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Fulltext Unusual branching pattern and termination of facial artery and its clinical implications for facial operations

Padur AA, Kumar N

J Vasc Bras, 2019 Jul 12;18:e20190021.
PMID: 31360158 DOI: 10.1590/1677-5449.190021

The facial artery is the main artery of the face and variations in its origin and its branching pattern have been documented. We report herein multiple facial artery branch variations in the face. A large posterior (premasseteric) branch originated from the left facial artery and coursed upwards behind the main trunk of the facial artery. This artery presented with a straight course and was closely related to the anterior border of the masseter. The branch then terminated by supplying the adjacent connective tissue below the parotid duct. It was also observed that the facial artery was very thick and tortuous and terminated as the superior labial artery. Knowledge of this variation is of great clinical significance in facial operations, especially for maxillofacial surgeons and plastic surgeons, because it forms the anatomical basis for the facial artery musculo-mucosal flap.
Fulltext Multiple Loops of External and Internal Carotid Arteries Vulnerable in Surgical and Radiological Procedures

Nayak S, Kumar N

Balkan Med J, 2018 05 29;35(3):285-286.
PMID: 29843502 DOI: 10.4274/balkanmedj.2017.1179
Morphohistological analysis of the prevalence and distribution of atheroma in the abdominal aorta and its branches: a cadaveric study

Kumar N, Aithal AP, Verma S

J Vasc Bras, 2021;20:e20210014.
PMID: 34267790 DOI: 10.1590/1677-5449.210014

Background: Aneurysms and atheromatous processes are prominent pathological features that are commonly associated with significant morbidity and mortality.
Objectives: This cadaveric study was conducted to evaluate the morphometric and histological aspects of atheromatous plaque formation in abdominal aortas and their branches and their associated morphological variations, if present, characterized by loops, kinking, or tortuosity.
Methods: The study was performed using 30 human cadavers (approx. 65-75 years). Frequency of occurrence of calcified plaques in the abdominal aorta and its branches and their morphometric measurements were noted and histological features were observed with the aid of Hematoxylin & Eosin staining.
Results: Variations in the abdominal aorta and the common iliac artery were observed in 16.6% of specimens. Atheromatous plaque formation was seen in 2 specimens (1 specimen was associated with kinking) while in 3 other specimens only variation in normal structure (kinking/ tortuous artery) was observed. Histological analysis showed foamy macrophages and dense calcification, giving an atheromatous appearance.
Conclusions: Cadaveric reports of the location, nature, and degree of plaque formation in the abdominal aorta and its branches are extremely important in clinical settings and for choosing treatment options.
Fulltext Exploring the perception on humanitarian issues from the health science students of Indian and Malaysian nationality: a cross sectional study

Kumar, Naveen, Nur Amni Mohd Shamsuddin, Normylia Jamil, Atiqah Mohd Zayed, Swamy Ravindra, S., Guru, Anita, et al.

Education in Medicine Journal, 2015;7(2):9-14.
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Objective: The idea of humanitarianism is evolving with progressing life. Awareness about this global issue has to be emphasized particularly among the younger generation and thus be encouraged to be exposed and involved in humanitarian projects in need. Being responsible citizens of the country one should develop concern about the humanitarian issues, and this attitude needs to be developed from student life. Methods: A cross sectional survey was conducted on 200 participants of the Malaysian and Indian (100 each) health science students using faculty validated close ended questionnaire. Results of the data were analyzed statistically by testing with chi square analysis from SPSS software. Results: From the present study, it has been observed that, despite the cultural and economical diversity between the two nations, there was no observable difference in student’s point of view on humanitarian issues in most of the areas concerned. Overall evaluation also reflected effect of the socio-economic status of the countries on the perception of the issue amongst the students. Conclusion: Despite of different geography, diverse culture and dissimilar socio-economic status, the need of concern towards humanitarian issues is observable. Students of both nations have positive attitude towards the humanitarian issues as well.
Fulltext Hepatoprotective effect of bone marrow-derived mesenchymal stromal cells in CCl4-induced liver cirrhosis

Aithal AP, Bairy LK, Seetharam RN, Kumar N

3 Biotech, 2021 Feb;11(2):107.
PMID: 33564610 DOI: 10.1007/s13205-021-02640-y

Bone marrow mesenchymal stromal cells (BM-MSCs) are multipotent stem cells which are ideal candidates for use in regenerative medicine. The objectives of this study were to evaluate the hepatoprotective effect of BM-MSC and its combination treatment with silymarin in carbon tetrachloride (CCl4)-induced liver cirrhosis animal model and to investigate whether tail vein or portal vein infusion was the ideal route for BM-MSC transplantation. 36 female Wistar rats were randomly divided into six groups (n = 6): Group 1 (normal control), Group 2 (received only CCl4, disease model), Group 3 (CCl4 + BM-MSCs through tail vein), Group 4 (CCl4 + BM-MSCs through portal vein), Group 5 (CCl4 + silymarin), Group 6 (CCl4 + BM-MSCs + silymarin). On the 21st day after treatment, blood samples were collected for biochemical estimations. After the experiment, the rats were sacrificed. Liver was dissected out and processed for histopathology and scanning electron microscopy studies. Liver enzyme and marker analysis, histopathological studies indicated that the combination of BM-MSCs and silymarin was effective in treating liver cirrhosis. Transplanted BM-MSCs in combination with silymarin ameliorated the liver tissue damage through their immunoregulatory activities. Among the two routes, the intravenous administration of cells through the tail vein was found to be more effective and safe.
Ratio Analysis Evaluation of Dermal Collagen and Elastic Fiber Contents: A Comparison of the Horizontal and Vertical Directions of Skin Tissues

