Implementing Formative Assessment in Human Anatomy Practical Sessions: Medical Students' Perception and Effect on Final Exam Performance.

Background: Formative assessment with feedback is part of the assessment program in medical education to improve students' learning. Limited research has focused on its application and impact on practical anatomy education. Methods: This study aimed to examine medical students' perceptions of formative assessment in practical anatomy sessions of body systems-based educational units and explore its influence on final practical exam performance. A descriptive, cross-sectional study was conducted. Data was collected from 173 Year 2 medical students through a survey that addressed their perception of process and importance of formative assessment and feedback. The survey employed a 5-point Likert scale. Two open-ended questions were appended at the end of the survey. Students' performance in Unit 3 (where formative assessment was conducted) was compared to their performance in Unit 2 (where no formative assessment was conducted) and with the performance of the previous academic year's students in Unit 3 (where no formative assessment was conducted). Descriptive statistics were used. The level of statistical significance was set at p-value < 0.05. Responses to open-ended questions (qualitative data) were counted, categorized as themes, and presented as frequencies and percentages. Results: The survey showed high internal consistency, and its validity was established through exploratory factor analysis. Results showed that the mean mark for the unit with formative assessment and feedback was significantly higher than for the units without formative assessment and feedback. Students showed positive perception of formative assessment and feedback conducted after practical anatomy sessions. They reported useful insights regarding the benefits they gained from formative assessment and feedback as well as constructive suggestions for future improvements. Conclusion: The study indicates that students positively perceived formative assessment and feedback sessions after practical anatomy sessions. Findings also refer to a positive effect of formative assessment on students' performance in summative practical assessment in anatomy.

Occurrence of the ossification of petrosphenoid ligament: a retrospective radiologic study from computed tomographic images.

BACKGROUND: Various ligaments present in the skull base are of clinical and surgical importance. One among them, is the petrosphenoid ligament (PSL). PSL may ossify either in a partial or complete form and forms the roof of Dorello's canal underneath which the abducens nerve passes. Studies argued both protective and adverse effects of the ossified PSL. Hence, the incidence of PSL ossification has become a relevant subject in clinical practice to radiologists, neurologists and neurosurgeons for understanding its potential role in abducens nerve compression. MATERIALS AND METHODS: We have undertaken this study to investigate the incidence of PSL ossification from multidetector computed tomography (MDCT) images of the patients who had been referred to the Medical Imaging Department of Mubarak Al-Kabeer Hospital in Kuwait. We retrospectively assessed a total of 200 patients' head CT scans (400 petroclival regions) between January 2021 and June 2022 in which 59% were males (n = 118) and 41% were females (n = 82) aged between 18 and 91 years. RESULTS: A total of 37 patients (26 male, 11 female) aged between 18-84 years were presented with ossification of PSL. Among these 37 patients, 28 patients were presented with unilateral ossified PSL, and 9 patients were presented with bilateral ossified PSL, amounting to the total of 46 ossified PSL from 400 CT images of the petroclival regions (11.5%). The genderwise and sidewise occurrence of the PSL ossification seen in different age groups were not statistically significant (p > 0.05). Among all the ossified cases, there was no patient presented with abducens nerve palsy. CONCLUSIONS: We believe our results provide baseline data in the region for understanding PSL ossification and its impact on the abducens nerve palsy.

Innervation Patterns of the Pronator Teres Muscle and Their Possible Role in Neurotization: A Systematic Review of Cadaveric Studies.

