Indian Journal of Anatomy

 A variation in biceps brachii muscle insertion by two tendons, one common tendon and another accessory tendon, in the right upper limb of a cadaver, 55 years old Indian male, was noted. A separate muscle bundleformed by several fibres from the medial side below the middle level of the arm continued as a narrow accessory tendon. This accessory tendon was in addition to the usual common belly, and was found to continue as a narrow tendinous slip and inserted in to the medial supracondylar ridge of humerus. The main muscle belly comprised of tendons from the short and long head and continued distally to form a common tendon which was inserted on the posterior part of the radial tuberosity. This variation may be considered as one of the potential cause of the pronator syndrome looking at the close relationship with the median nerve.

Key-words: Biceps Brachii Insertion; Variation.

 Introduction: The determination of sex and age of an individual is primary criteria of identification, but this is very difficult problem and becomes even more challenging when only a single bone like clavicle is available. The traditional methods of sexing bone are subjective and not of much help in medico legal cases where near 100% accuracy is needed. Aims: 1. Determination of sex and age of clavicle with the help of morphometric analysis. 2. Determination of age of clavicle with the help of digital X-rays. Methodology: This study was performed using 130 dry human clavicles with institutional ethical committee approval. Morphometric analysis of adult clavicles (108) was carried out using weighing machine, vernier calipers, scale, etc. Roentgenographic observations including adult (108) and young aged clavicles (22) were noted to estimate age with the help of visual seriation. Results & Conclusion: There was a significant difference in parameters like length, mid shaft circumference; weight and incidence of  rhomboid fossa were observed between  male and female clavicles. The present study emphasizes in the possibility of age estimation with the external appearance of medial end and X- ray observations of clavicle.

Keywords: Clavicle; Age Determination; Sex Determination; Medial End of Clavicle; Rhomboid Fossa; X-Rays.

 Background & Objectives: Fingerprint (dermatoglyphic) evidence is undoubtedly the most reliable and acceptable evidence till date in the court of law. Due to the immense potential of fingerprint as an effective method of identification an attempt has been made in the present work to analyse their correlation with gender of an individual. This study was done to determine significant differences in palmar dermatoglyphic parameters between males and females. Methods: Residents of Nijalingappa colony of  Raichur in Karnataka were the source of this study. 50 adult healthy males in the age group of 20 to 40 years and 50 adult healthy females of same age group were the subjects for this study. Sample collection was done by doing home visits and collecting palmar impression. Fingerprint pattern of all of them was recorded using duplicating ink. The prints were then subjected to dermatoglyphic analysis. Results: The Total Finger Ridge Count (TFRC) was significantly more in males compared to females. Females had significantly higher a-b ridge counts than males. There were no significant differences in the other parameters between males and females. Interpretation & Conclusion:  The gender differences in the dermatoglyphic patterns of palms are established by this study. This information is useful in forensic studies in identifying gender of a person.

Keywords: Dermatoglyphics; Hand; Fingers; Male; Female; Forensic Medicine.

 Objective: The popliteal vein is the main vein of lower limb, generally accompanied by the popliteal artery in the popliteal fossa.  It is of great  importance  to  have  the  knowledge  of  the veins of the lower limb and their anomalies, so as to avoid any vascular injury during the surgery on lower limb and for improved assessment and treatment of deep vein thrombosis. Hence, retrospectively to review and evaluate the types of variations and their frequencies  seen within the popliteal fossa, we carried out a cadaveric study in the Department of Anatomy of  Dr P.D.M.M.C. Amravati.   Materials and Methods: In the dissection hall, during routine dissection of formalin fixed cadavers of the adult donors a retrospective study of 20 bilateral (40 unilateral) lower limbs was performed.  Results: We found one variation in lower limb vein of a  64 year male cadaver.  In this case, the popliteal vein instead of continuing as femoral vein  bifurcated into  two veins  one of  which separately opened into the femoral vein in  the femoral triangle. Conclusion: Variations in popliteal fossa venous anatomy have many important clinical implications in deep venous thrombosis as well as in lower limb surgery . 

Keywords: Adductor Magnus; Popliteal Vein; Femoral Vein; Profunda Femoris Vein.