Kumar N, Kumar P, Nayak B S, Aithal P A, Guru A

J Clin Aesthet Dermatol, 2019 Dec;12(12):21-24.
PMID: 32038760

Background: Stretching force on the skin leads to the widening of scars and/or hypertrophy. The uneven distribution profile of collagen and elastic fibers in the human dermis (evaluated based on their topographic areas) might determine the direction of incision for a more pleasing aesthetic result. Materials and methods: Full-thickness skin samples were collected in the horizontal and vertical directions from 15 areas of 32 human cadavers. The histological preparation of the skin samples was performed using special Verhoeff-van Gieson staining. Image analysis in the TissueQuant software was performed using photomicrographs. Quantitative fraction measures for collagen and elastic fibers were completed. From the data obtained, various ratios between collagen in the horizontal (CH) and vertical (CV) directions and elastic fibers in the horizontal (EH) and vertical (EV) directions were established and expressed as CH:CV and EH:EV. Results: In the areas where CV:CH was less than 1 (low ratio of significance), the collagen content was significantly higher in the horizontal direction than the vertical direction (CH>CV). However, this finding is reversed (CV>CH) in areas where CV:CH is greater than 1 (high ratio of significance). Similarly, in areas where EV:EH is less than 1 (low ratio of significance), the elastic fiber content was significantly higher in the horizontal direction than the vertical direction (EH>EV), whereas such is reversed (EV>EH) where EV:EH is greater than 1 (high ratio of significance). Conclusion: The evaluation of ratios of dermal collagen and elastic fibers in different directions together with the data of asymmetric distribution provide a useful guideline for aesthetic surgeons looking to place elective incisions in the direction that will ensure an improved aesthetically pleasing result.
Fulltext Rare case of median nerve and brachial artery entrapment by an abnormal musculo-fascial tunnel in the arm: possible cause of neurovascular compression syndrome

Kumar N, Padur AA, Prabhu G, Shanthakumar SR, Bhaskar R

Anat Cell Biol, 2019 Mar;52(1):84-86.
PMID: 30984457 DOI: 10.5115/acb.2019.52.1.84

Entrapment neuropathies of the peripheral nervous system are frequently encountered due to anatomical variations. Median nerve is the most vulnerable nerve to undergo entrapment neuropathies. The clinical complications are mostly manifested by median nerve impingement in forearm and wrist areas. Median nerve entrapment could also occur at the arm, due to the presence of ligament of Struthers. Here we report a rare case of proximal entrapment of median nerve and brachial artery in the arm by an abnormally formed musculo-fascial tunnel. The tunnel was formed by the muscle fibers of brachialis and medial intermuscular septum in the lower part of arm. Due to this, the median nerve coursed deep, below the tunnel and continued distally into the forearm, underneath the pronator teres muscle and hence did not appear as a content of cubital fossa. The present entrapment of neurovascular structures in the tunnel might lead to pronator syndromes or other neurovascular compression syndromes.
Fulltext Morphometric analysis of patella and patellar ligament: a cadaveric study to aid patellar tendon grafts

Aithal Padur A, Kumar N, Lewis MG, Sekaran VC

Surg Radiol Anat, 2021 Dec;43(12):2039-2046.
PMID: 34570285 DOI: 10.1007/s00276-021-02837-z

PURPOSE: Morphometric analysis of the patella and the patellar ligament is crucial in diagnosing and surgical corrections of knee injuries and patellofemoral joint disorders. Dimensions of the patella and the patellar ligament are frequently used in implant design and ACL reconstruction. This study aims to obtain detailed morphometric data on the patellar ligament and its localization based on gross anatomical dissections in the adult cadavers.
METHODS: The present study consisted of 50 lower limbs from formalin-fixed male adult cadavers aged about 70 years (45-85) belonging to the South Indian population. Total length of the quadriceps tendon, patellar height, patellar ligament height, proximal width, distal width and thickness of the patellar ligament were measured meticulously. Mean, standard deviation, median scores of each parameter were computed for groups using SPSS 16.0. Level of significance was considered as p
Fulltext Solitary osteochondroma in the body of the pubic bone: a cadaveric case report