BACKGROUND: Contrary to the classic anatomical description, many recent studies have reported wide variations in branching patterns and location of motor branches that are supplying the pronator teres muscle. To understand these variations and their implications in surgical procedures of the nerve transfers, a systematic review was performed on the innervation of pronator teres muscle from cadaveric studies. METHODS: A systematic literature search was performed in databases such as Medline, PubMed, Google Scholar, SciELO, ScienceDirect, Cochrane reviews and orthopedics textbooks using the search terms "pronator teres nerve branches"; AND "number" OR "location" OR "length" OR "diameter" yielded 545 article links. Articles were evaluated according to PRISMA guidelines. RESULTS: A total of twenty cadaveric studies including 648 branches have registered 52.9% of two branch innervation pattern followed by 31.3%-single branch pattern; 13.5%-three branch pattern; 1.7%-four branch pattern, and 0.4%-five branch patterns, respectively. Of the 403 branches studied for their location in relation with the humeral intercondylar line, most branches were located distal to the line (50.3%), followed by 32.7% (proximal to it) and 16.8% at the line, respectively. The distance of branches located proximal and distal to humeral intercondylar line was in the range of 1.25-10 cm, and 1.1-7.5 cm, respectively. The mean length and diameter of nerves reported were 4.37 ± 2.43 cm, and 1.5 mm, respectively. CONCLUSIONS: Our data defined the morphometrics of nerve branches and they often met the required diameter for neurotization procedures. Our findings also demonstrated that the morphometrics, branching pattern and their location vary between populations and this information is very vital for surgeons during the nerve transfers.

Morphology of Anterolateral Ligament of the Knee: A Cadaveric Observation with Clinical Insight.

Background. The morphology and function of anterolateral ligament (ALL) of the knee are not clearly understood even today with all the sophisticated techniques available. There have been differing descriptions of the ALL of the knee in literature, and not all of them have been named or described clearly. Aim. The present study was undertaken to provide a clear structure/relationship description on ALL. Materials and Methods. We used 24 formalin-fixed cadaveric limbs. Knee regions of the all the limbs were neatly dissected and the ALL was exposed. Its proximal and distal attachments were traced carefully. Middle portion of ALL was removed and processed for histological analysis. Results. ALL was found in one right knee (4.16%). It extended distally from the lateral femoral condyle to the lateral tibial plateau margin. Its attachment on the tibial plateau was located between head of the fibula and Gerdy's tubercle. A strong connection was identified between the ALL and the periphery of the middle third of the lateral meniscus. Histological analysis of ALL confirmed the presence of true ligamentous structure in it with dense connective tissue and plenty of fibroblasts. Conclusion. The prevalence of ALL in different populations along with its clinical significance has been discussed in detail in this paper.

Occurrence of the retromolar foramen in dry mandibles of South-eastern part of India: a morphological study with review of the literature.

The retromolar foramen (RMF) is a rare anatomical structure situated in the retromolar fossa behind the third molar tooth. When it is present, the foramen is connected with the mandibular canal and is believed to transmit neurovascular structures that provide accessory source to the mandibular molars and the buccal area. Reports from the literature show that the presence of RMF could pose a challenge in complete blockage of the inferior alveolar nerve during mandibular surgeries. We report the incidence of retromolar foramen from ninety-four dry mandibles of south-eastern part of Karnataka State, India. The foramen was observed in 11 mandibles out of 94 included in the study (11.7%). In three mandibles, the foramen was present bilaterally (3.2%) and in three it was on the left side (3.2%) and in five it was on the right side (5.3%). For the first time, we also measured the dimensions of the retromolar area and distance of the foramen from third molar tooth to understand its risks during the surgical extraction of the lower third molar tooth. A thorough review of the literature has also been done to compare the present findings with the studies reported from the various populations.

Beneficial Effect of Cissus quadrangularis Linn. on Osteopenia Associated with Streptozotocin-Induced Type 1 Diabetes Mellitus in Male Wistar Rats.

Petroleum ether fraction of Cissus quadrangularis (PECQ) impact on the development of osteopenia in type 1 diabetic rat model has been evaluated. Diabetic rats were treated orally with two doses of PECQ. Another group of diabetic rats were treated with subcutaneous injection of synthetic human insulin. The cortical and trabecular bone thickness and bone strength were significantly decreased in diabetic rats. Treatment with two doses of PECQ significantly prevented these changes in diabetic rats. However, PECQ treatment (two doses) did not alter the glycemic levels in these diabetic rats. Increased levels of serum alkaline phosphatase (ALP), tartrate-resistant acid phosphatase (TRAP), and hydroxyproline were noted in diabetic rats when compared to normal control rats. The two doses of PECQ treatment further improved the serum ALP levels and significantly decreased the serum levels of TRAP and hydroxyproline. The effects of PECQ treatment on histological, biomechanical, and biochemical parameters are comparable to those of insulin. Since PECQ improves the bone health in hyperglycemic conditions by enhancing the cortical and trabecular bone growth and altering the circulating bone markers, it could be used as an effective therapy against diabetes-associated bone disorders.

