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Background: The nerve supply of the upper limb, which is provided by the brachial plexus, is extremely important from a medical and surgical perspective. Muscles of the flexor compartment of the arm are destined to have their nerve supply from the musculocutaneous nerve, a branch from the lateral cord of the brachial plexus. Variations in the formation and branching of the brachial plexus are not uncommon. These variations have clinical significance during surgical procedures, in the brachial plexus block, and in diagnostic clinical neurophysiology. Material & methods: The study was carried out in the department of anatomy consisting of 56 limbs during routine undergraduate dissection classes. Dissection of the infraclavicular part of the brachial plexus was done. The variations in the origin, number, and distribution of the branches derived from the cords to the flexor compartment of the arm and their correlations to the coracobrachialis were noted. Observation & results: 47 limbs (83.92%) showed a normal morphological pattern of formation and distribution of brachial plexus to the flexor compartment of the arm. 9 limbs (16.07%) showed variations in one form or the other. Two limbs (3.57%) showed an absence of musculocutaneous nerve (MCN). In 3 limbs (5.35%) coracobrachialis was not being supplied by MCN, and 4 limbs (7.14%) exhibited a communication between MCN and Median Nerve (MN). Conclusion: Variations in the nerves supplying the flexor compartment of the arm have clinical implications in post-traumatic evaluations and exploratory innervations of the arm for peripheral nerve restoration. It is important for surgeons, clinicians, and anatomists to be aware of these possible anatomical variations to avoid unexpected complications.

Introduction: There is a wide variation in different dimensions of trachea in same age group as well as in different age groups in both sexes. Besides anthropometry, the study of these morphometric variations is of profound clinical importance as it may help the pulmonologists to understand the aetiology of several pulmonary diseases like bronchitis, emphysema, pulmonary fibrosis and tuberculosis. Aim: To determine the variations in the dimensions of human trachea in the cadavers of age group 20-70 years in Northern India. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, during March 2019 to December 2021. A total of 40 tracheas were obtained from adult human cadavers which were included in present study by convenience sampling. The trachea was dissected with the larynx and principal bronchi and measurements were taken. Data collected was saved on Microsoft excel and was analysed by calculating percentages, mean and Standard Deviation (SD). Results: Mean length of trachea was 109.25 mm, mean subcarinal angle was 75.45°. Mean anteroposterior diameter, transverse diameter, mean height and distance between posterior ends of rings was 16.70 mm and 18.10 mm, 4.53 mm and 12.15 mm respectively and mean of inter-ring distance between 1st-2nd, 5th-6th, 10th-11th, 15th-16th tracheal rings was 1.12 mm. Conclusion: The present study revealed a wide variation in different dimensions viz. length, transverse and anteroposterior diameters, mean height, intertracheal ring distance and the subcarinal angle. Accurate anatomical knowledge of the variations is essential for understanding the pathophysiology and management of different airway disorders and in reconstructive surgery of tracheobronchial tree.

Introduction: Multiple factors in the contemporaneous trends in curriculum and medical education demand changes in teaching–learning methods with a dramatic change in the paradigm of teacher-centered teaching methods to student-centered learning methods. The jigsaw technique is an active learning methodology that involves active participation by the students in the learning process where they learn by teaching one another. It is an excellent potential tool to grasp an outsized load of information in a brief period or shorter time frame. The objective of the present study was to assess the effectiveness of the implementation of the jigsaw method as a learning tool during a graduate medical education setting. Methodology: The study was conducted among 150 phase I MBBS students during dissection in the department of anatomy. Two topics were decided and taught by didactic lecture. After taking the pretest, the topics were again taught by the jigsaw technique. After completion of the topic with this technique, students' knowledge regarding the topics was judged by taking a posttest. Pre- and postjigsaw technique assessment scores were calculated. The difference in the mean of pre- and posttests was estimated and compared by applying a paired-t-test to know the effectiveness of teaching methods. Results: The difference in the performance of the students in pre- and postjigsaw technique assessment scores test was calculated by applying paired-t-test which was found to be statistically significant (P < 0.001). About 100% of faculty members readily accepted the suggestion of implementing the jigsaw method. About 88% (132) of students showed enthusiasm and interest to take up the activity. Conclusion: There was an eloquent difference in the performance of the students in pretest and posttest knowledge scores. The results indicate a better performance by the students when they are involved actively in learning and found this method very helpful, interesting, and motivating.

