Drainage Pattern of Craniofacial Veins With Emphasis on its Influence on Facial Reconstruction Procedures.

As the facial transplantation procedures are becoming more popular and frequent in recent years, for repairing facial trauma, variations in the veins of head and neck needs to be reported time and again. This study was undertaken to examine the course and drainage pattern of the facial vein and external jugular vein on this context and emphasize its surgical implications. The authors studied the head and neck region of 50 embalmed cadavers of both sexes to document normal and variant anatomy of facial, retromandibular, and external jugular veins. In 30% of the head and neck regions, different draining pattern of the above-mentioned veins were observed. One of the rare variation discovered was the splitting of the retromandibular vein to embrace the external carotid artery within the parotid gland. The data about variations in the termination of facial vein, retromandibular vein, and external jugular vein, as observed in the present study might be useful in avoiding accidental injury to these vessels during any surgical intervention in the face as well as neck. Level of Evidence: IV.

Hunger-Based Versus Conventional Oral Feeding in Moderate and Severe Acute Pancreatitis: A Randomized Controlled Trial.

BACKGROUND: The length of hospitalization is prolonged in patients with acute pancreatitis due to delay in feeding. The present study aimed at evaluating hunger-based early feeding for its efficacy in reducing length of hospitalisation. AIMS AND METHODS: This was a parallel arm superiority randomized control trial. Patients with moderate and severe acute pancreatitis were randomised into hunger-based feeding and conventional feeding groups. Patients in hunger-based feeding group commenced feeding once they felt hungry and in conventional feeding group after normalization of biochemical parameters and resolution of symptoms. Patients were followed up till their discharge and were analyzed for length of hospitalisation, fasting duration, feed intolerance, incidence of infective morbidities and invasive procedures. RESULTS: Hunger-based feeding and conventional feeding group included 56 and 54 patients, respectively. Hunger-based feeding led to a decrease in length of hospitalization (6.3 days in hunger-based feeding vs 7.3 days in conventional feeding group, P = 0.041) and fasting duration (1.6 days in hunger-based feeding vs 2.7 days in conventional feeding group, P = 0.001).The incidence of feed intolerance (P = 0.098), infective morbidities and invasive non-surgical procedures were similar in both the groups. CONCLUSION: Hunger-based feeding significantly reduces length of hospitalization and fasting duration in cases of moderate and severe acute pancreatitis without any significant rise in the incidence of complications. Registration number of Clinical Trails Registry India CTRI/2019/01/017,144.

Variants of latissimus dorsi with a perspective on tendon transfer surgery: an anatomic study.

BACKGROUND: The latissimus dorsi (LD) is often used for tendon transfers to treat massive irreparable posterosuperior rotator cuff tears. The operation requires the LD tendon to be mobilized to reduce tension on the tendon. In that respect, any connection between the LD tendon and contiguous muscles may hamper tendon mobility and affect the surgical outcome. The goal of this study was to document the occurrence of connections between the LD and adjacent muscles and nerves. METHODS: We studied the scapular region on 48 embalmed cadavers. The skin and superficial fascia were removed according to Cunningham's manual of dissection, and the muscle was exposed. RESULTS: It was found that the LD and teres major (TM) muscles are connected by muscle fibers in 10% of the cadavers studied. Another vital discovery was that in some cadavers, the LD tendon was penetrated by a nerve. CONCLUSION: Fascial connections between the LD and TM are well known, but these muscle links are comparatively unusual. From the results of this study, one should pay particular attention to muscle links between the LD and TM during dissection of the LD for transfer. It can also be suggested that during transfer surgery, the LD tendon should be cautiously examined for the possibility of a nerve penetrating it.

A Cephalometric Analysis on Magnitudes and Shape of Sella Turcica.

