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Background: Although numerous surgical techniques have been described and deployed, flexor tenolysis remains one of the most challenging procedures in hand surgery and there is no standardised way of recording the outcomes. The aim of this study is to systematically review the evidence supporting current concepts and outcomes in flexor tenolysis. Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline and EMBASE databases were searched for articles published in English using the keyword search terms ‘flexor’ or ‘tendon’ and ‘tenolysis’ or ‘tenoarthrolysis’. A total of 555 articles were listed and further screening provided fourteen studies remaining for final inclusion. The parameters for data extraction included number of digits operated on, age of the patients, initial injury mechanism requiring flexor tenolysis, outcome assessment method, follow-up period, results and complications. The primary outcome was postoperative active range of motion. Results: 556 digits were included across all studies and the age of patients ranged between 1 and 75 years. Eleven out of fourteen of the articles used the Strickland criteria to report their outcomes. Other outcome measures used were total active motion (TAM), Buck-Gramcko and pulp-to-palm distance. In the studies which used the Strickland criteria, the average percentage of outcomes reported as ‘good’ or ‘excellent’ was 68% with a range between 45% and 91%. Three other studies used Buck-Gramcko, TAM and pulp-to-palm distance outcome reporting and achieved 72% ‘good’ or ‘excellent’, 84% improvement and 30% able to touch distal palm crease respectively. Conclusions: Although the literature contains a limited number of observational studies, the current evidence shows that 68% of well-selected patients who undergo flexor tenolysis achieve a good or excellent outcome as measured by the Strickland criteria. Level of Evidence: Level III (Therapeutic)

Introduction: Diagnosis of orofacial pathologies is difficult with the 2 dimensional (2D) images taken from conventional radiography. Cone-beam computed tomography (CBCT) has been developed with 3 dimensional (3D) modalities and has become a better alternative to conventional radiography. Highre solution axial, coronal, and sagittal sections are the most revealing, noninvasive techniques for assessing the maxillary sinus anatomical variations, pathology, and its adjacent structures and areas. Aim: This study aimed to analyze the prevalence of pathological changes in the maxillary sinus of asymptomatic cases using CBCT for diagnostic purposes. Materials and Methods: This study was evaluated among 200 patients for hidden pathologies in the maxillary sinus. Pathological findings were categorized as a mucosal thickening, polypoid mucosal thickening, radiopacification, and no pathological findings. Results: In the present study, the overall prevalence of the mucous retention cyst was found to be 30.25%, the polyp was 4.25%, the mucocele was 0.50%, and the overall mucosal thickenings was 35%. Conclusions: In our study, the mucosal thickening has a very high rate of incidental maxillary sinus pathologies in asymptomatic patients. Therefore, a detailed three-dimensional imaging using CBCT is stated in most patients for proper treatment planning. A careful review of the entire CBCT scans is essential to avoid under-or overestimation of potential complications in providing comprehensive health care.

With the increase in the number of observed gravitational wave (GW) signals, detecting strongly lensed GWs by galaxies has become a real possibility. Lens galaxies also contain microlenses (e.g., stars and black holes), introducing further frequency-dependent modulations in the strongly lensed GW signal within the LIGO frequency range. The multiple lensed signals in a given lens system have different underlying macro-magnifications ($|\mu|$) and are located in varied microlens densities ($\Sigma_\bullet$), leading to different levels of microlensing distortions. This work quantifies the fraction of strong lens systems affected by microlensing using realistic mock observations. We study 50 quadruply imaged systems (quads) by generating 50 realizations for each lensed signal. However, our conclusions are equally valid for lensed signals in doubly imaged systems (doubles). The lensed signals studied here have $|\mu|\sim[0.5, 10]$ and $\Sigma_\bullet\sim[10, 10^3]~{\rm M}_\odot/{\rm pc^2}$. We find that the microlensing effects are more sensitive to the macro-magnification than the underlying microlens density, even if the latter exceeds $10^3~{\rm M}_\odot/{\rm pc^2}$. The mismatch between lensed and unlensed GW signals rarely exceeds $1\%$ for nearly all binary black hole sources in the total mass range [10 M$_\odot$, 200 M$_\odot$]. This implies that microlensing is not expected to affect the detection or the parameter estimation of such signals and does not pose any further challenges in identifying the different lensed counterparts when macro-magnification is ${\leq}10$. Such a magnification cut is expected to be satisfied by ${\sim}50\%$ of the detectable pairs in quads and ${\sim}90\%$ of the doubles in the fourth observing run of the LIGO-Virgo detector network., Comment: 12 pages, 9 figures; Comments welcome