Background and Aims Arcuate foramina (AF), the atlas bridges formed by a delicate bony spicule over the posterior arch of atlas, have been implicated in the compression of the vertebral artery during extreme rotation of head and neck movements. Reduction in the size of arcuate foramina as compared with foramen transversarium (FT) is also an important cause for the compression of vertebral artery. Aim of the present study was to determine the morphometric differences between complete AF and ipsilateral foramina transversaria. Materials and Methods Eighty dry adult human atlas vertebrae were obtained in the Department of Anatomy, Government Medical College and Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. Measurements were taken of the maximum dimensions of AF and ipsilateral FT and cross-sectional area was also calculated. Results The following results were obtained. The AF were seen in total 11 (13.75%) vertebrae, 3 (3.75%) on the right side, 6 (7.5%) on left side, and 2 (2.5%) bilateral. The mean ventrodorsal (AFL) and superoinferior (AFH) diameter of AF was 8.79 mm and 5.98 mm, and 8.11 mm and 5.54 mm on the right and left sides, respectively, and the difference was found to be highly significant. The mean ventrodorsal (FTL) and mediolateral (FTW) diameter of the FT 8.19 mm and 6.56 mm, and 7.31 mm and 6.86 mm on the right and left sides, respectively, with significant difference on the right side. The mean cross-sectional area of AF was 41.32 mm2 and 35.38 mm2, and FT was 42.53 mm2 and 39.71 mm2 on the right and left sides, respectively, and AF has smaller area than ipsilateral FT. Conclusions Knowledge about the dimensions and cross-sectional area of the AF and ipsilateral foramina transversaria of the atlas vertebra can improve the success rate of surgeries, thus preventing damage to the adjoining vital structures.

Background and aims: Clinical skills are built upon the anatomical knowledge, the study of which must not be reduced to a level where it becomes detrimental to the care of patients. The drastic curtailment of period in basic teaching of anatomy in the curriculum of undergraduate medical students from one and a half year to one year, non availability of cadavers and decline in faculty have further reduced the general level of its applied aspect. This situation illustrates the need for organized teaching of clinically relevant Anatomy as part of post-graduate curriculum. The aim of the present study is to assess and evaluate the group’s perception towards organized teaching of clinically relevant Anatomy as part of clinical/surgical subjects. Materials and methods : Three groups were made which reflect their perception in the form of questionnaire responses towards organized teaching of clinically relevant anatomy as a part of clinical/surgical subjects. The questionnaire were framed to assess whether these visits were of any help in betterment of their understanding of clinical subjects. Results : Based on groups perception in the form of questionnaire responses the results were observed, recorded and tabulated. Before viewing the sections of regional anatomy 63.3% (19) of group I and 80% (72) of group II and in group III 86.7% (26) were in favour of having the moderate knowledge of the structures while attending the operation. After viewing the specimens out of 150 participants 86.7% rated this method of great help. 70% (105) were in view that the knowledge of normal histology also helps in understanding the subject of pathology. 91.3% (137) commented that of all the basic sciences, Anatomy is the most clinically relevant and should be revised thoroughly during post graduation courses. Conclusion: Anatomy forms back-bone of all specialties, without which foundation of clinical specialties could not be strengthened. Thus anatomy as it applies to all aspects of surgery and other clinical subjects should be revised thoroughly during their post-graduation.

Anomalous muscles donot usually cause symptoms but are of academic interest. Axillary arch is a variable muscular slip encountered in axilla. Purpose of the present study was to report a rare case of axillary arch muscle. Knowledge of this muscle variation and the possibility of finding it during axillary procedures are crucial for lymph node staging, lymphaedenectomy and for differential diagnosis in compressive pathologies of axillary vessels and brachial plexus. During routine dissection of left axilla in a 60-year old male cadaver, an anomalous muscular slip was encountered. The slip was extending between latissimus dorsi muscle to coracoid process, deltoid muscle, fascia covering biceps and coracobrachialis and was confirmed as axillary arch muscle. The embryological basis, genetics and clinical implications have been discussed. This rare variation will be of interest not only to anatomists but also for clinicians and surgeons dealing with this area.

Background and Objectives: Beta-thalassemia continues to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to evaluate the validity of “NESTROFT” (Naked Eye Single Tube Red Cell Osmotic Fragility Test) as a useful screening tool in the diagnosis of beta thalassemia trait. Material and Methods: The present study was conducted on 150 subjects in the department of haematology in a tertiary health care center in north Indian state of Punjab. In Group I, 111 cases diagnosed as microcytic hypochromic anaemia were selected. In Group II, 39 individuals (the family members of known cases of beta thalassemia major) were selected. Complete haemogram, NESTROFT and HbA2 levels by electrophoresis were done and the results were tabulated and analyzed statistically. Results: Of the 111 cases in Group I, 20 (18%) gave positive results with NESTROFT while 91 cases (82%) tested negative. In Group II, out of 39 cases, 30 (76.92%) tested positive with NESTROFT while 9 gave a negative result. In Group I, out of 20 NESTROFT positive cases, only 3 had HbA2 levels more than 3.5%. In Group II, all the 30 NESTROFT positive cases had HbA2 levels more than 3.5%. The test showed a sensitivity of 100%, specificity of 85.47%, a positive predictive value of 66% and a negative predictive value of 100%. Conclusion: Thus, NESTROFT is a valuable, cost-effective screening test for beta thalassemia trait and appears to be a valid test in rural setting with financial constraints.

