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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 68  |  Issue : 2  |  Page : 133-137

Is the trend of brachycephalization more advanced in females than males: An observational study on medical students in a rural medical college of Himachal Pradesh, North West Of India


1 Department of Anatomy, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
2 Department of Neurology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India

Date of Submission22-Mar-2019
Date of Acceptance20-Sep-2019
Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Vishal Kalia
Department of Anatomy, Dr. Rajendera Prasad Government Medical College Tanda Kangra, Kangra, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JASI.JASI_13_19

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  Abstract 


Introduction: The cephalic index (CI) was defined by Swidesh Professor of Anatomy Anders Retzius as a percentage of width to length in the skull. Head dimension changes follow a pattern in different populations. CI is used to determine the racial variation and sexual difference among the individual whose identity is unknown and to investigate the craniofacial deformities and brain development. Material and Methods: Himachali MBBS students of Dr. RPGMC, Tanda who satisfy the inclusion criteria were approached for consent to participate in the study. Detailed history, including birth history (including the place of birth), socio-economic history, and history of migration, was taken, and anthropometric examination was done by the investigator, as per the standard protocol. Results: We studied 77 medical students at Dr. RPGMC, Kangra at Tanda Himachal Pradesh, of which 40 (51.94%) were males and 37 (48.05%) were females. The mean age of all the students was 19.05 years. The mean head circumference of all the students was 54.31 ± 1.8 cm and minimum of 49.0 cm and maximum of 58.2 cm. Mean CI of the group was 77.85 ± 4.43. Male group had the mean CI of 76.96 ± 4.00. Female group had mean CI of 78.83±4.7 Most 18 (45%) of the male students had mesocephalic head shape and in female groups, 15 (40.5%) also had mesocephalic head shape. Discussion and Conclusion: From this study, we conclude that the dominant head shape is mesocephalic in both male and female, but the tendency of brachycephalization is more advanced in the female adult population of Himachal Pradesh.

Keywords: Brachycephalization, cephalic index, mesocephaly


How to cite this article:
Sharma V, Yadav S, Kalia V, Dwivedi D, Kumar G, Dhiman P. Is the trend of brachycephalization more advanced in females than males: An observational study on medical students in a rural medical college of Himachal Pradesh, North West Of India. J Anat Soc India 2019;68:133-7

How to cite this URL:
Sharma V, Yadav S, Kalia V, Dwivedi D, Kumar G, Dhiman P. Is the trend of brachycephalization more advanced in females than males: An observational study on medical students in a rural medical college of Himachal Pradesh, North West Of India. J Anat Soc India [serial online] 2019 [cited 2019 Dec 7];68:133-7. Available from: http://www.jasi.org.in/text.asp?2019/68/2/133/269035




  Introduction Top


The cephalic index (CI) was defined by Swedish Professor of Anatomy Anders Retzius (1796–1860) as percentage of width to length in the skull and wasfirst used in physical anthropometry to classify ancient human remains found in Europe.[1] Head dimension changes follow a pattern in different populations. The key factor in the process of head dimension changes is a small increase in the growth rate in a specific direction during infancy and childhood. The increases involve the posterior cranial base and occur in a posterior inferior and lateral direction resulting in significant changes of vault shape.[2]

CI is used to determine the racial variation and sexual difference among the individual whose identity is unknown and to investigate the craniofacial deformities and brain development.[3] It gives an idea how genetic characters are transmitted between parents and offspring. Various pathological conditions such as isolated or syndromic craniosynostosis primary mesocephaly and hydrocephalus present as abnormal CI in addition to other features.[4]

CI is the ratio of maximum width (Biparietal diameter) to the maximum length (occipitofrontal diameter) multiplied by 100. Where width is the distance between the most projecting points on the sides of the head (euryon) and head length is the distance between the glabella of front and inion on the back of the head.[5]

Anthropometry of the head can be divided into two:

  1. Cephalometric – Morphological study of all structures present in a human head and is applied in live individuals
  2. Craniofacial relations – measurement of bones and teeth in the dry skull.


