Most of the approaches for skull base surgeries are designed to drill the bone around the jugular foramen for proper exposure. In order to achieve this, an understanding of normal morphometric dimensions of jugular foramen is necessary.

To conduct the morphometric analysis and anatomical variations of jugular foramen (JF) in Northwest Indian population.

Anatomic study using human skulls.

Anteroposterior and mediolateral diameter of jugular foramen, depth (if domed) and width of jugular fossa were measured with the help of digital vernier caliper.

The mean, standard deviation (SD) and range of each dimension was computed. A comparison between right and left jugular foramina was made by using student's t-test.

Mediolateral diameter of jugular foramen and width of jugular fossa was significantly higher on the right side. An abnormal unilateral blockage of jugular foramen by a bone growth converting it into a slit was noted with anteroposterior (AP) diameter of 2.37 mm in one skull. Bilateral complete septation of jugular foramen into two and three compartments was observed in 2 (4%) and 3 (6%) of the skulls respectively. The domed bony roof was noticed in 66% of the skulls on both the sides.

The observed variations of JF are possibly due to constitutional, racial or genetic factors. Knowledge of the observed variations of this foramen may be important for neurosurgeons, radiologists and anthropologists.

The total subdivision of jugular foramen is not common in our environment. The jugular foramen is generally larger on right side. This study supports reported morphometric variations of jugular foramen, besides adding data on the Northwest Indian population.

CC: carotid canal; BO: basi-occiput; OC: occipital condyle; JF: jugular foramen; S: styloid process.

Singla A, Sahni D, Aggarwal A, Gupta T, Kaur H. Morphometric Study of the Jugular Foramen in Northwest Indian Population. J Postgrad Med Edu Res 2012;46(4):165-171.

Glaucoma is a leading cause of irreversible blindness. The fundamental problem in medical management of glaucoma is of patient compliance. An ideal drug or a drug combination is needed to slow the progression of this majorly symptomless disease.

To compare the efficacy and tolerability of the fixed combination latanoprost and timolol instilled once daily in the evening vs fixed combination of dorzolamide and timolol instilled twice daily in primary open angle glaucoma or ocular hypertension.

A 12-week, randomized, open, parallel group study including 50 patients with primary open angle glaucoma or ocular hypertension was conducted at a tertiary care hospital. Patients were randomized to group 1, (fixed combination (FC) latanoprost and timolol eye drops, once daily in evening) and group 2, (FC dorzolamide and timolol eye drops, twice daily). At baseline, 2, 4 and 12 weeks, IOP was recorded at 9 AM and 12 noon. The difference in IOP reduction in two treatment groups from baseline to 12 weeks was the main outcome measure.

Mean diurnal IOP was similar at baseline for both groups. Mean reduction in IOP from baseline to 12 weeks was 9.92 mm Hg (p = 0.001) in group 1 and 9.22 (p = 0.001) in group 2. The reduction in IOP in both groups 1 and 2 was statistically significant at all time intervals. There was a statistically significant advantage for group 1 at 12 weeks for both time readings (p = 0.013 and 0.002 respectively) as compared to group 2.

The fixed combination of latanoprost and timolol was more effective than that of dorzolamide and timolol in reducing mean diurnal IOP and both treatments were well tolerated. To confirm further such studies are required.

Ratol S, Walia R, Chaudhry M. A Comparative Analysis of the Efficacy and Safety of fixed Combinations of Latanoprost/Timolol vs Dorzolamide/Timolol in Primary Open Angle Glaucoma or Ocular Hypertension. J Postgrad Med Edu Res 2012;46(4):172-176.

Mobile phones have become an essential part and parcel of modern life. Some of the studies have shown potentially adverse consequences of excessive mobile phone use. Aim of this study was to explore the pattern of mobile phone use among young adults and evaluate the mobile phone use pattern on the substance dependence criteria and assess the adverse consequences of mobile phone use.

A 46-item questionnaire based on the ICD-10 substance dependence syndrome criteria, CAGE questionnaire and keeping the possible adverse consequences of excessive use in mind was given to the participants.

A total of 212 young adults with a mean age of 21.6 years participated in the study. About one-third of the participants met three or more of the ICD-10 diagnostic criteria for substance dependence and more than half (57.1%) fulfilled two or more items on the CAGE questionnaire. Those who fulfilled the dependence criteria spent more time per day on the mobile phone and more frequently had harmful consequences on various aspects of life.

Excessive mobile phone use is associated with adverse consequences in different spheres of life and some subjects use it in dependent pattern.

Nehra R, Kate N, Grover S, Khehra N, Basu D. Does the Excessive use of Mobile Phones in Young Adults Reflect an Emerging Behavioral Addiction? J Postgrad Med Edu Res 2012;46(4):177-182.

Urinary tract infection (UTI) is the most common and severe bacterial infection in children. Renal scarring and associated deterioration in the differential renal function is a frequent finding. Scarring may occur even in asymptomatic patients without vesicoureteric reflux.

Fifty-three children (43 M:10 F, mean age:5.3 years; range 2-10 years) with evidence of recurrent UTI were enrolled in the study. Patients with duplex or crossed fused ectopic kidneys and with acute or chronic renal failure were excluded from the study protocol. Each patient underwent ^99mTc-DMSA and ^99mTc-EC renal scintigraphy within a period of 2 weeks.