Familiarity with the shape and dimensions of sella turcica is important to recognize and manage pathological conditions of pituitary gland as well as for orthodontic treatment planning. The present study aims to describe the morphology and dimensions of sella turcica from Indian population, using lateral cephalograms to set a reference data for comparison among different races. The study used 36 lateral skull radiographs of both sexes between age group of 13 to 18 years. Shape of sella turcica was noted by visual inspection. Length, height anterior, height median, height posterior, distance between frontonasal suture and mental spine to midpoint of posterior clinoid process, and tuberculum sella were measured using digital vernier caliper with reference to Frankfort line. The results of the study revealed that mean length, height anterior, height median, height posterior were larger in females than in males. The morphological types identified include pointed posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with flask-shaped hypophyseal fossa. These observations would be beneficial for the clinicians and orthodontists to design treatment planning in pathology of pituitary gland and in correcting dentofacial anomalies.

Morphometric study of the medial orbital wall emphasizing the ethmoidal foramina.

PURPOSE: Ethmoidal foramina on the medial orbital wall show a higher incidence of variation. Surgeons performing endonasal, anterior cranial fossa and medial orbital wall surgeries must be aware of these variations as they are a source of hemorrhage and also serve as landmark in proximity to the orbital apex. AIM: The present study aims to describe the morphometric distances of various ethmoidal foramina between anterior lacrimal crest to optic canal in south Indian dry human skulls. MATERIALS AND METHOD: The study was done on 44 adult dry human skulls. The occurrence of Ethmoidal foramina was noted by direct inspection. The distance of Ethmoidal foramina from anterior lacrimal crest to optic canal was measured with the help of ruler, probe and magnifying glass. RESULTS: The Posterior ethmoidal foramina were found in all 44 skulls bilaterally. Middle ethmoidal foramen was present in 12 and 13 skulls on right and left, respectively. Anterior ethmoidal foramen was found in 38 and 37 skulls on right and left, respectively. The distance between anterior lacrimal crest (ALC) and posterior lacrimal crest (PLC) was in the range of 3-8 mm and that of ALC to anterior ethmoidal foramen was in the range of 24-30 mm. The range of distance between anterior ethmoidal foramen to posterior ethmoidal foramen was 9-17 mm and that between posterior ethmoidal foramen to optic canal was 5-13 mm. CONCLUSION: These observations would help to predict the anatomical variations in the position of ethmoidal foramina with respect to anterior and posterior lacrimal crest and ensure the safe and precise performance of medial orbital wall surgeries to avoid injuries to the important neurovascular bundles passing through various foramina and fissures.

Anterior pituitary dysfunction after traumatic brain injury: A prospective study.

OBJECTIVE: Anterior pituitary dysfunction is one of the major causes of disability and morbidity in patients suffering from traumatic brain injury (TBI). The present study was undertaken to evaluate the incidence of anterior pituitary dysfunction in cases of moderate and severe TBI, its value in long term prognostication and the factors which predispose to a higher incidence of anterior pituitary dysfunction in acute and chronic phases. METHODS: This was a prospective cohort study wherein 216 patients with moderate and severe TBI were evaluated within 72 hours of TBI (acute phase) and at 6 months (chronic phase). RESULTS: At 6 months, out of the 216 patients, 95 patients had expired and 35 patients had lost follow-up. The remaining 86 patients were evaluated at 6 months. In the acute phase, hypopituitarism was seen in 82.4% patients, thyroid axis deficiency was seen in 57.4% patients, gonadal axis deficiency in 54.2% patients and adrenal axis deficiency in 13.8% patients. In the chronic phase, hypopituitarism was seen in 59.3% patients, thyroid axis deficiency was seen in 24.4% patients, gonadal axis deficiency in 32.6% patients and adrenal axis deficiency in 23.3% patients. Patients with thyroid axis deficiency at admission had significant association with a bad modified Rankin Scale (mRS) score at 6 months. CONCLUSION: Thyroid and gonadotropin axes were most commonly affected and deficiency of at least one axis was found in 82.4% patients in the acute phase and 59.3% in the chronic phase. Thyroid axis deficiency had a negative impact on prognosis in post-TBI patients.

Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study.

