Guadua angustifolia Kunth leaves as a source for bioactive phenolic compounds: Optimization of ultrasound-assisted extraction using response surface methodology and antioxidant activities.

This study evaluated the ultrasound-assisted extraction of phenolic compounds from Guadua angustifolia leaves, along with their optimization using response surface methodology. The effects of two sonication process conditions were determined using a central composite experimental design, with three levels (low, medium, and high) evaluated for time (10, 20, and 30 min) and temperature (20 °C, 35 °C, and 50 °C). A total of 12 experiments with four replicates were conducted at the central point, with the total phenol and flavonoid contents determined using the Folin-Ciocalteu colorimetric method and complexation with AlCl3, respectively. The optimized extract was analyzed using ultra-performance liquid chromatography (UPLC), and the antioxidant capacity of the optimized extract was determined by DPPH• (2,2-Diphenyl-1-Picrylhydrazyl) and ABTS•+ (2,2'-Azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) assays. Extraction at 50 °C for 20 min was found to favor the extraction of phenol and total flavonoids. The experimental validation of the total phenol and flavonoid content produced values of 7.39 mg gallic acid equivalents per gram of dry matter and 1.55 mg quercetin equivalents per gram of dry matter, respectively. These values suggest that the extraction process is reproducible, with a relative standard deviation of 22.9 % and 14.1 %, respectively. The chromatographic profile showed that optimization favored the visualization of phenolic compounds compared to the non-optimized extract. The optimized extract had higher antioxidant capacity than the non-optimized extract, with values of 209.23 and 144.76 µmol Trolox per gram extract for the DPPH• and ABTS•+ techniques, respectively. Thus, the conditions evaluated in the ultrasound-assisted extraction were an efficient technique capable of extracting the maximum amount of phenolic compounds with antioxidant activity from the leaves of G. angustifolia, showing its potential application in various industries.

A Comparison Between Ultrasound-Guided Supraclavicular and Infraclavicular Approaches to Brachial Plexus Block for Elective Upper Limb Surgery.

BACKGROUND: Regional anaesthesia offers the anaesthesiologist, the surgeon, as well as the patient advantages over general anaesthesia such as being conscious through the surgery, avoiding multiple drugs, better haemodynamic stability, excellent postoperative analgesia, and faster per oral consumption post surgery. Compared with the axillary approach, the brachial plexus block at the level of the clavicle can anaesthetize all four distal upper extremity nerve territories without the requirement for a separate block of the musculocutaneous nerve. AIM: The aim of the study was to compare the effect of both supraclavicular and infraclavicular brachial plexus blocks in terms of time taken for onset, performance, and block success. MATERIALS AND METHODS: Sixty patients undergoing below-elbow upper limb surgeries were randomized into two groups: (i) supraclavicular (Group S) and (ii) infraclavicular (Group I). All patients received 30ml 0f 0.5% bupivacaine as the local anesthetic of choice. The block performance time, time taken for onset of sensory and motor blockade, total duration of block, and hemodynamic parameters were observed. The block performance times and the onset of the sensory blockade were the primary outcomes while the duration of the block and hemodynamic parameters were secondary outcomes. Two two-tailed independent sample t-tests will be used to compare the variables. RESULTS: We observed that the block performance time for the infraclavicular block (mean 14.833 minutes) was longer than the supraclavicular block (mean 10.37 minutes). This was statistically significant with p <0.001. In terms of onset of sensory blockade, the infraclavicular group (13.667 minutes) had a quicker onset compared to the supraclavicular group (17.333 minutes). This was also statistically significant with p <0.001. The mean total duration of sensory and motor blockade was similar in both groups (p-value of 0.341 and 0.791 respectively) and there was no statistical difference. There was no hemodynamic instability or complications in our study. CONCLUSION: Ultrasound-guided infraclavicular block is a relatively safer technique when compared to the supraclavicular technique with faster onset. The time taken for administering the infraclavicular block can be reduced by repeated exposure to the technique.

