Acquisition of cadavers for anatomy education and research in Malawi.

BACKGROUND: The use of human cadaveric dissection forms an essential part of teaching anatomy to health sciences students in Malawi. Despite worldwide struggles in acquiring sufficient human cadavers for anatomy education, the current recommendations on the best anatomy practices require the use of cadavers exclusively from the body donation programs. The current study aims to describe the sources of cadaveric bodies used for anatomy education in the Malawian context and reflect on the feasibility of using cadavers from the body donation program only. METHODS: A retrospective audit of the cadaveric records for the 2006-2022 academic years at the Kamuzu University of Health Sciences was done. The perceived challenges when sourcing the cadavers were identified and described based on the authors experiences in Malawi. RESULTS: The majority (97.3%) of the cadavers used between 2006 and 2022 were unclaimed bodies. The mean age of the cadavers was 45 years. Most (95.6%) of the unclaimed bodies were males. All the unclaimed bodies were sourced from hospitals. The body donation program in Malawi was patronized by populations of European descent only. Strongly held sociocultural and religious beliefs as well as economic reasons were perceived as significant barriers to acquiring cadavers of the indigenous Malawians through the body donation program. CONCLUSION: Cadavers for anatomy education in Malawi are mainly from unclaimed bodies, similar to other African countries. The authors support the transition from using "mostly unclaimed bodies (and, less often, body donation)" to using "mostly body donation (and, less often, unclaimed bodies)" through awareness campaigns that are targeted to address the prevailing challenges.

Morphometric study of the suprascapular notch and scapular dimensions in adult Malawian cadavers and implications of completely ossified superior transverse scapular ligament.

Introduction: the anatomy of the suprascapular notch and its relationship to scapular dimensions are critical in the management of suprascapular neuropathies. Individuals show considerable differences in the dimensions of the suprascapular notch across populations. The purpose of this study was to determine the morphology and morphometric dimensions of the suprascapular notch in adult Malawian cadavers and to suggest clinical implications associated with complete ossification of the suprascapular ligament. Methods: adult dry scapulae from undetermined sex specimens (n=125) obtained from the skeletal collection at Kamuzu University of Health Sciences were classified according to the Rengachary categorization method to assess the suprascapular notch superior transverse distance, mid transverse distance, depth, scapula length and width using a standard Vernier caliper. Results: the most prevalent suprascapular notch class was type I, which was found in 46 (36.8%) of all scapulae. Type VI was the least common, found in only 1 (0.8%) of the scapulae. The mean notch superior transverse distance was 1.3 ± 0.6 cm, while the mean maximum depth was 0.6 ± 0.3 cm. Only the differences in depth, however, were statistically significant (p=0.001). Conclusion: the current study has described the morphology and morphometry of the suprascapular notch in relation to the risk of suprascapular nerve entrapment associated with complete ossification of the suprascapular ligament. Our sample population generally showed smaller suprascapular notch and scapular dimensions than other populations. This should be considered during the management of suprascapular neuropathy and preoperative planning of surgical operations of the shoulder region.

Distribution of variations in anatomy of the circle of Willis: results of a cadaveric study of the Malawian population and review of literature.

INTRODUCTION: the circle of Willis is an anatomical structure of clinical importance particularly in the evaluation of neurovascular diseases. Individuals show considerable variations in the anatomical configuration of the circle of Willis. A cross-sectional study was conducted to determine the distribution of morphological variations of the circle of Willis in Malawians and compare with other ethnic groups. METHODS: brains were collected from twenty-four recently deceased black Malawians during autopsy at Queen Elizabeth Central Hospital, a referral teaching hospital in Blantyre, Malawi and fixed in 10% buffered formalin. Digital images of the interpeduncular region (exposing the circle of Willis) were taken with an 18.4 megapixels camera from the base of the brain. Whole-circle and segmental parameters of the circle of Willis were assessed using the Osiris computer programme and classified based on a 22-type classification scheme. RESULTS: the following morphological variations were observed: hypoplasia, aplasia, asymmetry and accessory vessels. Typical circle of Willis was seen in 26% of the cases. Only six of the original twenty-two types were observed. Consistent with most previous studies, types 1, 3, 4, 6, 8 and 9 were common while types 10-22 were rare. Three variants not previously described in the original scheme (unilateral PcoA aplasia, AcoA duplication, and PcoA aplasia with contralateral PcoA hypoplasia) were observed in this study. CONCLUSION: anatomical variations of the circle of Willis in Malawians seem to be distributed in similar frequencies and patterns as in other more-diverse populations. Circle of Willis variants with potential predilection for atherogenesis and aneurysm formation exist in the Malawian population. These should be considered in clinical practice.

A morphometric study of the mandibular foramen in dry adult human mandibles in a black Malawian population / Un estudio morfométrico del foramen mandibular en mandíbulas humanas adultas secas en una población malauí negra

SUMMARY: The inferior alveolar nerve block (IANB) technique is a common technique performed on patients in dental surgery, placement of mandibular implants and other procedures involving the mandible. Precise identification of the mandibular foramen (MF) is essential for dental surgeons to accurately administer local anesthetics. Inaccurate localization of the mandibular foramen may result in IANB failure and injury to neurovascular tissues. Therefore, this study aimed at investigating the precise location of the MF from various anatomical land marks in dry adult human mandibles of Malawian population. The study was conducted on 29 dry adult human mandibles of unknown sex of Malawian origin from the Anatomy Division collection of human skeletons housed in the Biomedical Sciences Department, College of Medicine, University of Malawi. To determine the position of the mandibular foramen, distances from mandibular foramen to anterior margin, posterior margin, mandibular notch, gonial angle and mandibular base using a Vernier caliper were measured. The mean distance of the MF from posterior margin of mandibular ramus was 11.26±1.22 mm (right side) and 11.47±1.35 mm (left side), from the anterior margin 20.85±3.12 mm (right side) and 20.85±3.22 mm (left side) mandibles. The mean distance between mandibular notch (MN) and MF was 23.87±2.61 mm (right side) and 23.53 ± 2.65 mm (left side). The mean distance between mandibular base (MB) and MF for the right and left were 28.47 ± 2.90 mm and 27.85 ± 2.99 mm respectively. The inferior limit of the mandibular foramen was located at 24.69 ± 3.65 mm (right side) and 24.25 ± 2.77 mm (left side) to the angle (AG) of the mandible. The findings of this study show that the anterior margin mean distance from the MF for both right and left mandibles seem to be bilateral symmetrical suggesting the interpretation that the needle for IANB could be inserted at about 21 mm from the anterior margin to the MF in an adult of Malawian origin during surgery.

RESUMEN: La técnica de bloqueo del nervio alveolar inferior (IANB) es una técnica común que se realiza en pacientes en cirugía dental, colocación de implantes mandibulares y otros procedimientos que involucran la mandíbula. La identificación precisa del foramen mandibular (MF) es esencial para que los cirujanos dentistas administren con precisión anestésicos locales. La localización inexacta del foramen mandibular puede resultar en una falla de la IANB y lesión de los tejidos neurovasculares. Por lo tanto, este estudio tuvo como objetivo investigar la ubicación precisa de la MF de varias marcas anatómicas en las mandíbulas humanas adultas secas de la población de Malawi. El estudio se llevó a cabo en 29 mandíbulas humanas adultas secas de sexo desconocido de origen malauí de la colección de esqueletos humanos de la División de Anatomía del Departamento de Ciencias Biomédicas de la Facultad de Medicina de la Universidad de Malawi. Para determinar la posición del foramen mandibular, se midieron las distancias desde el foramen mandibular hasta el margen anterior, margen posterior, incisura mandibular, ángulo gonial y base mandibular utilizando un calibre Vernier. La distancia media del MF desde el margen posterior de la rama mandibular fue de 11,26 ± 1,22 mm (lado derecho) y 11,47 ± 1,35 mm (lado izquierdo), desde el margen anterior 20,85 ± 3,12 mm (lado derecho) y 20,85 ± 3,22 mm (lado izquierdo) lado) mandíbulas. La distancia media entre la muesca mandibular (MN) y MF fue de 23,87 ± 2,61 mm (lado derecho) y 23,53 ± 2,65 mm (lado izquierdo). La distancia media entre la base mandibular (MB) y MF para la derecha y la izquierda fue de 28,47 ± 2,90 mm y 27,85 ± 2,99 mm, respectiva- mente. El límite inferior del foramen mandibular se ubicó a 24,69 ± 3,65 mm (lado derecho) y 24,25 ± 2,77 mm (lado izquierdo) del ángulo (AG) de la mandíbula. Los resultados de este estudio mues- tran que la distancia media del margen anterior desde el MF para las mandíbulas derecha e izquierda parece ser simétrica bilateral, lo que sugiere la interpretación de que la aguja para IANB podría insertarse a unos 21 mm del margen anterior al MF en una adulto de origen malauí durante la cirugía.

