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   2019| July-September  | Volume 68 | Issue 3  
    Online since January 7, 2020

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Tarsal tunnel syndrome: Anatomical facts and clinical implications
Chanatporn Inthasan, Pasuk Mahakkanukrauh
July-September 2019, 68(3):236-241
Introduction: Tarsal tunnel syndrome (TTS) associates with the posterior tibial nerve (PTN) entrapment at the medial side of the ankle. TTS is a major cause of heel pain. The diagnosis and treatments have several techniques. For accurate diagnosis and effective treatment, the surgeons need to have detailed anatomical knowledge of the arrangement of PTN. The aim of this present study is to describe anatomical aspects and TTS including its etiology, diagnosis, and treatments. Material and Methods: This literature review was done by searching the data from the following databases such as PubMed, Google Scholar, Springer, Elsevier (ScienceDirect), and book chapter. Results: This literature review showed anatomical variations of the PTN and its branches that used the malleolar-calcaneal axis for measurement of branching point. Moreover, these studies showed the origin and the number of branches. The diagnosis of TTS can be used numerous techniques such as neurophysiology, electromyography (EMG), ultrasound scanning (US), and magnetic resonance imaging. The treatment for TTS includes conservative approach, open surgery, and endoscopic procedures. Discussion and Conclusion: The anatomical knowledge of the neurovascular structures at the medial side of the ankle is not only considered for diagnostic purposes but also it ensures safe and effective operative procedures. This literature review will be beneficial for academics and clinicians.
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A study on thoracic splanchnic nerves: Anatomo-surgical appraisal
N Esakkiamma, WMS Johnson, Mariappan Senthiappan Arathi, Rajasundaram Archana
July-September 2019, 68(3):221-225
Introduction: The thoracic splanchnic nerves greater, lesser, and least are derived from medial branches of the lower seven thoracic sympathetic ganglia; they carry preganglionic fibers, pierce the diaphragmatic crura, and supply the abdominal viscera through coeliac and aorticorenal plexus. These splanchnic nerves carry pain conducting visceral afferent fibers from the upper abdominal organs, including the pancreas. The origin of the splanchnic nerves from different roots may have a significant role in clinical presentation of patients than the normal or absence of consecutive nerve roots. Material and Methods: The study was done on 26 formalin-fixed cadavers (52 sides) from the Chettinad Hospital and Research Institute, Chennai, and University College of Medical Sciences, Delhi. The endothoracic tissue and the parietal pleura in the paravertebral region were carefully removed from the 1st rib to 12th rib (costodiaphragmatic recess). The thoracic sympathetic chain and its medial branches were traced from its origin to medial arcuate ligament. Any variations in the origin, formation, and communication of the splanchnic nerves were noted and photographed. Results: The origins of splanchnic nerves were bilaterally asymmetrical in most of the cases. The greater splanchnic nerve (GSN) was always present, whereas lesser splanchnic nerve and least splanchnic nerve were found to be absent in 40% and 80% cases, respectively. The GSN showed great variability both in the level of its origin and in the pattern of its formation. In the present study, four different patterns of GSN origin were observed in addition to normal. Discussion and Conclusion: Significant differences were noted in the formation and communication between the thoracic splanchnic nerves. The patterns in the formation were not only different from cadaver to cadaver but also were bilaterally asymmetrical.