The Role of Ultrasound Features in Predicting the Breast Cancer Response to Neoadjuvant Chemotherapy.

Background Neoadjuvant chemotherapy (NACT) has become the standard of care for locally advanced breast cancer. This study investigates whether baseline ultrasound features can predict complete pathological response (pCR) after NACT. Methods This retrospective study was approved by the Institutional Review Board of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, with a waiver of informed consent. Records of female patients aged over 18 years with locally advanced breast cancer treated with NACT from 2018 to 2020 were reviewed. Baseline ultrasound parameters were assessed, including posterior effect, echo pattern, margin, and maximum lesion diameter. Tumor grade and immunophenotype were documented from the core biopsy. pCR was defined as the absence of invasive residual disease in the breast and axilla. Univariate and multivariate analyses assessed the association between ultrasound features and pathological response. Results A total of 110 breast cancer cases were analyzed: 36 (32.7%) were estrogen receptor (ER)-positive/human epidermal growth factor 2 (HER-2) negative, 49 (44.5%) were HER-2 positive, and 25 (22.7%) were triple-negative (TN). A pCR was achieved in 20 (18%) of cancers. Lesion diameter was significantly different between pCR and non-pCR groups, 28.5 ± 12 mm versus 39 ± 18 mm, respectively, with an area under the curve (AUC) of 0.7, a confidence interval (CI) of 0.55-0.81, and a p-value of 0.01. No significant association was observed between ultrasound features, tumor grade, and immunophenotype with pCR. Conclusion Ultrasound features could not predict pCR. A smaller tumor diameter was the only significant factor associated with pCR. Further prospective studies combining imaging features from different modalities are needed to explore the potential of varying imaging features in predicting post-NACT pathological response more comprehensively.

Safety and Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Hypervascular Pancreatic Lesions.

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is a common technique for diagnosing pancreatic lesions with high accuracy and a low incidence of procedural adverse events. However, occasional adverse events, particularly bleeding, may occur. Procedures for hypervascular lesions are considered important, but their risks are unknown. We aimed to evaluate the safety and diagnostic yield of EUS-FNB for hypervascular pancreatic solid lesions. This study included 301 patients with 308 solid pancreatic lesions who underwent EUS-FNB between May 2011 and December 2018. We performed propensity-score matching to balance clinical differences between hypervascular and hypovascular lesions and analyzed 52 lesions. We compared the safety and diagnostic performance of propensity score-matched cohorts. The sensitivity, specificity, and accuracy rates of EUS-FNB for hypervascular lesions were 94.7%, 100%, and 96.2%, and those for hypovascular lesions were 80.0%, 100%, and 84.6%, respectively. There was no difference in diagnostic performance between hypervascular and hypovascular lesions. Furthermore, adverse events occurred in only one patient (pancreatitis) in the hypovascular group. There were no significant differences in the occurrence of adverse events between hypervascular and hypovascular lesions (0% vs. 3.8%, p = 1.000). Therefore, EUS-FNB may be safe with a high diagnostic yield, even for hypervascular solid pancreatic lesions.

Synthesis and Characterization of a Biopolymer Pectin/Ethanolic Extract from Olive Mill Wastewater: In Vitro Safety and Efficacy Tests on Skin Wound Healing.

Wound-healing delay is one of the major problems of type 2 diabetes, representing also a clinical emergency in non-healing chronic wounds. Natural antioxidants show interesting wound-healing properties, including those extracted from waste derived from olive oil production. Olive mill wastewater is one of the main by-products of the olive oil-making process, and it is rich in high-value secondary metabolites, mainly hydroxytyrosol. We proposed an eco-friendly extraction method, employing both ultrasound-assisted and Soxhlet techniques and ethanol as a solvent, to recover valuable molecules from Roggianella cv (Olea europea L.) olive mill wastewater, which was further entrapped in a pectin polymer via an enzymatic reaction using porcine pancreatic lipase. Pectin, in combination with other substances, promoted and accelerated wound healing and demonstrated good potential to produce a biomedical conjugate for wound treatment. The antioxidant activity of the extracts and conjugate were evaluated against lipophilic (IC50 equal to 0.152 mg mL-1) and hydrophilic (IC50 equal to 0.0371 mg mL-1) radical species as well as the in vitro cytotoxicity via NRU, h-CLAT, and a wound-healing scratch assay and assessment. The pectin conjugate did not exert hemolytic effects on the peripheral blood, demonstrating interesting wound-healing properties due to its ability to stimulate cell proliferation in a dose-dependent manner.

