Computed tomography angiographic study of surgical anatomy of thyroid arteries: Clinical implications in neck dissection.

BACKGROUND: The course and variations of thyroid arteries must be understood by surgeons to prevent bleeding during operative procedures of the thyroid gland. There is limited scientific literature regarding the radiological anatomy of thyroid arteries in this geographical area, the Garhwal region of Sub-Himalayan belt, which is considered to be the endemic belt of goiter. Computed tomography angiography provides a three-dimensional orientation of the vascular and surgical anatomy of the entire cervical region. AIM: To estimate the proportion of variation in origin of thyroid arteries using Computed Tomography Angiography. METHODS: Using Computed Tomography Angiography, the presence and origin of the superior thyroid artery, inferior thyroid artery, and thyroid ima artery were observed and assessed. RESULTS: Out of total 210 subjects, superior thyroid artery was seen to be emerging from external carotid artery in 77.1% cases. The artery was found to be originating at the level of bifurcation of common carotid artery in 14.3% cases, whereas in 8.6% cases, it emerged as a direct branch of the common carotid artery. Similarly, the inferior thyroid artery was observed to be emerging from thyrocervical trunk, subclavian artery and vertebral artery in 95.7% cases, 3.3% and 1% cases, respectively. Thyroid ima artery was also reported in a subject, arising from the brachiocephalic trunk. CONCLUSION: To avoid vascular injuries, excessive and uncontrollable bleeding, intra-operative difficulties, and post-operative issues, it is imperative for surgeons to be aware of the course and variations of thyroid arteries.

Association of Vitamin D Status With Metabolic Syndrome and Its Individual Risk Factors: A Cross-Sectional Study.

Background Vitamin D deficiency has been associated with metabolic syndrome and its related outcomes, including type 2 diabetes mellitus, cardiovascular disease, myocardial infarction, and stroke. However, studies in Indian populations have provided conflicting results. Methods This single-center cross-sectional study was conducted in a tertiary care hospital in north India to determine the prevalence of vitamin D deficiency in patients with metabolic syndrome and to study the correlations of individual components of metabolic syndrome with 25 hydroxy vitamin D levels. The study included 235 patients aged between 30 to 70 years who met the criteria for metabolic syndrome. Patients with diabetes, hypothyroidism, Cushing's, and other disorders affecting vitamin D status, on supplements of vitamin D or anti-dyslipidaemic drugs were excluded. Information regarding socio-demographic characteristics, medical history, and anthropometric measurements were collected. Blood samples were collected to assess vitamin D levels. Results The prevalence of vitamin D deficiency (<20 ng/ml) was 76% among the study population. There was a significant negative correlation between vitamin D levels and diastolic blood pressure (Spearman's rho: -0.134, 95% CI: -0.82,-0.260, p=0.040), fasting blood glucose (Spearman's rho: -0.142, 95% CI: -0.101,-0.269, p=0.029), A weak correlation was also found between vitamin D3 levels and total cholesterol (Spearman's rho: -0.246, 95% CI: -0.119,-0.367, p<0.001), triglyceride levels (Spearman's rho: -0.246, 95% CI: -0.118,-0.370, p<0.001) and low-density lipoprotein (LDL) levels (Spearman's rho: -0.229, 95% CI: -0.102,-0.351, p<0.001). Conclusion The study findings suggest that vitamin D deficiency is prevalent among patients with metabolic syndrome in north India. There is a significant negative correlation between vitamin D levels and some components of metabolic syndrome. This highlights the need for further research to understand the underlying mechanisms and potential benefits of vitamin D supplementation in this population. Identification of high-risk individuals for hypovitaminosis D can aid in streamlining treatment guidelines and preventing unnecessary prescription of investigations in developing countries.

Surgical Anatomy of Vertebral Artery in Relation to Atlantoaxial Instrumentation: A Cadaveric Study.