 Background and Aims: The advent of more conservative methods in the renal surgery has necessitated a more precise knowledge of renal vascularisation at the renal hilum and it has its importance in partial and total nephrectomy and also in renal transplantation surgeries. This study is mainly aiming at the incidence in the number of renal hilar structures [renal artery, vein and pelvis]. Material and Methods: Totally 84 kidneys were studied in the present work by blunt dissection method.  These 84 kidneys were collected from department of Anatomy, Navodaya medical college and hospital, some were formalin stored and some freshly dissected from cadavers during the routine dissection classes of medical students. The incidence of no. of renal artery .vein and pelvis were observed. Results: Out of 84 kidneys studied, single renal artery was seen in 72 specimens and 12[14.28%] specimens showed double renal arteries coming separately from abdominal aorta and entering separately at the upper part and lower part of hilum. Double renal veins were seen in 3 specimens [3.57%]. These renal veins were coming out of hilum and passing in front of renal artery and entered the inferior venecava. Only one kidney [1.19%] showed double pelvis which was coming out of kidney separately from posterior upper and lower part of hilum and joined just before opening into the urinary bladder. Conclusion: The knowledge of such variations in number of structures is important in carrying out renal surgeries. 

Keywords: Kidney; Number; Renal Artery; Vein; Pelvis.

 Faculty development programs in medical education have received a shot in the arm after the MCI by the MCI Regulations on Graduate Medical Education, 1997, made it mandatory for all medical colleges to establish Medical Education Units (MEUs) or departments in order to enable faculty members to avail modern education technology for teaching. However, there is need for a systematic approach to comprehensively evaluate the effectiveness and the impact of these programs. The lessons learnt from such evaluation can then be suitably applied to increase the effectiveness of the program. This paper addresses this issue applied to an on-going faculty development program in medical teaching technology at the Armed Forces Medical College, (AFMC), Pune, India.

Keywords: Medical Education; Faculty Development Program.

 Dermatoglyphics is the science that studies the carvings over the volar aspect of skin over palms, soles & fingers. (Derma = skin, glyphics = carve) The markings are due to underlying interlocking patterns of dermal papillae & overlying corresponding epidermal ridges.  These features were found to be permanent variables and were inherited by polygenic system with individual gene contributing a small additive effect. Dermatoglyphic investigation has been undertaken to ascertain the reliability of dermatoglyphics as a predictive diagnostic tool for diabetes. 

The present research aims to primarily study the various dermatoglyphic patterns in the patients with Diabetes Mellitus and compare these statistically with the dermatoglyphic patterns innon diabetic individuals. The present study was carried out on 164 (96 male and 68 female) clinically diagnosed patients of diabetes mellitus and165 healthy controls ( 111 males and 54 females) were studied for comparison. Palmar prints were obtained in all the patients and controls and the dermatoglyphic patterns were analyzed using statistical considerations.Analysis of fingertip pattern like arch, radial loop, ulnar loop and whorls did not show any significant difference. TFRC, a-b ridge count, a-t-d angle and number of triradiirevealed increased frequency  in the diabetic cases as compared to controls.

Keywords: Arch; Dermatoglyphics; Diabetes Mellitus; Radial Loop; Ulnar Loop; Whorl.

 Background: Assessment drives learning. Reliable and valid question papers of higher cognitive function are difficult to produce, particularly for assessment of clinical problem solving. The present study was undertaken to analyze the essay questions and item writing flaws in the summative anatomy question papers. Methodology: 4 years Summative assessment question papers were collected and analyzed, (16 question paper and 32 essay questions) for cognitive level and item writing flaws by two assessors separately. Essay questions were analyzed according to modified blooms taxonomy of cognitive levels and by using validated checklist items. Item writing flaws were analyzed using validated checklists. The results were analyzed using SPSS software. Results: Among 32 essay questions analyzed, all of them were at level 1 of cognitive level of Bloom Taxonomy. Majority of questions addressed the competency that could be assessed only with essay question, were aligned to learning outcomes, structure and pertaining to must know aspects of curriculum. Out of 32 essay questions 17.2% were of average, 51.7% were good and 31% were of excellent quality. In connection with item wise flaws, majority of questions were ambiguous 86.2%, 75.9% questions were repeated in multiple years, same areas of curriculum was addressed in 51.7% questions and there was unequal distribution of marks among different topics in 75.9% papers. Conclusion: Well-constructed, peer-reviewed question papers meet the educational requirements and are advocated for assessing medical students. To construct the higher level of cognitive domain the faculty has to be well trained.

Keywords: Essay Question; Cognitive Domain; Assessment; Item Writing Flaws. 