Peripheral Artery Disease Diagnosed by Pulse Palpation as a Predictor of Coronary Artery Disease in Patients with Chronic Kidney Disease.

There is a need of simple, inexpensive, and reliable noninvasive testing to predict coronary artery disease (CAD) in patients with chronic kidney disease (CKD), where the prevalence of cardiovascular (CV) events and death is elevated. We analyzed the association between peripheral artery disease (PAD) and CAD in 201 patients with stage 5 CKD on dialysis using a prospective observational cohort. Diagnosis of PAD by both palpation and USD were significantly correlated. In patients with PAD diagnosed by palpation, CAD was observed in 80%, while in those diagnosed by USD, CAD was present in 79.1%. The absence of a pulse by palpation predicted CAD with a sensitivity of 55% and a specificity of 76%; USD showed a sensitivity of 62% and specificity of 60% to predict CAD. The risk of combined serious CV events and death was significantly higher in subjects with PAD diagnosed by palpation, but not by USD. PAD assessed by palpation also correlated with the occurrence of multivessel CAD and with the probability of coronary intervention. Both methods are moderately useful for predicting CAD, but PAD diagnosis by palpation was a better predictor of combined CV events and death and was also associated with CAD severity and likelihood of intervention.

Comparison of Magnetic Resonance Imaging and High-Resolution Ultrasound for the Diagnosis of Pathologies of the Peripheral Nerve.

The study was done to evaluate high-resolution ultrasound with Magnetic Resonance Imaging (MRI) for the diagnosis of peripheral nerve pathologies. Ultrasound examination and MRI were performed for selected cases, and their sensitivity and specificity were compared. Ultrasound was found to detect peripheral pathologies with greater accuracy as compared to MRI. Also, ultrasound was found to have higher sensitivity and specificity than MRI. It was concluded that ultrasound is a better adjunct tool for the diagnosis of peripheral nerve lesions when compared with MRI.

A Case of Ultrasound Suspected Microcephaly With a Normal Head Circumference at Birth.

A 25-year-old first-time mother from Nepal had a well-progressing spontaneous pregnancy. However, from the 37th week, her baby's biparietal diameter (BPD) stopped growing at around 83 mm. At 40 weeks, measurements suggested possible microcephaly and fetal growth failure but no other abnormalities. No travel, infections, or cytomegalovirus were identified prenatally. By 41 weeks, the BPD and head circumference (HC) decreased further, while the estimated fetal birth weight (EFBW) slightly increased. The baby girl was born at 41 weeks and 1 day with a low birth weight but a normal head circumference. Postnatal checks showed no abnormalities, and she was discharged with normal growth at 10 days old.

A Case Report of Wire-localised Excision of Impalpable Recurrent Papillary Thyroid Carcinoma and Discussion of Wire-guided Excision in the Head and Neck Pathology.

INTRODUCTION/BACKGROUND: Wire localisation techniques are used widely for precision surgery in many specialities. This convenient technique has not yet become mainstream in the field of head and neck surgery. With limited space and many vital structures coursing through the head and neck region, pathological nodes that are difficult to palpate can be a challenge for clinicians. CASE PRESENTATION: A patient with a history of papillary thyroid cancer treated with surgery and radioactive iodine had a single pathological node detected on ultrasound surveillance. An isolated recurrence of papillary thyroid carcinoma was confirmed. An excisional biopsy was performed using ultrasound wire guidance to successfully remove the diseased node with minimal morbidity. CONCLUSION: Wire-guided lymph node excision biopsy is a safe and effective method that can be applied to multiple pathologies. As of yet, it is not routine practice to employ this technique. Larger studies would increase the generalisability and safety profile of this technique in the head and neck region.