BACKGROUND: With the advent of pedicle screws and advanced instrumentation techniques, internal fixation and stabilization of upper cervical vertebrae are possible in fractures of an axis. However, the proximity of vertebral arteries (VAs) poses a unique challenge to surgeons during these procedures and can result in profound physical impairment to patients. Cadaveric studies contributing to fine anatomical details necessitate conducting such studies. METHODS: After receiving due ethical permission, this descriptive cross-sectional study was carried out on 10 cadavers in the department of Anatomy, All India Institute of Medical Science (AIIMS) Rishikesh. Twenty VAs were dissected along their course, and measurements of parameters related to the axis and atlas vertebra were noted. RESULTS: The length of the pre-osseous segment related to the axis (VAX-1) on the right and left sides were from 3.8 to 14.5 mm (7.48±3.88 mm) and 4.46 to 10.5mm (6.94±2.01mm) respectively. The length of the osseous segment related to the axis (VAX-2) on the right side and left sides were from 6.82 to 31 mm (17.9±7.84mm) and 7.35 to 20 mm (15.6±4.53). The osseous segment of the VA related to the axis (VAX-2) shows genu (bend), which extends to a variable distance towards the midline. The mean distance of VA genu from the midline of the axis vertebral body on the right and left sides was 15.6mm and 17.5 mm, respectively. The percentage of superior articular facet (SAF) surface area of the axis occupied by the VA was 25-50% in nine and 50-75% in 11 cadavers, reflecting incomplete occupancy. CONCLUSION: The study suggests that for instrumentation of the axis vertebra in the midline, the minimum distance between the genu of both sides of VA segments, related to an osseous segment of the axis (VAX-2) and medial extent of the VA groove of the atlas, should be considered as a safe zone to minimize inadvertent VA injury. During atlantoaxial fixation through a posterior approach in interarticular, pars, and pedicle screws, the surgical anatomy of the VA in relation to the osseous segment of the VA within the transverse process of the axis should be kept in mind to avoid inadvertent VA injury.

The Clinical-Audiological Cross Sectional Study of Deaf-Mute Patients in a Tertiary Care Centre of Uttarakhand State and Literature Review.

Deafmutism affects communication and wholesome development of an individual. India has a significant burden of deafness in the country. Even fourteen years after the launch of a National Program for Prevention and Control of Deafness in year 2006, we lack detailed data about the disability from most regions of the country. This study aims at finding out the prevalence, clinical history-examination and audiological profile of deaf-mute patients visiting the Out Patient Department (OPD) of a tertiary care institute in Uttarakhand, and compare the results with similar studies published during last 20 years from India to generate a literature review. Out of 46,049 patients that visited OPD of the institute during the given period of 24 months, 73 cases were short-listed clinically to be enrolled in the study. However, only 55 (75%) of them completed the questionnaire and audiological testing. All information was extracted from the patients/relatives with the help of a questionnaire in the Hindi language. The prevalence of deafmutism in patient presenting in our OPD in the study period was 0.3%. The history of pre-, peri- and post-natal risk factors was present in high percentage (58.2%, 78.2% and 34.5% respectively) of patients. This warrants review of our maternal and child healthcare strategies. The literature review revealed lack of uniform and standardized tool in conducting and reporting of studies on deafmutism. The questionnaire used in this study can be further improved and modified in the future as per the requirements of data collection.

A Comparative Morphometric and Histological Study of Human Fetus and Fetal Pancreas in Hyperglycemic and Normoglycemic Mothers.

BACKGROUND: A significant percentage of pregnancies with gestational diabetes mellitus (GDM) has been found to result in the delivery of macrosomic babies. The current study intends to highlight the correlation between maternal diabetes and fetal parameters as well as the histogenesis of the fetal pancreas in humans. MATERIALS AND METHODS: The study included thirty aborted fetuses, categorized into seven groups according to their gestational age. Morphometric analysis of fetal parameters and fetal pancreas was done, and the values were compared within different gestational age groups. Pancreatic tissue was processed, stained with Hematoxylin & Eosin, and examined. A comparison was then made between fetuses with and without gestational diabetes.  Results: All the fetal biometrics as well as pancreatic parameters showed greater numeric values in mothers with GDM as compared to the controls of the same gestational age groups. However, the difference was not statistically significant. Histogenesis in such fetuses revealed GDM-related hyperplasia of islets of Langerhans. CONCLUSION: A timely diagnosis of GDM is thus of paramount significance due to its potential implications so that appropriate interventions can be done on time, to improve the overall outcome.