Anastrozole promotes implantation by altering the expression of paxillin and fak in rat luminal uterine epithelium / El anastrozol promueve la implantación alterando la expresión de paxilina y fak en el epitelio uterino luminal de rata

An alternative hyper-ovulator inducer to replace clomiphene citrate (CC) is needed as it is unsuitable for women with polycystic ovarian syndrome and is associated with low pregnancy rates. Anastrozole is an effective hyper-ovulator inducer, but has not been well researched. In order to determine the effectiveness of anastrozole as a hyper-ovulator inducer and to an extent compare it with CC in similar situations, this study ascertained the effects of these drugs on the expression of the focal adhesion proteins, paxillin and FAK, which are uterine receptivity markers in the surface luminal uterine epithelial cells of day 1 and day 6 pregnant Wistar rats. The results show that paxillin is localized in focal adhesions at the base of the uterine epithelial cells at day 1 of pregnancy whereas at day 6, paxillin disassembles from the basal focal adhesions and localizes and increases its expression apically. FAK is faintly expressed at the basal aspect of the uterine epithelial cells while moderately expressed at the cell-to-cell contact at day 1 in all groups from where it disassembles and relocates apically and becomes more intensely expressed at day 6 of pregnancy in untreated and anastrozole treated rats. Although paxillin is localized apically at day 6, its expression is significantly down-regulated with CC treatment suggesting its interference with the implantation process. These findings seem to suggest that anastrozole could favor implantation.

Para reemplazar el citrato de clomifeno (CC) es necesario un inductor de hiperovulación alternativo, ya que no es adecuado para mujeres con síndrome de ovario poliquístico y está asociado con tasas bajas de embarazo. El anastrozol es un inductor eficaz del hiper-ovulador, pero no se ha investigado adecuadamente. Con el fin de determinar la efectividad del anastrozol como inductor del hiper-ovulador y, en cierta medida, compararlo con CC en situaciones similares, este estudio determinó los efectos de estos fármacos en la expresión de las proteínas de adhesión focal, paxillin y FAK, uterinas marcadores de receptividad en la superficie luminal de células uterinas epiteliales, del día 1 y día 6 en ratas Wistar preñadas. Los resultados muestran que la paxilina se localiza en adherencias focales en la base de las células epiteliales uterinas en el día 1 del embarazo, mientras que en el día 6, la paxilina se desmonta de las adherencias focales basales y localiza y aumenta su expresión apicalmente. FAK se expresa débilmente en el aspecto basal de las células epiteliales uterinas, mientras que se expresa moderadamente en el contacto de célula a célula en el día 1 en todos los grupos, donde se separa y se reubica apicalmente y se expresa con mayor intensidad el día 6 de la preñez, en pacientes no tratados y tratados. ratas tratadas con anastrozol. Aunque la paxillina se localiza apicalmente en el día 6, su expresión está significativamente disminuida con el tratamiento con CC, lo que sugiere su interferencia con el proceso de implantación. Estos hallazgos sugieren que el anastrozol podría favorecer el proceso de implantación.

Lopinavir and curcumin directly alters BAX/BCL2 and VEFG165b mRNA levels to suppress human squamous cervical carcinoma cell growth / Lopinavir y curcumina alteran directamente los niveles de ARNm de BAX/ BCL 2 y VEFG165 para suprimir el crecimiento de células de carcinoma cervical escamoso humano