Combined direct hysteroscopic and real-time ultrasound guidance facilitating safe insertion of intra-uterine brachytherapy applicator for locally advanced cervical cancer with significant endocervical stenosis: A novel collaborative approach.

Locally advanced cervical cancer is treated with combined chemoradiation (CCRT) - with the radiotherapy component comprising delivery of both external beam (EBRT) and intra-uterine brachytherapy (IUBT). Following initial pelvic and tumour irradiation via EBRT, secondary tissue fibrosis can obliterate the vagina and / or endocervical canal. 30-88% of women will develop some degree of stenosis, with complete stenosis reported in up to 11% of patients - making accessing the uterine cavity to insert brachytherapy applicators challenging and high risk (Bran et al., 2006). This can result in inadvertent uterine perforation, occurring in 2-10% of cases (Irvin et al., 2002); with subsequent abandonment of both the procedure and proceeding to IUBT to complete treatment. Omission of IUBT confers an at least 10% reduction in overall survival (Karlsson et al., 2017). Whilst ultrasound-guided insertion has been previously described (Van Dyk et al., 2021), we present a surgical video demonstrating a novel technique. We instead utilise a combination of both real-time ultrasound and direct hysteroscopic guidance to achieve successful IUBT applicator insertion following CCRT in a patient with stage IIa1 SCC cervix and previous failed insertion attempt due to complete stenosis of the endocervical canal. We demonstrate how post-radiation changes can be safely navigated - avoiding morbidity from procedural complications and ensuring successful outcome. Our case supports a collaborative approach to complex gynaecological cancer cases; with the combined skills of the oncology, radiology and surgical teams maximising patient safety - and optimising oncological treatment. Use of portable hand-held hysteroscopic devices would increase the feasibility of replicating our described technique in brachytherapy suites, mitigating need for theatre capacity; with MDT discussion central to the planning and staffing of cases.

Evaluating Patterns of Injectate Spread After Rectus Sheath Block: A Cadaveric Dissection Study.

INTRODUCTION: This cadaveric dye study assesses the effect of volume and number of injections on the spread of solution after ultrasound-guided rectus sheath injections. In addition, this study evaluates the impact of the arcuate line on solution spread. MATERIALS AND METHODS: Ultrasound-guided rectus sheath injections were performed on seven cadavers on both sides of the abdomen, for a total of 14 injections. Three cadavers received one injection of 30 mL of a solution consisting of bupivacaine and methylene blue at the level of the umbilicus. Four cadavers received two injections of 15 mL of the same solution, one midway between the xiphoid process and umbilicus and one midway between the umbilicus and pubis. RESULTS: Six cadavers were successfully dissected and analyzed for a total of 12 injections, while one cadaver was excluded due to poor tissue quality that was inadequate for dissection and analysis. There was a significant spread of solution with all injections caudally to the pubis without limitation by the arcuate line. However, a single 30 mL injection showed inconsistent spread to the subcostal margin in four of six injections, including in a cadaver with an ostomy. A double injection of 15 mL showed consistent spread from xiphoid to pubis in five of six injections, except in a cadaver with a hernia. CONCLUSIONS: Injections deep to the rectus abdominis muscle, using the same technique as an ultrasound-guided rectus sheath block, achieve spread along a large and continuous fascial plane without limitation by the arcuate line and may provide coverage of the entire anterior abdomen. A large volume is necessary for complete coverage and spread is improved with multiple injections. We suggest that two injections with a total volume of at least 30 mL per side may be needed to achieve adequate coverage in the absence of preexisting abdominal abnormalities.