Cephalometric is a technique that summarizes the anatomical complexities of the head of human being living within a geographic framework.[6]

On the basis of CI head shapes can be classified into the four international categories.

  1. Dolichocephalic – CI <74.9
  2. Mesocephalic – CI between 75 and 79.9
  3. Brachycephalic – CI between 80 and 84.9
  4. Hyperbrachycephalic – CI above 85.


Head form is longer (dolichocephalic) in the tropical zone, but in temperate zone, head form is more rounded (brachycephalic).[6] In the Nigerian population, male had CI of 77.21 and female had 76.50.[7] In the Gurung community of Nepal, male had CI of 83.1 and female had CI of 84.6.[8]

Since India is partly temperate and partly tropical zone so shows a tendency toward mesocephalization. In India, males are mesocephalic with a mean CI of 77.8 and females are Brachycephalic with CI of 80.85.[9] Head shape also changes from one generation to the other. First-generation of Japanese immigrants in Hawaii, it was noticed that they had an increased head breadth a decreased head length and a higher CI than their parents.[10]

The present study intends to evaluate the CI of Himachali medical students and also to find out the intergender difference in the CI.


  Material and Methods Top


MBBS students of Dr. RPGMC, Tanda who satisfy the inclusion criteria were approached for consent to participate in the study.

Inclusion criteria

  1. First year MBBS students of Dr. RPGMC, Tanda
  2. Age 18–25 years.


Exclusion criteria

  1. Students who refuse to be part of the study
  2. Operated cases of head diseases and anomalies
  3. All the forms of syndromic disorders.


Detailed history, including birth history (including place of birth), socio-economic history, and history of migration was taken, and anthropometric examination was done by the investigator, as per the standard protocol.

Anthropometric examination

  1. Each subject included in the study was measured for the following anthropometric body dimensions using standardized anthropometric techniques and instruments [11]
  2. Head length and head width – Spreading caliper was used to measure head length and head width up to the accuracy of 1 mm
  3. Head circumference was measured by using fiberglass tape and height by stadiometer
  4. Bodyweight – Using electronic weighing machine with the accuracy up to 10 g
  5. In addition to basic measurements the followings was calculated
  6. CI = Head width/HEAD length ×100.


Statistical analysis

Means and standard deviations were computed for all anthropometric measurements. The Student's unpaired t-test or Mann–Whitney U-test was applied for parametric and nonparametric data depending on the nature of data obtained to assess the extent of group differences.


  Results Top


We studied 77 medical students at Dr. RPGMC, Kangra at Tanda, Himachal Pradesh, of which 40 (51.94%) were males and 37 (48.05%) were females. Mean age of all the students was 19.05 years, with minimum of 18 years and maximum of 21.5 years. Most of the students 55 (71.42%) were from the rural background and only 22 (28.57%) were from urban background and among these 70% of males and 73% of females belonged to the rural background and 30% of males and 27% of females belonged to urban background. Only 17 (22.07%) students were from the plains and rest 60 (77.92%) were from hilly areas and of these 7 males and 10 females were from the plains and 33 males and 27 females were from hilly area. Most of the students were from middle-income group, 32 (41.55%) from lower-middle and 30 (38.96%) from upper middle-income group and rest belonged to the upper-income group 9 (11.68%) and 5 (6.49%) from upper lower-income group and 1 (1.29%) was from lower-income group [Table 1].
Table 1: Basic parameters

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The mean height of the all the students was 163.36 ± 9.14 cm with the minimum of 145 cm and maximum of 190.6 cm and among males, the mean height was 169.6 ± 6.82 cm and minimum of 151.7 cm to maximum of 190.6 cm and in the females, mean height was 156.63 ± 6.00 cm and minimum of 145 cm and maximum of 171 cm. The mean weight was 58.13 ± 10.35 kg with minimum of 37 kg and maximum of 95 kg, male students have a mean weight of 61.8 ± 9.86 kg with minimum of 41 kg and maximum of 89 kg and in female students, mean weight of 54.37 ± 9.65 kg and minimum of 37 kg and maximum of 95 kg. Facial shape of 60 (77.92%) students was normal, whereas 14 (18.18%) had rounded faces and 3 (3.89%) had triangular faces, and among the male students, 36 (87.5%) had normal faces and 1 (2.5%) had triangular faces and 4 (10%) had rounded faces and in female students, 25 (67.6%) had normal faces and 2 (5.4%) had triangular faces and 10 (27%) female students had rounded faces [Table 2].
Table 2: General anthropometry