Background: The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population. Methods: This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper. Results: The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. Conclusions: The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling.

Anatomical and morphometric analysis of accessory infraorbital foramen.

The aim of the present study was to analyze the anatomical and morphometric variation in shape, frequency of occurrence, direction, and position of accessory infraorbital foramen (AIOF) in relation to infraorbital foramen (IOF) in cadaveric dry skulls to minimize clinical complications and aid in surgical maneuvering in the maxillofacial region and implementing the regional block anesthesia. The IOF is an important anatomical landmark in these surgical manipulations. Because there is limited literature available on AIOF, which transmits accessory branch of the infraorbital nerve, the present study was designed. In the current study, 45 human dry skulls and 20 disarticulated maxillae have been used irrespective of sex. The other parameters included measuring the distance of AIOF from anterior nasal spine, frontomaxillary suture, infraorbital margin, IOF, and zygomaticomaxillary suture. The transverse and vertical diameter of foramen was also noted. All these measurements were taken using a digital caliper. The result of our study reveals that the presence of AIOF is more on the right side compared with the left side. Because the presence of accessory infraorbital nerve needs to be taken care of during maxillofacial surgical interventions, knowledge regarding the presence of AIOF should be taken into consideration for preoperative evaluation.

On the identities of Barbus mussullah Sykes and Cyprinus curmuca Hamilton with notes on the status of Gobio canarensis Jerdon (Teleostei: Cyprinidae).

The identity and generic placement of Barbus mussullah Sykes, the type species of Hypselobarbus Bleeker, have for long been unclear, variously having been considered a synonym of Cyprinus curmuca Hamilton or a species of Tor Gray or Gonoproktopterus Bleeker. Here, through a re-examination of the original descriptions and the examination of specimens from western peninsular India, we redescribe H. mussullah and show that Hypselobarbus is a valid genus, of which Gonoproktopertus is a junior synonym. Hypselobarbus mussullah is distinguished from all other species of Hypselobarbus by possessing both rostral and maxillary barbels; having the last simple dorsal-fin ray weak and smooth; the lateral line complete, with 41 +1 pored scales; 9/1/4 scales in transverse line between origins of dorsal and pelvic fins; and 5½ scales between lateral line and anal-fin origin. Species of Hypselobarbus are distinguished from other genera of Cyprinidae by possessing long, branched gill rakers and the anal fin distally rounded in adults. Hypselobarbus canarensis was found to be a valid species and H. kurali is considered its synonym. Hypselobarbus canarensis can be distinguished from all congeners by possessing both rostral and maxillary barbels; having the last simple dorsal-fin ray weak and smooth; the lateral line complete, with 40-42+1 pored scales; ½7-½8/1/3½ scales in transverse line from dorsal-fin origin to pelvic-fin origin; 4½ scales between lateral line and anal-fin origin. Hypselobarbus kolus is considered a synonym of H. curmuca, which is redescribed: it is distinguished from all congeners by possessing maxillary barbels only; the last simple dorsal-fin ray weak and smooth; 41-43+1 lateral-line scales; 9-10/1/4½-5 scales in transverse line between origins of dorsal and pelvic fins; and 5½-6 scales between lateral line and anal-fin origin. 

Role of Acorus calamus in preventing depression, anxiety, and oxidative stress in long-term socially isolated rats.

