The Clinical Anatomy of Cricothyroid Membrane – Its relevance to Emergent Subglottic Procedures.

The cricothyroid membrane is an important route for several other subglottic procedures as well. Though several authors and textbooks have mentioned the cricothyroid membrane, few have described its attachments and very few have studied its dimensions. Only two adult studies have been documented till date; both of which are western studies done in the United States of America. No studies have documented the dimensions of the cricothyroid membrane in children. Only one African study has documented dimensions of neonatal cricothyroid membranes. Race, heredity, climate and nutritional status are known to affect the body size of a population. It was my desire to study the dimensions of the cricothyroid membrane in our own South Indian population and also the structures at risk while puncturing the cricothyroid membrane. Based on my results, I suggest a vertical skin incision as it minimizes the chance of softtissue hemorrhage from vertically oriented anterior jugular veins. Palpation of the cricothyroid membrane should be repeated after the skin incision is made to confirm the correct position of the membrane. A transverse stab incision of the membrane near its lower border adjacent to the cricoid cartilage is recommended to avoid injury to the transverse cricothyroid artery. Tube sizes for emergent subglottic intubation have been reconsidered and new tube sizes suggested based on the present study to suit our south Indian population. To avoid or manage complications of surgical cricothyroidotomy, knowledge of the dimensions, relations, and vasculature of the cricothyroid membrane is imperative. A solid knowledge of the anatomy behind a cricothyroidotomy may reduce the anxiety of the physicians and paramedics performing the procedure. Cricothyroidotomy remains to be a safe and rapid means of securing emergency airway access in the absence of contraindications. This is the largest study done so far and the first study done on a non-American adult group and the first done on a non-African neonatal racial group. It is also the first study done to report cricothyroid membrane dimensions in children. It is my sincere hope that these values would be of immense help in the field of emergency medicine, anesthesia, intensive care management and neonatal care of the newborn

Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall

Introduction: Injury to the inferior epigastric artery (IEA) has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures. Materials and Methods: Sixty IEAs of 30 adult cadavers (male = 19; female = 11) were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS) and umbilicus. Results: The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32%) of the distance between the midline and the sagittal plane through ASIS at all levels. Conclusion: To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD)] away from the midline (or) slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains

Double burden of malnutrition among women of reproductive age: Trends and determinants over the last 15 years in India

Introduction: Double burden of malnutrition (DBM) has been recognized by the World Health Organisation (WHO) as an emerging Global Syndemic characterized by the simultaneous occurrence of both undernutrition and overnutrition. Women of the reproductive age group (15 to 49 years) are disproportionately affected by DBM and are at high risk of continuing the intergenerational cycle of malnutrition. This study aims to assess the changing trends and determinants of DBM among women of the reproductive age group in India. Materials and methods: We used data from three rounds of National Family Health Surveys (NFHS-3,4,5) conducted in years 2005–06, 2015–16, and 2019–2021. Descriptive statistics and Poisson regression analysis were done using weights with log link function. Results: The prevalence of anaemia, underweight and overweight/obesity was 57.2%, 18.6% and 24% respectively. The combined burden of underweight and anaemia has declined by 46% (21.6% to 11.7%), whereas the combined burden of overweight/obesity and anaemia has increased by 130% (5.4% to 12.4%) in the past 15 years. The prevalence of DBM, which includes both underweight and overweight/obesity with anaemia was 24.1% in 2021, a decline of 11% in 15 years. Women who were younger, rural, less educated, poor and middle class, and women living in the eastern, western and southern regions of India had higher risk for being underweight with anaemia and lower risk for developing overweight/obesity with anaemia. Conclusion: The significant decrease in underweight yet enormous increase in overweight/obesity over the past 15 years with the persistence of anaemia in both ends of the nutritional spectrum is characteristic of the new nutritional reality emphasizing the need to address malnutrition in all its forms. It is critical to consider geography and a population specific, double-duty targeted intervention to holistically address the risk factors associated with DBM and accomplish India’s commitment to the global agenda of Sustainable Development Goals-2030