatomical and orthopedic condition. However, managing the problem is a challenge, especially when neglected. In the current narrative review, we aim to highlight the pathologic anatomy and clinical correlation of this bony deformity with an emphasis on how to avoid neglecting its early diagnosis. CVT appears clinically as a rigid, by a rounded convex sole or called rocker-bottom foot deformity with a prominent heel. The main pathological cause of the deformity is due to the vertical position of the talus with rigid dorsal dislocation of the navicular bone as well as lateral and dorsal dislocation of the talonavicular joint. Its exact causes are still unknown; however, there is accumulating evidence of a genetic predisposition of CVT. In about half of cases, CVT is associated with other neuromuscular or genetic disorders. The CVT diagnosis depends on clinical and radiological findings. Radiological diagnosis may be missed in newborns because many tarsal bones remain unossified. Neglect of CVT can lead to significant disability and deformity with foot pain, abnormal gait, functional limitations, and problems wearing shoes, as well as difficulties in surgical treatment with more extensive tissue release. The type of surgery used to repair CVT deformity depends mainly on the age of the patient and the severity of the deformity, which gets worse with age. Screening for foot defects in newborns, especially those with rigid foot deformity or other congenital anomalies, is highly recommended to rule out the possibility of CVT and thus avoid its neglect and resulting difficulties. KEYWORDS: Rocker-Bottom Foot, Rigid Flatfoot, Convex Pes Valgus, Congenital Convex.