External occipital protuberance classification with special reference to spine type and its clinical implications.

PURPOSE: This investigation aimed to study the types of external occipital protuberance (EOP) with special reference to Type 3 (spine type). Detailed information will be useful for clinicians to manage occipital headaches or issues related to the biomechanics of the neck and for accurate radiological interpretations. METHODS: Thirty-one dry intact cadaveric skulls were studied for EOP classification. In Type III EOP cases, the size of EOP was noticed using different modalities and compared. The superior nuchal lines and external occipital crest were observed for their prominence and any variation. RESULTS: 42% of the skulls belong to Type 1, 51.5% to Type 2, and 6.5% to Type 3 EOP. Superior nuchal lines and external occipital crest were more prominent in Types 2 and 3 EOP. In Type 3 EOP cases, the mean length, width, and thickness of the spine as measured directly on the skull were 16.63 mm; 20.1 mm, and 7.82 mm respectively, the same as radiograph findings. CT examination revealed the average volume as 0.95 cm3. Out of two Type 3 EOP cases, the spine with larger values for its size was having a lesser volume value in CT. CONCLUSIONS: Plain lateral radiography is a reliable method to measure the length and thickness of spinous EOP. However, more values of these parameters for morphometry of the EOP spine do not mean more volume of EOP and vice versa. Detailed information regarding the occurrence of occipital spur and its morphology will be of great importance to neurosurgeons, sports, physicians, emergency departments, and radiologists.

Google trends in "anatomy": pre-pandemic versus during COVID-19 pandemic.

PURPOSE: The purpose of the present study was to assess the online search behavior for the keyword "anatomy" worldwide and to compare the pre-pandemic and during COVID-19 pandemic scenario for the same. METHODS: Google trends tool was used for the assessment of the search behavior for the term "anatomy". The data, i.e. relative search volume (RSV) were downloaded for this term using the all categories, web search and only YouTube settings during a period from 1.1.2019 to 3.31.2021 from www.trends.google.com . The geographic trends for this search query were plotted across the world. RESULTS: Seasonal peaks were observed for the search term "anatomy" during the first 3 months of the year and in months of September, October and November in 2019. Similar seasonal peaks were observed for the year 2020 except that there was sudden decrease in RSV for term "anatomy" in the month of March. Though trend for the rest of the year was same, but there was general lower RSV in 2020. The country with highest search hit was United States followed by Canada, Ireland, Australia and Philippines. CONCLUSION: The search trend for pre-pandemic and pandemic period was similar with overall lower RSV during 2020, where it noticeably decreased during the initial phase of lockdown, i.e. in the month of March. As the whole world is still in the COVID-19 pandemic era, the future studies may report the google trends once the pandemic is over and may compare the post-pandemic trend for the same.

Osseous deficiencies, pockets, superfluous lateral border thickening in scapula: a rare occurrence.

BACKGROUND: Beyond the nutrient and suprascapular foramen, the other foramina, holes or osseous deficiencies, pockets has rarely been reported in scapula. If present, the bony holes or deficiencies may lead to radiolucent areas and may be mistaken for sites of osteolytic destruction related to skeletal metastases, multiple myeloma or others. CASE REPORT: In the present case of left scapula, unusual osseous deficiencies of different size and shape along with pockets were observed in the body of scapula. The maximum height and width of largest bony deficiency was 35.8 mm and 12.6 mm. There was abnormal osseous thickening beside the lateral border of scapula along with the presence of some spines. Five nutrient foramina, three on the costal and two on the dorsal surface were noticed. CONCLUSIONS: The present case reports the osseous deficiencies, pockets and extra osseous growth along the lateral border, multiple nutrient foramina altogether in one specimen. Thorough anatomical knowledge of these unusual osseous variations can provide the clinicians, radiologists and forensic experts with better clinical judgement and may add insight to the surgical planning by orthopaedic surgeons.

Virtual thanks giving to a cadaver by medical students exposed to learning anatomy before and amidst COVID-19 pandemic.