Aceclofenac is a non-steroidal anti-inflammatory, analgesic and antipyretic agent. It has short biological half-life (4 hours). The present study aims to formulate sustained release Matrix tablet of Aceclofenac for improved patient compliance, better therapeutic efficacy, less side effects and reduced dosage regimen with less toxicity. Total six formulations (F1-F6) were prepared with varying ratios of Eudragit RS100 and Carbopol 934P as matrix forming agents and evaluated for various pre-compression and post compression parameters. Formulation (F3) containing 1:1 ratio of Eudragit RS100 and Carbopol 934P showed promising results in dissolution studies when compared to the rest of the formulations. Keywords: Aceclofenac, Matrix Tablets, Eudragit, Carbopol, Sustained Release.

A systematic review was conducted to identify the best management for acute proximal interphalangeal joint fracture-dislocations. A study protocol was designed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Due to limited data in the primary assessment, the hypothesis was tested in a secondary analysis of articles that marginally met the inclusion criteria (i.e. studies that included patients under 18 years of age). A further tertiary analysis was conducted by dividing the studies into closed reduction techniques, open reduction internal fixation and 'other studies' and a narrative synthesis was performed. The study found a higher rate of complications and arthritis in the closed reduction group compared to open reduction internal fixation, suggesting that operative management should be considered for acute PIP joint fracture-dislocations. Level of evidence: III.

Late embryogenesis abundant (LEA) proteins are identified in many crops for their response and role in adaptation to various abiotic stresses, such as drought, salinity, and temperature. The

Data science has been an invaluable part of the COVID-19 pandemic response with multiple applications, ranging from tracking viral evolution to understanding the effectiveness of interventions. Asymptomatic breakthrough infections have been a major problem during the ongoing surge of Delta variant globally. Serological discrimination of vaccine response from infection has so far been limited to Spike protein vaccines used in the higher-income regions. Here, we show for the first time how statistical and machine learning (ML) approaches can discriminate SARS-CoV-2 infection from immune response to an inactivated whole virion vaccine (BBV152, Covaxin, India), thereby permitting real-world vaccine effectiveness assessments from cohort-based serosurveys in Asia and Africa where such vaccines are commonly used. Briefly, we accessed serial data on Anti-S and Anti-NC antibody concentration values, along with age, sex, number of doses, and number of days since the last vaccine dose for 1823 Covaxin recipients. An ensemble ML model, incorporating a consensus clustering approach alongside the support vector machine (SVM) model, was built on 1063 samples where reliable qualifying data existed, and then applied to the entire dataset. Of 1448 self-reported negative subjects, 724 were classified as infected. Since the vaccine contains wild-type virus and the antibodies induced will neutralize wild type much better than Delta variant, we determined the relative ability of a random subset of such samples to neutralize Delta versus wild type strain. In 100 of 156 samples, where ML prediction differed from self-reported uninfected status, Delta variant, was neutralized more effectively than the wild type, which cannot happen without infection. The fraction rose to 71.8% (28 of 39) in subjects predicted to be infected during the surge, which is concordant with the percentage of sequences classified as Delta (75.6%-80.2%) over the same period.