Background and Aim: Social isolation stress (SIS) and individual housing have been shown to cause abnormal cognitive insufficiencies, altered anxiety levels, and signs of psychiatric diseases. Acorus calamus (AC), commonly known as Sweet Flag, has been widely used in India to treat neurological, metabolic, and respiratory disorders, indicating its potential therapeutic value. This study aimed to determine the antidepressant and antioxidative effects of AC on rats subjected to long-term, social isolation-induced stress. Materials and Methods: This study involved 2-month-old male rats (24) weighing approximately 180-200 g bred in-house. The rats were divided into four groups (n = 6): Group 1 received saline, Group 2 received SIS, Group 3 received only 50 mg/kg AC, and Group 4 received 50 mg/kg AC and SIS for 6 weeks. After this, behavioral, biochemical, and neuronal assays were conducted. Results: Behavioral experiments showed significantly higher activity levels (p < 0.001) in AC-treated rats than in the SIS group. In addition, rats subjected to SIS with AC treatment exhibited enhanced total antioxidants, superoxide dismutase, and neuronal assays compared to rats subjected to SIS alone. Conclusion: Acorus calamus treatment improved the antidepressant and antioxidant potential against SIS in rat brain tissue. Moreover, we proved that AC can effectively reverse the neurotoxicity induced by SIS in animal models. As we battle against the coronavirus disease 2019 pandemic and social isolation, AC could be considered a supplementary treatment to alleviate depressive-like symptoms in our present-day lifestyle.

Zebrafish as an experimental model for the simulation of neurological and craniofacial disorders.

Zebrafish have gained momentum as a leading experimental model in recent years. At present, the zebrafish vertebrate model is increasingly used due to its multifactorial similarities to humans that include genetic, organ, and cellular factors. With the emergence of novel research techniques that are very expensive, it is necessary to develop affordable and valid experimental models. This review aimed to highlight some of the most important similarities between zebrafish and humans by emphasizing the relevance of the first in simulating neurological disorders and craniofacial deformity.

Anomalous location of facial nerve deep to parotid gland.

The knowledge of normal and variant anatomy of the facial nerve is essential for safe surgery of the parotid gland. The location of a parotid mass in relation to the course of the facial nerve determines whether superficial or total parotidectomies should be performed. The variant course of the facial nerve within the parotid may endanger the nerve during parotid surgeries. The present report is an attempt to help the surgeons to minimize the error that can damage the nerve without previous knowledge of such type of rare variation.

Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event.

AIMS: The aim of this study is to characterize healthcare resource utilization and costs in patients with heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event. METHODS AND RESULTS: This was a retrospective observational cohort analysis. Patients with HFrEF were identified from the PINNACLE Registry and linked to a nationwide pharmacy and medical claims database. Worsening heart failure was defined as stable heart failure with a subsequent hospitalization and/or intravenous diuretic therapy. Healthcare resource use and costs in 2015 US dollars were analysed for dispensed prescriptions, outpatient encounters, and hospital encounters. Among 11 064 patients with HFrEF, 3087 (27.9%) experienced a worsening heart failure event during an average follow-up of 973 days. During the first 30 days after the worsening event, 19.8% of patients had hospital readmissions with heart failure as the primary or secondary diagnosis. During that same time period, mean per patient heart failure-related healthcare resource use included 1.3 prescriptions, 0.5 practitioner visits, and 0.5 hospital encounters (admissions, observations, or emergency care), for an average total medical cost of $8779 per patient including $5359 in heart failure-related costs. During the first year following worsening heart failure onset, mean per patient total and heart failure-related costs were $62 615 and $35 329, respectively. CONCLUSIONS: The economic burden following a worsening heart failure event calls for further review of methods to prevent progressive disease, improve adherence to guideline-directed therapy, and develop novel treatments and care strategies to moderate further progression.

Toxic Algae Silence Physiological Responses to Multiple Climate Drivers in a Tropical Marine Food Chain.