PURPOSE: Due to COVID-19 pandemic, Thanks giving ceremony to cadaver was different this year in two ways: the students were partially exposed to cadaveric dissections (for 7 months) and later learned Anatomy via online classes due to lockdown (for 5 months) and secondly it was not feasible to gather for the ceremony so virtual platform was preferred. The purpose of this study was to discern the gratitude for cadaver and to recognize the importance of cadaveric dissection from the reflection of students who experienced hybrid anatomy learning amidst COVID-19. METHODS: The study was conducted on 48 first year medical students who were admitted to the college in August 2019 and were willing to participate. An online invitation was sent to students to participate in virtual thanks giving to cadaver ceremony on the last day of their anatomy class (August 2020). RESULTS: Though the students partially studied gross anatomy with the aid of dissections on the cadaver; however, they expressed respect and gratitude to the silent mentor in the form of a card, poem, drawing or paragraph and shared it via google classroom platform. The students wished if they could continue their anatomy course in dissection hall as paused due to COVID-19 pandemic. CONCLUSIONS: Reflection of these students may mark impact on future anatomy students who may or may not get the chance for dissections. The thanks-giving gesture will also help to bind medical science and humanity especially during the crisis of pandemic.

Surgical anatomy of basal turn in relation to middle cranial fossa and round window as pertaining to middle fossa cochlear implant technique.

PURPOSE: The purpose of this investigation was to evaluate the relation of the basal turn of cochlea with middle cranial fossa and round window as pertaining to middle cranial fossa cochlear implant technique. METHODS: Fifty-four formalin preserved temporal bones were micro-dissected to expose the basal turn. The point (f) was marked on the basal turn of cochlea where there was minimum distance of basal turn of cochlea from the floor of middle cranial fossa (f1). The f-f1 distance, the angle (∠smf) and distance of point "f" from the round window (s-f) was measured. RESULTS: The mean minimum distance between basal turn of cochlea and floor of middle cranial fossa (f-f1) was 2.0 ± 0.7 mm.The point f was at mean distance (s-f) and angle (∠smf) of 14.7 ± 1.6 mm and 217° ± 13.7° from round window, respectively. CONCLUSIONS: The information may be helpful for designing appropriate electrode array for middle fossa technique especially for deciding the length of electrode array towards round window, as otherwise electrode may extend into vestibule of inner ear. In the cases where bone thickness between superior part of basal turn of cochlea and middle cranial fossa is < 1.5 mm, surgeon should be extra cautious.

Anatomy education of medical and dental students during COVID-19 pandemic: a reality check.

PURPOSE: During this forced down-time of COVID-19 pandemic, shift to virtual anatomy education is the solitary solution to support the learning of students. The purpose of this study was to understand the visible and invisible potential challenges being faced by the 1st year medical and dental students while attending digital anatomy classes. METHODS: The present study was conducted on 81st year medical and dental students who were admitted to their respective college in August 2019 and were willing to participate in the study. A multiple choice close-ended questionnaire regarding their opinion on virtual classes was designed and feedback was taken from the students. RESULTS: Majority (65%) of the students agreed that they missed their traditional anatomy learning i.e., dissection courses, face to face lectures and interaction with mentors. The students strongly felt the lack of confidence and difficulty in the topics completed without dissections, models, microscopic slides and other modalities. 83% felt lack of proper gadgets, high-band width and strong internet connections, a potential barrier in their digital learning. Lack of self-motivation was felt by 69% students. CONCLUSIONS: The current situation of anatomy education is not intentional, and is not the long term silver bullet solution for a visual subject like anatomy. Though learners face a lot of challenges, however, a shift to online must be supported at this time of health crisis. As the digital learning may go for indefinite period, the feedback of students may be helpful for relevant and timely modifications in digital anatomy education.

Anatomic variability of oval window as pertaining to stapes surgery.