Recently, sustained release formulations have become a very helpful tool in medical practice, providing patients with a variety of benefits. Sustained release is also a potential method for reducing pharmacological side effects by preventing fluctuations in the concentration of the drug in the plasma. Nowadays, relatively few pharmaceuticals are emerging from research and development, and current drugs are suffering from resistance as a result of their inappropriate usage. Thus, altering the operation is an appropriate and optimum method of increasing the effectiveness of a medicine by a little variation in the drug distribution. The release of the medication through such a system is regulated by both dissolution and diffusion processes. Most medications, if not correctly designed, may quickly release the drug at a higher pace, resulting in hazardous concentrations of the drug upon oral administration. This review discusses the fundamentals of sustained release formulations and the many varieties available. Key words: Matrix tablets, Sustained release, Sustain release polymers, Patient convenience and compliance.

Clinical assessment of the upper limb and hand requires a detailed history of the symptoms, or, in cases of trauma, the circumstances of the injury. Examination should be systematic and guided by a thorough knowledge of anatomy and the likely pathology. Various modalities of imaging can be applied to confirm or characterize the pathology. Each has particular indications and should be applied carefully so as to obtain the most accurate result.

With increasing sensitivities of the current ground-based gravitational-wave (GW) detectors, the prospects of detecting a strongly lensed GW signal are going to be high in the coming years. When such a signal passes through an intervening lensing galaxy or galaxy cluster, the embedded stellar-mass microlenses lead to interference patterns in the signal that may leave observable signatures. In this work, we present an extensive study of these wave effects in the LIGO/Virgo frequency band ($10$-$10^4$ Hz) due to the presence of the microlens population in galaxy-scale lenses for the first time. We consider a wide range of strong lensing (macro) magnifications and the corresponding surface microlens densities found in lensing galaxies and use them to generate realisations of the amplification factor. The methodologies for simulating amplification curves for both types of images (minima and saddle points) are also discussed. We then study how microlensing is broadly affected by the parameters like macro-magnifications, stellar densities, the initial mass function (IMF), types of images, and microlens distribution around the source. In general, with increasing macro-magnification values, the effects of microlensing become increasingly significant regardless of other parameters. Mismatch analysis between the lensed and the unlensed GW waveforms from chirping binaries suggests that, while inferring the source parameters, microlensing can not be neglected for macro-magnification $\gtrsim 15$. Furthermore, for extremely high macro-magnifications $\gtrsim 100$, the mismatch can even exceed $5\%$, which can result in both a missed detection and, consequently, a missed lensed signal., Comment: 18 pages, 13 figures. v2: Added section 5.7; updated section 5.6; typos corrected; references updated

Glomus tumor (GT) is a rare, benign neoplasm of the glomus apparatus. Being most common in the subungual region, it often misdiagnosed with dermatological conditions. Severe tenderness, paroxysmal pain and cold intolerance symptomatically denote GT. Clinical tests such as Love’s pin test and Hildreth’s test assist in diagnosing the disease. X-ray, ultrasonography and magnetic resonance imaging can confirm the severity of the lesion. Complete surgical excision is the only treatment available for these subcutaneous nodules. A middle-aged male with a hand pain, who misdiagnosed for dermatitis over 15-year period, has identified as having a large bone-boring GT. Awareness of GT among healthcare professionals is a must to increase the quality of life of patients.

In this work, an experimental setup for trio tube heat exchanger is designed and fabricated. The experimental setup is comprises of aluminum (inner tube 12.7 mm) and copper (intermediate tube 25.4 mm) and GI tube (outer tube 38.1 mm). The effective length of the heat exchanger is 2.1 m. For the hot fluid, a 2000 W capacity immersion heater was used to raise the temperature of the water. In this experimental setup, heat can be transferred between three liquids. Which is it’sspecial competence over the double tube heat exchanger. Three different flow arrangements can be maintained in the heat exchanger; N-H-C, C-H-C and C-H-N. The performance of the experimental setup was initially tested for water. The measurements were taken at 50 ℃ temperature of hot water and 30℃ of the other two water streams at the inlet. The experiments were conducted for counter flow arrangements of fluid streams so that the performance of the heat exchanger can be checked at the maximum amount of heat extraction from hot water. The temperature variation along the length of the heat exchanger was analyzed, the graphs are in good agreement with the standard graphs.

