Pitfalls in comparison of coronary artery measurements of Indian population with different geographical area studies

Introduction

Coronary artery disease (CAD) is the most common cause of morbidity and mortality especially in the developing countries. Coronary artery measurements (CAM) are the most important factor affecting the procedure and outcome of coronary angioplasty (PCI) as well as coronary by-pass operations (CABG). In this study, we aimed to establish a database for the normal CAM as well as for gender difference among the Indian population using quantitative coronary angiography (QCA) with an objective of assessing normal coronary vessel morphology of patients with normal coronaries.

Materials and methods

Four thousand angiograms from patients of Indian origin were studied prospectively after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study.

Results

Ten segments from right and left coronary arteries were taken for diameter measurements. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m² BSA). Among, 4000 patients, 933(23.3%) [M:F-521:412] had normal coronaries and 3067 (76.7%) were diseased.

Discussion and conclusion

The dimensions of the coronary artery segments of Indians were smaller (in BSA indexed and non-indexed data), compared to studies from other continents which can be due to their smaller BSA.

VARIATIONS OF FORAMEN TRANSVERSARIUM IN ATLAS VERTEBRAE : A MORPHOLOGICAL STUDY WITH ITS CLINICAL SIGNIFICANCE

Introduction: The second part of the vertebral artery along with vertebral venous plexus and sympathetic plexus traverses through vicinity of foramen transversarium of atlas. Derangement of these structures in their course may be seen due to deformities, narrowing and presence of osteophytes in foramen transversarium.

Methods: Two hundred foramen transversarium of 100 atlas vertebrae were grossly studied for their variations.

Results: Out of hundred atlas vertebrae examined, we found that all the vertebrae had foramina transversaria. Absence of costal element was noticed in five atlas vertebrae. 2 of the vertebrae showed incomplete unilateral foramen transversarium, 3 vertebrae showed bilateral incomplete foramen, In 1 vertebra along with normal foramen transversarium, complete retroarticular foramen was observed on the left side and incomplete retroarticular foramen observed on the right side of the posterior arch.4 vertebrae showed incomplete retroarticular foramen.

Conclusion: The increasing incidence of neck injuries and related syndromes necessitates the study of bony variations of the atlas vertebra and its transverse foramina. Due to the incomplete formation of the foramen transversarium the second part of vertebral artery is prone to be damaged easily during posterior cervical injuries and Surgeries. The bony bridges embracing the vertebral artery may be responsible for vertigo and cerebrovascular accidents hence the knowledge of such variations is important for Physicians, Otirhinolaryngologists, neurologists ,Orthopaedicians and Radiologists.

Topography of diaphyseal nutrient foramina of femora and their implications in bone grafting

Background : Long bones derive their nutrition through a nutrient artery that enters the bone through a foramen in its diaphysis. An orthopedic surgeon must be familiar with the topography of the nutrient foramina to avoid vascular compromise during surgery. Aim :This study attempts to analyze the topography of primary nutrient foramina of femora. Materials and method : One hundred dry adult femora were used for this study. The primary diaphyseal nutrient foramina were identified macroscopically using hand lens. The number of foramina and their position were noted and the foramina! index was calculated. Results : It was observed that 79% of femora had single primary nutrient foramen, 20% had double foramina and I% had three foramina. All the foramina were located between 30.8%-89.6% of total length of femur. 11.47 % of foramina were in the upper third, 1.64% in the lower third and the majority 86.88% of foramina were in the middle third of femur. The mean foramina!index was 46.01. 82.78% of foramina were located on the linea aspera, 14.75% on the medial surface and2.46% on the lateral surface. Conclusion : An orthopedic surgeon operating on femur must be careful in the middle 1/3rd, especially over the linea aspera as majority of primary diaphyseal foramina were observed in this region. A cogent knowledge of vascular topography ensures preservation of vasculature of the bone during surgeries. This enables rapid healing of surgical wound increasing the success rates of fracture fixation, bone grafting, vascularized microscopic surgeries and hip and knee replacement procedures.