 Traditionally Anatomy teaching consists of didactic lectures as well as dissections or prosections as per the requirement of the course. Lecture is defined as an oral discourse on a given subject before an audience for purpose of instruction and leaning. In the traditional method lectures were taken via chalk & board, but nowadays power point presentations are increasingly being used. Anatomy is the base of medical science in India and is taught practically to all disciplines of undergraduate health sciences in the first year. It is an acknowledged fact that a basic knowledge of Anatomy is a prerequisite to learn any other branch of medicine. All medical professionals must have a basic knowledge of Anatomy so as to ensure safe medical practice. To make Anatomy learning both pleasant and motivating, new methods of teaching gross anatomy are being assessed as medical colleges endeavour to find time in their curricula for new content without fore-going fundamental anatomical knowledge. This paper examines the other teaching methodologies for teaching gross anatomy. Conclusion: Proper utilization of newer technologies along with the traditional teaching methods will certainly lead to enhanced understanding of gross anatomy and will ultimately improve students’ performance.

Keywords: Anatomy; Medical Science; Newly Admitted Medical Students; Medical Professionals; Medical Practice; Traditional Methods & New Methods of Teaching. 

 The provision of learning gross anatomy in medical colleges provides an emotional as well as intellectual approach to medical education. The teaching of gross anatomy has, for centuries, relied on the dissection of human cadavers. Past research suggests that students find work on a cadaver to be distressing, but also rewarding. Hands-on educational experiences on cadavers can also stimulate student’s interest, increase knowledge retention and enhance development of clinical skills. Learning on human cadavers is complex learning experience and is not easy to quantify and evaluate objectively.

Such aspect pertains to question of professionalization, social skill and attitude towards death. There have been pro and con arguments on whether medical students should dissect the whole body or learn from pre-dissected bodies. The present study is an attempt to improve the concepts of Anatomy by supplementation of dissection videos and simultaneous osteology teaching during routine classroom dissections.

Keywords: Dissection-Videos; Osteology; Cadaveric-Dissection; Complex-Learning; Structured-Assessments; Medical-Education.

 Antenatal ultrasonography is noninvasive and done on routine basis in our institution. A four chamber view of the fetal heart is done as a part of regular sonographic examination of the fetus. Most cases of congenital heart disease are of structural rather than functional origin. Aims & objectives: To determine cardiac length (major longitudinal diameter) of the fetal heart during the third trimester of pregnancy. To evaluate the relationship between fetal heart dimensions obtained from sonography (cardiac length) and Gestational age (weeks) Biparietal diameter (mm) Femur length (mm) & abdominal circumference. Materials & Methods: The fetal heart was studied with transabdominal sonography in 132 single normal pregnancies in third trimester Measurement of cardiac length ( longitudinal diameter) of the heart was taken. Gestational age was assessed by fetal parameters that are biparietal diameter, femur length and abdominal circumference as per the norms in one of the Mumbai’s medical teaching institute and tertiary care centre. Results: The linear increase of the fetal heart shows a strong and significant correlation with the increase of biparietal diameter, femur length and abdominal circumference. Relationships between the cardiac data and fetal age, biparietal diameter, femur length and abdominal circumference were explored by allometry and linear regression analysis in order to estimate cardiac growth rates during third trimester. Conclusion: This study verified that the heart grows very rapidly during the third trimester (positive allometry). This suggests that noninvasive analysis of cardiac data can be useful for the assessment of gestational age or for prenatal detection of congenital heart disease [1].

Keywords: USG; BPD; FL; AC; & CL.

 Objectives: MCQs is the most commonly used method for assessing the performance of medical students. The aim of this study is to assess the quality of MCQs for creating viable question bank for future use, to identify the low achievers and their learning difficulties, faculty development and also for its use in high stake examination. Methodology: 150 students of First year MBBS course attended 20 MCQs in the subject of Anatomy Goa Medical College Bambolim Goa. The MCQs were best single response type with four options, each item comprising of one mark to be answered in fifty seconds for 20 marks. There was no negative marking and 50% score was considered as pass. Prevalidation of MCQs was done by senior faculties.  Post validation of the MCQs was done by Item analysis for Difficulty Index, Discrimination Index and Distractor Effectiveness. Results: The items analyzed had Difficulty Index (p) were acceptable (50%), too easy (10%) and too difficult (10%). The Discrimination Index (d) were good (50%), excellent (30%) and acceptable (20%).  Since all the items had response more than 5% and were functional distractors, the Distractor effectiveness was zero. Conclusion: Item analysis can tell us if an item was too easy or too difficult and how it can be discriminated between high and low achievers and also all the distractors were effective. 