Ectopic tooth eruption in a non-dental area is a rare entity, and is most common in oral cavity. There have been a few case reports of teeth erupting in mandibular condyle, chin, palate, coronoid process, and maxillary sinus. Ectopic tooth in the maxillary sinus are found incidentally on routine radiological examination, same time they can be symptomatic and associated with pathologies usually dentigerous cyst or odontogenic keratocyst. Facial pain, purulent rhinorrhoea, epistaxis, headache, swelling, and epiphora-related naso-lacrimal duct obstruction can also be seen. By Caldwell-Luc procedure the ectopic teeth within the maxillary sinus are often removed. In this study, a case of ectopic maxillary third molar tooth on right maxillary sinus is presented.

Laser first came into light in 1960 and had been used extensively in various fields of medicine. Laser has been experimented in the various dental field, and its utility is being recognized and established well in the dentistry. Lasers are widely used for a number of procedures such as cavity preparation, scaling, and root planning, surgical procedures like excision of soft tissue growths, etc., Improved healing, hemostasis, and sutureless excisions are some of the many advantages of laser over conventional treatment modalities. It is because of these advantages that laser is becoming more and more popular as a treatment option in various aspects of dentistry. We hereby present a case report, where we have used diode laser for surgical management of a proliferative verrucous leukoplakia (PVL), because of its many advantages over conventional methods. It presents very specific characteristics, mainly a more aggressive biological behavior than other forms of leukoplakia expressed by: A tendency toward multifocality (field cancerization); a high prospect of recurrence; and a high rate of malignant transformation, which can range between 40% and 100% in a follow-up period of 4.4-11.6 years. In this case, we evaluated the advantages of diode laser for the treatment of verrucous leukoplakia, where the results that we obtained were excellent. The patient had come for evaluation till the time of complete healing.

Purpose We offer collagenase Clostridium histolyticum (CCH) injections to all patients with a Dupuytren contracture and a palpable cord. We assessed whether more severe contractures respond less well or recur more frequently. Methods From a database of 502 CCH injections, 386 (77%) had a complete dataset with minimum 1-year face-to-face follow-up. Contracture severity was assessed using the Tubiana system: grade 1 (27%), grade 2 (49%), grade 3 (19%), and grade 4 (5%). Patients received a single intralesional injection of 0.58 mg CCH followed by manipulation. Finger position was measured at 6 to 12 weeks, 6 months, and 1 year. Failure to break the cord, skin tears, and any adverse events were noted. Recurrence was defined as a failure to maintain any prior correction to within 20°. Results There were 17 failures (4%) and 6 allergic reactions (1%). We found 31% corrected completely, with approximately half remaining corrected at 1 year. We achieved 43° (95% confidence interval, 40°–46°) correction of combined deformity, with 11° (95% confidence interval, 9°–13°) correction attrition over 1 year. Sixteen percent of treated digits experienced a recurrence with no difference between Tubiana grades, and one-third chose further treatment. Following treatment, Tubiana grade 1 contractures improved by 78% in comparison with higher grade contractures (55%–67% relative correction). By 1 year, all grades had a similar mean 46% relative correction. A complete correction was seen in 61% of grade 1 contractures, with more severe contractures less likely to correct completely (9%–24%). A 31% skin tear rate had no impact on outcome, recurrence, or long-term morbidity. Conclusions CCH may treat any Dupuytren cord regardless of severity. Although contracture may recur, few patients pursue further treatment within 1 year. Type of study/level of evidence Therapeutic IV.

