Pamela Mandela

Repeated exposure to dissection does not influence students' attitudes towards human body donation for anatomy teaching.

The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this “highly informed” group of potential donors.

Sex Variation in Occurrence of Myocardium in Human Mitral Valve Cusps

Las cuspides de la valva mitral estan constituidas principalmente por tejido conectivo y miocardio. Se ha demostrado que las fibras del tejido conectivo de las cuspides presentan diferencias en la organizacion segun sexo. El prolapso mitral, una enfermedad atribuida a defectos en las cuspides es mas frecuente en las mujeres. Las variaciones de sexo en el miocardio valvular sin embargo aun no se han estudiado. Las posibles variaciones en su organizacion puede mejorar la comprension de las diferencias de sexo en la prevalencia de prolapso mitral. El objetivo de este estudio fue determinar las variaciones anatomicas del miocardio valvar mitral por sexo, por medio un estudio comparativo de corte transversal. Un total de 48 los especimenes de corazon adulto (se utilizaron 27 hombres y 21 mujeres), obtenidos durante autopsias en la ciudad de Nairobi y desde el deposito de cadaveres Chiromo, despues de la aprobacion etica. Las cuspides valvares fueron extraidas. Fueron realizadas secciones de cuatro milimetros en el parte mas ancha de las cuspides anteriores y posteriores. Estas fueron procesadas por inclusion en parafina, corte y tincion con tricromico de Masson y fucsina-resorcina de Weigert con contraste Van de Gieson, para demostrar la presencia de musculo cardiaco, fibras colagenas y elasticas. Tanto cuspides anteriores como posteriores demostraron tres laminas histologicas, es decir, atrial, fibrosa y ventricular. Solo en la lamina atrial se observo musculo cardiaco. Esta lamina en los hombres se caracterizo por una banda de orientacion transversa de miocardio subendotelial, mientras que en las mujeres se observaron fibras longitudinales 0elasticas compactas, pero no musculo. La presencia de musculo cardiaco en la lamina atrial puede servir relativamente como proteccion contra el prolapso de la valvula mitral en los varones en comparacion con las mujeres.

Is cadaveric dissection vital in anatomy education? Perceptions of 1st and 2nd year medical students

Introduction: The use of innovative ways of teaching anatomy as well as shortage of cadavers for dissection have raised questions as to whether dissection should continue to be used in teaching anatomy. This study aimed to assess the views of medical and dental students on the importance of dissection in learning gross anatomy, and whether they would prefer other ways of learning anatomy instead of cadaveric dissection. Materials and Methods: First- and second-year students enrolled at the University of Nairobi (Kenya) were asked to fill an online questionnaire. Data gathered were analyzed using Statistical Package for Social Sciences. Results: Ninety-eight (83 medical and 15 dental) students participated in the study. All students agreed dissection was useful in learning anatomy. Up to 95.2% of medical and 86.7% of dental students favored dissection. Most students strongly agreed or agreed that dissection helped them to develop three-dimensional (3D) awareness of the human body (94.9%), work as a team (89.8%), learn medical terminology (85.7%), and learn how to use basic surgical instruments (80.6%). Dissection was preferred to use of 3D models, prosected specimens, computer-aided learning techniques, or modern imaging techniques by 63.3%, 60.3%, 37.7%, and 34.4% of the students, respectively. Conclusion: Dissection is an important resource for learning anatomy. Other teaching techniques should be used to supplement dissection rather than replace it.

Effect of Monocular Deprivation on Rabbit Neural Retinal Cell Densities

Purpose: To describe the effect of monocular deprivation on densities of neural retinal cells in rabbits. Methods: Thirty rabbits, comprised of 18 subject and 12 control animals, were included and monocular deprivation was achieved through unilateral lid suturing in all subject animals. The rabbits were observed for three weeks. At the end of each week, 6 experimental and 3 control animals were euthanized, their retinas was harvested and processed for light microscopy. Photomicrographs of the retina were taken and imported into FIJI software for analysis. Results: Neural retinal cell densities of deprived eyes were reduced along with increasing period of deprivation. The percentage of reductions were 60.9% (P < 0.001), 41.6% (P = 0.003), and 18.9% (P = 0.326) for ganglion, inner nuclear, and outer nuclear cells, respectively. In non-deprived eyes, cell densities in contrast were increased by 116% (P < 0.001), 52% (P < 0.001) and 59.6% (P < 0.001) in ganglion, inner nuclear, and outer nuclear cells, respectively. Conclusion: In this rabbit model, monocular deprivation resulted in activity-dependent changes in cell densities of the neural retina in favour of the non-deprived eye along with reduced cell densities in the deprived eye.