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Histopathological and Histomorphometric studies on the effects of Olanzapine on Testis: An experimental study in Albino Rats
Waqar Akram, Masooma Syed, Nafis Ahmad Faruqi
July-September 2019, 68(3):196-200
Introduction: Toxic effects of an antipsychotic drug on male gonad were explored experimentally. Olanzapine, an antipsychotic drug, has affinity for a wide range of receptors posing danger to the large variety of organs. Since olanzapine can bind to these receptors, a direct effect of these drugs on spermatogenesis is possible. Therefore testis, an organ least attended, has been selected in the present study. Material and Methods: Two groups of animals of the equal number were designed in such a way that the first group acted as control and second group acted as experimental. After histopathological comparison in the tissue of the testis, histomorphometric analysis was also performed to support the former. Twelve albino male rats were divided into two groups of six animals each. Olanzapine was injected in experimental rats in a dose of 4 mg/kg body weight intraperitoneally for 6 weeks. Sections of both experimental and control testis were examined under light microscope for histopathological findings. Histomorphometric informations were also collected to support the former findings by using ocular and stage micrometers. Student's t-test was used to compare the control testis findings with the single variable experimental one. Results: Experimental testis showed intra and interlobular edema, compressed seminiferous tubules, thinning and fragmentation of basement membrane. Spermatogenic cells were smudgy and compressed by edema fluid. Blood vessels showed inflammatory cells in the lumen. Discussion and Conclusion: Olanzapine-induced testicular degeneration might lead to reduced libido, a fact of great social impact.
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Role of fingerprint patterns in the histopathologically diagnosed breast cancer females
Vishram Singh, Sajjad Jafar, Nisha Kaul, Bindu Singh
July-September 2019, 68(3):211-214
Introduction: Breast cancer is the most common cancer among women in India followed by cervical cancer. It is a major threat to women today with nearly half a million deaths attributed mainly to the lack of early diagnosis. A fingerprint pattern determination is genetic, but it has been reported to be affected by the environmental factors in the first trimester of pregnancy. The importance of fingerprints in the modern world is not restricted to the field of forensic and criminal applications only. The purpose of this study is to examine the fingertip patterns among women with histopathologically diagnosed breast cancer and controls. Material and Methods: The study was conducted 145 histopathologically diagnosed breast cancer women and their fingerprint patterns compared with 145 normal healthy women with no family history of breast cancer. Results: The fingerprint patterns were analyzed between breast cancer and control group of individuals, which showed statistically difference. The most common pattern found in breast cancer females was ulnar loop (67.93%) followed by whorl (24.68%) arches (4.13%) and radial loop (3.24%)while in the normal females, the most common pattern was whorl (50.82) follow by arches (17.58%) radial loop (16.27%) and ulnar loop (15.31%). Discussion and Conclusion: According to our study, we conclude that dermatoglyphics may help in identifying women with risk of breast cancer. The dermatoglyphics can serve as an inexpensive, noninvasive anatomical and effective tool to determine the individuals with breast cancer in their future.
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Origin and prevalence of right conus artery: A cadaveric study
Hina Nafees, Sanjeev Kumar Jain, Sonika Sharma, Dilshad Ahmad Usmani
July-September 2019, 68(3):232-235
Introduction: The human heart is mainly supplied by the right and left coronary artery. Conus artery is one of the essential branches of the right coronary artery (RCA). If this artery emerges directly from the anterior aortic sinus with no noticeable common trunk, this is known as the third coronary artery (TCA). Often, this anatomic variation left unvisualized during selective coronary arteriography. This study is an effort to notice the incidence and origin of the right conus artery in human cadaveric heart. Material and Methods: A total of 50 human cadaveric hearts were dissected, and the incidence and origin of conus artery were noted. Results: Out of the 50 hearts examined, 10 hearts had separate source of conus artery through anterior aortic sinus. Here, the artery is termed as TCA. In 11 cases, the conus artery show aortic origin with common opening of RCA. In 29 cases, conus artery arises outside the aorta from RCA. Among the 10 cases, origin of conus artery is directly from the aorta, 7 (14%) were male and 3 (6%) were female. Discussion and Conclusion: The occurrence of TCA is a blessing to a person and the one with TCA is less possibly to die from unexpected inherent death from cardiac pathology.