PURPOSE: The purpose of the study is to study the details of dimensions and shape of oval window in different age groups, sides and genders and their clinical implications. The oval window is a key structure while performing surgeries in relation to stapes. An intricate knowledge of the shape and size of the oval window is important for the reconstruction and fitting of cartilage compatible with the native shape of the oval window. METHODS: Sixty normal wet cadaveric temporal bones of known age; gender and side were micro-dissected. The maximum height and width of the oval window was measured. The shape of the oval window was noticed. RESULTS: The mean value for maximum height and width of the oval window was 1.31 ± 0.28 mm and 2.67 ± 0.42 mm, respectively. The height and width of the oval window ranged between 1 mm and 1.5 mm and 2 mm and 3 mm in majority of the cases. he oval window was found to be oval shaped in 53.3% cases, other shapes such as kidney, D shape, rectangular or trapezoidal were also observed. CONCLUSIONS: The refined morphometric information of the oval window will help in preoperative assessment and surgical planning of various oval window-related surgical procedures. The knowledge may also help in designing and selecting proper cartilage shoe for the best outcome. Narrow oval window may cause procedural complications and surgeon discomfort in various stapes surgeries.

Utility of Artificial Intelligence Amidst the COVID 19 Pandemic: A Review.

The term machine learning refers to a collection of tools used for identifying patterns in data. As opposed to traditional methods of pattern identification, machine learning tools relies on artificial intelligence to map out patters from large amounts of data, can self-improve as and when new data becomes available and is quicker in accomplishing these tasks. This review describes various techniques of machine learning that have been used in the past in the prediction, detection and management of infectious diseases, and how these tools are being brought into the battle against COVID-19. In addition, we also discuss their applications in various stages of the pandemic, the advantages, disadvantages and possible pit falls.

Students' Perception of Newly Experimented "Rangoli Art" in Anatomy Education: A Pilot Study.

Art and drawing have a well-established history with the teaching and learning of anatomy, as symbolized by Leonardo Da Vinci's Vitruvian Man. However, its efficacy relatively declined in modern anatomy education. The purpose of this study was to survey students' views regarding the "anatomy Rangoli-making activity" and to discern if this art form may be implicated in anatomy education. In this group activity, the basic anatomical drawing of the specific structure was made on the floor, and then the different structures in the illustration were filled with relevant powdered Rangoli colors. The present study was conducted on seventy-eight first-year medical students who were willing to participate in the study. A mixed questionnaire regarding their opinion on the "anatomy Rangoli-making activity" was designed and feedback was taken from the students. The majority of the students replied that the Rangoli-making activity was interesting, promoted team spirit, and improved confidence to draw and understand the concept of the diagrams. The students agreed that it is an innovative method of anatomy learning. Almost 99% of students suggested incorporating such art activities in anatomy learning for future students. The enthusiastic response of the students to this activity is encouraging to introduce such art base activities in anatomy education and learning. Future multicenter studies on this learning method may be planned to check its efficacy.

Morphology and Morphometry of Human Paracentral Lobule: An Anatomical Study with its Application in Neurosurgery.

BACKGROUND: The human paracentral lobule (PCL) is the medial continuation of the precentral and postcentral gyri. It has important functional area related to the lower limb and perineum. Its visible surface that corresponds to magnetic resonance imaging scout images varies in morphology, so it requires exact data. Studies related to such data are rare. With such a facile, we studied the morphology and morphometry of PCL. MATERIALS AND METHODS: Fifty formalin-fixed adult human brains dissected in the midsagittal plane were used in this study. First, the morphological types of PCL and its boundary were determined, followed by morphometry of its extrasulcal surface using digital vernier calipers. Measurements were done along the anteroposterior axis (length) and vertical axis (height). In addition to that, the extent of motor and sensory area into PCL was also measured. RESULTS: Three distinct morphological types of PCL were found: continuous (2%), partially segmented (91%), and completely segmented type (7%). In completely segmented type, a short transitional lobulolimbic gyrus was also found in three cases. The mean extrasulcal surface of the left PCL was significantly larger, both in males (left 10.67 cm2 vs. right 8.80 cm2) and in females (left 8.80 cm2 vs. right 6.99 cm2). Irrespective of gender and sidedness, motor area was significantly larger than the sensory area. CONCLUSION: Reported data will be useful in diagnosis and treatment of diseases affecting the human PCL. Variations in the distribution of sensorimotor cortex over PCL may help further assessment of hemispheric lateralization and the location of central sulcus as a reliable indicator of cytoarchitectonic borders.