Effects of monocular deprivation on the dendritic features of retinal ganglion cells

La privacion monocular de la vision resulta en cambios anatomicos en la corteza visual en favor del ojo no privado. Aunque la retina forma parte de la via visual, hay escasez de datos sobre el efecto de la privacion monocular en su estructura. El objetivo de esta investigacion fue describir los efectos de la privacion monocular en las caracteristicas de las dendritas de las celulas ganglionares de la retina. Se diseno un estudio cuasi-experimental. Se examinaron 30 conejos (18 experimentales, 12 controles). La privacion monocular se logro a traves de la sutura unilateral del parpado en los animales de experimentacion. Los conejos fueron observados durante tres semanas. Cada semana, 6 animales experimentales y 3 control fueron eutanasiados, donde se obtuvo la retina y fue procesada para realizar microscopia optica. Las microfotografias de la retina fueron tomadas con una camara digital y luego se utilizo el software FIJI para su analisis. El numero de dendritas primarias, terminales y el area del campo de dendritas en los ojos no privados aumento un 66,7% (p=0,385), 400% (p=0,002), y 88,4% (p=0,523), respectivamente. Los ojos no privados, tenian 114,3% mas dendritas terminales (p=0,002) en comparacion con los controles. Entre los ojos privados, todas las variables medidas tuvieron un aumento gradual en las dos primeras semanas, seguido de descenso con mayor privacion. No se observaron diferencias estadisticamente significativas entre los ojos privados y el grupo control. En conclusion, la privacion monocular produce un aumento de los contactos sinapticos en los ojos no privados, con cambios reciprocos que se manifiestan en los ojos privados de la vision.

Surgical Anatomy of the Cervical Part of the Hypoglossal Nerve

Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (± 5.99) mm and 15.19 (± 6.68) mm, respectively. The point where it crossed the ICA was 12.24 (± 3.71) mm superior to the greater horn of hyoid, 17.16 (± 4.40) mm inferior to the angle of the mandible, and 39.08 (± 5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study population. Caution should be exercised during surgical procedures in the neck. The study also revealed that the mastoid process is a reliable fixed landmark to locate the hypoglossal nerve.

Periduodenal Tuberculosis masquerading as Annular Pancreas

Background: Perforations complicate up to 5-10% of peptic ulcer diseases. Mortality following peptic ulcer perforation can peak 29%. Of the factors that influence the outcome of peptic ulcer perforation, treatment delay is most important and modifi able. This study reviewed delay and how it affected outcome in patients treated for perforated peptic ulcers at the Kenyatta National Hospital. Methods: Patient’s files for the period January 2002 to December 2007 were reviewed and direct interviews carried out for patients seen from January to December 2008. Data sought included patient demographics, clinical presentation, time from symptom onset to presentation at casualty, time from presentation at casualty to surgical treatment and the treatment outcomes. Data was entered using a structured data sheet /questionnaire. The effect of delay as a determinant of outcome was evaluated using univariate analysis. Results: One hundred and ninety three patients were evaluated. Twenty four patients (12.4%) died. Sixty one patients (31.6%) developed complications post-operatively. Thirty patients were reoperated for the complications. No patient treated within 24 hours died. Complications rate was 0 %, 1.5% and 29.5% for patients treated within 24 hours, 24-48 hours and after 48 hours respectively. Delay >48 hours was significantly associated with increased mortality (p value <0.001), morbidity (p value <0.001), and surgical site infections (p value <0.001). The mean length of hospital stay for patients with delay <48 hours and over 48 hours was 7.22 (+ 1.9) and 19.7 days (+ 19.1) respectively (p<0.001). Conclusion: Delay of more than 48 hours is associated with high morbidity and mortality. Efforts should be made to reduce the amount of pre-treatment delay to less than forty eight hours.