The arcuate foramen or retroarticular vertebral artery ring is formed by the bony bridges over groove for vertebral artery on the posterior arch of atlas vertebrae. It is formed by ossification of the oblique ligament of atlas; i.e., the fibrous tissue present at the lower border of posterior atlantooccipital membrane. A complete ring is reported to be seen in 2% to 14% of the subjects. However, a bilateral complete ring is extremely rare seen only in 1.1% of subjects. We are reporting here one such case where a retroarticular vertebral artery ring was present on both the sides of the same atlas. On the right side its anteroposterior (length) diameter was 6.4 mm and superoinferior diameter (height) was 5.3 mm respectively. The corresponding figures on the left side were 6.2mm & 4.9 mm. A knowledge of such vertebral rings is useful not only for neurophysicians and neurosurgeons but also for radiologists and medical practitioners in general. Its clinical and surgical implications are discussed in detail and a flood of light has been thrown on different theories of its development whether ontogenically, phylogenically or environmentally.

En la vértebra atlas, los puentes posteriores, los puentes laterales y los túneles postero-laterales son las protrusiones óseas que pueden causar presión externa en la arteria vertebral cuando pasa del foramen transverso de la vértebra cervical al foramen magnum del cráneo. Ejemplares que muestran dichas protrusiones fueron clasificadas según tengan puentes del atlas completos o incompletos que pueden predisponer a la insuficiencia vertebrobasilar y al síndrome cervicogénico especialmente durante los movimientos de cuello. El objetivo del estudio es saber la incidencia, ontogenia y filogenia de los puentes del atlas junto con las implicaciones clínicas. Este canal de la arteria vertebral del atlas y la morfología de los puentes fueron estudiados en un total de 60 (120 lados) vértebras atlas humanas completas y secas obtenidas de la colección de esqueletos del Departamento de Anatomía del Government Medical College de Amritsar en Punjab. La incidencia de la impresión de la arteria vertebral (44), la impresión profunda de la arteria vertebral (42) era 71,66%, el puente parcial fue 13,33% y el puente lateral parcial fue 3,33% en el lado derecho y 5% en lado izquierdo. También se observaron doce anillos completos y un túnel 1.66% postero-lateral. La ocurrencia de estos puentes óseos abrazando la arteria vertebral es de suma importancia clínica, pueden causar efecto de comprensión en la arteria vertebral durante la rotación extrema de la cabeza y movimientos de cuello manifestándose en mareos, desmayos, diplopía temporal, vértigo y desórdenes neurológicos. El conocimiento de esta variación es importante para médicos, otorrinolaringólogos, neurólogos y ortopedistas que en la práctica diaria están en contacto con estas enfermedades de la columna vertebral y sus consecuencias. In atlas vertebrae, the posterior bridges, lateral bridges and postero-lateral tunnels are the bony outgrowths which may cause external pressure on the vertebral artery when it passes from foramen transversarium of the cervical vertebra to foramen magnum of the skull. Specimens exhibiting such outgrowths were classified as having incomplete or complete atlas bridges that may predispose to vertebro-basilar insufficiency and cervicogenic syndrome especially in neck movements. The objective of the study is to know the incidence, ontogeny and phylogeny of atlas bridges along with its clinical implications. The groove of the vertebral artery of the atlas and the morphology of the bridges were studied in a total of 60 (120 sides) complete and dry human atlas vertebrae obtained from the skeletal collection of Department of Anatomy,GovernmentMedicalCollege,Amritsar,Punjab. The incidence of impression of vertebral artery (44), deep impression of vertebral artery (42) was 71.66%, Partial ponticuli were 13.33% and Partial lateral ponticuli were 3.33% on right side and 5% on left side. Twelve complete rings and one 1.66% postero-latetal tunnel was also observed. Occurrence of these bony bridges embracing the vertebral artery is of great clinical importance, may cause compression effect on the vertebral artery during extreme rotation of head and neck movements presenting with dizziness, fainting, transient diplopia, vertigo and neurological disturbances. The knowledge of this variation is important for physicians, otolaryngologists, neurologists and orthopaedicians who in every day practice are in contact with the diseases of spine and their consequences.

Background and Objectives. Thoracic lesions account for various benign and malignant conditions. Of these lung carcinoma (mainly primary) is the most common carcinoma in the world. The present study was undertaken to know the pathological spectrum of thoracic lesions and to correlate cytoradiological findings. Materials and Methods. The present study was conducted in a tertiary care center of North India on 74 patients over an 18-month period. CT guided transthoracic FNAC (TTFNA) was carried out, and aspirates were drawn, examined, and compared with radiological diagnoses. Results. The diagnostic accuracy for FNA in the present study was calculated to be 95.94% (using cytology as the gold standard). The predominant lesion was malignancy (85.1%), followed by suspicions of malignancy and inflammatory pathology (5.40% each). By cytology, the most common malignant lesion was adenocarcinoma (48%) followed by squamous cell carcinoma (40%), small cell carcinoma (8%), and undifferentiated carcinoma (4%). Cytoradiological correlation was found to be 89.2% in the present study. Conclusion. Present study thus concludes that TT FNA of thoracic lesions is a simple, safe, economically prudent technique associated with low morbidity and leading to quick and early diagnosis.