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Gross Anatomy Teaching for Medical
Undergraduates Through Computer-Based
Simulation: Introduction and Evaluation of
Effectiveness
Navbir Pasricha , Dinesh K. Badyal , Parmod Kumar Goyal , Eti Sthapak
1. Anatomy, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND 2. Pharmacology, Christian Medical
College and Hospital, Ludhiana, IND 3. Forensic Medicine and Toxicology, Adesh Institute of Medical Sciences and
Research, Bathinda, IND
Corresponding author: Navbir Pasricha, navbirpasricha@gmail.com
Abstract
Background
Cadaveric teaching has been the gold standard for gross anatomy instruction through the ages and across the
geographic spectrum, but with issues of availability faced in many medical schools, there is a need to look
for other options. Digital tools like virtual dissectors that simulate the cadaver have been around for some
years now, but their acceptability to the teachers and students and effectiveness need to be validated in the
settings where applied.
Aim
To evaluate the acceptability, feasibility and effectiveness of using computer-based simulation tools for
teaching gross anatomy via online mode to undergraduate medical students.
Methodology
A prospective crossover randomized controlled study was conducted online on 200 (120 males (60%) and 80
females (40%), Year 1 medical undergraduates (mean age males: 19.67 years and females: 19.52 years),
wherein two broad topics of head and neck region were taught by didactic lectures delivered online via
Zoom. Dissection videos were prepared for both cadaveric and computer-based simulation teaching. Groups
were divided by random allocation and pre- and post-tests and feedback surveys were conducted online.
Results
A significant increase from pre- to post-test scores was found in both cadaveric and computer-based
simulation techniques. However, more change was found in the computer technique as its t-value was more
than the cadaveric technique. The feedback from the students was that the computer-based simulation
teaching method gave them a good insight into 3D understanding of the human body, increased
understanding of relations of body structures and capacity to grasp surface anatomy.
Conclusion
The study concluded that teaching gross anatomy through computer-based simulation techniques is
acceptable to both the students and faculty. The study also concluded that it is an effective and feasible
method that can be used to complement cadaveric teaching to revisit areas already dissected and for quick
revision.
Categories: Anatomy, Medical Education, Medical Simulation
Keywords: problem-based learning (pbl), virtual dissection, anatomy teaching and learning, 3-d visualization,
cadaveric dissection, computer simulation dissection
Introduction
Dissection is indispensable for a correct and comprehensive knowledge of gross anatomy which can
translate into safe and efficient clinical practice, but medical institutes worldwide have been facing a
paucity of cadavers, with procurement further hindered during the COVID pandemic [1]. With the emphasis
on competency-based medical education, regulatory bodies insist on inculcating clinical reasoning skills
from the pre-clinical years, which require an understanding of imaging and three-dimensional anatomy [2].
This requires the student to understand pattern and form which requires time and opportunity for
reconstruction, testing, validation and modification of the image. Over the years, it has also been observed
that students are becoming averse to the cadaver due to increasing awareness of dangers related to the
1 2 3 1
Open Access Original
Article DOI: 10.7759/cureus.49517
How to cite this article
Pasricha N, Badyal D K, Goyal P, et al. (November 27, 2023) Gross Anatomy Teaching for Medical Undergraduates Through Computer-Based
Simulation: Introduction and Evaluation of Effectiveness. Cureus 15(11): e49517. DOI 10.7759/cureus.49517
components of the embalming fluid like formaldehyde and also complain of dissection as a stressful
instruction [3]. With digitalization having made fast inroads into medical education, the role of dissection
has been modified as each student reverts back to an atlas on his smartphone or device. Since defining the
exact anatomical site of a lesion is crucial for physicians to diagnose, differentiate and treat safely, adequate
anatomical knowledge is essential for surgeons and anyone performing an invasive procedure on a patient
[4]. However, with the worldwide curricular reforms those have resulted in a reduction both in the gross
anatomy teaching hours and its context, there is a need to do a serious re-examination of the way in which
anatomy is taught [5]. Medical institutions in developing countries like India are quickly joining the
bandwagon of acquiring virtual dissection tools, but it remains to be scientifically assessed if these tools can
be implemented into the curricula and whether they will lead to effective teaching and learning. There is a
need to evaluate whether the use of computer simulation techniques to teach gross anatomy to students is
an equal or better technique as compared to cadaveric dissection. Thus, the study was undertaken with the
aim to evaluate the acceptability, feasibility and effectiveness of the introduction of computer-based
simulation for teaching gross anatomy to medical undergraduates. This article was previously presented as a
poster at the Experimental Biology 2021 conference held virtually on April 27-30, 2021 and published as a
meeting abstract as cited in https://faseb.onlinelibrary.wiley.com/doi/10.1096/fasebj.2021.35.S1.05064.