Following the success of the highly active antiretroviral therapy, the potential of multidrug combination regimen for the management of cancer is intensely researched. The anticancer effects of curcumin on some human cell lines have been documented. Lopinavir is a FDA approved protease inhibitor with known apoptotic activities. Dysregulated apoptosis is important for the initiation of cancer while angiogenesis is required for cancer growth and development, this study therefore investigated the effects of the combination of lopinavir and curcumin on cell viability, apoptosis and the mRNA expression levels of key apoptotic and angiogenic genes; BAX, BCL2 and VEGF165b in two human cervical cell lines; human squamous cell carcinoma cells - uterine cervix (HCS-2) and transformed normal human cervical cells (NCE16IIA). The two human cervical cell lines were treated with physiologically relevant concentrations of the agents for 120 h following which BAX, BCL2 and VEGF165b mRNA expression were determined by Real Time qPCR. The Acridine Orange staining for the morphological evaluation of apoptotic cells was also performed. The combination of lopinavir and curcumin up-regulated pro-apoptotic BAX and antiangiogenic VEGF165b but down-regulated the mRNA levels of anti-apoptotic BCL2 mRNA in the human squamous cell carcinoma (HCS-2) cells only. The fold changes were statistically significant. Micrographs from Acridine Orange staining showed characteristic evidence of apoptosis in the human squamous cell carcinoma (HCS-2) cells only. The findings reported here suggest that the combination of curcumin and the FDA approved drug-lopinavir modulate the apoptotic and angiogenic pathway towards the inhibition of cervical cancer.

Tras el éxito de la terapia antirretroviral altamente activa, se investiga intensamente el potencial del régimen de combinación de múltiples fármacos para el tratamiento del cáncer. Se han documentado los efectos anticancerígenos de la curcumina en algunas líneas celulares humanas. Lopinavir es un inhibidor de proteasa aprobado por la FDA con actividades apoptóticas conocidas. La apoptosis disrregulada es importante para el inicio del cáncer, mientras que la angiogénesis es necesaria para el crecimiento y desarrollo del cáncer. Por lo tanto, este estudio investigó los efectos de la combinación de lopinavir y curcumina sobre la viabilidad celular, la apoptosis y los niveles de expresión del ARNm de genes apoptóticos y angiogénicos clave: BAX, BCL2 y VEGF165b en dos líneas celulares cervicales humanas; células de carcinoma de células escamosas humanas: cérvix uterino (HCS-2) y células cervicales humanas transformadas (NCE16IIA). Las dos líneas celulares cervicales humanas se trataron con concentraciones fisiológicamente relevantes de los agentes durante 120 horas, después de lo cual la expresión de ARNm de BAX, BCL2 y VEGF165b se determinó mediante qPCR en tiempo real. También se realizó la tinción con naranja de acridina para la evaluación morfológica de células apoptóticas. La combinación de lopinavir y curcumina reguló incrementando BAX proapoptósicos y VEGF165b antiangiogénicos, pero reguló a la baja los niveles de ARNm del BCL2 antiapoptótico en células de carcinoma de células escamosas humanas (HCS-2) únicamente. Los cambios en el pliegue fueron estadísticamente significativos. Las micrografías de la tinción con naranja de acridina mostraron evidencia característica de apoptosis solo en las células del carcinoma de células escamosas humanas (HCS-2). Los hallazgos reportados aquí sugieren que la combinación de curcumina y el fármaco aprobado por la FDA lopinavir modulan la vía apoptótica y angiogénica hacia la inhibición del cáncer cervical.

Focal adhesion proteins, vinculin and integrin ß5, during early pregnancy in rat uterine epithelial cells: anastrozole favors their normal distribution / Proteínas de adhesión focales, vinculina e integrina ß5, durante el embarazo temprano en células epiteliales uterinas de rata: anastrozol favorece su distribución normal

SUMMARY: An alternative superovulator to replace clomiphene citrate is needed as clomiphene citrate is associated with low pregnancy rates. Anastrozole is an effective superovulator, but it has not been well researched. In order to determine the effectiveness of anastrozole as a superovulator and to compare it with clomiphene citrate in similar situations, this study ascertained the effects of these drugs on the expression of the focal adhesion proteins, vinculin and integrin β5, which are uterine receptivity markers, in the uterine epithelial cells of day 1 and day 6 pregnant Wistar rats. The results show that vinculin and integrin β5 are co-localized at the base of the uterine epithelium at day 1 of pregnancy whereas at day 6, they disassemble from the basal focal adhesions and co-localize and significantly increase their expression apically (p≤0.0001). Moreover, there is a significant difference in the protein expression levels of vinculin and integrin b5 in uterine luminal epithelial cells between untreated (control) and chlomiphene citrate treated rats (p≤0.0001), anastrozole and chlomiphene citrate treated rats at day 6 (p≤0.0001) suggesting the interpretation that anastrozole seems to enhance their expression in order to perhaps assist in the implantation process of the blastocyst. The immunofluorescence experiments agree with the vinculin and integrin β5 gene expression findings in which at day 6 of pregnancy, vinculin and integrin β5 gene expression are significantly upregulated in uterine luminal epithelial cells in the anastrozole treated group relative to the calibrator sample (p≤0.0001). These findings suggest that anastrozole is implantation friendly.

