The effects of COVID-19 on placental morphology.

The impact of the COVID-19 infection, caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during the pandemic has been considerably more severe in pregnant women than non-pregnant women. Therefore, a review detailing the morphological alterations and physiological changes associated with COVID-19 during pregnancy and the effect that these changes have on the feto-placental unit is of high priority. This knowledge is crucial for these mothers, their babies and clinicians to ensure a healthy life post-pandemic. Hence, we review the placental morphological changes due to COVID-19 to enhance the general understanding of how pregnant mothers, their placentas and unborn children may have been affected by this pandemic. Based on current literature, we deduced that COVID-19 pregnancies were oxygen deficient, which could further result in other pregnancy-related complications like preeclampsia and IUGR. Therefore, we present an up-to-date review of the COVID-19 pathophysiological implications on the placenta, covering the function of the placenta in COVID-19, the effects of this virus on the placenta, its functions and its link to other gestational complications. Furthermore, we highlight the possible effects of COVID-19 therapeutic interventions on pregnant mothers and their unborn children. Based on the literature, we strongly suggest that consistent surveillance for the mothers and infants from COVID-19 pregnancies be prioritised in the future. Though the pandemic is now in the past, its effects are long-term, necessitating the monitoring of clinical manifestations in the near future.

Ophthalmic artery arising from the external carotid artery system: the middle meningeal artery in South African patients.

BACKGROUND: The ophthalmic artery is the first branch of the internal carotid artery. It arises from the supraclinoid segment of the internal carotid artery within the subarachnoid space and enters the orbit via the optic canal. However, due to complex embryogenesis, the ophthalmic artery can arise from different parts of the internal carotid artery or the distal branches of the external carotid artery. This is usually associated with a variation in the course of the ophthalmic artery through the superior orbital fissure instead of coursing through the optic canal. The ophthalmic artery and its branches vascularise the eyeball and its contents. Consequently, information about its morphologic variation is essential for treating clinical conditions such as central retinal artery occlusion, retinoblastoma chemoembolization, and ophthalmic artery aneurysm. CASE PRESENTATION: We report on two cases of the ophthalmic artery arising from the middle meningeal artery in one adult (33-year-old Indian female) and one pediatric (2-year-old African male) South African patient examined by digital subtraction angiography. The patients were diagnosed with arteriovenous malformations and bilateral retinoblastoma, respectively. CONCLUSIONS: The ophthalmic artery plays a vital role in vision generation. Thus, its anatomy is of clinical interest to neurosurgeons, ophthalmologists, and interventional radiologists.

Right vertebral artery arising from the right common carotid artery with an absent brachiocephalic trunk.

The right and left vertebral arteries are the first branches of the ipsilateral subclavian arteries. However, in the presence of anatomical variation due to complex embryogenesis, the vertebral artery can arise directly from the aortic arch or any of its major branches. The atypical origin of the vertebral artery is commonly associated with the left vertebral artery. Anatomical variation in the origin of the right vertebral artery is rare. Most available reports are case reports from international studies. We report on a case of right vertebral artery arising from the ipsilateral common carotid artery with an absent brachiocephalic trunk in a South African patient examined by digital subtraction angiography. Reports on anatomical variations are of diagnostic importance prior to surgical interventions or endovascular treatment of cerebrovascular diseases such as cerebral aneurysms and arteriovenous malformations.

Fenestration of the vertebrobasilar junction detected with multidetector computed tomography angiography.

The complex embryonic origin of the vertebrobasilar system may result in a wide range of anatomical variations. It has been hypothesized that the formation of fenestrations are likely to occur due to the failure of regression of the bridging arteries that connect the longitudinal neural arteries during embryogenesis. Fenestration of the vertebrobasilar system is a rare anatomical variation that involves a luminal division of the artery, that has a single origin into two separate and parallel channels which are rejoined distally. Fenestrations are important anatomical variants in patients undergoing endovascular and invasive intracranial interventions. Vascular fenestration has been associated with aneurysms, arteriovenous malformations, neuralgia, and vertebrobasilar ischaemia. We report on 3 cases of fenestration at the vertebrobasilar junction in 1 female and 2 male patients, respectively, using multidetector computed tomography angiography. The length of the fenestrated segment of the artery measured 4.41 mm, 3.90 mm, and 5.90 mm, respectively in the patients. Our report is clinically important as the presence of this anatomical variation may influence the management of cervical and intracranial pathologies. Increased awareness of the prevalence of anatomic variations contributes to the advancement of noninvasive imaging capabilities.

Radiological anatomy of the intracranial vertebral artery in a select South African cohort of patients.

The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and Caucasian) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Understanding the patterns of anatomical variations of the VAs will contribute significantly to the interpretation of ischemic areas and diagnosis of various diseases in the posterior circulatory territory.

An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population.