Research on the effects of climate change in the marine environment continues to accelerate, yet we know little about the effects of multiple climate drivers in more complex, ecologically relevant settings - especially in sub-tropical and tropical systems. In marine ecosystems, climate change (warming and freshening from land run-off) will increase water column stratification which is favorable for toxin producing dinoflagellates. This can increase the prevalence of toxic microalgal species, leading to bioaccumulation of toxins by filter feeders, such as bivalves, with resultant negative impacts on physiological performance. In this study we manipulated multiple climate drivers (warming, freshening, and acidification), and the availability of toxic microalgae, to determine their impact on the physiological health, and toxin load of the tropical filter-feeding clam, Meretrix meretrix. Using a structural equation modeling (SEM) approach, we found that exposure to projected marine climates resulted in direct negative effects on metabolic and immunological function and, that these effects were often more pronounced in clams exposed to multiple, rather than single climate drivers. Furthermore, our study showed that these physiological responses were modified by indirect effects mediated through the food chain. Specifically, we found that when bivalves were fed with a toxin-producing dinoflagellate (Alexandrium minutum) the physiological responses, and toxin load changed differently and in a non-predictable way compared to clams exposed to projected marine climates only. Specifically, oxygen consumption data revealed that these clams did not respond physiologically to climate warming or the combined effects of warming, freshening and acidification. Our results highlight the importance of quantifying both direct and, indirect food chain effects of climate drivers on a key tropical food species, and have important implications for shellfish production and food safety in tropical regions.

Nitrogen uptake potential under different temperature-salinity conditions: Implications for nitrogen cycling under climate change scenarios.

As projected by climate change models, increase in sea surface temperature and precipitation in the future may alter nutrient cycling in the coastal regions due to potential changes in phytoplankton community structure and their ability to assimilate nitrogen (N) and carbon (C). An experiment simulating different temperature and salinity conditions (28°C-35 ambient conditions, 28ºC-31, 31ºC-35 and 31ºC-31) in mesocosms containing 1000 L of coastal water from the Arabian Sea was performed and N uptake rates were measured using 15N tracer technique on 2nd, 5th, 7th and 10th day of the experiment. The results show that, under all conditions, the total N (NO3- + NH4+) uptake rates were lower in the beginning and on the final day of the tracer experiment, while it peaked during middle, consistent with chlorophyll a concentrations. Total N uptake rate was significantly lower (p = 0.003) under ambient temperature-lower salinity condition (28ºC-31) than the others. This indicates that lowering of salinity in coastal regions due to excessive rainfall in the future may affect the N uptake potential of the phytoplankton, which may change the regional C and N budget.

Assessing the presence of marine toxins in bivalve molluscs from southwest India.

The south west coast of India has been showing a steady increase in shellfish cultivation both for local consumption and fishery export, over recent years. Perna viridis and Crassostrea madrasensis are two species of bivalve molluscs which grow in some selected regions of southern Karnataka, close to the city of Mangalore. In the early 1980s, shellfish consumers in the region were affected by intoxication from Paralytic Shellfish Poison present in local bivalves (clams and oysters) resulting in hospitalisation of many, including one fatality. Since then, there have been no further reports of serious shellfish intoxication and there is little awareness of the risks from natural toxins and no routine monitoring programme in place to protect shellfish consumers. This study presents the findings from the first ever systematic assessment of the presence of marine toxins in mussels and oysters grown in four different shellfish harvesting areas in the region. Shellfish were collected and subjected to analysis for ASP, PSP and lipophilic toxins, as well as a suite of non-EU regulated toxins such as tetrodotoxin and selected cyclic imines. Results revealed the presence of low levels of PSP toxins in oysters throughout the study period. Overall, total toxicities reached a maximum of 10% of the EU regulatory limit of 800 µg STX eq/kg. Toxin profiles were similar to those reported from the 1980 outbreak. No evidence was found for significant levels of ASP and lipophilic toxins, although some cyclic imines were detected, including gymnodimine. The results indicated that the risk to shellfish consumers during this specific study period would have been low. However, with historical evidence for extremely high levels of PSP toxins in molluscs, there is a strong need for routine surveillance of shellfish production areas for marine toxins, in order to mitigate against human health impacts resulting from unexpected harmful algal blooms, with potentially devastating socio-economic consequences.

Hypselobarbus bicolor, a new species of large barb (Teleostei: Cyprinidae) from the Western Ghats of India.