Background: The mental health and well-being have been severely impacted by the COVID-19 crisis. People are distressed due to the immediate impacts as well as the consequences of physical isolation, which could have lasting effect on overall well-being. The study aimed to assess the psychological effect of the pandemic on the general population of India using COVID-19 specific scales.Method: An online, cross-sectional study was conducted from 20th June 2020 to 4th July 2020 on persons of both sexes and aged 18 years or more. A convenient sampling method was used for recruiting participants. An online Google form was designed and distributed using social media platforms. The psychological effect of the pandemic was assessed using validated scales of coronavirus anxiety scale, obsession with COVID-19 scale, and fear of COVID-19 scale respectively.Result: The study received responses from 2004 participants from 31 states and union territories of India. The overall prevalence of psychological disorder due to COVID-19 was 53.3% (n=1068). The prevalence of anxiety was found to be 3.29% (n=66), obsession 13.47% (270) and fear 46.9% (1045). Around 2.8% (55) of the participants suffered from all three psychological disorders. Pearson correlation test showed a significant positive correlation between all the three psychological morbidities.Conclusions: The study findings showed high prevalence of mental health problems among Indian population during the COVID-19 outbreak with a positive correlation between them.

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel’s sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

Introduction: Amniotic constriction bands occur in approximately one in every 15,000 live births and is graded using the Patterson Classification system. Methods: A case series of all patients with amniotic constriction band that presented to Alder Hey Children's Hospital was compiled between the years 1993 and 2012, data was described and a classification system developed. Results: Thirty seven patients were identified. Of these 17 had amniotic constriction confined to the upper limbs and three of the lower limbs only. Seventeen had both upper and lower limb deformity. Twenty eight children underwent surgical intervention whilst nine to date have not. Conclusion: Constriction band of the upper limb was the most common with lower limb bands the least. There is no agreement on the nomenclature of this condition making amalgamation of the literature problematic. A more specific classification of upper limb bands has been suggested which includes anatomical location and depth of band.

A systematic review was conducted to identify the best management for chronic scapholunate dissociation. EMBASE, MEDLINE, and CENTRAL were searched from 1965–2016. A narrative synthesis was performed. One thousand, one hundred and ninety-one citations were identified, of which 17 had final analysis. In all interventions, the pain score at 2 years reduced from 6.0 to 2.8 with similar effect from capsulodesis and tenodesis techniques. Overall there was an 18% loss of flexion arc. Radial to ulnar arc improved in capsulodesis (+19%; n = 45) and worsened in tenodesis (−6%; n = 45). Grip strength was better in capsulodesis (+31%; n = 64 versus + 11%; n = 56). There was insufficient evidence to link radiological outcome with clinical outcome. Rates of complications (20%) and CRPS (3.8%) were high, with implications for patient consent. Due to heterogeneity in data collection, the lack of comparative studies and short-term follow-up, no conclusion regarding the superiority of a single technique was possible. Longer term comparative studies are required, as are natural history studies. A minimum data set has been advised.Level of evidence: II

Approximately 150 L of plasma are purified each day by glomerular filtration, tubular secretion, and tubular reabsorption to produce 0.6 to 2.5 L of urine. The amount of urine produced is influenced by environmental temperature, fluid intake, time of day, emotional state, and many other factors.1 The composition of urine reveals much about body function. Metabolic waste products such as carbon dioxide, urea, uric acid, creatinine, sodium chloride, and ammonia are normally present and have no particular pathological significance. The presence of albumin (a protein), glucose, ketones, and various other substances, however, may indicate malfunction of the kidneys or some other organ of the body.1 Biological importance of Ass urine: (Sanskrit :khara; Latin : Asinusequidae) The urine of Ass has been mentioned useful as destroyer of epilepsy (apasmara), intensity (unmada) and in seizures. The mode of its use has been mentioned as internal as drink. Apart from the above mentioned diseases, the urine of Ass has also been prescribed to cure diabetes and various diseases caused by worms.2,3

The paper deals with an extensive study of null and timelike geodesics in the background of wormhole geometries. Starting with a spherically symmetric spacetime, null geodesics are analyzed for the Morris-Thorne wormhole(WH) and photon spheres are examined in WH geometries. Both bounded and unbounded orbits are discussed for timelike geodesics. A similar analysis has been done for trajectories in a dynamic spherically symmetric WH and for a rotating WH. Finally, the invariant angle method of Rindler and Ishak has been used to calculate the angle between radial and tangential vectors at any point on the photon's trajectory., Comment: 19 pages, 10 figures

