Evaluation of a surgical simulator for learning clinical anatomy

BACKGROUND

New techniques in imaging and surgery have made 3-dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficacy of 2 supplemental, self-study methods for learning shoulder joint anatomy to determine which method provides for greater transfer of learning to the clinical setting.

METHODS

Two groups of medical students studied shoulder joint anatomy using either a second-generation virtual reality surgical simulator or images from a textbook. They were then asked to identify anatomical structures of the shoulder joint as they appeared in a videotape of a live arthroscopic procedure.

RESULTS

The mean identification scores, out of a possible score of 7, were 3.1 +/- 1.3 for the simulator group and 2.9 +/- 1.5 for the textbook group (P = 0.70). Student ratings of the 2 methods on a 5-point Likert scale were significantly different. The simulator group rated the simulator more highly as an effective learning tool than the textbook group rated the textbook (means of 3.2 +/- 0.7 and 2.6 +/- 0.5, respectively, P = 0.02). Furthermore, the simulator group indicated that they were more likely to use the simulator as a learning tool if it were available to them than the textbook group was willing to use the textbook (means of 4.0 +/- 1.2 and 3.0 +/- 0.9, respectively, P = 0.02).

CONCLUSION

Our results show that this surgical simulator is at least as effective as textbook images for learning anatomy and could enhance student learning through increased motivation. These findings provide insight into simulator development and strategies for learning anatomy. Possible explanations and future research directions are discussed.

Inhibitory effect of the plant Boerhavia diffusa l. against the dermatophytic fungus Microsporum fulvum

Antifungal activity (reduction in colony diameter) of various extracts (pt. ether, chloroform, ethyl acetate, ethyl alcohol and aqueous) of aerial and root parts of Boerhavia diffusa (Nictaginaceae) was screened against dermatophytic fungi Microsporum fulvum. Statistically significant increase has been recorded in the % inhibition of the target fungal species with increasing test concentrations (1000-5000 ppm) of chloroform, ethyl acetate and ethyl alcohol extracts of the root. The maximum % inhibition observed in various solvent extracts of root was about 26% (chloroform), 46% (ethyl alcohol) and 57% (ethyl acetate) at 5000 ppm concentration with time exposure of 10 days. The colony diameter of the target mycelial colony decreased with increasing supplementation of the phytoextract, showing the presence of significant amount of some antifungal phytochemical moiety.

Axillary metastases from recurrent oral carcinoma

The rationale for surgical treatment of head and neck cancer is based on a predictable pattern of metastasis. There is aberrant or unpredictable spread rarely and typically only in recurrent disease. There are few published reports to our knowledge of axillary metastases from squamous cell cancer (SCC) of the head and neck. We present a patient who developed axillary node disease on the other side after recurrence of a squamous cell carcinoma of the floor of the mouth. She died 11 months after excision of the recurrence.

Traditional Remedies for Fertility Regulation

Plants have been used worldwide for treatment of various human ailments since antiquity. Their use is still quite prevalent in developing countries in the form of traditional/folkloric system of medicine. Intensive chemical and pharmacological studies on traditional/folkloric medicinal plants during the last 5 decades have led to the validation of traditional claims in many cases and facilitated identification of their active principles. The active principles have provided leads in the development of several life saving drugs, which are in clinical use today. A large number of these plants are used for birth control in different countries. The present review has, therefore, been planned to provide an account of the investigations carried out on traditional/folkloric plants used for fertility regulation. The status of scientific validations of their anti-fertility potential and identification of active principles during the last 28 years are discussed. The literature survey shows that approximately 318 different plants are in traditional/folkloric use worldwide, of which 227 plants are of Indian origin. So far, 74 plants have been screened for their anti-fertility potential, 48 of them have been found to be effective. Active principles of about 15 plants have been identified during the period under review.

A new 2-carbamoyl pteridine that inhibits mycobacterial FtsZ

The preparation of a new 2-carbamoyl pteridine, its activity data against FtsZ from M. tuberculosis (Mtb), and in vitro antibacterial data against Mtb strain H37Ra are presented.