Binary logistic regression analysis of hard palate dimensions for sexing human crania

Sex determination is the preliminary step in every forensic investigation and the hard palate assumes significance in cranial sexing in cases involving burns and explosions due to its resistant nature and secluded location. This study analyzes the sexing potential of incisive foramen to posterior nasal spine length, palatine process of maxilla length, horizontal plate of palatine bone length and transverse length between the greater palatine foramina. The study deviates from the conventional method of measuring the maxillo-alveolar length and breadth as the dimensions considered in this study are more heat resistant and useful in situations with damaged alveolar margins. The study involves 50 male and 50 female adult dry skulls of Indian ethnic group. The dimensions measured were statistically analyzed using Student's t test, binary logistic regression and receiver operating characteristic curve. It was observed that the incisive foramen to posterior nasal spine length is a definite sex marker with sex predictability of 87.2%. The palatine process of maxilla length with 66.8% sex predictability and the horizontal plate of palatine bone length with 71.9% sex predictability cannot be relied upon as definite sex markers. The transverse length between the greater palatine foramina is statistically insignificant in sexing crania (P=0.318). Considering a significant overlap of values in both the sexes the palatal dimensions singularly cannot be relied upon for sexing. Nevertheless, considering the high sex predictability of incisive foramen to posterior nasal spine length this dimension can definitely be used to supplement other sexing evidence available to precisely conclude the cranial sex.

Variation in the origin of right obturator artery - A case report

Most commonly, the Obturator artery arises from the anterior trunk of internal iliac artery. However, origin of the Obturator artery from external iliac artery was reported at 25% by Missankov et al. [3], 1.1% by Bergman et al. [1], 1.3% by Jakubowicz and Czerniawska- Grzesinska [2].Due to its high frequency of variations in course and origin, Obturator artery had drawn the attention of anatomists, surgeons and radiologists. In this case report, we are presenting an anomalous origin of right Obturator artery from right external iliac artery. The knowledge of this variation is important anatomically, radiologically and surgically.

FINGERPRINT PATTERN CHARACTERISTICS OF INTELLECTUALLY DISABLED CHILDREN - AN ORIGINAL STUDY

Fingerprint patterns are unique patterns made by friction ridges and furrows present on the pads of finger tips. Uniqueness and persistence are the two underlying features of fingerprint patterns. Aim of this present study was to determine the differences in the incidence of fingerprint patterns in intellectually disabled children compared to normal healthy children. Intellectual disability is a generalized disorder appearing before adulthood and is characterized by limitations in both intellectual functioning and in adaptive behavior. The present study comprising of 120 students (60 intellectually disabled and 60 controls) was carried out in Pediatrics outpatient department, Yenepoya Medical College and Hospital, Mangalore. The incidence of the four fingerprint patterns (Ulnar loop, Radial loop, Whorls and Arches) were determined in both the groups. Ulnar loop pattern had the highest incidence in both the groups and the least incidence was shown by arch pattern. There exists difference in the frequency of the fingerprint patterns in males and females of both the groups. The study was conducted to observe for any difference in the incidence of fingerprint patterns between intellectually disabled and normal children.

PARTIALY FUSED SPLENIC LOBULE- A CASE REPORT

Spleen is the largest lymphatic organ in humans. It is situated in the left hypochondrium and partly in the epigastrium, between the fundus of the stomach and the diaphragm. It consists of large encapsulated mass of lymphoid and vascular tissues (1). We encountered a case of partially fused splenic lobule in the anterior end with attachment to the main splenic mass through a stalk of splenic tissue. As such, the variation of this kind is rare and had various important clinical implications in the field of surgery, radio diagnosis and gastroenterology.

Enhancement of Hippocampal CA3 Neuronal Dendritic Arborization by Glycyrrhiza glabra root extract Treatment in Wistar Albino Rats

Background:

In the traditional system of medicine, the roots and rhizomes of Glycyrrhiza glabra (Gg) (family: Leguminosae) have been in clinical use for centuries.

Aim:

In the present study, we investigated the role of aqueous extract of root of Gg treatment on the dendritic morphology of hippocampal Cornu Ammonis area three (CA3) neurons, one of the regions concerned with learning and memory, in 1- month- old male Wistar albino rats.