"Mushroom" Autologous Partial Ossicular Replacement Prosthesis: Long-term Results.

OBJECTIVE: Evaluate a new autologous mushroom-shaped cortical bone partial ossicular replacement prosthesis (MPORP) for cost-effective and sustainable hearing results. STUDY DESIGN: Prospective study. SETTING: Tertiary care center. PATIENTS: Forty-two patients suffering from chronic otitis media with intact superstructure of the stapes and partially or completely eroded incus. INTERVENTIONS: Group-1 (n = 24) underwent only tympanoplasty with MPORP; group-2 (n = 18) underwent intact canal wall mastoidectomy (ICW) with MPORP. MAIN OUTCOME MEASURES: Hearing results were evaluated using a four frequency average (measured at 0.5, 1, 2, 3 kHz) pure tone air conduction (PTA), air-bone gap (ABG), and word recognition scores (WRS) after 3, 6, and 12 months and compared with preoperative results. RESULTS: Overall, successful rehabilitation of ABG to 20 dB or less was achieved in 92% of patients. Mean postoperative ABG was 15.35 ±â€Š4.18 dB showing mean improvement of 23.89 ±â€Š5.95 dB. In group-1, mean postoperative ABG was 18.47 ±â€Š3.65 dB, showing an improvement of 25.92 ±â€Š5.3 dB. In group-2, mean postoperative ABG was 18.47 ±â€Š3.65 dB showing an improvement of 20.14 ±â€Š4.96 dB. Hearing improvement in all the cases together and both the groups checked separately was statistically significant (paired t test, p < 0.001). Group 1 had, on average, 5 dB better hearing than group 2 (unpaired t test, p > 0.05). CONCLUSION: The MPORP is obtainable from the local site, easily constructed, bio-compatible, cost-effective, less bulky, adequately rigid for sound transmission, magnetic resonance imaging (MRI) compatible, and provides sustainable hearing gain because it has better chances of integration with the head of stapes.

A Historical Review of Indian Perspectives on Techniques of Tympanoplasty.

Reconstructive surgery of the conductive hearing mechanism is collectively called as tympanoplasty, which has gradually evolved over time with the contributions from all over the word. The aim of the present historical review is to summarize the Indian contributions in the development of the technique of tympanoplasty. The literature review was conducted using only the "Medline" search using keywords "tympanoplasty" and "ossiculoplasty" in "India" on 15th June 2016. A total of 195 articles and abstracts were found dated from the year 1998 onwards. Articles describing work on technique were included, and those describing only experimentation with graft material were excluded. All articles were fully read and analysed. It was found that there had been experiments regarding the choice of anaesthesia and the use of combinations of different chemical agents for this purpose. There were suggestions in favour of monitored anaesthesia care for the surgery in select patients. Surgeons expressed their perspectives on the time and conditions for the surgery, laterality of surgery, different types of incisions, use of endoscopes, graft placement techniques, ossicular replacements with autologous or allogenic grafts, and the timing of prophylactic antibiotic therapy given after or during the surgery. The range of work is wide and covers most of the aspects of surgery; however, the incorporation of a uniform methodology and standards reporting results were lacking in the articles reviewed.

Indian Perspectives on Graft Materials Used for Repair of Tympanic Membrane.