Protective effect of Cissus quadrangularis Linn. on diabetes induced delayed fetal skeletal ossification.

BACKGROUND: Delayed fetal skeletal ossification is one of the known complications of maternal diabetes. OBJECTIVE: The present study was designed to evaluate the protective role of petroleum ether extract of Cissus quadrangularis (PECQ) on diabetes-induced delayed fetal skeletal ossification. MATERIALS AND METHODS: Female Wistar rats were rendered diabetic with streptozotocin (STZ, 40 mg/kg, intraperitonial) before mating. After confirmation of pregnancy, the pregnant rats were divided into three groups: normal control group, diabetic control group, and diabetic + CQ group. The diabetic + CQ group pregnant rats were treated with PECQ (500 mg/kg body weight) throughout their gestation period. Immediately after delivery, pups were collected from all three groups and processed for alizarin red S-alcian blue staining in order to examine the pattern of skeletal ossification. RESULTS: Fewer ossification centers and decreased extent of ossification of forelimb and hindlimb bones were observed in the neonatal pups of diabetic control group as compared to those in the normal control group. PECQ pretreatment significantly restored the ossification centers and improved the extent of ossification of forelimb and hindlimb bones in the neonatal pups of diabetic + CQ group as compared to those in the diabetic control group. CONCLUSIONS: The results suggested that PECQ treatment is effective against diabetes-induced delayed fetal skeletal ossification. However, further studies on the isolation and characterization of active constituents of PECQ, which can cross the placental barrier and are responsible for the bone anabolic activity are warranted.

Clinical and functional significance of accessory brachialis muscle: an unique anatomical variant / Significado clínico y funcional del músculo braquial accesorio: una variante anatómica única

A thorough knowledge of the variations in the patterns of muscle insertion and the consequent neurovascular entrapment due to them is important for orthopedic and plastic surgeons. During routine dissection, we encountered a unique occurrence of an accessory brachialis muscle (acBr) blending with the medial aspect of bicipital aponeurosis in the cubital fossa. It also entrapped the median nerve and brachial artery due to its superficial position. The abnormality reported here might result in neurovascular compression symptoms in the upper limb and possible mechanical advantages or disadvantage in the flexion of elbow joint. To the best of our knowledge, the brachialis variant insertion we present here is rare in the list of its anomalies. We also discuss in this report the embryological background and the clinical application of the variation that can abet clinicians in evaluating symptoms involving the upper limb.

Es importante para los cirujanos ortopédicos y plásticos, el conocimiento integral de las variaciones en los patrones de inserción de los músculos y el consiguiente atrapamiento neurovascular. Durante una disección de rutina, encontramos un caso único de un músculo accesorio braquial con aponeurosis bicipital en el lado medial de la fosa cubital. También cubre la arteria braquial y nervio mediano debido a su posición superficial. La anomalía informada aquí podría resultar en síntomas de compresión neurovascular en el miembro superior y las posibles ventajas o desventajas mecánicas de flexión de la articulación del codo. De acuerdo a lo estudiado, la inserción variante braquial que presentamos aquí es un caso raro dentro de la lista de sus variaciones. También se discuten en este informe la base embriológica y la aplicación clínica de la variación que puede ser útil para los clínicos en la evaluación de los síntomas relacionados con el miembro superior.