There has been much confusion around the identity of Hypselobarbus pulchellus, an endemic large barb of the Western Ghats. Recent works highlighted the fact that it is likely that two similar-looking species have been considered as H. pulchellus. A genetic analysis helps differentiate the two forms: viz., H. pulchellus and a new species, here described as H. bicolor sp. nov. Hypselobarbus bicolor can be distinguished from all other species of Hypselobarbus based on a combination of the following characters: two pairs of barbels, lateral line complete, with 34-36+1-2 pored scales, ½6/1/3½ scales in the transverse row; 11-12 predorsal scales; last simple dorsal ray weak, dorsal fin with 9½ branched rays, gill rakers short and simple, 4-6+11-12 on first gill arch; proximal end of fifth ceratobranchial slightly curved, with 5+3+2 teeth; overall coloration dark grey with an ill-defined silver- or bronze-coloured band running along length of body, two scales high, on lateral-line scale-row and row above it; fins devoid of any markings; and small, closely-placed tubercles restricted to the tip of the snout in large males.

Pathogenic marine microbes influence the effects of climate change on a commercially important tropical bivalve.

There is growing evidence that climate change will increase the prevalence of toxic algae and harmful bacteria, which can accumulate in marine bivalves. However, we know little about any possible interactions between exposure to these microorganisms and the effects of climate change on bivalve health, or about how this may affect the bivalve toxin-pathogen load. In mesocosm experiments, mussels, Perna viridis, were subjected to simulated climate change (warming and/or hyposalinity) and exposed to harmful bacteria and/or toxin-producing dinoflagellates. We found significant interactions between climate change and these microbes on metabolic and/or immunobiological function and toxin-pathogen load in mussels. Surprisingly, however, these effects were virtually eliminated when mussels were exposed to both harmful microorganisms simultaneously. This study is the first to examine the effects of climate change on determining mussel toxin-pathogen load in an ecologically relevant, multi-trophic context. The results may have considerable implications for seafood safety.

Barilius ardens (Teleostei: Cyprinidae), a new species from the Western Ghats, India, with redescription of B. malabaricus and B. canarensis.

The identities of Barilius canarensis and B. malabaricus have hitherto been confused. An attempt to resolve their identities by examining fresh collections from their respective type localities, i.e., southern Karnataka and northern Kerala, yielded a new species, which is herein described as B. ardens. The new species differs from B. canarensis and B. malabaricus by the presence of a row of 7-9 large vertically elongate blotches on the flank, in large adults the first three blotches broken into a smaller row of intercalate spots (vs. two rows of spots: the first consisting of 9-11oval spots, the second with 3-4 smaller spots); and 5+4+3 (vs. 5+4+2) pharyngeal teeth. The new species is distinguished from B. bakeri by having 5+4+3 (vs. 5+4+2) pharyngeal teeth; and the dorsal and anal fins margined with bright orange (vs. white). Barilius malabaricus (hitherto in the synonymy of B. canarensis) is shown to be a valid species distinguished from the latter by having 11½ (vs. 10½) branched dorsal-fin rays and 14½-15½ (vs. 13½) branched anal-fin rays; both species are redescribed.

Evaluation of dietary essentiality of vitamins for Penaeus monodon (Fabricius).

The effect of exclusion of individual water-soluble (thiamine, riboflavin, pyridoxine, cyanocobalamin, pantothenic acid, folic acid, niacin, biotin, choline, inositol, ascorbic acid) and fat-soluble vitamins (vit. A, D, K and E) in semi-purified diets on growth and survival of juvenile shrimp, P. monodon was studied in the laboratory for 8 weeks. Diets lacking riboflavin and vitamin K did not affect growth and survival of shrimp. However, deletion of inositol and choline resulted in poor growth. Maximum growth was observed in the control diet (C1) which was supplemented with all vitamins. Diet deficient in ascorbic acid, biotin, folic acid, niacin, thiamine and alpha-tocopherol resulted in poor appetite and poorer feed conversion efficiency. All treatments except the control (C1) resulted in histological changes in the digestive gland cells. Detachment or destruction of the epithelial cells was observed in all treatments lacking individual vitamins but more severely in the treatment without a vitamin supplement followed by inositol, choline and ascorbic acid deficient diets.