Morphometeric study of dens and its clinical importance

Background: The axis vertebra's distinguishing characteristic is the existence of the odontoid process. The axis vertebra's morphology is very different from the morphologies of the other cervical vertebrae. Surgery on the axis vertebrae is exceedingly risky, and dens of axis vertebrae fractures are fairly common. As a result, it is essential to have a good grasp of the anatomical variance before performing the procedure. The study aimed to evaluate the morphometric parameters of the odontoid process of the axis vertebra. The different anatomical parameters of the odontoid process of the vertebra will be measured and compared with the previously studied parameters. Methods: Thirty dried human axis vertebrae of unknown sex will be taken. The linear and angular morphometric measurements of odontoid process will be recorded by using vernier caliper and goniometer. Results: The mean height, a-p diameter, and minimum and maximum width were 15.8mm, 10.7mm, 10.3mm and 8.5mm respectively. The total height and vertical angle were 38.1mm and 52.2 degrees respectively. Conclusions: To prevent damage to vital components and to help treat dens fractures, the information gleaned from this study may be helpful to surgeons working around the dens of the axis vertebra

Level of conus medullaris termination in adult Kashmiri population: a magnet resonance imaging-based study

Background: The spinal cord is considered as the principle content of vertebral canal. It begins as a downward extension of medulla oblongata at the level of upper border of first cervical vertebrae (C1). The terminal part of spinal cord is conical and is termed as conus medullaris. In adults the level of termination of conus medullaris varies between T12 to L3 vertebrae. The level of termination of conus medullaris is clinically important to avoid injuries during spinal anaesthesia and lumber puncture. Methods: The saggital magnetic resonance images of 168 patients were reviewed in the Department of Radiodiagnosis, Government Medical College, Srinagar from January 2022 to June 2022. The most caudal point of the cord was considered as the tip of conus medullaris. A line was drawn through the tip perpendicular to the long axis of spinal cord to determine its location with adjacent vertebra. Results: The level of conus medullaris termination was most commonly located at T12-L1 intervertebral disc level. The results revealed a significant statistical difference in levels of termination of conus medullaris with respect to age and sex. Conclusions: In literature, the highest level of conus medullaris termination is stated to be at T11-T12 Intervertebral disc and the lowest level at the body of L3 vertebra. Therefore, spinal anaesthesia and lumber puncture procedure should be done below L3 vertebral body in order to avoid iatrogenic complications

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Morphometric analysis of dry human patella – A cross-sectional observational study from Kashmir, North India

Background: The kneecap, also called the patella, is located in front of the knee joint and protects it from injury. It is the most prominent sesamoid bone of the body and is embedded in the quadriceps tendon. The purpose of this study is to perform a detailed morphometric examination of the patella and compare it to specimens from the right and left sides of the patella. Methods: In this cross-sectional observational study, 40 dried patellae were collected from the Department of Anatomy, Government Medical College, Srinagar, of which 21 were right-sided and 19 were left-sided specimens. Height, width, and thickness of the patella; length and width of the articular facets on the medial and lateral sides; and length of the central ridge were among the parameters examined in the study. Results: The mean height, width, and thickness of the patella specimens were 4.10 cm, 2.01 cm, and 4.10 cm, respectively, according to morphometric analysis. The dimensions of the articular facet on the lateral side were found to be statistically different from the dimensions of the articular facet on the medial side, with P = 0.05 considered statistically significant. According to Koyunco's classification, 87.5% of the patella specimens belonged to type B. Conclusion: The morphometric analysis of the patella in this study may help to design implants for reconstruction and guide orthopedic surgeons in reconstructive and fixation surgery of the patella