Materials And Methods
This prospective crossover randomized controlled study was conducted with MBBS first-year students in the
Department of Anatomy. All 200 students enrolled (120 males (60%) and 80 (40%) females), with the
institute, participated in the study. Sensitization of faculty members was done by discussing with them the
proposed plan of study. The students were divided into two groups of hundred students each by a process of
simple random sampling. Two broad topics from head and neck anatomy were undertaken: the temporal-
infratemporal region and deep dissection of the neck as these are both important regions of head and neck
gross anatomy and involve visualization and spatial arrangement of a number of anatomic structures.
The data tool included single correct response, multiple choice questions that tested the ability of students
to analyze clinical and spatial anatomy. Questions that involved identification and recall from images were
also included. Anonymous Feedback Survey Questionnaires comprising 12 statements to be scored with the
aid of a five-point Likert scale and qualitative data was collected in the form of responses to two open-ended
questions and delivered online through Google survey forms. Before attempting the feedback questionnaire
and as mandated by the directions of the ethics committee, the participants were informed that filling out
the survey was voluntary and anonymity would be maintained at all times as no email addresses or names
were collected.
The lesson plan and competencies to be covered were decided according to the National Medical
Commission of India, Competency Based Medical Education Under Graduate Curriculum-1 [6]. A series of
videos were shot while dissecting the cadaver and while teaching on the computer simulation table. These
videos were analyzed for any disparity in points covered via the two techniques and serially arranged
proceeding from superficial to deeper layers of the body. Didactic lectures were delivered online on the pre-
decided topics via the Zoom app. Pre-test was given to all the students via timed Google forms. Pre-test for
both sessions had 10 items as multiple-choice questions with one single correct answer. Before giving the
pre-test, a mock drill was done a few days before by giving a multiple-choice questions (MCQ) test on these
timed Google forms so that students get acclimatized to timed Google tests. The students were then divided
into two groups by random allocation. One group was taught gross anatomy on the cadaver by online video
projection of dissection videos prepared on the cadaver using Zoom. The second group was instructed on the
computer-based simulation table again projected online by Zoom. Since this study was done during the
lockdown period where students were being instructed online, one group was taught dissection videos
prepared on the cadaver and the second group on videos prepared on a computer simulation table. In both
cases, as these were pre-recorded videos, teaching was kept interactive as far as possible and paused when
requiring further explanation by the students. The students in both groups were then asked to fill out post-
test questionnaires using Google form which were time limited. The post-test items were the same as pre-
test questions with the order of appearance scrambled. This teaching methodology was followed for two
broad topics of head and neck gross anatomy. Since all the undergraduate medical students enrolled in year
1 were given the teaching intervention, they were invited to provide their anonymous feedback for the same
via a Google survey form regarding their perception and satisfaction with the use of both modalities only if
they consented to it. The feedback form had 10 items based on a five-point Likert scale and four open-ended
questions. It was duly assured that all information shared would be kept confidential and in no way the
student’s identity be revealed. It was also assured that the study or information gathered by it will not affect
the students teaching and learning opportunities or academic grades. The teachers’ perceptions of the
students' understanding of anatomy and the teaching methodology were assessed by written feedback forms.
The form had 11 items based on the Likert scale and three open-ended questions.
Since the responses to online pre- and post-tests and feedback forms were on Google survey forms, they
were automatically shifted to Excel sheets. Data from only those participants who had given both tests of a
particular session were included in the study. Quantitative analysis included proportions and mean. Chi-
square was used to compare proportions. Paired sample T-Test was used to compare pre- and post-test
scores. The satisfaction index was calculated for Likert scale-based questions in the feedback forms. Themes
2023 Pasricha et al. Cureus 15(11): e49517. DOI 10.7759/cureus.49517 2 of 8
were identified for the responses to open-ended questions in both faculty and student feedback forms and
tabulated. Satisfaction index (S.I.) for all the statements was calculated using the formula: [(n1 * 1) + (n2 * 2)
+ (n4 *4) + (n5 * 5)] * 20 / (n1 + n2+ n4+ n5), where n is the total number of students rating the statement under
reference. Scores were determined as follows: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5
= strongly agree [7].
Results
The teaching intervention was administered to all 200 students enrolled in the first-year undergraduate
program. Out of these 200, a total of 135 and 149 students participated in Session 1 (temporal and
infratemporal region gross anatomy) and Session 2 (deep dissection of the neck), respectively, by responding
to the online tests (no students were excluded from the teaching intervention, but data was taken from only
those who gave both the pre-test and post-test in a given session). Students were administered a pre-test
before the teaching session and a post-test after the session. Since some students who gave the pre-test
abstained from the post-test, data from the ones who gave both tests were included for analysis. The
demographic profile of the subjects is depicted in Table 1.
Variable Pre-test Post-test Number of students who attempted both the tests
Session 1: Temporal and infratemporal region Total 135 139 135
Male 85 (62.9%) 90 (64.7%)
Female 46 (34.1%) 49 (35.3%)
Session 2: Deep dissection of the neck Total 169 169 144
Male 124 (73.4%) 118 (69.8%)
Female 45 (25.6%) 51 (30.1%)
TABLE 1: Demographic Characteristics of the Participants
The pre-test score of head and neck (topic 1) among the cadaveric teaching group was 4.90±1.90, while in
the computer simulation group, this score was 5.14±1.82. No significant difference was observed in the mean
score of both techniques (p=0.467); hence, the subject selection was unbiased for the two techniques. The
post-test score among the cadaveric teaching group was 6.63±2.13, while in the computer simulation group,
this score was 7.39±2.00. A significant difference was observed in the mean score of both techniques
(p=0.033). The mean score of computer simulation teaching was significantly more than the cadaveric
teaching technique. A further significant increase from pre- to post-test was found in both cadaveric and
computer techniques. However, more change was found in the computer technique as its t-value is more
than the cadaveric technique as depicted in Tables 2, 3. The pre- to post-test score difference of Session 1
among the cadaveric technique group was 1.96±1.64, while in the computer technique group, this score
difference was 2.18±1.42 as seen in Table 4. No significant difference was observed in the mean score
difference between the techniques (p=0.443). The pre- to post-test score difference of Session 2 among the
cadaveric technique group was 0.70±1.95, while in the computer technique group, this score difference was
0.97±1.50. No significant difference was observed in the mean score difference between the techniques
(p=0.356).
Session 2
Score
t-value p-valueCadaveric Computer
Mean SD Mean SD
Pre-test 6.14 2.09 6.58 2.02 -1.37 0.172
Post-test 6.67 1.96 7.23 1.83 -1.73 0.086
Significance t=2.90, p=0.005 t=5.45, p<0.001
TABLE 2: Comparison of Pre- and Post-Test Scores of Session 2
2023 Pasricha et al. Cureus 15(11): e49517. DOI 10.7759/cureus.49517 3 of 8
Topic
Score difference: pre- and post-test
t-value p-valueCadaveric Computer
Mean SD Mean SD
Topic 1 1.96 1.64 2.18 1.42 -0.77 0.443
Topic 2 0.70 1.95 0.97 1.50 -0.93 0.356
TABLE 3: Comparison of Pre- and Post-Test Score Difference of Trainings
A further significant increase from pre- to post-test was found in both cadaveric and computer techniques.
However, more change was found in the computer technique as its t-value is more than the cadaveric
technique as shown in Table 4.
Computer simulation teaching Cadaveric teaching
Variable Strongly
disagree Disagree Not
sure Agree Strongly
agree
Strongly
disagree Disagree Not
sure Agree Strongly
agree
1. Helped in understanding 3D
anatomy 1 (1.3%) 7 (9.3%) 8
(10.7%)
39
(52%)
20
(26.7%) 1 (1.3%) 17
(22.4%)
24
(31.6%)
26
(34.2%)
8
(10.5%)
2. Helped in understanding
relations of body structures 1 (1.3%) 2 (2.7%) 9 (12%) 45
(60%)
18
(24%) 3 (3.9%) 15
(19.7%)
21
(27.6%)
33
(43.4%)
4
(5.3%)
3. Increased capacity to grasp
surface anatomy 2 (2.7%) 6 (8%) 13
(17.3%)
42
(56%)
12
(16%) 0 (0%) 14
(18.7%)
28
(37.3%)
30
(40%) 3 (4%)
4. Should be the first method for
teaching 4 (5.3%) 15 (20%) 18
(24%)
27
(36%)
11
(14.7%) 9 (11.8%) 28
(36.8%)
14
(18.4%)
22
(28.9%)
3
(3.9%)
5. This method could help in quick
revision 2 (2.7%) 9 (12%) 13
(17.3%)
34
(45.3%)
17
(22.7%) 1 (1.3%) 18
(23.7%)
25
(32.9%)
28
(26.8%)
4
(5.3%)
6. Can improve retention and recall 1 (1.3%) 2 (2.7%) 17
(22.7%)
44
(58.7%)
11
(14.7%) 0 (0%) 8
(10.6%)
25
(32.9%)
38
(50%)
5
(6.6%)
7. Could enhance performance in
exams 2 (2.7%) 2 (2.7%) 19
(25.3%)
42
(56%)
10
(13.3%) 0 (0%) 10
(13.3%)
26
(34.7%)
36
(48%) 3 (4%)
8. Safer method in pandemic 1 (1.3%) 2 (2.7%) 6 (8%) 32
(42.7%)
34
(45.3%) 2 (2.6%) 6 (7.9%) 15
(19.7%)
31
(40.8%)
22
(28.9%)
9. Dissection was aligned with the
lecture 1 (1.4%) 1 (1.4%) 12
(16.2%)
45
(60.8%)
15
(20.3%) 1 (1.3%) 5 (6.7%) 11
(14.7%)
43
(57.3%)
15
(20%)
10. Sessions were well-planned 0 (0%) 1 (1.3%) 9 (12%) 38
(50.7%)
27
(36%) 0 (0%) 4 (5.3%) 13
(17.1%)
42
(55.3%)
17
(22.4%)
TABLE 4: Analysis of Student Feedback on the Teaching Techniques
Percentages are given in brackets.
The pre- to post-test score difference of Topic 1 among the cadaveric technique group was 1.96±1.64, while
in the computer technique group, this score difference was 2.18±1.42 as seen in Table 4. No significant
difference was observed in the mean score difference between the techniques (p=0.443). The pre- to post-
test score difference of Topic 2 among the cadaveric technique group was 0.70±1.95, while in the computer
technique group, this score difference was 0.97±1.50. No significant difference was observed in the mean
score difference between the techniques (p=0.356).
A total of 151 students gave feedback out of which 108 (71.5%) were males and 43 (28.5%) were females. As
shown in Table 5, the computer simulation technique had more responses of agree and strongly agree for
2023 Pasricha et al. Cureus 15(11): e49517. DOI 10.7759/cureus.49517 4 of 8
understanding 3D anatomy, relations of body structures and grasping surface anatomy. There were more
responses of agree and strongly agree choices for the computer simulation technique to be the first method
of teaching and that could help with quick revision and recall, and thus enhance performance in exams.
More number of participants strongly agreed that teaching on the computer simulation table would be safer
in the pandemic. Both groups strongly agreed that the sessions were well-planned and aligned with the
lectures.
S.No. The teaching method Cadaveric
teaching
Computer
simulation
1. Gave me a good insight into 3D understanding of the human body 66.05 78.67
2. Increased my understanding of the relations of body structures and organs 65.26 80.53
3. Increased my capacity to grasp surface anatomy 65.87 74.93
4. This technique should be the first method of teaching 55.26 66.93
5. Can be helpful in quick revision for examination preparation 64.21 74.67
6. Improved my retention and recall of gross anatomy 70.53 76.53
7. Will enhance my performance in theory examinations 68.53 74.93
8. Teaching sessions were well-planned 78.95 84.27
9. Were well aligned with the gross anatomy lectures 77.60 79.46
10. Considering physical distancing due to COVID pandemic, this learning method can be used safely
in the future 77.11 85.60
Average score 68.94 77.65
TABLE 5: Student Feedback Satisfaction Index for the Cadaveric and Computer Simulation
Techniques
The range of satisfaction index is 1-100 [7].
The satisfaction index of the computer simulation technique was greater than the cadaveric technique for all
variables noted and in summation, as shown in Table 6. The faculty also showed a better acceptability of the
computer simulation teaching technique. The general consensus was that although it can provide
opportunities to students for revision, avenues for more interaction and student-led dissection, it can never
replace cadaveric dissection.
2023 Pasricha et al. Cureus 15(11): e49517. DOI 10.7759/cureus.49517 5 of 8
Questions Computer simulation Cadaveric
Aspects
which you
liked best
Useful for both online and offline teaching. Provides clear understanding. Boon during
COVID time; helps to cover many topics in small time quick revision; can help to make
concepts; explanation was very comprehensive; clear visualization to all students at one
go; can dissect same body again and again; less time-consuming; and co-relate cross-
sectional anatomy
Can never replace cadaveric teaching
Aspects
which you
did not like
Internet connectivity with online teaching; in online teaching, lag between speaker’s talk
and demonstration; students are unable to feel and dissect structures themselves; and
technical part of computer simulation is difficult
Orientation of anatomical region little
difficult, Cannot get the feel of structures
Suggestions
for
improving
Provide videos to students for revision; plan for more interaction; a session every
week/biweekly to clear doubts; provide videos to students for revision; and allow students
to use the simulation table themselves
For thorough concepts, need to add both
cadaveric and computer simulation.
Dissection involving big structures/musc les
by cadaveric and minute dissections by
computer simulation
TABLE 6: Thematic Response of Faculty Feedback
A total of seven faculty provided the feedback.
Discussion
Anatomy teaching should prepare students for clinical practice, by providing them with a 3D perspective of
anatomical structures, using the whole armamentarium of tools provided by modern technology along
with the irreplaceable cadaveric teaching. Although simulation in medicine has been in vogue since the
ninth century when Madame du Coudray used mannequin pelvis and babies to train midwives for childbirth,
its use became more rampant with the introduction of versatile human simulators by the late 1990s and early
2000s [8]. Simulation has been used in training for departments of Anesthesia, Pharmacology, Physiology,
Surgery and Pediatrics to name a few [9] for quite some time, but their use in anatomy to replace cadaveric
dissection has been quite debatable for quite some years now. If we consider the requirements according to
the Competency Based Medical Education (CBME) curriculum rolled out in 2019, the integration and the
emphasis on a need-based schedule rather than time-based curricula based on cadaveric dissection do not
easily facilitate vertical integration. The fixed dissection sequence limits the ability of cadaveric dissection
to integrate into case-based curricula. It is difficult to personalize as students are unable to correct
dissection mistakes or re-visit completed dissections [4]. Many medical schools have difficulty in the
procurement of cadavers, yet medical student numbers are constantly increasing, along with awareness
about the harmful effects of formalin. This coupled with greater emphasis on clinically relevant anatomy
enhances the role and scope of virtual or digital dissection, not just for anatomists, but also for all medical
educators like radiologists and surgeons [10]. Students over the years are also getting averse to cadaveric
dissections because of the limitations like smell, color, inability to change the position or auscultate [11].
Another very valid point emerging is that the concept of spatial anatomy needed for a physician to
understand radiographs or a surgeon for interventions is difficult to learn in physical cadaver dissections,
which only promotes recall of lexical information [12]. To counter these drawbacks, virtual dissection or
computer simulation dissection is beneficial as it works on the principle of manipulating computed
tomography (CT) scan data in three dimensions to reveal the different organ systems and their anatomical
relationships [4].
With the new interest in virtual or computer simulation dissection, it became important to document its
effectiveness as compared to the traditional methods. Zhao et al. [13] in 2020 published a meta-analysis of
randomized controlled trials and found that virtual dissection significantly increased learners’ examination
scores compared with traditional learning as seen in our study. Of the 15 studies that met their inclusion
criterion, only two compared virtual dissection with cadaveric dissection that reiterates our aim to
undertake this study to compare the pedagogical benefits of computer simulation with cadaveric dissection.
Hariri et al. [14] compared two groups of medical students who studied shoulder joint anatomy using either a
second-generation virtual reality surgical simulator or images from a textbook. The mean scores the students
obtained out of 7 were 3.1±1.3 for the simulator group and 2.9±1.5 for the textbook group (p=0.70). Although
our study compares computer simulation teaching with cadaveric teaching, we too found that in both our
teaching sessions, the mean post-test score of the computer simulation group (7.39 and 7.23) was better than
the cadaveric group (6.63 and 6.67), respectively. A similar study by Prinz et al. [15] compared surgical videos
with 3D computer animations to teach ophthalmology procedures to medical students resulting in a
significant improvement in knowledge and a better acceptance of multimedia-assisted teaching.
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Our study showed that the satisfaction index of the computer simulation technique (77.65) was greater than
the cadaveric technique (68.94), which is in concordance with the findings of Keedy et al. [16], who reported
higher overall satisfaction and ease of use with the 3D computer teaching module for teaching hepatobiliary
anatomy. The study by Hariri et al. [14] also reported that students felt greater ease of use with the surgical
simulator.
Gould et al. [17] tested the usability and acceptability of a computer-assisted tool to teach
neuroanatomy and found that 85.7% of students agreed it could improve their performance in an exam,
whereas in our study, 56% study agreed and 13.3% strongly agreed that computer simulation technique
would help in quick revision and performance before an exam as compared to 48% and 4% by cadaveric
technique. While 50.7% of our students agreed that computer simulation techniques could be the first
method of teaching, only 31.6% of their respondents said that the computer-assisted technique could
remain as a stand-alone plan, although 97.5% of them agreed that it could supplement other traditional
learning methods. In comparison, only 88% of the faculty responded favorably to our faculty feedback of
80% to the computer simulation teaching.
A study done by Saltarelli et al. showed that teaching done in the cadaveric laboratory showed a significant
advantage over multimedia simulation programs [18]. This raises concerns that the incorporation of
simulation into the curriculum requires careful alignment between learning objectives and competencies.
Much of the feedback we received confirmed that students observed that “The topics covered are correlated
to each other”, gave them “better 3D orientation and better understanding”, “gave the exact location of
structures in human body”, “can be used for revision purpose”, “it enhanced my practical knowledge of
human body”, “it was understandable” and “It was related to the topic taught”.
Anatomy education should aim to continue in an integrated manner throughout medical teaching and
learning. The aim of Competency-Based Medical Education is to produce lifelong learners who can
understand spatial and radiological imaging and analyze it to the disease condition seen in the living
anatomy, which is much more doable with computer-based simulation anatomy. Unfortunately, technology
has its limitations too, like the lack of haptics which is achieved by incising the skin and touching the
structures. Also, the cost of obtaining and maintaining these tools is a big limiting factor, if added to the
cost of training the facilitators, and then becomes a major challenge for developing countries [19]. Still,
institutions that can afford these expensive tools need validation by studies like the present one and that by
Wish-Baratz et al. [20] to document the feasibility and effectiveness of this teaching tool.
Limitations
This study was done for only two broad topics of head and neck gross anatomy but, for a better translation,
should cover limb and visceral anatomy too to give a better understanding of which teaching method would
be acceptable, effective and feasible for teaching and learning gross anatomy of the abdomen, pelvis and
thoracic viscera and the extremities.
Conclusions
The study concludes that it is feasible to use computer simulation techniques for teaching anatomy to
medical undergraduates. Also, it was considered to be an effective method of learning by the students as it
was found to induce a significant improvement in their understanding and perception. Teaching faculty also
accepted the computer simulation technique as an effective method of teaching as computer-based
simulation teaching provides for quick revision, can help to make concepts by providing clear visualization
to all students at one go and students can dissect the same region again and again, but it was agreed that for
thorough conceptualization, students need to be exposed to both cadaveric and computer simulation
techniques for gross anatomy teaching as the haptic feedback obtained from cadaveric dissection is
unparalleled. Potential applications and implications can be useful for undergraduate and postgraduate
students who wish to revisit anatomy during surgical training years, for time-restricted curricula and as a
combination tool with other instructional methods available.
Additional Information
Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the
work.
Concept and design: Navbir Pasricha, Dinesh K. Badyal, Parmod Kumar Goyal
Acquisition, analysis, or interpretation of data: Navbir Pasricha, Eti Sthapak
Drafting of the manuscript: Navbir Pasricha, Dinesh K. Badyal, Parmod Kumar Goyal, Eti Sthapak
Critical review of the manuscript for important intellectual content: Navbir Pasricha, Dinesh K.
2023 Pasricha et al. Cureus 15(11): e49517. DOI 10.7759/cureus.49517 7 of 8
Badyal, Parmod Kumar Goyal, Eti Sthapak
Supervision: Dinesh K. Badyal, Parmod Kumar Goyal
Disclosures
Human subjects: All authors have confirmed that this study did not involve human participants or tissue.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was received from
any organization for the submitted work. Financial relationships: All authors have declared that they have
no financial relationships at present or within the previous three years with any organizations that might
have an interest in the submitted work. Other relationships: Abstract was published in FASEB journal after
poster presentation in Experimental Biology 2021 as cited:
https://faseb.onlinelibrary.wiley.com/doi/10.1096/fasebj.2021.35.S1.05064.
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