Systemic sclerosis, localized morphea, en coup de sabre and aortic regurgitation: a rare association

A 24-year-old male presented with Raynaud's phenomenon, digital infarcts, salt and pepper pigmentation and characteristic facies. There was gastrointestinal involvement clinically, endoscopically as well radiologically. In view of these findings and the demonstration of anti-nuclear antibodies with a homogeneous pattern of immunofluorescence and ScL-70 antibodies, he was diagnosed as a case of diffuse cutaneous systemic sclerosis. In addition, the patient had plaques of localized morphea, en coup de sabre with facial hemiatrophy on the left side, and mild aortic regurgitation (detected on echocardiography). The occurrence of these rare associations of localized plaques of morphea, en coup de sabre and aortic regurgitation in a single case of systemic sclerosis is quite an exceptional and interesting occurrence.

Malignant change after 18 months in a lower limb ulcer: acute Marjolin's revisited

Lower limb ulcers present a common clinical problem and are at risk of malignant change. A Marjolin's ulcer has traditionally been regarded as malignant change in a long standing ulcer and/or scar tissue. We report a case of Marjolin's degeneration that developed in an ulcer only 18 months following the initial injury. Such a short latent period has not been reported for over 70 years. This report highlights the possibility of early Marjolin's change and we propose a ranked diagnostic screen to aid in early identification of possible malignant change, based on the current published evidence.

A serological study of intrafamilial spread from patients with sporadic hepatitis E virus infection

Intrafamilial transmission is rare in epidemic hepatitis E; its frequency in sporadic hepatitis E is not known. We followed up 86 household contacts (age range 4-75 years, mean +/- SD 32.4 +/- 15.8; 49 males), who were family members of patients with acute sporadic hepatitis E. Of the 86 contacts, 68 (79%) tested negative for IgG anti-hepatitis E virus antibodies. Four (4.7%) had IgM anti-hepatitis E virus antibodies at the time of diagnosis of hepatitis E in the index case; two of these contacts possibly had hepatitis E virus infection acquired simultaneously with that in the index case, and two could have had intrafamilial transmission. None developed serological evidence of hepatitis E virus infection over a period of 49 +/- 18 days after the diagnosis of index case, although a majority lacked IgG antibodies to hepatitis E virus and were likely to be susceptible. This suggests that person-to-person transmission is uncommon in sporadic hepatitis E.

Insecticidal activity of the plant Phyllanthus amarus against Tribolium castaneum

The plant Phyllanthus amarus is used as folk medicine since the year 1800 and has been established for its important medicinal properties particularly for liver ailments. The present communication explores the insecticidal activity of ethanolic extract of aerial and root parts of this plant against stored grain pest Tribolium castaneum. LC 50 values of ethanolic aerial part were 895.77, 473.91, 279.89 and 260.85 microg/cm2, while 512.62, 376.96, 248.88 and 209.79 microg/cm2 for ethanolic root part at the exposure of 3, 5, 7, 9 and 11 days respectively. Ethanolic root extract possessed significant insecticidal activity against T. castaneum.

Influence of continuous light and darkness on the secretory pinealocytes of Heteropneustes fossilis

In an earlier study on Heteropneustes fossilis, evidence of secretory activity in the pinealocytes had been demonstrated at the electron microscopic (EM) level and it was found to exist in two phases: a secretory phase (light cells) and a storage phase (dark cells). In the present investigation, H. fossilis was subjected to artificial photoperiods of continuous illumination and continuous darkness for a period of ten days and the effect on the secretory pinealocytes was studied at the EM level. Marked results were observed within the short period of ten days emphasizing the role of environmental photoperiod on the secretory activity of the pinealocytes. During continuous illuminated phase, both light and dark cells were observed: the light cells showed intense secretory activity and dark cells a storage one. During the dark phase both types of cells were present but in different metabolic states and neither of the cells demonstrated synthetic nor storage activity. Light cells were metabolically active but not secretory active and dark cells showed a necrotic condition. Phagocytotic activity of the dark cells was also seen. Intense neural activity was also observed during exposure to both the artificial photoperiods. The results highlight the role of light on the secretory activities of the pinealocytes of the catfish pineal organ.