Application prospect of computer vision technology assisted ultrasonography in diagnosis and treatment of liver diseases / 中华消化外科杂志

Ultrasound examination has the advantages of non-radiation, non-invasive, low cost and high efficiency, and is the most commonly used method of liver imaging examination. In recent years, the application of computer vision technology to the intelligent analysis of ultrasound images has become a research hotspot in the field of intelligent healthcare. Through large-scale data training, the intelligent analysis model of ultrasound omics based on machine learning algorithm can assist clinical diagnosis and therapy, and improve the efficiency and accuracy of diagnosis. Based on the literature, the authors summarize the application proprect of computer vision technology assisted ultrasonography in the evaluation of diffuse liver lesions, focal liver lesions, microvascular invasion of liver cancer, postoperative recurrence of liver cancer, and postoperative therapy response to trans-catheter arterial chemoembolization.

RUSHing to the Diagnosis: Aortic Abdominal Aneurysm Detected Using the Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol in the Wards.

The rapid ultrasound for shock and hypotension (RUSH) protocol is a useful tool used in the emergency department (ED) when addressing the severity and etiology of shock. It was designed to be performed in under two minutes with evaluation of the pump (heart), tank (inferior vena cava, thoracic and abdominal compartments) and the pipes (large arteries and veins). However, its application or one similar should extend beyond the ED and into the hospital floor. Here we present an 80-year-old gentleman with a history of atrial fibrillation (A-Fib) on anticoagulation who arrived at the ED due to an episode of pre-syncope just prior to arrival. Initial EKG is concerning for A-Fib with rapid ventricular response (RVR) with a rate in the 130s. After fluid resuscitation patient improved and he was admitted to the telemetry floor for further cardiac workup and cardiology consultation. While waiting for a room in the ED, patient became hypotensive, diaphoretic and pale. After complaining of lower abdominal pain, the ED physician performed a RUSH which showed an abdominal aorta of 8 cm concerning for dissection. Diagnosis was confirmed with CT angiography of the abdomen and he was taken to the OR with successful repair of the abdominal aortic aneurysm (AAA). Patient made meaningful recovery and was discharged to in-patient rehab. The patient described in this vignette was delayed in the ED due to lack of beds on the floor. This allowed for quick ultrasound work-up by the ED physician which led to immediate recognition of the AAA and immediate response by the vascular surgery team. Should this patient have been on the hospital floor, it is unclear if such prompt steps would have occurred prior to patient's further hemodynamic demise.

Automatic classification of thyroid nodules in ultrasound images using a multi-task attention network guided by clinical knowledge.

Thyroid cancer has been the most prevalent cancer in the recent three decades. Ultrasonography is one of the mainly used methods for diagnosing thyroid nodules. Several computer-aided diagnostic methods were proposed to aid radiologists in analyzing ultrasound images of the thyroid gland. Most methods, however, only determine the benignity or malignancy of the thyroid nodule and do not explain the decision-making process of them, which cannot gain the trustworthiness of clinicians because they are not consistent with the physician's diagnostic process. In our work, we design a multi-task branching attention network in which each of the descriptors of the ACR TI-RADS lexicon is first classified. All respective scores are calculated to get the risk stratification of the nodule. Ultimately, based on the risk stratification, the benignity or malignancy of the nodule is determined. This work provides an automated method that incorporates the ACR TI-RADS characterization of thyroid nodules for detecting the level of risk and the benignity or malignancy of thyroid nodules. Thus the work establishes the trustworthiness of clinicians in deep learning models and improves physician efficiency and diagnostic rates to some extent compared to previous studies. For the diagnosis of thyroid nodules, evaluation indices including accuracy, sensitivity, and specificity were 93.55%, 93.86%, and 93.14%, respectively. The experiments show that our approach obtains comparable performance to most advanced methods in diagnosing ultrasound images of the thyroid nodules and is supported by explanations in clinical terms using the ACR TI-RADS lexicon.

Deep-Learning-Based Ultrasound Sound-Speed Tomography Reconstruction with Tikhonov Pseudo-Inverse Priori.