Scope of anatomy teaching in problem-based learning (PBL) sessions of integrated medical curriculum / Alcance de la enseñanza de la anatomía en sesiones de aprendizaje basado en problemas del curriculum integrado de medicina

Problem based learning (PBL) made a great impact on the methodology of teaching. The major advantage of PBL method of teaching is integration of basic and clinical sciences in an integrated curriculum. This is achieved by presenting clinical problems to students which contain learning objectives from subjects related to the given clinical problems. In recent reports deficiencies have been reported regarding quantity of anatomy content of the clinical problems which has resulted in difficulty in understanding of theanatomy. We have made an attempt to quantify the content of anatomy and its sub-disciplines in PBL curriculum by a case study method using 'documentary analysis' at School of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia. From the results of our study it is apparent that learning objectives for anatomy is not sufficiently spread across all the clinical problems and there is very less coverage of the sub-disciplines of anatomy particularly osteology and embryology. The benefits of PBL method of teaching is definitely more than that of traditional method, the uneven distribution of anatomy and its sub-disciplines had a major impact on the students during their clinical years.

El aprendizaje basado en problemas (ABP) generó un gran impacto en la metodología de la enseñanza. La principal ventaja del método ABP es la integración de las ciencias básicas y clínicas en un curriculum integrado. Esto se consigue mediante la presentación de los problemas clínicos a los estudiantes, que contienen objetivos de aprendizaje de temas relacionados con los problemas propuestos. En informes recientes se han reportado deficiencias en cuanto a la cantidad de contenido de la anatomía en los problemas clínicos, lo que se ha traducido en dificultades en la comprensión de la anatomía. Hemos hecho un esfuerzo para cuantificar el contenido de la anatomía y sus sub-disciplinas en el curriculum de ABP mediante el método de estudio de caso con "análisis documental" en la Facultad de Medicina y Ciencias de la Salud, UCSI University, Kuala Lumpur, Malasia. A partir de los resultados de nuestro estudio es evidente que los objetivos de aprendizaje para la anatomía no se extienden suficientemente a través de todos los problemas clínicos, y hay poca cobertura de la anatomía en las sub-disciplinas, en particular osteología y embriología. Los beneficios del método de ABP en la enseñanza es, sin duda, mayor que la de los métodos tradicionales, además la distribución desigual de la anatomía y sus sub-disciplinas, tuvieron un gran impacto en los estudiantes durante sus años clínicos.

A rare anatomical variation of the Berrettini anastomosis and third common palmar digital branch of the median nerve.

Variations in the origin and distribution of Berrettini anastomosis between the digital branches of the ulnar and median nerves exist and are well described in the literature. During regular dissections by medical students, we encountered a rare variation in the left hand of an approximately 50-year-old male cadaver. Berrettini anastomosis connecting the third common palmar digital branch of the median nerve with the fourth common palmar and proper palmar digital branches of the ulnar nerve presented a plexiform nature. This communicating branch and the third common palmar digital branch of the median nerve were perforated by the superficial palmar arch. Further, the superficial palmar arch was incomplete, and it was solely formed by the superficial branch of the ulnar artery. The unusual relationship of Berrettini anastomosis with the superficial palmar arch is very rare, and knowledge about such a variation is important when performing carpal tunnel release, flexor tendon surgery, and Dupuytren's fasciectomy and when dealing with arterial repairs and vascular graft applications in the hand.

Anti-osteoporotic activity of the petroleum ether extract of Cissus quadrangularis Linn. in ovariectomized Wistar rats.

BACKGROUND: The plant Cissus quadrangularis (CQ) is used as an osteoprotective agent in Ayurveda, the Indian system of alternative medicine. The present study was done to validate the anti-osteoporotic role of the petroleum ether extract of CQ on ovariectomy-induced osteoporosis in rats. METHODS: Female wistar rats were divided into five groups of six rats each; (1) The Normal control (NC) group (n=6) received no surgery and no treatment, (2). The Sham control (SHAM) group (n=6) received sham surgery but no treatment, (3) the Ovariectomized (OVX) group (n=6) received an ovariectomy and normal saline treatment for 90 days, (4) the Ovariectomized+raloxifene (OVX+RAL) group (n=6) received an ovariectomy and treatment with raloxifene, a known anti-osteoporotic agent for 90 days commencing from 22nd post ovariectomy day and (5) the Ovariectomy+Cissus quadrangularis (OVX+CQ) group (n=6) received an ovariectomy, and treatmentwith the petroleum ether extract of CQ 500 mg/kg body weight daily for 90 days commencing from 22nd post ovariectomy day. At the end of the treatment period, rats in all groups were sacrificed and the right femur was used for biomechanical analysis, and the left femur for histomorphometrical analysis. RESULTS: CQ significantly increased the force required to break the femur (p<0.001) and significantly increased the thickness of both cortical (p<0.001) and trabecular bone (p<0.001). This action of CQ was comparable to the action of raloxifene. CONCLUSIONS: The petroleum ether extract of CQ stem seems to possess anti-osteoporotic activity in rats.