RESUMEN: Es necesario un superovulador alternativo para reemplazar el citrato de clomifeno, debido a que está asociado con bajas tasas de preñez. El anastrozol es un superovulador eficaz, sin embargo es poca su investigación. Con el fin de determinar la efectividad del anastrozol como superovulador y compararlo con citrato de clomifeno en situaciones similares, se determinaron los efectos de estos fármacos sobre la expresión de las proteínas de adhesión focal, vinculina e integrina β5, en marcadores de receptividad uterina en días 1 y 6, en las células epiteliales uterinas de ratas Wistar preñadas. Los resultados muestran que la vinculina y la integrina β5 se co-localizan en la base del epitelio uterino al día 1 de la gravidez mientras que al día 6 se desmontan de las adherencias focales basales, co-localizan y aumentan significativamente su expresión apicalmente (p≤0.0001). Además, existe una diferencia significativa en los niveles de expresión de proteína de vinculina e integrina β5 en células epiteliales luminales uterinas entre ratas no tratadas (control) y tratadas con citrato declomifeno (p≤0.0001), ratas tratadas con anastrozol y citrato declomifeno al día 6 (p≤0,0001) sugiriendo la interpretación de que el anastrozol parece mejorar su expresión con el fin de ayudar en el proceso de implantación del blastocisto. Los experimentos de inmunofluorescencia coinciden con los resultados de la expresión de los genes vinculina e integrina β5 en los cuales al día 6 de la preñez, la vinculina y la integrina β5 están significativamente reguladas en células epiteliales luminales uterinas en el grupo tratado con anastrozol con respecto a la muestra del calibrador (p<0,0001). Estos hallazgos sugieren que el anastrozol es favorable para la implantación.

An anatomical and osteometric study of the femoral sulcus angle in adult Malawians.

BACKGROUND: Femoral sulcus angle is particularly important in clinical evaluation of patellofemoral joint. Individuals show considerable differences in asymmetrical dimensions of the femur. OBJECTIVES: To determine the size of femoral sulcus angles in adult black Malawians using the skeletal collection in the department of Anatomy, College of Medicine and assess their gender differences; to compare femoral sulcus angles of Malawians with other ethnic groups. METHODS: A cross sectional study was done in which femoral sulcus angles of dry bones were measured using a goniometer. RESULTS: There is no significant difference in the mean sulcus angles between right and left femora in males (p=0.8100) and females (p=0.0742); between all males combined and females combined (p=0.8845). There is a significant difference in the mean between all left femora combined and all right femora combined (p=0.0260). CONCLUSION: This study has provided the mean size of the femoral sulcus angle of adult Malawians. These findings suggest that the size of the sulcus angle cannot determine gender among adult black Malawians suggesting the interpretation that femora asymmetric dimensions are population specific, which should be considered in the patellofemoral joint evaluation.

Anastrozole is a dose-specific superovulator and favors implantation in rats: a prospective study.

An alternative superovulator to replace clomiphene citrate (CC) is needed as it is unsuitable for women with polycystic ovarian syndrome and is associated with low pregnancy rates. Anastrozole is an effective superovulator, but has not been well researched. The aim of this study was to determine the optimal dose of anastrozole as a superovulator and ascertain its effects on implantation and uterine ultrastructure during early pregnancy in Wistar rats using scanning electron microscopy. The uterine morphological characteristics which were studied in day 1 and 6 pregnant rats include microvilli density, length, surface "beads", surface glycocalyx, cell borders and apices, uterine surface fording and large surface protrusions. A significant increase in implantation sites is seen in the 15 mg/kg anastrozole group, compared to control. Day 1 and 6 anastrozole groups have similar morphology to the control and different to the CC group. At day 6, large surface protrusions are mostly noted but not limited to anastrozole-treated rats; anastrozole also appears to retain glycocalyx to some extent. The increased number of implantation sites in the 15 mg/kg anastrozole group suggests that this dose superovulates and favors implantation. Anastrozole is probably dose-/species-specific and additionally the surface uterine morphology suggests that anastrozole is implantation friendly.