INTRODUCTION: The most common type of vascular complication during cervical spine surgery is the vertebral artery (VA) injury. The presence of anatomical variation in the artery's morphology has been a significant factor for arterial injury during surgery. Therefore, physicians planning interventions in the craniospinal region need to be aware of the extents of variations. In addition to vascular injury, anatomical variations can predispose to some pathologies in the posterior circulation territory. To provide useful data to interventional radiologists, anatomists, and surgeons, we evaluated the anatomical features of the V1 and V2 segments of the VA in a South African population. MATERIALS AND METHODS: The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian and White) who had undergone computed tomography angiography (CTA) from January 2009 to September 2019. RESULTS: The VA exhibited morphological variation in its course. We report the incidence of variant origin of the left VA, all from the aortic arch. Variation in the level of entry into the transverse foramen ranged between C7 and C3. A left dominant pattern was observed; we also report on hypoplasia of the VA. In addition, we report incidence of VA tortuosity at V1, V2 to be 76.6% and 32.1%, respectively. CONCLUSIONS: The baseline data established in this study regarding the diameter, variant origin, and level of entry into the transverse foramen will assist neurosurgeons and interventional radiologists in interpreting, diagnosing, and planning and executing various vascular procedures and treatment of pathology in the vicinity of the VA.

Could COVID-19 Trigger a Rebirth in Anatomy Education? A Glimpse of Anatomists' Responses to Pandemics of the Past and Present.

Pandemics are nothing unusual but indeed lead to devastating effects that play a pivotal role in reshaping human history. The COVID-19 outbreak is currently responsible for major educational crises globally as most of the world has been faced with a mandated lockdown, and forced closure of educational institutions, including medical colleges. Anatomists have therefore been challenged to unlock technology in effort to achieve best deliverables for their discipline, without the use of traditional teaching aids such as the cadaver, osteological banks, prosected specimens, models, and microscopic slides. At present, the virtual classroom is the only option for the anatomist, thereby omitting vital aspects of the hidden curriculum such as ethical-reasoning, empathy, respect, professionalism, interpersonal, and communication skills. As body donations dwindle, the era of teaching in a cadaverless environment is upon us. This marks the beginning of a paradigm shift in education and research for anatomists worldwide. Given the variable pathological-morphological presentation in COVID-19-related deaths, it is also likely that the autopsy component of anatomic pathology will be resuscitated to demystify the underlying mechanisms of the virus. Since COVID-19 may never disappear completely, we would like to recommend that international anatomical societies collectively reach out to statutory bodies to devise a standardized method of teaching anatomy, employing readily available cost-effective resources, in the face of pandemics. However, if anatomy as a discipline has survived a millennium, surely anatomists can fight the "scourges" that have plagued them as various perspectives have been bandied about to welcome in a new normal.

Parietal foramen: incidence and topography.

BACKGROUND: The parietal foramen (PF) is a small inconsistent aperture located at the border of the middle 1/3 and posterior 1/3 of the parietal bone near the sagittal suture and is considered an emissary foramen. Cranial emissary foramina are of utmost importance due to the structures that traverse the foramen. Variations in these foramina are common. Knowledge of the PF is important when performing neurosurgical procedures as the emissary vessels are at risk. MATERIALS AND METHODS: The present study used 100 dry adult calvaria to determine the frequency of PF, the diameter of the PF, as well as topography of the PF (using the sagittal suture as an anatomical landmark). RESULTS: A total of 32% of calvaria had PF present bilaterally; whilst 35% of calvaria had unilateral PF. The study also reports 5% calvaria in which PF were present on the sagittal suture. The mean diameter recorded was 1.55 mm (0.74-3.08 mm), and the mean distance between the lateral margin of the PF and the sagittal suture was 9.02 mm (4.44-18.20 mm). CONCLUSIONS: Knowledge of the incidence and topography of the PF may aid neurosurgeons in creating and adjusting techniques and procedures in order to mitigate the risk of injury to emissary veins and other structures emerging from the PF.

An anthropometric evaluation of the scapula, with emphasis on the coracoid process and glenoid fossa in a South African population.