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The mean head circumference of all the students was 54.31 ± 1.80 cm with minimum of 49.0 cm and maximum of 58.2 cm. Male students had mean head circumference of 55.4 ± 1.50 cm with minimum of 52.0 cm and maximum of 58.2 cm, whereas female students had mean head circumference of 53.10 ± 1.28 cm with minimum of 49.0 cm and maximum of 55.10 cm with the statistically significant difference of P = 0.003. The mean head length of all students was 18.52 ± 0.91 cm with minimum of 16.1 cm and maximum of 20.5 cm, among the male students, mean head length was 19.12 ± 0.69 cm with minimum of 17.5 cm and maximum of 20.5 cm and in the female students, the mean head length was 17.87 ± 0.64 cm with minimum 16.1 cm and maximum of 18.9 cm, and the difference was statistically significant with value of P = 0.014.

The mean head width of the group was 14.39 ± 0.63 cm and minimum head width of 12.9 cm and maximum of 16.5 cm. In the male group, mean head width was 14.7 ± 0.58 cm and minimum width of 13.4 cm and maximum width of 16.5 cm.

Mean CI of the group was 77.85 ± 4.43and ranging from 67–88.88 and male group had the mean CI of 76.96 ± 4.00 and minimum of 67 and maximum of 87.76 and female group had mean CI of 78.83 ±4.7 and minimum of 70 and maximum of 88.88 [Table 3].
Table 3: Cephalic anthropometry

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Among the male students, 18 (45%) had mesocephalic head shape and 14 (36.0%) were dolichocephalic and 7 (17.5%) were brachycephalic and only 1 (2.5%) had hyperbrachycephalic. Among the female students, 15 (40.5%) had mesocephalic head shape and dolichocephalic and brachycephalic were in 8 (21.6%) each, and 6 (16.2%) had hyperbrachycephalic head shape. For the whole group, 33 (42.85%) had mesocephalic head shape, dolichocephalic was the second-most common 22 (28.57%) and 15 (19.48%) were brachycephalic and 7 (9.09%) were hyperbrachycephalic [Table 4].
Table 4: Head shape

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  Discussion Top


There are many studies from the different regions of India on CI which have shown the CI to be ranging from 77.08 to 81.34 in males and from 72.15 to 85.75 in females. Gurjaria a study from Maharashtra, Andhra, and Gujarat has shown CI from 78.14, 77.32, to 80.82[12] and from Southern Odisha, Patro et al. shown mean CI of 77.75[13] Shah and Jhadhav [14] in Gujarat and Utterkar et al.[15] in south Gujarat have shown CI of 80.8 and 81, respectively. From Punjab, Mahajan et al. have shown CI for both sexes as 85.53[16]

In Himachal Pradesh, there is paucity literature on CI on adult; hence, our study will provide useful data on CI from Himachal Pradesh. There was one published study from Himachal on the full-term newborn by Pankaj et al. studied CI in newborns which have shown mean CI as 80.97 ± 4.8.[17] In this study, we found the mean CI for the males was 76.96 ± 4, whereas for females was 78.83 ± 4.7. Mean CI for the whole group in our study was 77.85 ± 4.43 which was less than that shown by Pankaj et al. and the difference might be because the CI keeps on changing till the 18 years and our study is on the adult.

In this study, the dominant type head shape of the whole group was mesocephalic 42.85% and dolichocephalic was the second-most common 28.57% and brachycephalic third 19.48% and hyperbrachycephalic the least common 9.09%. In the male groups, mesocephalic was the most common 45% and dolicocephalic the second common 36% and brachycephalic the third 17.5% and hyperbrachycephalic the least 2.5%, whereas in female group, though the most common head shape was mesocephalic 40.5% and the second common were dolichocephalic and brachycephalic 21.6% each and hyperbrachycephalic the third common 16.2%. On looking the trend of the head shapes, it shows that in female group, the trend is toward the brachycephalization as brachycephaly and hyperbrachycephaly constitute 37.8%, whereas reverse is true for the males that 36% is dolichocephalic as shown in [Figure 1]. This suggests that the tendency of brachycephalization is more advanced in females than males. Similar pattern was shown in Indian study in medical students by Yagsin et al[9]., and in Southern Odisha by Patro et al[13]., and reverse was found in study from Mumbai by Khair et al[18]., from West Bengal by Ghose [19], and from central India by Nair et al.[20]. as shown in [Table 5].
Figure 1: Showing the trend of cephalic index in male and female students

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Table 5: Comparison of present study with previous studies

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  Conclusion Top


From this study, we conclude that the dominant head shape is mesocephalic in both males and females, but the tendency of brachycephalization is more advanced in female than male population of Himachal Pradesh.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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McIntyre GT, Mossey PA. Size and shape measurement in contemporary cephalometrics. Eur J Orthod 2003;25:231-42.  Back to cited text no. 3
    
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Collett BR, Heike CL, Atmosukarto I, Starr JR, Cunningham ML, Speltz ML, et al. Longitudinal, three-dimensional analysis of head shape in children with and without deformational plagiocephaly or brachycephaly. J Pediatr 2012;160:673-80.  Back to cited text no. 4
    
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Akinbami BO. Measurement of cephalic indices in older children and adolescents of a Nigerian population. Biomed Res Int 2014:527473.  Back to cited text no. 7
    
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Yagain VK, Shakunthala R. Pai, Sneha G. Kalthur, Chethan, P and Hemalatha I. Study of cephalic index in Indian students. Int J Morphol 2012;30:125-129.  Back to cited text no. 9
    
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Argyropoulos E, Sassouni V. Comparison of the dentofacial patterns for native Greek and American-Caucasian adolescents. Am J Orthod Dentofacial Orthop 1989;95:238-49.  Back to cited text no. 10
    
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Weiner JS, Lourie JA. International Biological Programme Human Bbiology: A Guide to Field Methods. Oxford, Edinburgh: Published for International Biological Programme, Blackwell Scientific; 1969.  Back to cited text no. 11
    
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Gurjaria IJ. Comparison of cephalic index of three states of India. Int J Pharm Bio Sci 2012;3:1022-31.  Back to cited text no. 12
    
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Patro S, Sahu R, Rath S. Study of cephalic index in Southern Odisha population. IOSR J Dent Med Sci 2014;13:41-4.  Back to cited text no. 13
    
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Shah GV, Jhadhav HR. The study of cephalic index in students of Gujarat J Anat Soc India 2004;53:25-6.  Back to cited text no. 14
    
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Utterkar K, Deepa S, Gupta S, Adani R, Kubavat D M, Nagar S K et al. Study of cephalic index in South Gujarat. Int J Recent Trends Sci Technol 2013;8:87-9.  Back to cited text no. 15
    
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Mahajan A, Khurana BS, Seema, Batra AP. The study of cephalic index of Punjabi students. J Punjab Acad Forensic Med Toxicol 2009;9:718-25.  Back to cited text no. 16
    
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Pankaj S, Prabhakaran K, Kanchan K. The shape of head and face in normal full term newborn in hills of Himachal Pradesh. Int J Anat Res 2016;4:3161-3.  Back to cited text no. 17
    
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Khair S, Bhandari D, Wavhal S. Study of cephalic index of medical students of Mumbai region. Indian J Appl Res 2013;3:232-4.  Back to cited text no. 18
    
19.
Ghose R. A study of cephalic index among the young age group of West Bengal in relation to sex and geographic factors. Indian J Basic Appl Med Res 2018;7:239-45.  Back to cited text no. 19
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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