Materials and Methods:

The aqueous extract of root of Gg was administered orally in four doses (75, 150, 225 and 300 mg/kg) for 4 weeks. After the treatment period, all experimental animals were subjected to spatial learning (Morris water maze, Hebb-William's maze and elevated plus maze) tests. At the end of the spatial memory tests, the rats were deeply anesthetized with Pentobarbitone and killed their brains were removed rapidly and fixed in rapid Golgi fixative. Hippocampal CA3 neurons were traced using camera lucida, and dendritic arborization and intersections were quantified. These data were compared to those of age-matched control rats.

Results:

The aqueous root extract of Gg in the dose of 150 and 225 mg/kg/p.o showed a significant (P < 0.01) enhancement of dendritic arborization (dendritic branching points) and dendritic intersections along the length of both apical and basal dendrites in hippocampal (CA3) pyramidal neurons is comparable to control.

Conclusion:

Based on our results obtained, we conclude that constituents present in aqueous root extract of Gg have neuronal dendritic growth stimulating properties.

Beneficial effect of aqueous root extract of Glycyrrhiza glabra on learning and memory using different behavioral models: An experimental study

Background:

In the traditional system of medicine, the roots and rhizomes of Glycyrrhiza glabra (Gg) (family: Leguminosae) have been studied for their ability to improve a variety of health ailments.

Aims:

The present study was designed to investigate the beneficial effects of Gg root extract on learning and memory in 1-month-old male Wistar albino rats. Four doses (75, 150, 225, and 300 mg/kg) of aqueous extract of root of Gg was administered orally for six successive weeks.

Materials and Methods:

The aqueous extracts were evaluated for their effect on spatial learning and memory in rats using the elevated plus maze, Hebb–William maze, and Morris water maze tests which served as the exteroceptive behavioral model. Diazepam-induced amnesia served as the interoceptive behavioral model.

Results:

Results showed that all the doses of aqueous root extract of Gg significantly enhanced the memory; however, in the doses of 150 and 225 mg/kg, it showed a significant (P < 0.01) enhancement in learning and memory. Furthermore, Diazepam-induced amnesia was reversed by the aqueous root extract of Gg (150 and 225 mg/kg, p.o.).

Conclusion:

These findings suggest that the memory enhancement effects of Gg may be mediated by its antioxidant and anti-inflammatory activities. Thus, Gg appears to be a promising drug for improving memory in the management of impaired learning, dementia, Alzheimer's disease, and other neurodegenerative disorders.

Sexual dimorphism of the craniofacial region in a South Indian population

INTRODUCTION

To the best of our knowledge, the sexually dimorphic characteristics of the craniofacial region among the South Indian population are not available in the current literature. We aimed to determine these characteristics using discriminant function analysis.

METHODS

A total of 80 recent skulls (40 male, 40 female) from the Department of Anatomy, Yenepoya Medical College, Yenepoya University, Karnataka, India, were analysed. Ten craniofacial parameters were measured and subjected to univariate and multivariate statistical analyses using the Statistical Package for the Social Sciences version 13.0.

RESULTS

Statistical analyses revealed that the differences in the bizygomatic, orbital and biorbital breadths of males and females were significant (p < 0.05). Direct method gave an accuracy of 68.8% for sex determination. In stepwise analysis, bizygomatic breadth and upper facial height were selected, giving a 65.0% accuracy for sex prediction.

CONCLUSION

Craniofacial parameters are sexually dimorphic. The present study established several features of craniofacial morphometry that can be used for sex determination among the South Indian population. The findings of the present study serve as a foundation for future studies that aim to compare craniofacial parameters among various ethnic groups in South India.

IN VITRO FREE RADICAL SCAVENGING ACTIVITY OF BAUHINIA RACEMOSA

In vitro free radical scavenging activity of aqueous and ethanolic bark extracts of Bauhinia racemosa was assessed by studying its ability to scavenge DPPH, Nitric oxide, hydroxyl radical and reducing power. Both the extracts showed effective free radical scavenging activity. Ethanolic extract was comparatively more potential than aqueous extract. The results support its traditional use in various ailments and as a source of natural antioxidants which protect cells against oxidative stress.

