Jon Cornwall

The current state of diabetes mellitus in India

Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the disease. 1,2 In 2000, India (31.7 million) topped the world with the highest number of people with diabetes mellitus followed by China (20.8 million) with the United States (17.7 million) in second and third place respectively. According to Wild et al. 3 the prevalence of diabetes is predicted to double globally from 171 million in 2000 to 366 million in 2030 with a maximum increase in India. It is predicted that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India, while China (42.3 million) and the United States (30.3 million) will also see significant increases in those affected by the disease. 3,4 India currently faces an uncertain future in relation to the potential burden that diabetes may impose upon the country. Many influences affect the prevalence of disease throughout a country, and identification of those factors is necessary to facilitate change when facing health challenges. So what are the factors currently affecting diabetes in India that are making this problem so extreme?

Who donates their body to science? An international, multicenter, prospective study

The altruistic act of body donation provides a precious resource for both teaching and researching human anatomy. However, relatively little is known about individuals who donate their bodies to science (donors), and in particular whether donors in different geographical locations share similar characteristics. A multicenter prospective survey of donors registering during 2010 in three different geographical locations, New Zealand, Ireland, and the Republic of South Africa, was conducted to identify donor characteristics. The 28‐question survey included sections on body donation program awareness, reasons for donating, giving tendency, education, ethnicity, relationship status, occupation, religion, and political preference. Two hundred surveys (81%) were returned [New Zealand 123 (85% response rate), Republic of South Africa 41 (67%), and Ireland 36 (92%)]. Results indicate that donors share certain characteristics including reason for donating (80% cited a desire to aid medical science as the main reason for wishing to donate their body); family structure (most donors are or have been in long‐term partnerships and ≥85% have siblings); and a higher proportion with no religious affiliation compared to their reference population. Some variations between locations were noted including donor age, the mode of program awareness, occupation, relationship status, political preference, organ donor status and with whom donors had discussed their decision to donate. This information could be important for assisting the identification of potential body donors in new and established bequest programs. Anat Sci Educ.

The wider importance of cadavers: Educational and research diversity from a body bequest program

The debate surrounding the use of cadavers in teaching anatomy has focused almost exclusively on the pedagogic role of cadaver dissection in medical education. The aim of this study was to explore the wider aspects of a body bequest program for teaching and research into gross anatomy in a University setting. A retrospective audit was undertaken on body donation and the use of cadaver specimens for teaching and research at our institution between 1876 and 2009. The body bequest program, first established in 1943, now receives more than 40 donations per year. In addition to the medical course, nine other University degrees and courses currently use cadaver specimens for gross anatomy; four of these are research degrees and the remainder undergraduate degrees and courses. The use of cadaver specimens by non‐University groups has also increased, particularly during the past decade, such that there are now 16 different groups using cadaver specimens for instructional courses; most of these are professional medical courses. The use of cadavers for both research and teaching may encourage a more evidence‐based approach to clinical anatomy. This unique audit, spanning more than a century of anatomy education within a single University Medical School, highlights the utility of a robust body bequest program and the wide range of students and health professionals who interact with this precious resource. Anat Sci Educ 2:234–237, 2009

Did the American Medical Association make the correct decision classifying obesity as a disease

The American Medical Association (AMA) recently classified obesity a disease, defining obesity as having a Body Mass Index (BMI) measure above 30.1 This decision went against the advice of its own Public Health and Science Committee, and has sparked widespread discontent and discussion amongst medical and healthcare communities. The fact that this classification has been made has potential ramifications for health care around the world, and many factors need to be considered in deciding whether the decision to make obesity a disease is in fact appropriate.

Functional Morphology of the Thoracolumbar Transversospinal Muscles

Study Design. A qualitative and semiquantitative study of the morphology of the human thoracolumbar transversospinal (TSP) muscles. Objective. To further define the functional morphology of the thoracolumbar TSP muscles. Summary of Background Data. The TSP muscle group plays an important role in vertebral function but few studies have rigorously investigated their morphology throughout the thoracolumbar region and details on the location of motor endplates (MEPs) and fiber types are sparse. Methods. Thoracolumbar TSP muscles were examined by microdissection in five cadavers (seven sides). MEPs were identified using acetylcholinesterase histochemistry in muscles between T5 and S4 unilaterally in two cadavers. The relative proportions of type I and type II skeletal muscle fibers were determined using immunohistochemistry on whole cross sections of every TSP muscle from one side of one cadaver (T5–S4). Results. TSP morphology was homogeneous and consistent throughout the thoracolumbar region. Notable differences to standard descriptions included: (1) consistent attachments between muscles; (2) no discrete cleavage planes between muscles; and (3) attachment sites over the sacrum and to lumbar zygapophysial joints. Previously undescribed small muscles were found attaching to the medial sacrum. All TSP muscles were multipennate, with fibers arranged in parallel having one MEP per muscle fiber. Muscles were highly aerobic (mean proportion of type I fibers 89%), with the proportion of type I fibers decreasing caudally. A significantly greater proportion of type I fibers were found in the midthoracic compared to the low lumbar regions. Conclusion. The complex morphology of the TSP muscles indicates that they would be better classified as spinotransverse muscles. They are multipennate, highly aerobic, with fibers organized in parallel, an arrangement lending itself to “fine-tuning” of vertebral movements. Understanding their morphology has implications for investigation, treatment, motor control, and biomechanics.

Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference

BackgroundThere is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers.MethodIn this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described.ResultsOur method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI.ConclusionsWe intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality.

Bacterial contamination of unused, disposable non-sterile gloves on a hospital orthopaedic ward.

BACKGROUND Non-sterile disposable gloves are used on large hospital wards, however their potential role as a vehicle for pathogen transmission has not been explored in this setting. AIMS This study investigates glove use on a hospital orthopaedic ward to examine whether pathogen contamination occurs prior to contact with patients. METHOD Glove samples were aseptically removed from boxes on a hospital orthopaedic ward on opening and days 3, 6 and 9 thereafter. Following elution of bacteria and viable counts, glove isolates were identified by standard techniques and 16s rDNA sequencing. Methicillin resistance of staphylococci was determined by disc diffusion, Epsilon tests and PCR. Gloves were inoculated to determine two isolate survival rates. RESULTS Total bacterial counts ranged from 0 to 9.6 x 10(3) cfu/glove. Environmental bacteria, particularly Bacillus species, were present on 31/38 (81.6%) of samples. Half (19/38) the samples were contaminated with skin commensals; coagulase negative staphylococci were predominant. Enterococcus faecalis , Klebsiella pneumoniae , Pseudomonas sp. or methicillin susceptible Staphylococcus aureus were recovered from 5/38 (13.2%) of samples. Significantly more skin commensals and pathogens were recovered from samples from days 3, 6, 9 than box-opening samples. Staphylococcus epidermidis and Klebsiella pneumoniae inoculated onto gloves remained viable for several days but counts decreased. CONCLUSION Health care workers introduced skin commensals and pathogenic bacteria into glove boxes indicating that unused, non-sterile gloves are potential pathogen transmission vehicles in hospitals. Findings highlight adherence to handwashing guidelines, common glove retrieval practice, and glove-box design as targets for decreasing bacteria transmission via gloves on hospital wards.

The diverse utility of wet prosections and plastinated specimens in teaching gross anatomy in New Zealand

Anatomical education has traditionally used cadaveric material to study the human body, with both wet prosections and plastinated (PP) material commonly utilized. However, the frequency of use of these different preparation modes in a tertiary institution has not been previously examined. An audit of PP use in the Department of Anatomy and Structural Biology at the University of Otago was performed for 2009, assessing the number of courses, variety, and number of PP used throughout 2009. Results indicate the unique and diverse nature of PP utilization and are discussed with reference to their relative strengths and weaknesses. Such information is useful to those wishing to initiate or maintain programs that involve the teaching of human anatomy with cadaveric material. Anat Sci Educ.

Evaluation of free i-applications for tertiary level gross anatomy education.

BACKGROUND The use of electronic resources in education, including i- applications used on portable handheld devices, is increasing. Apple® handheld devices are popular, with free applications the most prevalent download form. Many gross anatomy i- applications are available, however no information on the quality of free anatomy products is available. Rating such products could therefore guide product recommendations. AIM To evaluate the quality and range of free iPod® applications that are applicable for tertiary level gross anatomy education. METHODS A search of the iTunes® Application Store with keywords anatomy, free, medical, functional, clinical, gross, and human was performed, with inclusion based on free applications containing human gross anatomy usable for tertiary education purposes. Application specification was noted; each was trialled independently and rated for usability, specification, academic level, and quality (image and programme). RESULTS Sixty-three applications were identified and eleven met inclusion criteria. Two provided gross anatomy of the entire body, nine examined specific regions or systems. Five were judged introductory in academic level, five intermediate, and one advanced. One application was rated low quality, and four excellent. None were considered difficult to use (six easy, five medium). Application size ranged between 1.2MB and 229MB (mean 27MB). CONCLUSIONS There are few free i-applications for learning gross anatomy and most concentrate on individual body systems, with the academic level and usability of all products well rated. Results suggest some free I- applications could be suitable adjuncts for gross anatomy education at both an undergraduate and graduate level.

The ethics of 3D printing copies of bodies donated for medical education and research: What is there to worry about?

Many emerging technologies have the potential to revolutionise aspects of everyday life. At every turn, new examples of technological advances surround us, from self-driving cars through to gene therapy and genomic medicine. The rapid development and integration of 3D printing is another example of a new technology having a major impact on society. Objects can now be printed as near-perfect reproductions by anyone with a moderately capable computer and enough money to purchase a 3D printer. Everyday items, furniture, household appliances, and even guns can now be reproduced. Even human body parts, from cadavers donated to medical science, are now being 3D printed and used for the purpose of medical education and research.1