Recently, there has been a growing interest in studying the autoregressive conditional duration (ACD) models, originally introduced by (Engle, R. F., and J. R. Russell. 1998. “Autoregressive Conditional Duration: A New Model for Irregularly Spaced Transaction Data. Econometrica 66: 1127–1162). ACD models are useful for modeling the time between the events, especially, in financial context, the time between trading of stocks. In this paper, we propose a specific type of nonstationary ACD model, viz., time varying ACD model (tvACD), by allowing the parameters of the usual ACD model to vary as functions of time. Some probabilistic and inferential aspects of such models have been investigated. We also develop a local polynomial procedure for the estimation of the parameter functions of the proposed tvACD model. Asymptotic properties of the estimators have been investigated, including the asymptotic normality. The asymptotic distribution being dependent on the parameters of the original distribution, a weighted bootstrap estimator is suggested and its validity is established. Simulation study and empirical analysis using high frequency data (HFD) from National Stock Exchange (NSE, INDIA) illustrate the application of the proposed tvACD model.

We have been practicing surgical management of adult upper limb spasticity for the past 5 years. So far, we have evaluated 20 patients, and we have operated on nine patients with spasticity of the upper limb in Cyprus and the United Kingdom. We aim to present the setup and running of a new service, which is devoted to Surgery for Spasticity of the Upper Limb. We present our structure, organisational processes and service provision as well as our results in the nine cases that had surgical treatment as a part of their management (as well as our preferred techniques). We discuss our outcomes as well as our learning points from these cases. We also believe that selective neurectomy procedures can be very useful in the surgical management of upper limb spasticity. Tendon transfers to augment finger extension have a limited role and provide no significant benefits in adult spasticity cases. In addition, we found that the extensor carpi ulnaris transfer to extensor carpi radialis brevis has in our experience, reliable results regarding concentric wrist extension as well as easier rehabilitation. Furthermore, in severe cases, where no functional improvement is expected, joint fusions have a more predictable outcome. Spasticity reduction surgery does gain ground with the increase in survival of stroke patients as well as traumatic brain injury patients. Therefore, up to date methods for assessing, operating and evaluating postoperatively this category of patients need to be vigorously checked.

A 29-year-old female had presented to surgical out patient’s department complaining of lump in the anterior abdominal wall. Ultrasound and magnetic resonance imaging revealed a solid degenerated tumor in the anterior abdominal wall. It was surgically excised and histopathology confirmed it to be ‘ancient’ schwannoma. To our knowledge, this is the second reported case of an abdominal wall ancient schwannoma in the medical literature. Key words: Schwannoma, abdominal wall, magnetic resonance imaging.

The aim of this study was to evaluate early and mid-term clinical outcomes after isolated subscapularis Z-lengthening in children with shoulder internal rotation contractures resulting from brachial plexus birth palsy.Children with brachial plexus birth palsy treated with subscapularis tendon Z-lengthening from 2001 to 2011 were retrospectively reviewed. Over this period, 31 patients were identified. Primary outcome was improvement in Mallet score after surgery, and secondary outcome measures were active range of motion and Mallet sub-scores. Clinical outcomes were collected at three time intervals: pre-operatively, one-year post-operative and at latest follow-up.After exclusion, 21 patients remained for further analysis. Mean age at surgery was 3.7 years (range, 1.2-8.7), and mean follow-up length was 6.5 years (2.9-9.7). Moderate improvements were found for mean Mallet score, active external rotation, active abduction and hand-to-mouth movement at one year and latest follow-up. However, improvements in active external rotation and Mallet score were not fully maintained at final follow up.Isolated subscapularis Z-lengthening is effective at early follow-up, but results are not maintained at mid-term follow-up.