MULTIPLE BILATERAL ANOMALIES OF CAROTID ARTERIES - A CASE REPORT

Anatomical variations of carotid arterial system which are not infrequently encountered have a great impact on the surgical approaches of the neck. Although the described individual variations of the carotid arteries are well-known in the literature, the combination of anomalies reported in this case has not been, to the best of our knowledge, previously described. We present a rare case of high bifurcation of the common carotid artery, unusual tortuosity (''S”-shape) of the common carotid and external carotid arteries, anomalous origin of the superior thyroid artery and linguofacial trunk on both sides. The anomalies in the present case were compared with those reported before. The embryogenesis of such a combination of anomalies is not clear, but the anatomic consequences may have important clinical implications.

A STUDY ON MORPHOLOGY OF THE BICEPS BRACHII MUSCLE

The anatomical variations and abnormalities of the muscles of the upper limb have become significant because of new imaging techniques, such as computed tomography and magnetic resonance imaging. Among the three muscles of the anterior compartment of the arm, a very uncommon anomaly of the biceps is having three or more heads. Knowledge of the existence of the three headed or four headed biceps brachii may become significant in preoperative diagnosis and during surgery of the upper limb. The present study was undertaken to observe the anomalous origin, insertion and the incidence of three or more heads biceps brachii in the adult human cadavers. This study was carried out on 24 human cadavers at Dr. Pinnamaneni Siddhartha institute of medical sciences & research foundation (Dr. PSIMS & R.F) Gannavaram; Krishna Dist; A.P. Variant biceps brachii may cause compression of neurovascular structures because of their close relationship to brachial artery and median nerve. The surgeons and traumatologists have to keep such muscular variations in mind.

RADIO ULNAR SYNOSTOSIS: A CASE REPORT

Congenital radio-ulnar synostosis is caused by a failure of segmentation between the radius and ulna. It occurs rarely, with approximately 350 cases reported. Congenital radioulnar synostosis is equally affected in males and females with half of patients showing bilateral involvement. While most cases of congenital radio-ulnar synostosis occur spontaneously around one in five cases is associated with a family history of the same affliction. This condition can also occur as part of an underlying syndrome or in association with other developmental abnormalities. Congenital radio ulnar synostosis is diagnosed by clinicians through medical history and careful physical examination. X-rays or CT scans are be used to confirm the deformity. The diagnosis of congenital radio-ulnar synostosis is more often made in late childhood or at adolescence, as pain is rarely a complaint and much mobility of elbow flexion and extension preserved. In relatively mild cases, when patients themselves may notice subtle limitations or differences in forearm rotation the diagnosis is typically made at an earlier age.

The mendosal suture of the occipital bone: occurrence in Indian population, embryology and clinical significance

The occipital bone is ontogenetically and functionally unique when compared to the other bones of the skull in humans and other mammalian cousins. The occipital bone develops from six ossification centers; any defect in the ossification process will give rise to mendosal suture (accessory suture) and conditions like posterior plagiocephaly. There is a paucity of literature regarding the mendosal suture and further more, its report in Indian population is not known. The present study was conducted to find out the occurrence of mendosal suture in the Indian dry skulls. Fifteen specimens (3%) were found to have these sutures out of five hundred (500) skulls examined. Nine (3.1%) samples are of male skulls out of two hundred ninety (290) and six (2.85%) samples are that of female skulls out of two hundred ten (210). The mendosal suture ran close to the superior nuchal line in all specimens and traveled medially from the lambdoidal suture. The length of the sutures ranged from 0.8 cm to 2.6 cm (1.88 cm) on the right side and 1.4 cm to 2.9 cm (1.94 cm) on the left side respectively in male skulls; and 0.7 cm to 2.8 cm (1.55 cm) on the right side and 1 cm to 2.4 cm (1.42 cm) on the left side, respectively, in female skulls. The origin of mendosal suture from the lambdoidal suture was 5.7 cm to -6.3 cm (5.98 cm) from the tip of the mastoid process on the right side and 5.6 to -6.3 cm (6 cm) on the left side, respectively, in male skulls; and 5.4 cm to -5.8 cm (5.58 cm) on the right side and 5.4 cm to -5.6 cm on the left side respectively in female skulls. The occurrence and clinical significance of the present study is discussed.