The exact dimensions of the scapula, including the coracoid process and glenoid fossa, are fundamental in the patho-mechanics of the glenohumeral joint (GHJ); as these structures act as initiators of shoulder movement. The aim of the study was to evaluate the anthropometric parameters of the GHJ, with emphasis on the coracoid process and glenoid fossa. The morphometric (Linear Tools 2012, 0-150mm, LIN 86500963) and morphological parameters of a total of one hundred and sixty-four (n = 164) dry bone scapulae [Right (R): 80; Left (L): 84, Male (M): 68; Female (F): 96] were recorded. Results: (i) Shape of glenoid fossa: Type 1: (R) 16.5%, (L) 11.0%; Male (M) 20.1%, Female (F) 7.3%; Type 2: (R) 14.0%, (L) 15.2%; (M) 18.3%, (F) 11.0%; Type 3: (R) 18.3%, (L) 25.0%; (M) 27.4%, (F) 15.9%. (ii) Notch type: Type 1: (R) 1.7%, (L) 7.3%; (M) 6.7%, (F) 2.4%; Type 2: (R) 47.0%, (L) 43.9%; (M) 59.2%, (F) 31.7%. (iii) Vertical diameter of glenoid fossa (VD) (mm): (R) 35.2 ± 3.1, (L) 34.9 ± 3.0; (M) 35.3 ± 3.2, (F) 34.6 ± 2.8. (iv) Horizontal diameter 1 (HD1) of glenoid fossa (mm): (R) 18.4 ± 3.3, (L) 17.5 ± 2.9; (M) 18.2 ± 3.3, (F) 17.4 ± 2.6. (v) Horizontal diameter 2 (HD2) of glenoid fossa (mm): (R) 24.5 ± 2.9, (L) 23.6 ± 2.6; (M) 24.2 ± 2.7, (F) 23.7 ± 2.8. (vi) Length of coracoid process (CL) (mm): (R) 41.7 ± 4.7, (L) 41.5 ± 4.9; (M) 42.1 ± 4.7, (F) 40.7 ± 4.8. (vii) Width of coracoid process (CW) (mm): (R) 13.3 ± 1.9, (L) 14.2 ± 11.9; (M) 13.1 ± 1.9, (F) 15.1 ± 14.5. (viii) Coracoglenoid distance (CGD) (mm): (R) 27.4 ± 8.3, (L) 28.2 ± 3.5; (M) 28.2 ± 7.4, (F) 27.0 ± 3.4. In the present study, Type 3 (oval) was observed to be the predominant glenoid fossa shape with a higher incidence in male individuals and on the right side. Although only notch Types 1 (without a notch) and 2 (with one notch) were observed in this study, Type 2 (one notch) was the most prevalent, presenting with a significant p-value (p = 0.019), suggesting that notch Type 1 (without a notch) and 2 (with one notch) are common findings in the right and left side of individuals. The findings observed in this study may provide knowledge regarding the role of the coracoid parameters in etiology of subcoracoid impingement while knowledge on the glenoid fossa parameters and variations are essential for evaluation in shoulder arthroplasty for glenoid fractures and anterior dislocations, and for glenoid prosthesis designs for the South African population.

Long head of biceps brachii tendon and transverse humeral ligament morphometry and their associated pathology.

BACKGROUND: As a dynamic stabiliser and flexor of the glenohumeral joint, the long head of the biceps brachii tendon (LHBBT) is further stabilised by the retinacular activities of the transverse humeral ligament (THL). MATERIALS AND METHODS: The LHBBT and THL which were obtained from a total of 40 cadaveric upper limb specimens (n = 80; females: 36, males: 44; right: 40, left: 40), were bilaterally dissected and subjected to morphometric evaluation. RESULTS: The results are in millimetres. LHBBT length: 81.99 ± 21.28 right, 79.73 ± 17.27 left; 79.82 ± 19.66 male, 82.14 ± 19.03 female; LHBBT width: 4.28 ± 1.31 right, 4.67 ± 1.43 left; 4.35 ± 1.17 male, 4.63 ± 1.60 female; THL length: 20.91 ± 5.24 right, 21.19 ± 6.63 left; 21.52 ± 5.71 male, 20.48 ± 5.92 female; THL width: 16.65 ± 6.92 right, 16.63 ± 7.49 left; 16.83 ± 6.65 male, 16.40 ± 7.84 female. With larger LHBBT length observed on the right side and larger LHBBT width observed on the left side; both parameters appeared to be distinctly longer in female individuals. On the contrary, the THL length and width were evidently greater in male individuals, with larger lengths and widths present on the left and right sides respectively. CONCLUSIONS: These findings may contribute to South African literature and to clinical knowledge as these parameters are important in the successful outcomes of tenotomy, tenodesis and shoulder-related procedures.

An anatomical study of the facial artery / Un estudio anatómico de la arteria facial

The facial artery (a branch of the external carotid artery) is the main artery of the face. It gives rise to seven branches viz. inferior labial, superior labial, inferior alar, superior alar, lateral nasal and angular arteries, which are variable. This study included a dissection of twenty embalmed adult cadaveric head and neck specimens. The parameters of origin, branching patterns, termination and variations were analysed and compared with sex and laterality. The facial artery followed the standard anatomical description of origin in 84.62 % of the sample. Variations: (i) origin as a linguofacial trunk in 12.82 % and (ii) high origin in 2.56 % was observed. Male specimens displayed a higher number of linguofacial trunk origins (7.69 %). The branching patterns of the facial artery was classified into six types, with subtypes for Types 1 and 2. Subtype 1-A (standard anatomical description with early termination) occurred in most of the sample (46.15 %). Males were found to have more variations in branching patterns than females (48.72 % and 41.03 % respectively). Termination of the facial artery was as follows: inferior labial artery (5.13 %), superior labial artery (10.26 %), inferior alar artery (10.26 %), superior alar artery (46.15 %), lateral nasal artery (5.13 %), and angular artery (20.51 %). A single case (2.56 %) of an abortive artery was noted. Statistical analysis showed that sex was independent of each parameter observed in this study. Anatomical knowledge of the facial artery is of importance to clinicians and surgeons during procedures such as musculomucosal, island flaps and aesthetic dermatology.

