Histological development of human foetal shoulder joint

Background: Shoulder joint is a multiaxial, diarthrodial joint of ball and socket variety. The various components of shoulder joint i.e. capsule, various ligaments, joint cavity and synovial tissue start developing in early embryonic and foetal life roughly in between 6th to 12th week of foetal development. The present study aims to analyze the sequences of development of various structures of shoulder joint in human embryo and compare the findings with other observers to gain some insight regarding its development and an attempt is made to correlate these observations clinically to analyze cause and management of recurrent shoulder dislocations. Methods: Shoulder joints of 32 foetuses collected from areas in and around Jammu were dissected properly and decalcified in Gooding and Stewart’s solution. Sections were cut after obtaining blocks by paraffin wax embedding method. Slides were stained using Haematoxylin and Eosin, Masson’s trichrome and orcein staining and important findings were documented.Results: The bony structures - head of humerus and glenoid fossa and joint cavity appear by 10 weeks which prolongs into bicipital sulcus by 12-1/2 weeks. Synovial tissue appears by 10 weeks and synovial villi appear by 14 weeks. Glenoid labrum, capsular ligament, coracohumeral ligament and superior glenohumeral ligament are seen by 10 weeks. Middle glenohumeral ligament is seen at 12-1/2 weeks while inferior glenohumeral ligament is seen at 14 weeks. Tendon of biceps is seen at 10 weeks. Conclusions: By 10 weeks of gestational age various structures of shoulder joint develop in situ, resembling in form and arrangement as those of adults. From these early stages, development proceeds rapidly to achieve adult characteristics. There are no intermediate stages in between where structures similar to those of lower forms i.e. syn/amphi artroses appear temporarily.

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

Effect of cyclophosphamide on the microanatomy of liver of albino rats

Background: Cyclophosphamide is widely used in the treatment of various neoplastic diseases and diseases associated with altered immunity. Higher doses used for longer duration effects many organs like urinary bladder, lungs, liver, heart and male reproductive organs.Methods: To study the effect of cyclophosphamide on the micro anatomy of liver, sixty eight Albino rats were taken and divided into three groups, group A (control group) of 20 animals, were fed with routine diet, group B (low dose group) of 24 animals, were given cyclophosphamide at the dose of 0.5 mg/100 gms in addition to the routine diet and group C (high dose group) of 24 animals, were given high dose of cyclophosphamide at the dose of 0.7 mg/100 gms of weight of animal in addition to the routine diet. The animals were sacrificed at intervals of 3, 6, 9 and 12 weeks, 5 microns sections of the tissue were prepared and stained with Haematoxylin and Eosin stain.Results: Microscopic changes in liver were apparent in the drug treated animals. In group B the changes appeared after 6 weeks while in group C they started appearing after 3 weeks of drug treatment. The changes were in the form of fatty changes, hemorrhages and central vein congestion.Conclusion: Cyclophosphamide induces histological changes like fatty infiltration and central vein congestion in the liver. These changes are with low doses given for longer durations and manifest earlier when larger doses are used. Thus it is advised that patients receiving cyclophosphamide should be periodically evaluated for liver dysfunction.

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI