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Papers by Sarah Sangma
Cureus
The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibi... more The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. The review protocol was submitted with PROSPERO (ID: 319251). PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. Data were depicted by self-generated images. The initial search identified 174 articles. After applying the inclusion and exclusion criteria, 57 articles were shortlisted. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Twelve deltoid IMI sites and techniques were identified. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); middeltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The authors received no specific funding for this study except for the journal publication charges.
International Journal of Anatomical Variations, 2017
The intracranial parts of the vertebral arteries (VAs), basilar artery (BA) and their branches to... more The intracranial parts of the vertebral arteries (VAs), basilar artery (BA) and their branches together form the vertebrobasilar system (VBS). Numerous anomalies have been seen in VBS, which are usually benign. Many authors have reported unilateral hypoplasia of VAs, posterior and anterior inferior cerebellar arteries and variation in origin of branches of VA and BA. These are thought to develop due to some errors during development. Aplasia of VA is a common variant but seldom reported. During routine dissection a rare variant of VA along with multiple variations in other arteries of vertebrobasilar system was observed in one cadaveric brain. It was observed that there was aplasia of left VA and left PICA took origin from the right VA, crossed midline and supplied the contralateral side of the cerebellar hemisphere. Double origin of right anterior inferior cerebellar artery (AICA) and bilateral fetal PCA (posterior cerebral artery) was also observed.
Cureus
The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibi... more The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. The review protocol was submitted with PROSPERO (ID: 319251). PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. Data were depicted by self-generated images. The initial search identified 174 articles. After applying the inclusion and exclusion criteria, 57 articles were shortlisted. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Twelve deltoid IMI sites and techniques were identified. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); middeltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The authors received no specific funding for this study except for the journal publication charges.
International Journal of Anatomical Variations, 2017
The intracranial parts of the vertebral arteries (VAs), basilar artery (BA) and their branches to... more The intracranial parts of the vertebral arteries (VAs), basilar artery (BA) and their branches together form the vertebrobasilar system (VBS). Numerous anomalies have been seen in VBS, which are usually benign. Many authors have reported unilateral hypoplasia of VAs, posterior and anterior inferior cerebellar arteries and variation in origin of branches of VA and BA. These are thought to develop due to some errors during development. Aplasia of VA is a common variant but seldom reported. During routine dissection a rare variant of VA along with multiple variations in other arteries of vertebrobasilar system was observed in one cadaveric brain. It was observed that there was aplasia of left VA and left PICA took origin from the right VA, crossed midline and supplied the contralateral side of the cerebellar hemisphere. Double origin of right anterior inferior cerebellar artery (AICA) and bilateral fetal PCA (posterior cerebral artery) was also observed.