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Evaluation of Rumex nepalensis Spreng. root extract on biochemical and histopathologic parameters of mice liver
Tefera Belsty, Peter Etim Ekanem, Gebreegziabher Gebremedhin, Haile Gebreselassie, Hayelom Kebede
July-September 2019, 68(3):205-210
Introduction: The Rumex nepalensis Spreng. (RN) root has various medicinal uses such as the treatment of abdominal colic, tonsillitis, arthritis, diarrhea, and infertility. The present study evaluated the subacute toxic effects of RN root extract on the histology and biochemical parameters of the liver in mice. Material and Methods: A total of 24 male and female mice were used and randomly assigned into four equal groups. Group I (control) received distilled water. Groups II, III, and IV received root extract of RN at 250, 500, and 1000 mg/kg/day for 28 consecutive days, respectively. Data obtained were processed using SPSS statistical software version 20 and presented using tables and graphs, while liver sections were processed and their histopathology microscopically observed. Results: Mice treated with 250 and 500 mg/kg/day of the root extract showed no significant changes in body weight in both sexes. Males treated with 1000 mg/kg/day of the extract had significant weight reduction, while the females did not show weight change. Alanine aminotransferase serum levels were significantly increased in all mice treated with 1000 mg/kg/day of the root extract. Histopathological changes such as congestion of portal and central veins, sinusoid dilatation, and Kupffer cell proliferation were observed in the 500 and 1000 mg/kg of the root extract treated groups. Mortality was also noticed in these two groups, though not confirmed as being toxicity related. Discussion and Conclusion: Treatment with hydroalcoholic root extract of RN revealed hepatotoxic effects at 500 and 1000 mg/kg of the root extract. This shows that the consumption of high doses of RN may be hazardous.
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Evaluation of the relationship between age and gender of fossa navicularis magna with cone-beam computed tomography in orthodontic subpopulation
Fatma Akkoca Kaplan, Esra Yesilova, Ibrahim Sevki Bayrakdar, Mehmet Ugurlu
July-September 2019, 68(3):201-204
Introduction: Fossa navicularis magna (FNM) was defined as a notch-like defect on the inferior side of the clivus. The aim of this study was to evaluate the relationship between FNM with age and gender with cone-beam computed tomography (CBCT) in a Turkish orthodontic subpopulation. Material and Methods: The study group consisted of 195 patients (109 females and 86 males) having CBCT scans. The patients had no known syndromes, history of neurological diseases, or surgical intervention in the region of the interest. On FNM-detected patients, comparison of gender and age was performed. Descriptive statistics and Chi-square statistical analysis were made using the Statistical Package for the Social Sciences 20.0 (SPSS 20) program. P < 0.05 was accepted as statistically significant. Results: FNM was identified in 32 (17.4%) patients. Among these patients, 23 were female (21.1% of all female patients) and 9 were male (10.4% of all male patients), and the age ranged between 7 and 29 (mean age: 14 ± 3.3) years. There was no statistically significant relationship between the presence of FNM and gender. Discussion and Conclusion: FNM is an important anatomic variation of the skull base, and it should be monitored carefully by oral and maxillofacial radiologists. The presence of fossa navicularis should also be investigated in other communities throughout CBCT, and a wider database should be established.