An unusual communication between the mylohyoid and lingual nerves in man: its significance in lingual nerve injury.

The mylohyoid nerve is the branch of the inferior alveolar nerve (IAN) which arises above the mandibular foramen. An abnormal communication between the mylohyoid nerve and lingual nerve (LN) was noted during the routine dissection of a male cadaver. Communicating branches between IAN and LN have been identified as a possible explanation for the inefficiency of mandibular anesthesia. The communication between mylohyoid and lingual nerve was found in this case after the LN passes in close relation to third molar tooth, which makes it more susceptible to injury during third molar extractions.

Effect of radio-frequency electromagnetic radiations (RF-EMR) on passive avoidance behaviour and hippocampal morphology in Wistar rats.

INTRODUCTION: The interaction of mobile phone radio-frequency electromagnetic radiation (RF-EMR) with the brain is a serious concern of our society. OBJECTIVE: We evaluated the effect of RF-EMR from mobile phones on passive avoidance behaviour and hippocampal morphology in rats. MATERIALS AND METHODS: Healthy male albino Wistar rats were exposed to RF-EMR by giving 50 missed calls (within 1 hour) per day for 4 weeks, keeping a GSM (0.9 GHz/1.8 GHz) mobile phone in vibratory mode (no ring tone) in the cage. After the experimental period, passive avoidance behaviour and hippocampal morphology were studied. RESULTS: Passive avoidance behaviour was significantly affected in mobile phone RF-EMR-exposed rats demonstrated as shorter entrance latency to the dark compartment when compared to the control rats. Marked morphological changes were also observed in the CA(3) region of the hippocampus of the mobile phone-exposed rats in comparison to the control rats. CONCLUSION: Mobile phone RF-EMR exposure significantly altered the passive avoidance behaviour and hippocampal morphology in rats.

Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis.

Lateral epicondylitis (LE) or tennis elbow has been the subject of concern during the last 60 years, but the pathogenesis of the LE remains unclear. The LE can be due to the tendinogenic, articular or neurogenic reasons. Numerous theories have been put fourth in the recent past, out of which one of the most popular theories is that the condition results from repeated contraction of the wrist extensor muscles, especially the extensor carpi radialis brevis (ECRB) which may compress the posterior branch of the radial nerve (PBRN) at the elbow during pronation. We studied 72 upper limbs (36 formalin-fixed cadaver) for the origin, nerve supply and the course of PBRN in relation to the ECRB as one of the goal for the present study. The possible presence of an arch of the ECRB around the PBRN was also observed and recorded. The nerve to ECRB was a branch from the radial nerve in 11 cases (15.2%); from the PBRN in 36 cases (50%) and from the superficial branch of the radial nerve in 25 cases (34.7%), respectively. The ECRB had a tendinous arch in 21 cases (29.1%); a muscular arch in 8 (11.1%) cases and the arch was absent in 43 cases (59.7%). When the ECRB had a tendinous or muscular arch around the PBRN, it may compress the same and this condition may worsen during the repeated supination and pronation as observed in tennis and cricket players. The presence of such tendinous or muscular arch should be considered by orthopedicians and neurosurgeons, while releasing the PBRN during LE surgery.

Palmar type of median artery as a source of superficial palmar arch: a cadaveric study with its clinical significance.