La arteria facial (una rama de la arteria carótida externa) es la arteria principal de la cara. Da lugar a siete ramas: labial inferior, labial superior, alar inferior, alar superior, arterias nasales y angulares laterales, además de ramas pequeñas variables. Este estudio incluyó una disección de veinte muestras de cabeza y cuello de cadáveres adultos fijados. Los parámetros de origen, patrones de ramificación, terminación y variaciones fueron analizados y comparados con el sexo y la lateralidad. La arteria facial se originó de manera normal en el 84,62 % de la muestra. Variaciones: (i) origen como tronco linguofacial en 12.82 % y (ii) se observó un origen alto en 2,56 %. Las muestras en los hombres mostraron un mayor número de orígenes del tronco linguofacial (7,69 %). Los patrones de ramificación de la arteria facial se clasificaron en seis tipos, con subtipos para los Tipos 1 y 2. El subtipo 1-A (descripción anatómica normal con terminación temprana) se observó en (46,15 %) de la muestra. Las muestras de varones tenían una mayor variación en los patrones de ramificación que las muestras de mujeres, 48,72 % y 41,03 % respectivamente. La terminación de la arteria facial fue la siguiente: arteria labial inferior (5,13 %), arteria labial superior (10,26 %), arteria alar inferior (10,26 %), arteria alar superior (46,15 %), arteria nasal lateral (5,13 %) y arteria angular (20,51 %). Se observó un solo caso (2,56 %) de una arteria abortiva. El análisis estadístico mostró que el sexo era independiente de cada parámetro observado en este estudio. El conocimiento anatómico de la arteria facial es importante para los médicos y cirujanos durante procedimientos como colgajos musculomucosal y en la dermatología estética.

Perceptions of South African academic instructors toward the teaching and learning of anatomy.

BACKGROUND: Reflecting on teaching is commonly cited as a fundamental practice for personal and professional development. Educational research into the scholarship of teaching and learning anatomy includes engaging in discipline specific literature on teaching, reflecting on individual teaching methods and communicating these findings to peers. The aim of this paper was to formally assess the opinions of senior anatomy instructors regarding the state of anatomical knowledge at their respective institutions. MATERIALS AND METHODS: An open-ended questionnaire was devised consisting of eight direct questions seeking opinions on anatomy teaching, knowledge, potential educational developments and general thoughts on the teaching of anatomy to medical students. These were distributed to senior Anatomy Faculty (identified by the author by their affiliation with the Anatomical Society of Southern Africa) based at the eight national medical schools within the country. RESULTS AND CONCLUSIONS: A number of key themes emerged. Most senior faculty felt that the standard of medical education at their respective institutions was "good." However, emphasis was also placed on the "quality of teaching" incorporating clinical scenarios. There were also indications that staff are split into those that are keen to do research and those that are happy to provide teaching to medical students as their primary function. Several challenges such as time constraints within the curricula, lack of cadavers to reinforce knowledge and lack of appropriately qualified staff were highlighted. Recommendations included fostering partnerships with both clinicians and medical scientists into the anatomy curriculum thus improving teaching and research.

The morphometry and morphology of the foramen magnum in age and sex determination within the south african black population utilizing computer tomography (CT) scans / Morfometría y morfología del foramen magnum en la determinación de edad y sexo dentro de la población negra sudafricana mediante tomografía computarizada (TC)

SUMMARY: The morphology and morphometry of the foramen magnum aid forensic studies in identifying unknown individuals according to age and sex. Moreover, these parameters of the foramen magnum have clinical relevance to surgeons in the transcondylar approach. This study aimed to analyze the morphometry and morphology in relation to the age and sex of individuals within the South African Black population, utilizing computerized tomography images. The use of computerized tomography images allowed for accurate morphometric diameters using the SLICER 3-D software version 4.7.0. Radiological images also provide a patient's clinical history. Thus, the process of exclusion in respect to patients with pathological conditions of the skull is achieved. The sample studied included 150 computerized tomography images (93 males and 57 females) arranged according to age cohorts (children aged 1-12 years, adolescents aged 13-17 years and adults aged 18-25 years). The morphometric parameters viz. antero-posterior diameter, transverse diameter and area of the foramen magnum was analyzed in relation to age and sex. The morphological variations of the foramen magnum was simultaneously observed between males and females and within the age groups. The objective of this study were to improve data on the morphological and morphometric parameters of the foramen magnum in the South African Black population. This study also attempted to associate the morphological and morphometric parameters of the foramen magnum with age and sex determination.

RESUMEN: La morfología y morfometría del foramen magnum ayuda a los estudios forenses en la identificación de individuos desconocidos según la edad y el sexo. Además, parámetros del foramen magnum tienen relevancia clínica para los cirujanos en el abordaje transcondilar. Este estudio tuvo como objetivo analizar la morfometría y la morfología del foramen magnum, en relación con la edad y el sexo, dentro de la población negra sudafricana, utilizando imágenes de tomografía computarizada. El uso de imágenes de tomografía computarizada permitió definir diámetros morfométricos precisos utilizando el software SLICER 3-D versión 4.7.0. Las imágenes radiológicas también proporcionan antecedentes de la historia clínica de un paciente. De este modo, se logra el proceso de exclusión con respecto a los pacientes con afecciones patológicas del cráneo. La muestra estudiada incluyó 150 imágenes de tomografía computarizada (93 hombres y 57 mujeres) organizadas según cohortes de edad (niños de 1 a 12 años, adolescentes de 13 a 17 años y adultos de 18 a 25 años). Los parámetros morfométricos que se consideraron fueron: diámetro antero-posterior, diámetro transversal y área del foramen magnum. Las variaciones morfológicas del foramen magnum se observaron simultáneamente entre hombres y mujeres y dentro de los grupos de edad. El objetivo de este estudio fue mejorar los datos sobre los parámetros morfológicos y morfométricos del foramen magnum en la población negra sudafricana. Este estudio también intentó asociar los parámetros morfológicos y morfométricos del foramen magnum con la determinación de la edad y el sexo.