Ultrasound sound-speed tomography (USST) is a promising technology for breast imaging and breast cancer detection. Its reconstruction is a complex non-linear mapping from the projection data to the sound-speed image (SSI). The traditional reconstruction methods include mainly the ray-based methods and the waveform-based methods. The ray-based methods with linear approximation have low computational cost but low reconstruction quality; the full wave-based methods with the complex non-linear model have high quality but high cost. To achieve both high quality and low cost, we introduced traditional linear approximation as prior knowledge into a deep neural network and treated the complex non-linear mapping of USST reconstruction as a combination of linear mapping and non-linear mapping. In the proposed method, the linear mapping was seamlessly implemented with a fully connected layer and initialized using the Tikhonov pseudo-inverse matrix. The non-linear mapping was implemented using a U-shape Net (U-Net). Furthermore, we proposed the Tikhonov U-shape net (TU-Net), in which the linear mapping was done before the non-linear mapping, and the U-shape Tikhonov net (UT-Net), in which the non-linear mapping was done before the linear mapping. Moreover, we conducted simulations and experiments for evaluation. In the numerical simulation, the root-mean-squared error was 6.49 and 4.29 m/s for the UT-Net and TU-Net, the peak signal-to-noise ratio was 49.01 and 52.90 dB, the structural similarity was 0.9436 and 0.9761 and the reconstruction time was 10.8 and 11.3 ms, respectively. In this study, the SSIs obtained with the proposed methods exhibited high sound-speed accuracy. Both the UT-Net and the TU-Net achieved high quality and low computational cost.

Rehabilitative interventions for ischaemic digital ulcers, pain, and hand functioning in systemic sclerosis: a prospective before-after study.

BACKGROUND: Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vasculopathy, cellular inflammation, fibrosis of the skin associated with multiple internal organs involvement. Ischaemic digital ulcers (IDU) of the hands commonly occur in patients with SSc adversely affecting functional independence. PURPOSE: Aim of the study is to investigate the effectiveness of a rehabilitation protocol based on the combined use of ultrasound (US) therapy and therapeutic exercise in terms of ulcers healing, pain relief, and hand functioning in patients affected by SSc with IDUs. Moreover, we also investigated the safety of the proposed intervention. STUDY DESIGN: Prospective before-after study. METHODS: We included 20 patients with IDUs secondary to SSc. All patients were treated with US combined with manual therapy, including McMennel joint manipulation, pompage mobilization technique and connective tissue massage, for 10 sessions. We evaluated softness, dyschromia, pain, and hand mobility using the Pressure Sore Status Tool (PSST), the Numerical Rating Scale (NRS), and the Duruoz Hand Index (DHI) at T0 and at the end of the treatment (T1). RESULTS: Treatment with US combined with manual therapy significantly reduced ulcers depth, improved ulcers margins, and reduced periwound skin damage (median PSST score 16 at T1, p<0.0001). Moreover, significant benefits were reported in terms of pain relief (NRS 3 at T1; p<0.0005), and hand function (DHI score 19 at T1; p<0.0005). Finally, this approach seems to be safe, without side effects reported at the end of treatment, along with an optimal compliance. CONCLUSION: Therapeutic US combined with manual therapy should be used as additional intervention to manage IDUs in SSc patients.

The long-term effects of wearing moderate minimalist shoes on a child's foot strength, muscle structure and balance: A randomised controlled trial.