INTRODUCTION: Repair of Tympanic Membrane (TM) is one of the most common surgeries performed by the otologists. Literature reveals that Indian surgeons have contributed substantially in the research on techniques and graft materials used for the repair of tympanic membrane, though no review has been written so far highlighting their contributions. AIM: To summarize and analyse the contributions of Indian authors who have used different graft materials for repair of TM and their studies listed in Medline search. MATERIALS AND METHODS: A literature review was conducted using a Medline search using keywords of 'myringoplasty' and 'tympanoplasty' with 'India' on 30th June 2016. A total of 243 articles were found listed onwards from year 1998. Out of these 50 articles in which type 1 tympanoplasty or myringoplasty was performed using different graft materials were selected. The content of each abstract was studied in order to identify studies related to topic. RESULTS: Authors have experimented with a variety of tissues as graft materials. Temporalis Fascia (TF) has been most widely used in 58.6% studies as graft material. The next popular graft is tragal perichondrium. The graft take up rates varied from 68.5% to 100%, while method of reporting of hearing gain in most studies was inconsistent amongst studies, though most studies have reported achievement of serviceable hearing of < 25 dB in most patients. CONCLUSION: TF was the most prefered material due to anatomic proximity, light material and strength. It was followed in popularity by tragal perichondrium and tragal cartilage. All graft materials have given satisfactory hearing results.

Anomalies of radial and ulnar arteries / Anomalias nas artérias radial e ulnar

Abstract During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

Resumo Durante dissecção de membro superior direito de um cadáver de 70 anos, do sexo masculino, conduzida em um departamento de anatomia, foram observadas anomalias tanto na origem quanto no curso das artérias radial e ulnar. Após descer 5,5 cm desde a borda inferior do músculo redondo maior, a artéria braquial anomalamente se bifurcava em uma artéria radial medialmente, e em uma artéria ulnar lateralmente. No braço, a artéria ulnar se encontrava ao lado do nervo mediano, e seguia um curso normal no antebraço. A artéria radial se encontrava medialmente ao nervo mediano no braço e, então, no nível do epicôndilo medial, ela cruzava do lado medial para o lado lateral do antebraço, na superfície dos músculos flexores. O curso da artéria radial era superficial e tortuoso em todo o braço e antebraço. As variações das artérias radial e ulnar aqui descritas foram associadas a formação e curso anômalos do nervo mediano no braço. Conhecimento sobre anomalias neurovasculares são importantes para cirurgiões vasculares e radiologistas.

Anomalies of radial and ulnar arteries.

During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

Durante dissecção de membro superior direito de um cadáver de 70 anos, do sexo masculino, conduzida em um departamento de anatomia, foram observadas anomalias tanto na origem quanto no curso das artérias radial e ulnar. Após descer 5,5 cm desde a borda inferior do músculo redondo maior, a artéria braquial anomalamente se bifurcava em uma artéria radial medialmente, e em uma artéria ulnar lateralmente. No braço, a artéria ulnar se encontrava ao lado do nervo mediano, e seguia um curso normal no antebraço. A artéria radial se encontrava medialmente ao nervo mediano no braço e, então, no nível do epicôndilo medial, ela cruzava do lado medial para o lado lateral do antebraço, na superfície dos músculos flexores. O curso da artéria radial era superficial e tortuoso em todo o braço e antebraço. As variações das artérias radial e ulnar aqui descritas foram associadas a formação e curso anômalos do nervo mediano no braço. Conhecimento sobre anomalias neurovasculares são importantes para cirurgiões vasculares e radiologistas.

Euphorbia hirta: Its chemistry, traditional and medicinal uses, and pharmacological activities.

The oldest remedies known to mankind are herbal medicines. India is known worldwide for its Ayurvedic treatment. Euphorbia hirta is often used traditionally for female disorders, respiratory ailments (cough, coryza, bronchitis, and asthma), worm infestations in children, dysentery, jaundice, pimples, gonorrhea, digestive problems, and tumors. It is reported to contain alkanes, triterpenes, phytosterols, tannins, polyphenols, and flavanoids. This review describes the medicinal properties, chemical constituents, and other important aspects of Euphorbia hirta.

The utility of the tongue blade test for the diagnosis of mandibular fracture.

A short cut review was carried out to establish whether the tongue blade test is useful in the clinical assessment of patients with mandibular trauma. Altogether 269 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.