The foramen transversarium of typical and atypical cervical vertebrae: morphology and morphometry / El foramen transverso de vértebras cervicales típicas y atípicas: morfología y morfometría

The seven cervical vertebrae found in the human body are classified into typical and atypical vertebrae. Their transverse processes contain foramen transversarium (FT) and traditionally there is one foramen present on each side, of similar size. However, variations of this foramen regarding its shape, size, number, laterality, location and osteometric characteristics have been documented in the literature. This morphological and morphometric study was conducted on 126 cervical vertebrae (82 typical and 44 atypical) obtained from the osteological bank at the University of Kwa-Zulu Natal to produce a database which may serve as a useful guideline to medical personnel. There were variations observed regarding shape, number of FT, laterality and position, which have not previously been reported. The most types of variations were evident in the typical cervical vertebrae, then secondly, the seventh cervical vertebrae. The axis vertebrae did not display any accessory FT or variations.

Las siete vértebras cervicales que se encuentran en el cuerpo humano se clasifican como vértebras típicas y atípicas. Sus procesos transversos presentan un foramen transverso (FT) y normalmente este foramen es de tamaño similar en cada lado. Sin embargo, se han reportado en la literatura variaciones de este foramen, con respecto a su forma, tamaño, número, lateralidad, ubicación y características osteométricas. Este estudio morfológico y morfométrico se realizó en 126 vértebras cervicales (82 típicas y 44 atípicas) obtenidas del banco de Osteología de la Universidad de Kwa-Zulu Natal, para producir una base de datos que pueda servir como una guía útil para el personal médico. Se observaron variaciones con respecto a la forma, el número de FT, la lateralidad y la posición, que no se habían reportado anteriormente. La mayoría de los tipos de variaciones eran evidentes en las vértebras cervicales típicas y en segundo lugar en las séptimas vértebras cervicales. Los axis no mostraron ningún FT accesorio o variaciones.

Post-mortem brain weight reference range for a select South African population / Rango de referencia del peso cerebral post-mortem para una población sudafricana seleccionada

Human brain weight plays a significant role in clinical and forensic settings, as cause of death may affect brain weight; and may be used in the detection of abnormalities associated with neurological disorders. Brain weights are geography specific and incorrect reference ranges may hinder interpretation during clinical and autopsy settings. This study assessed the influence of age, sex and race on post-mortem brain weights of a select medico-legal population; to create a geographically relevant reference range of brain weights for the eThekwini region. Standard autopsy protocol and procedures, using the Ghon method of dissection were implemented on four hundred and eighty-one decedents. Decedents were obtained from a medico-legal state mortuary in the eThekwini region, KwaZulu-Natal, South Africa from June 2015 to March 2016. Black South African decedents comprised 83.6 % (402/481) of the sample population and whom reference ranges were formulated. Male decedents attained peak weight significantly earlier in the 11-20 year age interval, whereas female decedents in the 41-50 year age interval. However, no significance was observed between brain weight and age (p=0.799). Significant differences between sexes was noted, with mean male brains weighing significantly more (137.69 g, p<0.001). The mean brain weights were 1404.82±145.07 g and 1267.13±163.96 g in Black males and females, respectively. Post-mortem brain weights were predominantly of Black South Africans, with brain weights of both sexes comparably like those reported in the Northern hemisphere. However, brain weights attained peak weight at different age intervals, with variant brain weights between different racial groups within South Africa. Therefore, brain weight reference ranges may not be applicable to another geographic locality.

El peso del cerebro humano tiene un rol importante en los entornos clínicos y forenses, ya que la causa de la muerte puede afectar el peso del éste; además puede se puede usar en la detección de anomalías asociadas con trastornos neurológicos. Los pesos cerebrales son específicos de la geografía y rangos de referencia incorrectos pueden dificultar la interpretación en la clínica y la autopsia. Este estudio evaluó la influencia de la edad, el sexo y la raza en el peso cerebral post-mortem de una población médico-legal seleccionada; para crear un rango de referencia geográficamente relevante de pesos cerebrales para la región eThekwini. El protocolo y los procedimientos estándar de autopsia, utilizando el método de disección de Ghon, se implementaron en 481 cadáveres. Los cadáveres se obtuvieron de un depósito de cadáveres médico-legal en la región de eThekwini, KwaZulu-Natal, Sudáfrica, entre junio de 2015 a marzo de 2016. Los cadáveres, afro descendientes de Sudáfrica, comprendían el 83,6 % (402/ 481) de la población de la muestra y se formularon los rangos de referencia. Los fallecidos masculinos alcanzaron el peso máximo significativamente más temprano en el intervalo de edad de 11-20 años, mientras que las mujeres fallecidas, correspondió al intervalo de edad de 41 años. Sin embargo, no se observó significación entre el peso del cerebro y la edad (p = 0,799). Se observaron diferencias significativas entre sexos, con cerebros masculinos medios que pesaban significativamente más (137,69 g, p<0,001). Los pesos cerebrales medios fueron 1404,82±145,07 g y 1267,13±163,96 g en hombres y mujeres negros, respectivamente. Los pesos cerebrales post-mortem fueron predominantemente de sudafricanos negros, con pesos cerebrales de ambos sexos comparables a los reportados en el hemisferio norte. Sin embargo, los pesos cerebrales alcanzaron el peso máximo a diferentes intervalos de edad, con pesos cerebrales variables entre diferentes grupos raciales dentro de Sudáfrica. Por lo tanto, los rangos de referencia de peso del cerebro pueden no ser aplicables a otra localidad geográfica.

