Background On 7th May 2022, human monkeypox was identified in the United Kingdom, a non‐endemic zone, with subsequent multi‐country outbreaks. About 6 weeks later, the European Centre for Disease Prevention and Control reported 1158 confirmed cases in non‐endemic countries scattered within the European Economic Area (EEA), and a total of 1882 cases confirmed worldwide, inclusive of the EEA. These numbers are expected to increase with high alert and amplified surveillance established in non‐endemic regions. In light of a looming epidemic, current understanding of the virus, and identification of gaps in the literature remain critical hence warranting a scoping review of available literature. Methods Literature searches were performed through PubMed, SCOPUS, ScienceDirect and Hinari to identify studies eligible for inclusion in accordance with PRISMA guidelines. Results Seventy‐seven articles were included in the review. Majority of the cases were from the Central African clade (n = 29,905) versus the West African clade (n = 252). 6/16 articles that reported vaccination status stated that none of the cases were vaccinated. In the remaining articles, approximately 80%–96% cases were unvaccinated. It was noted that 4%–21% of the vaccinated individuals got infected. The secondary attack rate ranged from 0% to 10.2%, while the calculated pooled estimated case fatality rate was 8.7%. Conclusion This scoping review provides an extensive look at our current understanding on monkeypox disease. Further studies are needed to better understand its risk factors, genetics and natural history, in order for public health strategists to generate prevention strategies and management decisions.
Rouvière's sulcus (RS) is increasingly being recognized as an important extra‐biliary landmark during laparoscopic cholecystectomy (LC). The aim of this study was to conduct a systematic analysis of the prevalence and morphological types of RS. A systematic search was conducted through the major databases PubMed, ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), SciELO, and the Cochrane Library to identify studies eligible for inclusion. The data were extracted and pooled into a random‐effects meta‐analysis using STATA software. The primary and secondary outcomes of the study were the pooled prevalence of RS and its morphological types, respectively. A total of 23 studies (n = 4,495 patients) were included. The overall pooled prevalence of RS was 83% (95% confidence interval [CI] [78, 87]). There were no significant differences in prevalence between cadaveric studies (82%, 95% CI [76, 87]) and laparoscopic studies (83%, 95% CI [77, 88]). The open RS constituted 66% (95% CI [61, 71]) of all cases, while the closed type was present in 34% (95% CI [29, 39]). RS is a relatively constant anatomical structure that can be reliably identified in most patients undergoing cholecystectomy. It can therefore be used as a fixed extra‐biliary landmark for the appropriate site at which to start dissecting during LC to help prevent iatrogenic bile duct injury.
Gantzer’s muscle is an accessory head of the flexor pollicis longus (FPL). Its incidence, attachments as well as relations to nervous structures have been shown to exhibit population variations, which have important clinical bearings. Data from our setting however remains partly elucidated. To study the muscle, the skin of the anterior forearm and fascia were removed to expose the flexor compartment of the forearm. The flexor muscles were also identified and reflected. The Ganzter’s muscle was identified as that muscle belly originating from the flexor digitorum superficialis, the radius, the medial humeral epicondyle or the ulna coronoid process and inserted on the flexor pollicis longus or the flexor digitorum superficialis muscle. Its prevalence, laterality, origin, insertion, shape and relation to the anterior interosseous nerve were determined. The data obtained was entered into SPSS and percentages calculated for the different variables. The muscle was found in 19/43 (44%) cadavers on the right and on 20/43 (46%) on the left. In 5 out the 43 cadavers (11%), the muscle was present bilaterally while in the rest, it existed solely as either on the right orleft (predominantly on the left, 46%). The Gantzer’s muscle was also noted to predominantly originate from the Flexor Digitorum Superficialis muscle (72% on the left, 76% on the right) and insert on the Flexor pollicis longus (100%). As regards its shape, it was predominantly triangular, on both right side (65%) as well as the left side (54%). In majority of the cases, the muscle also lay posterior to the anterior interosseous structures (100% on the left and 89% on the right). In conclusion, the Gantzer’s muscle is relatively common in our population, exhibits marked population variations and as such should be taken into account especially during surgical approach to the anterior elbow to avoid its inadvertent injury.
Persistent sciatic vein is considered a relatively rare anatomical finding, commonly associated with the Klippel-Trenaunay-Weber syndrome. We report a case of a large unilateral persistent sciatic vein in the right lower limb of an adult male cadaver, identified during routine dissection. The size of the vein was comparable to the sciatic nerve and it was originated from the union of posterior tibial veins at the distal end of the popliteal fossa. It was ascending in the posterior part of the thigh, medial to the sciatic nerve, before coursing through the infrapiriform foramen of the greater sciatic foramen and terminating by draining into the internal iliac vein. Further dissection revealed conventional anatomy of the femoral venous system. The epidemiology, anatomy, diagnosis and management a persistent sciatic vein are also discussed.
Data from previous studies have highlighted on the use of transverse cervical artery (TCA) flaps as posterior neck musculocutaneous flaps in reconstructive surgeries. General preference of flap selection relies heavily on the neurovascular supply of the flap in question and even though known, the transverse cervical artery has been shown to vary among populations, therefore affecting its use as a potential flap. Additionally, variant points of origin of the trans-cervical artery have been shown to predispose to brachial plexus compression. Our data on the same, however, remains partly elucidated and therefore a study aimed at describing the conventional and variant origin of the TCA in a Kenyan population would aid in deciding on its use as musculocutaneous flaps and determining the possible prevalence of brachial plexus compression because of its variant origin. The origin of the transverse cervical artery was studied bilaterally in 26 adult Kenyan cadavers in the Department of Human Anatomy, University of Nairobi. As regards their origin, the different types were photographed and grouped into five: Types I to V relative to its origin. The data collected was then analysed using SPSS version 21 and findings presented as percentages. The findings were presented in a bar graph and pie chart. The TCA was present in all the 26 cadavers studied. Type I origin of the TCA was the most common (71.15%) while type V was the least (1.92%). While type I origin occurred mostly on the left limbs, the other types were more prevalent on the right side. The significant variant origin of the TCA and its resultant aberrant course should be important considerations during the planning of posterior neck musculocutaneous flaps as well as in understanding brachial plexus compression associated with its variant origin. Key Words: Anatomy, Transverse cervical artery.
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