Nayak SB, Kumar N, Sirasanagandla SR, Srinivas SP, Pamidi N, Shetty SD

Anat Cell Biol, 2018 Jun;51(2):136-138.
PMID: 29984059 DOI: 10.5115/acb.2018.51.2.136

Osteochondromas develop as cartilaginous nodules in the periosteum of bones. They are the commonest benign tumors of the skeleton, generally observed in the long bones. Rarely, they are also found in the axial skeleton, flat bones of skull and facial bones. During a regular dissection, we came across a solitary osteochondroma in posterior surface of the body of the right pubic bone. Histopathology of the bony projection confirmed the typical features of the osteochondroma. The symptomatic osteochondromas are usually evaluated during radiographic examination. Though, the observed osteochondroma is relatively smaller its unusual location is remarkable and knowledge of occurrence of such nodules is clinically important during the diagnosis and planning of treatment.
Pharmacokinetics and Bioequivalence of Fixed-Dose Combination of Simvastatin and Ezetimibe Tablets: A Randomized, Crossover, Open-Label Study in Healthy Volunteers

Leong CW, Yee KM, Rani TA, Lau KJ, Ahmad S, Amran A, et al.

Clin Pharmacol Drug Dev, 2024 May 15.
PMID: 38745538 DOI: 10.1002/cpdd.1411

The current study aimed to evaluate the bioequivalence of a new generic combination of simvastatin and ezetimibe with the reference formulation. An open-label, randomized, 3-period, 3-sequence, crossover study, including 60 healthy volunteers, was implemented. Participants received the test and reference formulation, each containing 20 mg of simvastatin and 10 mg of ezetimibe as a single-dose tablet, separated by a minimum of 2-week washout periods. Blood samples were collected for 20 time points from predose to 72 hours after the dose. The total ezetimibe assay was carried out using a validated liquid chromatography-tandem mass spectrometry, while unconjugated ezetimibe, simvastatin, and simvastatin β-hydroxy acid determination was done via a validated ultra-performance liquid chromatography-tandem mass spectrometry. Each assay was preceded by a liquid-liquid extraction step. The pharmacokinetic parameters were derived using noncompartmental analysis and then compared between the reference and test formulations via a multivariate analysis of variance. No statistical difference was found in under the concentration-time curve from time 0 to the last quantifiable concentration and maximum concentration of unconjugated ezetimibe, total ezetimibe, and simvastatin between the reference and test formulations. The 90% confidence intervals of unconjugated ezetimibe, total ezetimibe, and simvastatin natural log-transformed under the concentration-time curve from time 0 to the last quantifiable concentration, and maximum concentration were in the range of 80%-125% as per the bioequivalence acceptance criteria. Therefore, the test formulation was bioequivalent to the reference formulation.
Fulltext Impact of Varicocele on Testicular Oxidative Stress and Sperm Parameters in Experimental Animals: A Systematic Review and Meta-Analysis

Russo GI, Saleh R, Finocchi F, Juma AR, Durairajanayagam D, Kahraman O, et al.

World J Mens Health, 2024 Jul;42(3):563-573.
PMID: 38449451 DOI: 10.5534/wjmh.230260

PURPOSE: Varicocele has been associated with high seminal oxidative stress (OS), impaired semen quality, and reduced male fertility potential. However, the exact mechanism(s) underlying the development of varicocele-mediated infertility and the cause-effect relationship between varicocele and testicular dysfunction are not fully understood. The aim of this systematic review and meta-analysis (SRMA) is to investigate the impact of varicocele on testicular OS markers and sperm parameters in experimental animals with varicocele as compared to animals without varicocele.
MATERIALS AND METHODS: A literature search was performed using the Scopus and PubMed databases on studies that investigated testicular OS markers and sperm parameters in animals with varicocele. The primary outcomes included malondialdehyde (MDA) (nmol/mg) levels whereas the secondary outcomes included total sperm count (×106), sperm vitality (%), total sperm motility (%), and sperm DNA fragmentation (SDF) (%). Standardized mean difference (SMD) (95% confidence interval [CI]) was chosen to express the effect size. The quality of the included studies was evaluated using the Cambridge Quality Checklist.
RESULTS: Out of 76 identified articles, 6 studies on rats were included in the meta-analysis. The analysis showed a significant increase of MDA (SMD: 15.61 [1.93, 29.29]; p=0.03) in rats with varicocele vs. controls. We also observed a significant decrease in total sperm count (SMD: -17.45 [-28.97, -5.93]; p<0.01), sperm vitality (SMD: -16.41 [-26.30, -6.52]; p<0.01), total sperm motility (SMD: -17.67 [-24.90, -10.44]; p<0.01), and a significant increase of SDF (SMD: 7.41 [1.23, 13.59]; p=0.02), in rats with varicocele vs. controls. The quality of the included studies was ranked as high.
CONCLUSIONS: This SRMA indicates a significant increase in levels of testicular MDA and SDF and a reduction of sperm quality in experimental animals with varicocele. These findings support the potential role of testicular OS in the development of varicocele-induced testicular damage.