Anatomy of the dorsalis pedis artery / Anatomía de la arteria dorsal del pie

The dorsalis pedis artery (DPA) is the largest blood vessel distal to the ankle joint. It is the continuation of the anterior tibial artery (ATA) and runs along the dorsum of the foot until the 1st intermetatarsal space. The DPA gives rise to five branches, viz. medial tarsal, lateral tarsal, arcuate, deep plantar and dorsal metatarsal arteries. Given the vast blood supply provided by the DPA, in the current era of microvascular surgery, the anatomy of the DPA is of increasing interest to anatomists, surgeons and angiographers. The aim of this study was to outline the course, origin, branching patterns and possible variations of the DPA. The present study included the dissection of forty (n=40) cadaveric specimens of the lower limb region (Left: 25; Right: 15). The origin, course and branching patterns of the artery were studied. These morphological parameters were further analysed with regard to laterality to determine if a correlation existed. The Pearson Chi-square test was employed and a p value of less than 0.05 was deemed statistically significant. Although the DPA was present in 97.5 % of cases, it followed the standard anatomical description in only 42.5 % of cases. The DPA originated from the peroneal artery in 5 % of cases. In 25 % of cases, DPA deviated laterally. Variation in the branching pattern of the DPA, which was recorded in 50 % of cases, was further classified according Types 1 to 6. The findings of this study correlated closely with most previous studies. However, the incidence of lateral deviation of the DPA was higher in this study as well as the incidence of Type 1 variation in branching pattern. Additionally, this study proposes a novel variation in branching pattern which has been termed Type 6, which displays a recurrent branch of the Type 5 variation. The DPA has an important role in a clinical setting since the DPA flap is employed in reconstructive surgeries and peripheral circulation may be assessed by the palpation of the DPA pulse. Therefore, a thorough understanding of the anatomy of the DPA is of prime importance to podiatrists, surgeons, anatomists and angiographers.

La arteria dorsal del pie (ADP) es el vaso sanguíneo más grande distal a la articulación del tobillo. Es la continuación de la arteria tibial anterior (ATA) y se extiende a lo largo del dorso del pie hasta el primer espacio metatarsiano. La ADP da lugar a cinco ramas: a. tarsalis medialis, a. tarsalis lateralis, a. arcuata, a. plantaris profunda y aa. metatarsales dorsales. Dado el vasto suministro de sangre proporcionado por la ADP, en la era actual de la cirugía microvascular, la anatomía de la ADP es de creciente interés para los anatomistas, cirujanos y expertos en angiografía. El objetivo de este estudio fue delinear el curso, origen, patrones de ramificación y las posibles variaciones de la ADP. El presente estudio incluyó la disección de cuarenta (n = 40) muestras cadavéricas del miembro inferior (izquierda: 25; derecha: 15). Se estudiaron los patrones de origen, curso y ramificación de la arteria. Estos parámetros morfológicos se analizaron adicionalmente con respecto a la lateralidad para determinar si existía una correlación. Se empleó la prueba Chi-cuadrado de Pearson y se consideró estadísticamente significativo un valor de p de menos de 0,05. Aunque la ADP estuvo presente en el 97,5 % de los casos, siguió la descripción anatómica estándar en solo el 42,5 % de los casos. La ADP se originó en la arteria fibular en el 5 % de los casos. En el 25 % de los casos, la ADP se desvió lateralmente. La variación en el patrón de ramificación de la ADP, que se registró en el 50 % de los casos, se clasificó según los tipos 1 a 6. Los hallazgos de este estudio se correlacionaron estrechamente con la mayoría de los estudios previos. Sin embargo, la incidencia de desviación lateral de la ADP fue mayor en este estudio, así como la incidencia de la variación del tipo 1 en el patrón de ramificación. Además, este estudio propone una nueva variación en el patrón de ramificación que se ha denominado Tipo 6, que muestra una rama recurrente de la variación Tipo 5. La ADP tiene un papel importante en la clínica, ya que el colgajo de la ADP se emplea en cirugías reconstructivas y la circulación periférica se puede evaluar mediante la palpación del pulso de la ADP. Por lo tanto, una comprensión profunda de la anatomía de la ADP es de vital importancia para los podólogos, cirujanos, anatomistas y en la angiografía.