Die Technik der tibiotalaren Arthrodese mit Kompressionsmarknagel

Tibiotalar arthrodesis still remains the primary choice of treatment for disabling ankle arthropathy since the results of ankle arthroplasty are not yet convincing. Numerous operative techniques have been described, with an increasing trend towards the use of internal fixation and compression. Using an intramedullary compression nailing technique, 137 tibiotalar fusions were performed at our hospital. The special design of the nail allows distal interlocking in the talus and dynamic axial compression with high primary stability. With correct joint axis, only the cartilage joint surfaces were removed. For axis correction the corresponding bony joint surfaces were also resected. We also performed a dowel technique with bone grafting from the lateral malleolus. We examined 110 of the 137 patients during follow-up. A primary union could be achieved in 99 cases (90.0%). A further six cases (5.5%) healed after recompression and bone grafting. Nonunion remained in five cases (4.5%). Operative complications included one tibial shaft fracture and one hematoma. Septic complications were three superficial and eight deep infections. Sufficient pain relief after arthrodesis was reported by 70 (63.6%) patients; in 37 (33.6%) patients the symptoms remained unchanged and 3 (2.7%) patients found their pain to be worse than before the procedure. Intramedullary compression nailing is shown to be an effective technique for tibiotalar arthrodesis in severe ankle arthropathy. The main advantages of the technique are limited soft tissue damage in the ankle area and high primary stability allowing early weight bearing.

Protection by live Mycobacterium habana vaccine against Mycobacterium tuberculosis H37Rv challenge in mice

BACKGROUND & OBJECTIVES

In recent years the efficacy of BCG vaccine against tuberculosis has been questioned and there is no alternative vaccine available. Several strategies are being applied to get a satisfactory vaccine. Two approaches are generally considered: the subunit vaccines and the whole cell vaccines. The objective of this investigation was to evaluate an avirulent mycobacteria, Mycobacterium habana, as a whole cell vaccine to protect mice from infection of M. tuberculosis H37Rv.

METHODS

AKR and immunocompromised SJL/J mice were immunized with live M. habana vaccine. These mice were challenged with M. tuberculosis H37Rv eight weeks later along with unimmunized control mice. Protection by M. habana vaccine was measured through several parameters, which included survival of challenged mice, dissemination of challenge strain and histopathology of lung tissues.

RESULTS

M. habana vaccinated animals were healthier than the unvaccinated mice after challenge with M. tuberculosis and survived with significant increase in mean survival time. The viable count of challenge strain was at least 100-fold less in vaccinated mice than the control mice. The lung tissues in unvaccinated mice showed marked bronchopneumonia with clusters of acid fast bacilli, whereas vaccinated mice showed small areas of damage and evidence of protection subsequently.

INTERPRETATION & CONCLUSION

It may be concluded from the evidence presented here that mice vaccinated with M. habana were protected from challenge with M. tuberculosis in both normal and immunocompromised states.

Persistent chlorinated pesticides and intra-uterine foetal growth retardation: a possible association

OBJECTIVE

To examine the association between DDT (dichlorodiphenyl trichloroethane) and HCH (hexachlorocyclohexane) exposure and intra-uterine growth retardation (IUGR, <10th percentile of birth weight for gestational age).

METHOD

We detected p,p'-DDT, o,p'-DDT, p,p'-DDD, p,p'-DDE and alpha-HCH, beta-HCH, gamma-HCH, delta-HCH in maternal blood, placenta and cord blood, collected at parturition, from mothers with IUGR babies ( n=30) and from those with babies of normal weight ( n=24), using gas-liquid chromatography equipped with electron capture detector ((63)Ni). The adjusted odds ratios (ORs) for these pesticides in mothers and infants were determined by multiple logistic regression.

RESULTS

There were statistically significant associations ( P<0.05) between maternal blood levels of alpha-HCH (OR=1.22; 95% CI: 1.02-1.46), gamma-HCH (OR=1.38; 95%CI: 1.05-1.80), delta-HCH (OR=1.61; 95% CI: 1.01-2.54), total HCH (OR=1.07; 95% CI: 1.01-1.13) and p,p'-DDE (OR=1.21; 95%CI:1.03-1.42) and IUGR after adjustment for potential confounders. Also, significant association (P<0.05) between cord blood levels of gamma-HCH (OR=1.14; 95% CI: 1.00-1.31), delta-HCH (OR=1.31; 95% CI: 1.00-1.75), total HCH (OR=1.07; 95% CI: 1.00-1.14) and IUGR were found after adjustment for potential confounders. A significant negative correlation between body weight of newborn babies and p,p'-DDE in maternal blood (r= -0.25; P<0.05) and delta-HCH and p,p'-DDE in the cord blood (r= -0.27 and -0.26; P<0.05) was noticed after gestational age had been accounted for.