Morphological and Morphometric Analysis of the Orbital Aperture and Their Correlation With Age and Gender: A Retrospective Digital Radiographic Study.

Purpose Precise knowledge about clinically observed bony orbital aging is needed for surgical planning for acceptable cosmetic results. The effect of age and gender on the facial skeleton and orbital aperture has been appreciated earlier, but its quantification remains ignored. The purpose of this study was to evaluate age- and sex-related changes in the shape of the orbital aperture and construct a reference data set for the aging phenomenon in Indians. Methods Two hundred digital radiographs (Water's/frontal view) of the skull, obtained for various reasons, were evaluated. The radiographs comprised 107 males and 93 females aged between 10 and 60 years (10-59 years). Orbital shape, height/width, and interorbital/biorbital distances were noted, and orbital indices (OIs) were calculated. Orbital parameters thus obtained were compared between right and left sides and males and females. The relation of the parameters with age and gender was analyzed. Results Four types of orbits, round (33.5%), elliptical (30.5%), rectangular (27.5%), and square (9.5%), were noted in the study population. The average value of height and width of the right orbit was found to be higher than that of the left (p > 0.05). Male patients had higher (p > 0.05) and wider (p > 0.05) orbits than females. The right OI (81.55 ± 5.30) was higher than the left (80.75 ± 4.80) (p > 0.05). When comparatively evaluated between gender, both orbits were found to be of the microseme type with a mere difference (p > 0.05). The average interorbital/biorbital distance was 1.27 ± 2.11 and 9.78 ± 4.40 cm, respectively, without any gender difference. No significant relation was found between the age change and the parameters defined (p > 0.05), except in one age group (10-19 years). Conclusions Orbital dimensions showed no association with age and gender except in one age group (10-19 years); a pubertal growth spurt in females might be causing this phenomenon. The morphometric data may be useful in forensic anthropology and better planning for reconstructive surgeries in the orbito-maxillary region.

Green tea [Camellia sinensis (L.) O. Kuntze] extract reverses the despair behaviour in reserpinised and diabetic mice.

Green tea (C. sinensis) extract (GTE) dose dependently produced reversal of despair in normal, reserpinised and diabetic mice, thereby demonstrating an antidepressant effect. Although the exact mechanism is yet to be explored, the possible inhibition of catechol-o-methyl transferase and monoamine oxidase enzymes may be responsible for antidepressant activity of GTE.

Modulatory role of green tea extract on antinociceptive effect of morphine in diabetic mice.

Diabetic neuropathic pain is an important microvascular complication, and morphine has been demonstrated to be ineffective in this condition. Therefore the present study was designed to investigate the modulatory effect of green tea extract (GTE) on the decreased antinociceptive effect of morphine in diabetic mice. The tail withdrawal test was performed for measurement of the nociceptive threshold in both streptozotocin (STZ)-injected and control mice. Four weeks after administration of STZ, antinociception of morphine (5 mg/kg, s.c.) alone or in combination with GTE (25, 50, and 100 mg/kg, i.p.) was measured. Experimental diabetes markedly decreased the antinociceptive effect of morphine. The decrement in morphine response was significantly attenuated by GTE administration. When GTE (25 mg/kg) and a nitric oxide (NO) inhibitor, L-N(G)-nitroarginine methyl ester (L-NAME) (10 mg/kg, i.p), were co-administered along with morphine (5 mg/kg, s.c) in diabetic mice, the antinociceptive action of morphine was significantly increased as compared with the GTE + morphine-treated diabetic group, but the increased antinociceptive action was significantly attenuated by administration of an NO precursor, L-arginine (100 mg/kg, i.p), instead of L-NAME. Plasma nitrite concentrations were estimated using the Griess reagent. Diabetes significantly increased the plasma nitrite levels that were attenuated by GTE administration. When GTE (25 mg/kg) and L-NAME (10 mg/kg, i.p) were co-administered along with morphine (5 mg/kg, s.c) in diabetic mice, the plasma nitrite levels were significantly decreased as compared with the GTE + morphine alone-treated diabetic group, but the decreased plasma nitrite levels were significantly reversed by administration of L-arginine (100 mg/kg) instead of L-NAME. It may be concluded that increased NO formation may be responsible for the decreased antinociceptive effect of morphine in diabetic mice and that GTE restored the antinociceptive effect of morphine by inhibition of NO production. The results of the present study indicate the possibility of adding GTE as an adjuvant in the treatment of diabetic neuropathic pain.