Analysis of results was performed by comparing the diagnostic accuracy of the summed ^99mTc-EC and ^99mTc-DMSA images for the detection of renal cortical scars and correlation (linear regression analysis) between the two renal scintigraphic procedures for the estimation of differential renal function. ^99mTc-DMSA imaging demonstrated scarring in 41 kidneys whereas ^99mTc-EC scintigraphy revealed scarring in 29/41 kidneys only. The percentage function of both kidneys with ^99mTc-EC and ^99mTc-DMSA showed good correlation. The r² for left kidney was 0.95 and for right kidney was 0.94.

^99mTc-EC scintigraphy has low sensitivity (70%) for the detection of cortical scarring as compared to ^99mTc-DMSA (100%) renal imaging. On the hand, ^99mTc-DMSA static imaging gives good estimate for the DRF and the values are in good agreement with the corresponding values derived from dynamic ^99mTc-EC scanning.

Raja S, Pareek V, Singh B, Sharma S, Rao KLN, Mittal BR. Comparison of ^99mTc-Ethylene Dicysteine and ^99mTc-Dimercaptosuccinic Acid Scintigraphy for the Evaluation of Cortical Scarring and Differential Renal Function in Children with Recurrent Urinary Tract Infection. J Postgrad Med Edu Res 2012;46(4):183-186.

Thermoplastic immobilization devices are used in head and neck radiotherapy to increase precision of treatment delivery. However, there is concern about increase in radiation induced skin morbidity with the use of such devices. This study was conducted with an aim to evaluate any increase in clinically observed skin reactions with the use of thermoplastic immobilization devices.

Fifty patients of head and neck cancers undergoing radical radiotherapy were randomized into two study groups in this prospective randomized study. Group ‘A’ received treatment with thermoplastic immobilization device. Group ‘B’ received treatment without any immobilization device. A weekly assessment of normal tissue reactions was done using Radiation Therapy Oncology Group (RTOG) acute radiation acute radiation morbidity scoring criteria.

Increase in skin reactions was seen in patients using thermoplastic devices. Grade 3 reactions were seen in 56 vs 52% in the study and control group respectively. The difference was however not statistically significant (p = 0.09).

Increase in skin dose with use of thermoplastic immobilization devices may not clinically translate into a significant increase in acute skin reactions. Thermoplastic immobilization devices can be safely used in head and neck cancers to ensure accurate radiation delivery.

Bahl A, Ghosal S, Kapoor R, Bhattacharya T, Sharma SC. Clinical Implications of Thermoplastic Mask Immobilization on Acute Effects of Radiotherapy in Head and Neck Cancers. J Postgrad Med Edu Res 2012;46(4):187-189.

Ultrasonographic evaluation of clubfoot is an objective method of severity assessment. The objective of this article is to assess the reliability of clubfoot severity assessment by sonographic evaluation of talonavicular angle (TNA) and the reliability of assessing change in angle on simulated Ponseti manipulation.

Twenty-six infants with unilateral idiopathic clubfoot, treated by serial manipulation and casting by Ponseti technique, were prospectively evaluated by clinical scoring (Dimeglio and Pirani scores) and sonographic measurements of TNA at the start of treatment, after midfoot correction and after complete correction achieved. The TNA and the change in TNA on simulated Ponseti manipulation were noted. Total number of POP casts required to achieve final correction were noted; and correlated with change in TNA on attempted Ponseti manipulation.

Mean TNA in clubfoot (66.46°) in static position was significantly different from that of contralateral normal foot (101.3°). Mean change in TNA on simulated Ponseti manipulation was 22.54° (5-50°) and it showed negative correlation with clinical scores and total number of casts required for final correction (p < 0.05). Linear regression analysis revealed that the change in TNA on simulated Ponseti manipulation was the best predictor of treatment outcome in congenital talips equinovarus (CTEV) (with predictability of 60% compared to 19 and 25% of Dimeglio score and Pirani score respectively).

Sonographic evaluation of TNA and change in TNA on simulated Ponseti manipulation can better assess the severity of clubfoot in infants. This objective method of assessment is less expensive, clinically applicable reproducible and it can better predict the treatment outcome.

Gupta N, Sudesh P, Prakash M, Tripathy SK, Dhillon MS. Is Sonographic Calculation of Talonavicular Angle During Ponseti Correction of Clubfoot a Reliable Prognostic Indicator? J Postgrad Med Edu Res 2012;46(4):190-195.

Manohar K, Parghane RVR, Kumari S, Bhattacharya A, Mandal AK, Mittal BR. Multiple Vertebral Hemangiomas Mimicking Metastases in a Patient with Rena Carcinoma: Importance of Hybrid Imaging with SPECT/CT and FDG PET/CT. J Postgrad Med Edu Res 2012;46(4):196-197.

Sharma A, Kumar S, Goyal P, Law AD, Lal A, Singh S. Steroid Responsive Parenchymal Lung Involvement and Acute Renal Failure in a Patient with Relapsing Polychondritis. J Postgrad Med Edu Res 2012;46(4):198-201.

Kashyap R, Tiwari MK, Senthil R, Bhattacharya A, Gupta V, Mittal BR. Utility of F-18 Fluorothymidine PET Over F-18 Fluorodeoxyglucose PET/CT in Detection of a Recurrent Glioma. J Postgrad Med Edu Res 2012;46(4):202-203.