Predictors of shoulder degeneration in the Kwazulu-Natal population of South Africa / Indicadores de la degeneración del hombro en la poblacion Kwazulu/Natal de Sudáfrica

SUMMARY: The critical shoulder angle and acromion index are conventional radiological tools employed as predictors of shoulder degeneration. As they represent the static components of glenohumeral stability, the scapulo-humeral geometry and underlying subacromial tissue appear as the resultant cause-effect factors. Consequently, the purpose of this study was to investigate the critical shoulder angle and acromion index as interrelated parameters within the South African population. The measurement of both biomechanical parameters was conducted on two-hundred and sixty (n = 260) true AP radiographs. This was a cross-sectional study that also incorporated the demographic representation of the population group which was analysed accordingly. The mean values recorded for both the critical shoulder angle (36.31±5.84º) and acromion index (0.74±0.13) suggested rotator cuff arthropathy. The results confirmed the theories of Nyffeler et al. (2006) and Moor et al. (2012) who alluded to glenoid inclination and the acromial coverage over the humeral head. A significant proportionality correlation, verified by a P value of 0.000, was established between the acromion index and critical shoulder angle which may assist to differentiate between normal asymptomatic shoulders and those with cuff disease. Furthermore, these predictors of shoulder degeneration may present as a preventative tool against tear progression.

RESUMEN: El ángulo crítico del hombro y el índice acromial son herramientas radiológicas convencionales empleadas como indicadores de la degeneración del hombro. Debido a que representan los componentes estáticos de la estabilidad glenohumeral, la geometría escápulo-humeral y el tejido subacromial subyacente aparecen como los factores causa-efecto resultantes. En consecuencia, el propósito de este estudio fue investigar el ángulo crítico del hombro y el índice acromial como parámetros interrelacionados dentro de la población sudafricana. La medición de ambos parámetros biomecánicos se realizó en 260 radiografías antero-posteriores (AP). Se realizó un estudio transversal que también incorporó la representación demográfica del grupo de la población que fue analizada. Los valores medios registrados tanto para el ángulo crítico del hombro (36,31 ± 5,84º) como para el índice del acromión (0,74 ± 0,13) sugirieron una artropatía del manguito rotador. Los resultados confirmaron las teorías de Nyffeler et al. (2006) y Moor et al. (2012) que aludían a la inclinación glenoide y a la cobertura acromial sobre la cabeza humeral. Se estableció una correlación de proporcionalidad significativa, verificada por un valor de P de 0,000, entre el índice acromial y el ángulo crítico del hombro, lo que puede ayudar a diferenciar entre los hombros asintomáticos normales y aquellos con enfermedad del manguito rotador. Además, estos predictores de degeneración del hombro pueden ser útiles como una herramienta preventiva contra la progresión del desgarro.

Morphologic relationship between the coronary arteries during fetal development / Relación morfológica entre las arterias coronarias durante el desarrollo fetal

SUMMARY: A detailed understanding of the coronary arteries is of paramount importance in the management of coronary arterial diseases. The arterial supply to the heart originates from right (RCA) and left (LCA) coronary arteries which form an oblique inverted crown within the atrioventricular groove. This study aimed to document the embryologic relationship between the RCA and the LCA including their lengths, diameters, branching patterns and arterial dominance in fetuses. Forty-one human fetal heart specimens with an age range of 13.13 to 26.95 weeks were dissected at the Department of Clinical Anatomy, University of Kwazulu-Natal, Durban, South Africa. The RCA arose from the right aortic sinus and was dominant in all the specimens. The LCA was classified into types according to their branching pattern. The bifurcation, trifurcation and quadrifurcation of the LCA occurred in 68.3 %, 29.3 % and 2.4 % of hearts, respectively. The mean lengths of the RCA and LCA were 0.98±0.54 mm and 1.83±0.77 mm, respectively. The mean external diameters of the RCA and LCA were 0.38±0.12 mm and 0.49±0.17 mm, respectively. There was a significant correlation between the RCA and LCA length and the fetal age which is indicative of significant changes in the coronary vasculature with fetal growth.

RESUMEN: Una comprensión detallada de las arterias coronarias es de suma importancia en el manejo de las enfermedades en estas arterias. El suministro arterial al corazón se origina de las arterias coronarias derecha (ACD) e izquierda (ACI) que forman una "corona oblicua invertida" dentro del surco atrioventricular. Este estudio tuvo por objetivo documentar la relación embriológica entre la ACD y la ACI, incluyendo sus longitudes, diámetros, patrones de ramificación y dominio arterial en fetos. Se disecaron 41 corazones de fetos humanos con un rango de edad de 13,13 a 26,95 semanas, en el Departamento de Anatomía Clínica, Universidad de Kwazulu-Natal, Durban, Sudáfrica. La ACD surgió del seno aórtico derecho y fue dominante en todos los especímenes. La ACI se clasificó en distintos tipos según su patrón de ramificación. La bifurcación, trifurcación y cuadrifurcación de la ACI ocurrieron en 68,3 %, 29,3 % y 2,4 % de los corazones, respectivamente. Las longitudes medias de la ACD y ACI fueron 0,98 ± 0,54 mm y 1,83 ± 0,77 mm, respectivamente. Los diámetros externos medios de la ACD y ACI fueron 0,38 ± 0,12 mm y 0,49 ± 0,17 mm, respectivamente. Hubo una correlación significativa entre la longitud de la ACD y la ACI y la edad fetal, que es indicativa de cambios significativos en la vasculatura coronaria con crecimiento fetal.