Green tea extract and catechin ameliorate chronic fatigue-induced oxidative stress in mice.

Chronic fatigue syndrome (CFS) is an illness characterized by persistent and relapsing fatigue, often accompanied by numerous symptoms involving various body systems. The etiology of CFS remains unclear, but a number of studies have shown that oxidative stress may be involved in its pathogenesis. The present study was designed to investigate the protective effect of green tea extract (GTE) and catechin in the mouse model of CFS. Animals were subjected to a forced swimming test session of 6 minutes every day for 7 days; a significant increase in immobility time on successive days represented the CFS in mice. Biochemical analysis revealed that the chronic swim test significantly increased lipid peroxidation levels and decreased glutathione levels in mouse whole-brain homogenate. Treatment with GTE (25 or 50 mg/kg, i.p.) and catechin (50 or 100 mg/kg, i.p.) for 7 days reversed the increase in immobility time. Protection was correlated with the lowered levels of lipid peroxidation and restoration of reduced glutathione levels in the brains of fatigued mice. These findings strongly suggest the pivotal role of oxidative stress in the pathophysiology of CFS and that GTE and catechin could be used as potential agents in the management of CFS and warrant the inclusion of GTE and catechin in the treatment regimen of CFS patients.

Green tea (Camellia sinensis) extract ameliorates endotoxin induced sickness behavior and liver damage in rats.

Immune activation, either by cytokines or endotoxin, elicits a constellation of nonspecific symptoms such as weakness, malaise, listlessness, fatigue, adipsia, anorexia, depression and anxiety collectively termed as sickness behavior. Further, endotoxin administration in animals has been implicated in the pathogenesis of many types of liver disease. Green tea, a common household drink, is rich in antioxidant polyphenols demonstrating inhibitory effects on cytokine production. The present study was designed to investigate the effect of chronic treatment of green tea extract (GTE) on lipopolysaccharide (LPS)-induced sickness behavior and liver damage in rats. The hypothesis was tested through the analysis of LPS-induced behavioral changes in rats, in plus maze and open field paradigms. Other parameters such as feeding and water consumption, weight loss and organ weight index were also estimated. Liver function tests were conducted to investigate the effect of GTE supplementation on LPS-induced hepatic dysfunction. The results of the study demonstrated that GTE significantly attenuated LPS-induced sickness behavior as well as hepatic damage either by its antioxidant activity or by inhibiting LPS induced cytokine production in rats.

Reversal of LPS-induced immobility in mice by green tea polyphenols: possible COX-2 mechanism.

An endotoxin (lipopolysaccharide, LPS) is known to activate the hypothalamo-pituitary adrenocortical axis, as well as norepinephrine and indolamine metabolism. Systemically administered LPS produces depression in the forced swimming-induced despair behaviour model in mice. The present study was designed to investigate the effect of green tea extract (GTE) on LPS-induced despair behaviour and to explore the mechanism involved in modulation of LPS-induced immobility by GTE. GTE (10-100 mg/kg) pretreatment reversed LPS-induced immobility in a dose-dependent manner. Rofecoxib (2 mg/kg) and nimesulide (2 mg/kg), COX-2 inhibitors, also reversed the LPS-induced immobility, which was significantly potentiated by concomitant administration of GTE. On the other hand, GTE did not show any potentiating effect on immobility with naproxen (10 mg/kg), which is a nonselective COX blocker. Interestingly the antioxidant, carvedilol (2 mg/kg) did not produce any effect on immobility either in normal or in LPS treated mice. The results of the study implicate the role of COX-2 inhibition by GTE in the reversal of LPS-induced immobility.