BACKGROUND: From retrospective research, it is believed that children who predominantly spend their time shod have poorer foot strength and performance than those who are predominantly barefoot. Children's foot motion has been shown to be adversely affected by standard school shoes; however, the long-term effect of moderate minimalist shoes on foot strength, muscle structure and balance in children is unknown. RESEARCH QUESTION: Does wearing moderate minimalist shoes, compared to stiff shoes, benefit a child's foot strength, muscle structure and performance over time? METHODS: Seventy healthy children (9-12 yr) were randomly assigned to wear standard (control), or minimalist shoes (experimental) at school, for nine months. Cross-sectional areas (CSA) of Abductor Hallucis (AH) and Flexor Digitorum Brevis (FDB) muscles, and toe flexor strength (TFS) of hallux and lesser toes separately, were primary outcome measures. Single leg balance (SLB), Y-balance test (YBT) and standing long jump (SLJ) were secondary outcome measures. Pre- and post-intervention measurements were analysed for between group differences with ANCOVA. RESULTS: Minimalist shoes resulted in moderate but statistically non-significant increases in muscle CSA (AH η2p =.04, FDB η2p =.05) and TFS (hallux η2p =.05, lesser toes η2p =.04). Significant moderate to large improvements in YBT in the experimental group were found in the postero-medial (P = .04, η2p =.07) and postero-lateral (P = .01, η2p =.10) directions. YBT (anterior, postero-medial and postero-lateral) was correlated with hallux TFS (R =.29,.27 and.33 respectively), lesser toes TFS (R =.28,.35 and.38 respectively) and SLJ (R =.30,.39 and.57 respectively). CSA of FDB was correlated with SLJ (R =.34) and SLB (R =.42). SIGNIFICANCE: Wearing moderate minimalist shoes long-term improves balance in children. TFS is correlated with better balance and SLJ. Moderate minimalist school shoes are recommended for children.

Traumatic Myositis Ossificans of Temporalis Muscle: Systematic Review, Meta-Analysis and Case Reports.

Introduction: Traumatic myositis ossificans is rare pathology affecting muscles/soft tissue. Its involvement in temporalis muscle is rarely reported in literature. The aetiopathogenesis is unknown, the diagnosis is based on clinco-radiological findings. Surgical management and follow-up are paramount. Materials and Methods: A database search was done using Science Direct and PubMed search engines along with other published and unpublished literature. The final publications were tabulated using a custom made Performa. The available publications were subjected to appropriate statistical analysis. The data were recorded on excel spreadsheet (Microsoft Inc), and review was made using Review Manager (Rev Man) software for meta-analysis. Results: A total of 21 articles were considered for systemic review and meta-analysis. Forest plotting for demographics included the gender predilection/age of involvement. The data segregation was done with "temporalis involved" group and "other than temporalis involved" group. The study was free of homogeneity ( τ 2 = 0.26 I 2 = 5%) for gender and age. The overall analysis revealed that Temporalis muscle although rare to be affected shows greater propensity for involvement. This is supported by a lesser degree of heterogeneity ( τ 2 = 0.000) with a I 2 value of (The test showed a higher degree of significance for overall effect of muscle involvement (Z = 2.33, p = 0.02) (< 25%). The test showed a higher degree of significance for overall effect of muscle involvement (Z = 2.33, p = 0.02) (< α = 0.05).Case reports.Two male cases with similar age predilection, reported after sustaining trauma. Both the cases presented with limited mouth opening and ultrasound was done for the first time to arrive at clinic-radiological diagnosis. The management was conservative with temporalis myotomy and coronidectomy. Conclusion: Traumatic myositis ossificans presents as a rare disorder that poses a dilemma to the treating surgeon. The present article makes an attempt to critically analyse the pathology that is scantly reported in the literature.

Ultrasound diagnosis of infections in pregnancy.

Pregnancy is a unique period in which several changes occur in the mother, to ensure that the semiallograft fetus is not rejected. Some of these changes decrease the immunity of the mother to infections. As such, some infections in pregnancy which may not ordinarily cause severe symptoms can be more severe in the mother and importantly some of these infections pose a danger to the fetus either directly or indirectly. In dealing with infections in pregnancy, attention should focus on both the consequences of the infection on the mother as well as in the fetus. Over the last decade, some of these infections have significantly influenced clinical practice. This series on Infections in Pregnancy in this journal provides a comprehensive cover of this topic. Here we focus on the fetal impact of infections in pregnancy and how ultrasound scan can help in identifying some of these infections and more importantly map out pathways for managing the pregnancies including counselling and additional invasive procedures.