Post-mortem organ weights at a medico-legal state facility in the eThekwini region / Peso de órganos post-mortem en un servicio médico legal en la región eThekwini

SUMMARY: Organ weights may be influenced by various demographic parameters and environmental conditions, and they differ among populations. Numerous studies have been conducted in the Northern hemisphere, with paucity of literature regarding organ weights of many Southern hemispheric populations. This study aimed to document post-mortem organ weights of decedents in the eThekwini region, and to determine the influence of age, sex, population grouping and body length on the weight of these organs. The study utilised 500 decedent organs (n=500), obtained from a medico-legal state mortuary in the eThekwini region, KwaZuluNatal, South Africa. It entailed gross examination and weighing of the thoracic viz. heart, right and left lungs, and abdominal organs viz. liver, spleen as well as the right and left kidneys. All organs attained maximum or peak weights at various age intervals, with the heart continuing to increase in weight until 80 years of age. Organ weights illustrated statistical significance with age. The heart, lungs and liver were the only organs that showed statistical significance with sex. However, mean spleen weights were higher in females than in males, while the weights of both kidneys were higher in males. Organ weights of White decedents were higher than those of other population groups. There was a positive correlation between body length and all organ weights. Post-mortem organ weights of the present study are comparably higher than those reported in the Northern hemisphere. Therefore, organ weights reported from one geographic location may not be applicable to another and may lead to erroneous references ranges and possibly hinder interpretation during autopsy settings.

RESUMEN: El peso de los órganos puede estar influenciado por diversos parámetros demográficos y condiciones ambientales; además estos difieren entre las poblaciones. Se han realizado numerosos estudios en el hemisferio norte, con escasa información en la literatura sobre el peso de órganos en poblaciones del hemisferio sur. Este estudio tuvo como objetivo documentar el peso de órganos post mortem en la región eThekwini y determinar la influencia de la edad, sexo, agrupación de la población y longitud corporal sobre el peso de los órganos. Para el estudio se utilizaron 500 órganos (n = 500), obtenidos del Servicio Médico Legal de la Región eThekwini de KwaZulu-Natal, Sudáfrica. Se estudiaron el peso y tamaño de las vértebras torácicas, el corazón, pulmones derecho e izquierdo, órganos abdominales, como el hígado, bazo, además del peso de los riñones derecho e izquierdo. Los pesos medios de órganos registrados para la población de la muestra fueron: corazón (328,93 g), pulmón derecho (581,73 g), pulmón izquierdo (485,92 g), hígado (1376,62 g), bazo (153,50 g), riñón derecho (146,67 g) y riñón izquierdo (154,32 g). Los órganos alcanzaron pesos máximos a diferentes intervalos de edad: el corazón continuó aumentando de peso hasta los 80 años de edad (438.00 g), mientras que los pulmones alcanzaron un peso maximo a los 61-70 años (720.70 g / 573.11 g). Los órganos abdominales, como el hígado (1550,67 g), el bazo (196,87 g) y los riñones (146,67 g / 154,32 g), alcanzaron todos el peso máximo entre los 41-50 años de edad. Todos los pesos de los órganos mostraron diferencias estadísticamente significativas de acuerdo a la edad. En el corazón, los pulmones y el hígado se observó una diferencia estadísticamente significativa de acuerdo al sexo. Sin embargo, los pesos medios del bazo fueron mayores en las mujeres que en los hombres, mientras que el peso de ambos riñones fueron mayores en los hombres. El peso de los órganos de los cadáveres de la muestra fue mayor al peso que en otros grupos de población. Al comparar los diferentes grupos de población, el riñón derecho fue el único órgano en el que no se observó una diferencia estadísticamente significativa. Hubo una correlación positiva entre la longitud corporal y los pesos de los órganos. Los pesos de los órganos post-mortem, del presente estudio, son comparativamente mayores a los reportados en el hemisferio norte. Por lo tanto, información sobre el peso de órganos de una ubicación geográfica determinada puede no ser aplicable a otra y puede conducir a una interpretación errónea durante la autopsia.

Tablet technology in medical education in South Africa: a mixed methods study.

OBJECTIVE: The purpose of this study was to establish the use of mobile devices by learners at a selected medical school. Distribution of mobile devices was an inaugural initiative implemented by our college. DESIGN: A mixed methodology design using a questionnaire comprising both open-ended and close-ended questions was analysed from 179 (60 male; 119 female) second year medical students registered for the Anatomy course. Open-ended questions were analysed using a thematic approach by identifying emergent ideas and concepts. Close-ended questions were analysed using SPSS V.21.0. SETTING AND PARTICIPANTS: Second year medical students at a medical school in South Africa. RESULTS: Three main themes emerged, namely, (a) mobile device engagement, (b) advantages and (c) challenges affecting use of mobile devices. A majority of learners accessed their tablets for lecture notes; more females were inclined to access these devices than males. Challenges experienced included poor wifi connectivity on and off the university campus; some students were not keen on the idea of mobile devices and preferred traditional methods of teaching. CONCLUSIONS: Mobile devices have been adopted by learners at our university. Uses of technology outlined are related to Eraut's intentions of informal learning. Integrating tablets into classes had a positive effect on student access to course material.