CONCLUSION

Exposure of pregnant women to organochlorine pesticides may increase the risk of IUGR, which is a contributing factor for infant mortality in India.

Antifungal activity of Boerhavia diffusa against some dermatophytic species of Microsporum

Various extracts petroleum ether, chloroform, ethyl acetate and ethyl alcohol) of aerial and root parts of Boerhavia diffusa was sereened for Antitungal activity (Inhibition in sporulation) against dermatophytic fungi Microsporum gypseum, M. fulvum and M. canis by using broth dilution method. Extracts of aerial part not show any noticeable antifungal activity. Ethyl acetate extract of root part of the plant was found to be most effective of against target fungal species. The maximum inhibition of mycelial growth was observed for M. gypseum (78.83%) followed by M. fulvum (62.33%) and M. canis (42.30%) of ethyl acetate in the test concentration of 1000 microg/ml 24 hours of incubation. The sporulation of target fungal species decreases with increasing supplementation of phytoextract, confirms the presence of some antifungal phytochemical moiety in roots of the plant.

Two morphological types of pineal window in catfish in relation to photophase and scotophase activity: a morphological and experimental study

The pineal window is a transparent/translucent pineal covering on the dorsal surface of the cranium of certain fishes and is associated with light reactions of fish. In the present study, catfish species Clarias batrachus, Heteropneustes fossilis, Mystus vittatus, M. seenghala, and M. cavassius were examined for the type of pineal window present. Two morphologically different types of pineal window were found: an opaque-looking pineal window in C. batrachus and H. fossilis and a translucent type of pineal window in M. vittatus, M. seenghala, and M. cavassius. The distributional pattern of pigments in the melanophores at the pineal window were studied in terms of Melanophore Index (MI). In all of the species studied, a pineal foramen, a subepidermal lens-like tissue, and pineal end vesicle were present. Experiments were carried out on catfish having the opaque pineal window, as it is uncommon in catfish. Catfish with normal and shielded pineal window were exposed to conditions of artificial constant illumination (LL) and darkness (DD) to evaluate the effects of altered photoperiods on the state of pigmentation of melanophores at the pineal window. Recordings of diel activity patterns, which are light dependent in catfish, were carried out under both natural and artificial photoperiods in fish with a normal or shielded window in order to assess its functional nature. The existence of two morphologically and functionally different types of pineal window in a relatively closely related group of catfish has been demonstrated in this study. The nature of the opaque type of pineal window has been reconsidered based on new experimental evidence.

Differential organization of a LINE-1 family in Indian pygmy field mice

Southern blot hybridization analysis of genomic DNAs digested with restriction endonuclease EcoR I and Ava II from Mus musculus domesticus, Mus booduga and Mus terricolor with a cloned repetitive DNA fragment of Mus booduga as a probe showed difference in restriction pattern of this DNA in these three species. Further Southern analysis of the BamH I digested genomic DNAs from these species hybridized with cloned DNA fragment as a probe and sequencing of the cloned DNA revealed that this 252 bp cloned DNA fragment is a part of BamHI repeat element of genus Mus and is 87% homologous to the contiguous portion of the Mus musculus domesticus LINE-1 element. The species specific fragment pattern generated by different restriction endonucleases using this DNA as a probe revealed difference in the organization of LINE-1 repetitive element in the three species of genus Mus.

Environmental exposure to lead as a risk for prostate cancer

OBJECTIVE

To evaluate the possible role of environmental exposure to lead as a risk factor for prostate pathology in patients suffering from prostate cancer (PCA) and benign prostate hyperplasia (BPH).

METHODS

Blood lead (BPb) level was determined in PCA and BPH cases using a graphite furnace Atomic Absorption Spectrophotometer and compared with those in a control group living in the similar socioeconomic environment.