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Association of vascular endothelial growth factor and soluble fms-like tyrosine kinase-1 polymorphisms with their circulating protein levels in preeclampsia
Pallavi Arora, Sushil Kumari Sangwan, Ranjan Gupta, Sankat Mochan, Sunil K Gupta, Shobhit Saxena, Neerja Rani, Neerja Bhatla, Sadanand Dwivedi, Arundhati Sharma, Renu Dhingra
July-September 2019, 68(3):215-220
Introduction: Normal development of placental vascular tree requiring angiogenesis and vasculogenesis is structurally and functionally indispensable for both adequate placental growth and delivery of nutrients from mother to the fetus. Impaired placental angiogenesis has been implicated in the pathophysiology of pregnancy complications which have immediate and long-lasting effects on the mother and her child, such as preeclampsia (PE) and fetal growth restriction. The mechanisms underlying the deregulation of placental angiogenesis in PE include a misbalance between the secretion and activity of pro-angiogenic (vascular endothelial growth factor [VEGF]) and anti-angiogenic (soluble fms-like tyrosine kinase-1 [sFlt-1]) factors. Considering the important roles of VEGF and sflt1 in pregnancy, functional polymorphisms in these genes may be potentially important as genetic markers for susceptibility to PE. Thus, the aim of the study was to screen for the presence of VEGF and sFlt-1 gene polymorphisms and to measure their levels in PE patients and controls of Indian origin. Material and Methods: Fifty each of clinically diagnosed patients and gestational and maternal age-matched normotensive, nonproteinuric controls were recruited after taking informed consent. DNA isolated from blood samples was processed for polymerase chain reaction amplification followed by restriction fragment length polymorphism to screen for the presence of VEGF + 936C/T, sFlt-1 (+4244G/A, −4771G/T, −523C/G) polymorphisms. Serum levels of VEGF-A and sFlt-1 were measured by Sandwich enzyme-linked immunosorbent assay (ELISA). Results: Decreased frequency of wild type genotype with respect to VEGF + 936C/T and sFlt-1 (+4244G/A, −4771G/T, and −523C/G) polymorphisms was seen in patients. ELISA results showed lower VEGF-A (198.43 ± 14.63 pg/ml vs. 235.08 ± 16.72 pg/ml [mean ± standard error of mean]) and higher sFlt-1 levels (2932.81 [1802.33–5760.46] pg/ml vs. 1114.94 [655.03–2694.35] Median [Range]; P < 0.05) in patients as compared to controls. Preeclamptic women with increased frequency of VEGF + 936CT genotype had lower serum levels of VEGF-A. However, preeclamptic women with increased frequency of GA, AA, GT, TT, CG, and GG genotypes of sFlt-1 (+4244G/A, −4771G/T, −523C/G) polymorphisms had increased serum levels of sFlt-1. Discussion and Conclusion: The present study shows, for the first time, a possible association of VEGF and sFlt-1 polymorphisms with gene expression and altered protein levels in preeclamptic patients of Indian origin.
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An assessment of Genotoxic Damage in Exfoliated Buccal Cells using Saliva as a tool
Sonia Jaiswal, PK Sharma
July-September 2019, 68(3):181-186
Introduction: Exfoliated buccal cells serve as an ideal site for genotoxic events since they are the first cells to come in contact with anything ingested or inhaled. Micronuclei (MNs) are also known as Howell–Jolly bodies and are a result of some aneugenic and clastogenic events. The aim of the study was to assess the severity of genotoxic damage in the exfoliated cells of participants consuming smokeless tobacco and its products and those diagnosed with oral submucous fibrosis (OSMF). Material and Methods: Individuals addicted to alcohol, pleasure drugs, or smoked forms of tobacco were excluded from the study. Saliva was collected and centrifuged; smear was prepared using the pellet, while the supernatant was used to extract DNA. The cells collected were stained with Feulgen fast green and acridine orange. Results: A progressive increase in the number of MNs was observed from the control group to those who consumed smokeless tobacco and their products, while the frequency of MNs was found to be the highest in participants with Oral Submucous Fibrosis. Discussion and Conclusion: Micronucleus assay using saliva as a tool can be useful in detecting early genotoxic damage.