The superficial palmar arch (SPA) and its contributing arteries are highly variable. The palmar type of median artery (PMA) can be involved in the formation of the SPA by replacing the superficial palmar branch of the radial artery (RA) or the ulnar artery (UA). The present study was undertaken to investigate the presence of the PMA and its contribution in the formation of SPA in 42 cadavers (84 upper limbs) of Indian origin. When there was a PMA, its outer diameter was measured in the carpal tunnel. The PMA was found in 13 upper limbs (15.4%), and of these ten incidences (11.9%), the PMA took part in the formation of SPA, and in three instances (3.5%), the PMA did not make up part of the SPA. Out of the ten cases in which the PMA contributed to the formation of SPA, in six cases (7.1%), the PMA anastomosed with the UA; in three cases (3.5%), the PMA anastomosed with both the UA and the RA, and in one incidence (1.1%), the PMA joined the arteria radialis indicis (deep branch of the RA) to complete the SPA. The outer diameters of the median arteries varied between 0.8 and 2.6 mm with the mean value of 1.7 mm. The present study concludes that the median-ulnar type of SPA was the most common type of SPA when the PMA was encountered as a source of superficial arterial arcade of the hand, followed by the radial-median-ulnar type. The vascular patterns found in this study are important to hand surgeons. The present study of PMA origin, course, and its contribution to the SPA will add to the existing knowledge of the vascular anatomy of forearm and hand.

Nerve loop around the axillary vessels by the roots of the median nerve a rare variation in a south Indian male cadaver: a case report.

INTRODUCTION: Median nerve is normally formed by the union of medial and lateral root arising from the medial and the lateral cords of the brachial plexus respectively. However, variations in the formation and its relation with the axillary vessels are not uncommon. Therefore, knowledge of the variations in the nerve formation and course is useful for the clinicians during surgery and for differential diagnosis of uncommon clinical conditions. CASE PRESENTATION: During the routine dissection in the department of anatomy, Kasturba Medical Collage, Manipal, India, we found unique anatomical variations in the formation and the course of the roots of the median nerve forming the neural loops around the axillary artery and vein. CONCLUSION: Here we report the detailed description of these variations along with its clinical, embryological relevance and review of literature.

Petroleum ether extract of Cissus quadrangularis (Linn.) enhances bone marrow mesenchymal stem cell proliferation and facilitates osteoblastogenesis.

OBJECTIVE: To evaluate the effects of the petroleum ether extract of Cissus quadrangularis on the proliferation rate of bone marrow mesenchymal stem cells, the differentiation of marrow mesenchymal stem cells into osteoblasts (osteoblastogenesis) and extracellular matrix calcification. This study also aimed to determine the additive effect of osteogenic media and Cissus quadrangularis on proliferation, differentiation and calcification. METHODS: MSCs were cultured in media with or without Cissus quadrangularis for 4 weeks and were then stained for alkaline phosphatase. Extracellular matrix calcification was confirmed by Von Kossa staining. marrow mesenchymal stem cells cultures in control media and osteogenic media supplemented with Cissus quadrangularis extract (100, 200, 300 microg/mL) were also subjected to a cell proliferation assay (MTT). RESULTS: Treatment with 100, 200 or 300 microg/mL petroleum ether extract of Cissus quadrangularis enhanced the differentiation of marrow mesenchymal stem cells into ALP-positive osteoblasts and increased extracellular matrix calcification. Treatment with 300 microg/mL petroleum ether extract of Cissus quadrangularis also enhanced the proliferation rate of the marrow mesenchymal stem cells. Cells grown in osteogenic media containing Cissus quadrangularis exhibited higher proliferation, differentiation and calcification rates than did control cells. CONCLUSION: The results suggest that Cissus quadrangularis stimulates osteoblastogenesis and can be used as preventive/ alternative natural medicine for bone diseases such as osteoporosis.

Sternalis muscle revisted in South Indian male cadaver: a case report.

INTRODUCTION: Sternalis/rectus sternalis is a rare muscle found in the chest wall. Only 3-5% of the cases are found world wide. CASE PRESENTATION: Here we report the case of Sternalis in the 60-year-old South Indian male cadaver. This report discusses the origin, orientation, relations of this muscle. CONCLUSION: Importance of the knowledge of the presence of these rare muscles in clinical diagnosis and therapeutic implications is discussed.