Keywords: MCQs; Item Analysis; Difficulty Index; Discrimination  Index; Distractor Effectiveness.

 Introduction: Middle turbinate is an important landmark of lateral nasal wall during endoscopy. The aim of this study was to examine the surgical anatomy of middle turbinate in hemisected heads which allows better visualization of the middle turbinate and middle meatus and to provide anatomical knowledge to the surgeons performing Endoscopic Sinus Surgeries (ESS) and middle turbinectomies. Method: The openings of paranasal sinuses in middle meatus were studied in 100 hemisected adult Indian cadaveric heads. Results: The mean angles between the lowermost portion of limen nasi and openings of frontal sinus i.e. f’, middle ethmoidal cells i.e. m’, maxillary sinus i.e. s’ were 64.8°, 46.71°, 38.59° respectively. The mean distance between the lowermost portion of limen nasi and openings of frontal sinus i.e. f, middleethmoidal cells i.e. m, maxillary sinus i.e.s.are 41.07 ± 4.86 mm, 43.56 ± 3.8 mm, 36.84 ± 3.96 mm.The difference observed in the readings for the two sides is not statistically significant.

Three percent cases showed two middle ethmoidal cell openings.Fivepercentcases showed dual maxillary sinus openings.Fourpercent cases showed absence of maxillary sinus openings.

Keywords: Endoscopic; Surgeons; Middle; Osteomeatal; Complex. 

 Aims:  The study of foramen Ovale is of great surgical importance in procedures like percutaneous trigeminal rhizotomy for trigeminal neuralgia, electroencephalographic analysis for seizure and diagnostic transfacial fine needle aspiration technique in perineural spread of tumour. Localization of the foramen ovale can be difficult due to imaging quality (improved by biplanar radiology systems), operator inexperience and anatomical variations. Methods and Material: The present study was conducted on 38 dry adult, human skulls of unknown sex obtained from Bone Bank of the Department of Anatomy, IIMSR, Warudi, Jalna. In this study, presence of anatomic variations in shape of foramen ovale was noted. The length and width of foramen were measured. Comparison between right and left was done. Results: Mean length of foramen ovale was 7.27mm and mean width was 3.18mm. There was no statistical significant difference between means of the length and width of the right and left  sided. It’s shape was typically oval in 19, almond in 10, round in 6 and slit like in 3 skulls. Conclusions: These anatomical variations in size and shape of foramen ovale should be borne in mind during the surgical and diagnostic importance around the foramen ovale.  

Keywords: Foramen Ovale; Foramena of Skull; Anatomical Variation.

 Double inferior vena cava is rare congenital variation resulting from the persistence of the embryonic cardinal venous system. Duplication of inferior vena cava is rare occurrence where the left side cardinal venous system persists as the left inferior vena cava. This study was carried out in the Department of Anatomy, Dr. P. D. M. M. C. Amravati. Total thirty male adult cadavers were dissected to study the inferior vena cava. Out of thirty, in one cadaver, the duplication of inferior vena cava was observed. This anomaly was discussed along with its embryological basis. Apart from duplication of inferior vena cava, no any other anomaly was found.

Keywords: Inferior Vena Cava; Congenital Variation; Duplication.

 Background: When delivery of a  preterm infant is anticipated accurate antenatal assessment of the fetal weight can be a useful adjuvant for establishing a plan of management .That will minimize perinatal morbidity and mortality rate. Objective: To estimate fetal birth weight by measuring fetal abdominal circumference and biparietal diameter in 3rd trimester high risk pregnancies by Ultrasonography. To devise a simple and accurate equation for estimating birth weights of preterm and low birth weight fetuses. Methods and material: The study population was made up of 92 high risk 3rd trimester pregnant patients. Fetal measurements were made by real time USG machine.  Result: In the present study estimated fetal birth weight calculated by Gray Thurnau’s equation formula  was highly correlated with actual birth weight  with correlation coefficient of 0.925. Conclusion: Abdominal circumference and biparietal diameter are the best indicators to assess birth weight in high risk pregnancies.

   Keywords: Fetal Birth Weight; Ultrasonography; Abdominal Circumference and Biparietal Diameter.