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Vascular endothelial growth factor alleviates endoplasmic reticulum stress via PERK, IRE1, and ATF6 pathways in trophoblast cells
Sankat Mochan, Manoj K Dhingra, Sunil K Gupta, Shobhit Saxena, Pallavi Arora, Neerja Rani, Neerja Bhatla, Sada Nand Dwivedi, Renu Dhingra
July-September 2019, 68(3):187-195
Introduction: In developing countries, preeclampsia is still a leading cause of maternal mortality and morbidity, affecting nearly 8%–10% of pregnancies and overall death. Apart from various stresses that placenta undergoes while pregnancy, endoplasmic reticulum (ER) stress has been the center of attraction for several researchers all across the globe. Imbalance in circulating pro- and anti-angiogenic agents in maternal serum has also been linked with the upregulation of stress at subcellular level. The present study is an attempt to demonstrate the role of pro-angiogenic factor in mitigating ER stress in trophoblast cells. Material and Methods: Evaluation of expression of ER stress markers (eIF2α, X-box binding protein-1, and ATF6) at various time points was done after exposure of varying concentration (s) of pro-angiogenic factor (from preeclamptic mothers) to trophoblast cells (BeWo cells). Expression was also analyzed when BeWo cells were exposed to recombinant vascular endothelial growth factor (VEGF) along with serum from preeclamptic mothers. Molecular techniques used were immunofluorescence staining and Western blot analysis. Results: Immunofluorescence staining and Western blot analysis demonstrated upregulated expression of studied ER stress markers in BeWo cells when they were exposed to Preeclampsia (PE) sera. Exogenous addition of recombinant VEGF along with preeclamptic sera significantly reduced the expression of ER stress markers. Discussion and Conclusion: In the present study, significantly reduced expression of ER stress markers in BeWo cells indicates an interrelationship of angiogenic factor and molecular transmembrane sensors. Further experimentations thus may provide a strong base for the modulation of ER stress sensors, which could be effective in minimizing ER stress in preeclamptic pregnancies and thus would bring a new hope to numerous women worldwide.
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Evaluation of sperm DNA fragmentation after cryopreservation in ejaculated spermatozoa
Vishan Dev Singh Jamwal, Sandeep Karunakaran, Nikita Naredi, N Nagaraja, Sushil Kumar, Shallu Jamwal, Arun Kumar Yadav
July-September 2019, 68(3):226-231
Introduction: Infertility has been declared as a public health concern by the World Health Organization. Infertility affects approximately 10%–15% of couples worldwide. Male factors contribute significantly to infertility approximately 35% of couples. Assessment of the integrity of sperm DNA is important in male infertility. Semen cryopreservation techniques as a measure of fertility preservation have been shown to increase DNA fragmentation. The main objective is to study the effects of cryopreservation on sperm DNA fragmentation in ejaculated spermatozoa. Material and Methods: The study was conducted in a tertiary care referral hospital for infertility during the period of January 01, 2013–March 31, 2014. A total of one hundred patients who met the inclusion criteria were included in the study. Sperm DNA fragmentation was done prefreeze and postthaw by sperm chromatin dispersion test. Results: Mean sperm count prefreeze was 56.6 million/ml (standard deviation [SD] = 22.5 million) of semen. Lowest concentration of spermatozoa in the study population was 25 million/ml of semen and highest concentration of spermatozoa in the study population was 120 million/ml of semen. Postfreeze concentration had mean of 66.1 million (SD = 22.4 million). DNA fragmentation in prefreeze was 3.5% (0.3%) and in postfreeze 3.6% (0.3%). There was statistically significant difference between prefreeze and postfreeze values both in sperm count and DNA fragmentation. There was a statistically significant correlation between age and postthaw DNA fragmentation. Discussion and Conclusion: Although cryopreservation increases the DNA fragmentation level of washed sperm significantly, this does not prevent us from utilization of cryopreservation facility because benefits far outweigh the adverse effects of cryopreservation.
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Anomalous branching pattern of the profunda femoris artery with incomplete transposition of the femoral vein in the femoral triangle
Lakshmisha Y Rao, Mangala M Pai, MD Prameela, Kostubh Singh, Amit Massand
July-September 2019, 68(3):242-244
During routine dissection of a female cadaver, we observed variation in vascular structures in the right femoral triangle. The profunda femoris artery was taking a high origin from the femoral artery (FA) just deep to the inguinal ligament, and the lateral femoral circumflex artery was arising from the FA. We also observed differences in the drainage pattern of great saphenous vein, wherein it was superficially crossing the FA to drain into the femoral vein which was located posterior to the FA. This type of rare vascular variation is informative to clinicians, cardiologists, and operating surgeons.
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