RESULTS

BPb was significantly higher in PCA and BPH cases than in normals (P < 0.05). Blood levels of zinc and copper were significantly lower in PCA and BPH cases when compared with controls (P < 0.05). In all the three groups, a statistically significant positive correlation between lead and thiobarbituric acid reactive substances (TBARS) measured as malondialdehyde, and negative correlation between blood lead and antioxidant GSH level, indicative of possible generation of reactive oxygen species, were also observed after adjusting for age as a possible confounders. However, positive association between blood lead and TBARS was relatively higher in PCA patients (r = 0.77, P < 0.05) than in BPH (r = 0.32, P < 0.05) and normal (r = 0.30, P < 0.05).

CONCLUSION

These results with limited power seem to suggest for the first time that environmental exposure of aging males to lead may be a risk factor for prostate cancer and/or benign prostate hyperplasia possibly through generation of reactive oxygen species and/or reducing the level of zinc which acts as a cellular growth protector.

Green tea (Camellia sinensis) protects against selenite-induced oxidative stress in experimental cataractogenesis

Cataract is the leading cause of blindness worldwide. It is a multifactorial disease primarily associated with oxidative stress produced by free radicals. The protection offered by various antioxidants in cataract development is well established. Polyphenolic compounds present in green tea (Camellia sinensis) are reported to possess antioxidant property in various pathological conditions. The present study was undertaken to evaluate the anticataract potential of green tea leaf (GTL) extract in the development of lens opacification. Enucleated rat lenses were randomly divided into normal, control and treated groups and incubated for 24 h at 37 degrees C. Oxidative stress was induced by sodium selenite in the culture medium of the two groups (except the normal group). The medium of the treated group was additionally supplemented with GTL extract. After incubation, lenses were subjected to glutathione and malondialdehyde estimation. Enzyme activity of superoxide dismutase, catalase and glutathione peroxidase was also measured in different sets of the experiment. In vivo cataract was induced in 9-day-old rat pups of both control and treated groups by a single subcutaneous injection of sodium selenite. The treated pups were injected GTL extract intraperitoneally prior to selenite challenge and continued for 2 consecutive days thereafter. Cataract incidence was evaluated on 16th postnatal day by slit lamp examination. There was positive modulation of biochemical parameters in the organ culture study. Green tea was also found to reduce the incidence of selenite cataract in vivo. The results suggest that green tea possesses significant anticataract potential and acts primarily by preserving the antioxidant defense system.

Reversal of lead-induced oxidative stress by chelating agent, antioxidant, or their combination in the rat

The influence of N-acetyl cysteine (NAC), an antioxidant, on the therapeutic efficacy of meso-2,3-dimercaptosuccinic acid (DMSA), a hydrophilic, and its ester, monoisoamyl 2,3-dimercaptosuccinate (MiADMS), a lipophilic, both soft tissue lead mobilizers, was investigated in lead-preexposed rats. The subsequent treatment of lead-exposed animals with DMSA, MiADMS, or NAC reversed the lead-induced alterations in blood delta-aminolevulinic acid dehydratase, catalase, malondialdehyde (MDA), reduced glutathione, oxidized glutathione, and brain MDA levels. The combined treatment with DMSA and NAC was more effective than that with MiADMS and NAC in enhancing the restoration of all these parameters indicative of lead-induced oxidative stress. These reversals were consistent with the lead-removing ability of DMSA and MiADMS but not that of NAC. As the reversal of these parameters by NAC was independent of its lead-mobilizing capability, this ought to be mainly due to its strong antioxidant property. The increase in blood and brain zinc levels upon lead exposure appears to be the result of the redistribution of endogenous zinc due to lead. Subsequent treatment with DMSA, MiADMS, NAC, or their combination decreased the brain zinc as its excretable complexes with a transient increase in blood zinc level. The ideal treatment of lead poisoning seems to be a combination of a lead chelator and an antioxidant.

Solution conformation of a rationally designed nonapeptide

Partial 'turn-helix' type modules comprised of LD and DL chiral beta-turns serving as potential helix nucleators have been connected with a view to designing a nascent 'helix-turn-helix' type structure. Conformation of the resultant peptide Boc-(D)Glu-Ala-Aib-Lys-Val-Pro-(D)Asp-Leu-Leu-NHMe has been described in both DMSO and water.