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The Gantzer’s muscle is often present in the flexor compartment of the forearm. It lies underneath flexor digitorum superficialis and compresses the anterior interosseous nerve. Furthermore, this muscle frequently bestows an accessory muscle of flexor pollicis longus or flexor digitorum profundus, or sometimes together. The current meta-analysis aims to compute the prevalence of subtypes of Gantzer’s muscle. Major electronic databases (PubMed, Scopus, Google Scholar, etc.) were searched for title and abstract. After removing the duplicate citations, the titles/abstracts were shortlisted with the help of inclusion and exclusion criteria. The shortlisted titles/abstracts were downloaded or collected from the library. The data of all subtypes of Gantzer’s muscle were pooled from shortlisted published manuscripts for meta-analysis. The pooled estimate of other anatomical characteristics was also observed. A total of 59 cadaveric studies of sample size 5,903 were evaluated for pooled prevalence of flexor pollicis longus (accessory head). Similarly, the authors evaluated 14 studies of 1,627 upper limbs for flexor digitorum profundus (accessory head). The unit of analysis was per 100 upper limbs. The Pooled prevalence of accessory muscle of flexor pollicis longus and flexor digitorum profundus were 48% (95% CI, 44%–52%) and 17% (95% CI, 13%–21%), respectively. The Gantzer’s muscle is present in 2/3rd of the upper limbs. Accessory head of flexor pollicis longus is almost three times more common than the accessory head of flexor digitorum profundus. A classification of Gantzer’s muscle is needed to reduce the ignorance of these variants.
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BackgroundA newly emerged SARS-CoV-2 variant B.1.1.529 has worried the health policy makers worldwide due to the presence of a large number of mutations in its genomic sequence, especially in the spike protein region. World Health Organization (WHO) has designated it as a global variant of concern (VOC) and has named as Omicron. A surge in new COVID-19 cases have been reported from certain geographical locations, primarily in South Africa (SA) following the emergence of Omicron. Materials and methodsWe performed an in silico analysis of the complete genomic sequences of Omicron available on GISAID (until 2021-12-10) to predict the functional impact of the mutations present in this variant on virus-host interactions in terms of viral transmissibility, virulence/lethality, and immune escape. The mutations present at the receptor binding domain (RBD) of the variants were assessed using an open analysis pipeline which integrates a yeast-display platform with deep mutational scanning. Further, we performed a correlation analysis of the relative proportion of the genomic sequences of specific SARS-CoV-2 variants (in the period of 01 Oct-10th Dec, 2021) with the current epidemiological data (new COVID-19 cases and deaths) from SA to understand whether the Omicron has an epidemiological advantage over existing variants. ResultsCompared to the current list of global VOCs/VOIs (as per WHO) Omicron bears more sequence variation, specifically in the spike protein and host receptor-binding motif (RBM). Omicron showed the closest nucleotide and protein sequence homology with Alpha variant for the complete sequence as well as for RBM. The mutations were found primarily condensed in spike region (28-48) of the virus. Further, the mutational analysis showed enrichment for the mutations decreasing ACE2-binding affinity and RBD protein expression, in contrast, increasing the propensity of immune escape. An inverse correlation of Omicron with Delta variant was noted (r=-0.99, p< .001, 95% CI: -0.99 to - 0.97) in the sequences reported from SA post-emergence of the new variant, later showing a decrease. There has been a steep rise in the new COVID-19 cases in parallel with increase in the proportion of Omicron since the first case (74-100%), on the contrary, the incidences of new deaths have not been increased (r=-0.04, p>0.05, 95% CI =-0.52 to 0.58). ConclusionsOmicron may have greater immune escape ability than the existing VOCs/VOIs. However, there are no clear indications coming out from the predictive mutational analysis that the Omicron may have higher virulence/lethality than other variants, including Delta. The higher ability for immune escape may be a likely reason for the recent surge in Omicron cases in SA. HighlightsO_LIHigher immune escape ability than the existing VOCs/VOIs C_LIO_LINo clear indications of increased affinity for ACE2 binding C_LIO_LIDriving a new COVID-19 wave in South Africa C_LIO_LIOutcompeting Delta variant C_LIO_LICurrently, no clear evidence for increased virulence/lethality C_LI
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ImportanceHigher risks of contracting infection, developing severe illness and mortality are known facts in aged and male sex if exposed to the wild type SARS-CoV-2 strains (Wuhan and B.1 strains). Now, accumulating evidence suggests greater involvement of lower age and narrowing the age and sex based differences for the severity of symptoms in infections with emerging SARS-CoV-2 variants. Delta variant (B.1.617.2) is now a globally dominant SARS-CoV-2 strain, however, current evidence on demographic characteristics for this variant are limited. Recently, delta variant caused a devastating second wave of COVID-19 in India. We performed a demographic characterization of COVID-19 cases in Indian population diagnosed with SARS-CoV-2 genomic sequencing for delta variant. ObjectiveTo determine demographic characteristics of delta variant in terms of age and sex, severity of the illness and mortality rate, and post-vaccination infections. DesignA cross sectional study SettingDemographic characteristics, including vaccination status (for two complete doses) and severity of the illness and mortality rate, of COVID-19 cases caused by wild type strain (B.1) and delta variant (B.1.617.2) of SARS-CoV-2 in Indian population were studied. ParticipantsCOVID-19 cases for which SARS-CoV-2 genomic sequencing was performed and complete demographic details (age, sex, and location) were available, were included. ExposuresSARS-CoV-2 infection with Delta (B.1.617.2) variant and wild type (B.1) strain. Main Outcomes and MeasuresThe patient metadata containing details for demographic and vaccination status (two complete doses) of the COVID-19 patients with confirmed delta variant and WT (B.1) infections were analyzed [total number of cases (N) =9500, Ndelta=6238, NWT=3262]. Further, severity of the illness and mortality were assessed in subsets of patients. Final data were tabulated and statistically analyzed to determine age and sex based differences in chances of getting infection and the severity of illness, and post-vaccination infections were compared between wild type and delta variant strains. Graphs were plotted to visualize the trends. ResultsWith delta variant, in comparison to wild type (B.1) strain, higher proportion of lower age groups, particularly <20 year (0-9 year: 4.47% vs. 2.3%, 10-19 year: 9% vs. 7%) were affected. The proportion of women contracting infection were increased (41% vs. 36%). The higher proportion of total young (0-19 year, 10% vs. 4%) (p=.017) population and young (14% vs. 3%) as well as adult (20-59 year, 75% vs. 55%) women developed symptoms/hospitalized with delta variant in comparison to B.1 infection (p< .00001). The mean age of contracting infection [Delta, men=37.9 ({+/-}17.2) year, women=36.6 ({+/-}17.6) year; B.1, men=39.6 ({+/-}16.9) year and women= 40.1 ({+/-}17.4) year (p< .001)] as well as developing symptoms/hospitalization [Delta, men=39.6({+/-} 17.4) year, women=35.6 ({+/-}16.9) year; B.1, men=47({+/-}18) year and women= 49.5({+/-}20.9) year (p< .001)] was considerably lower. The total mortality was about 1.8 times higher (13% vs. 7%). Risk of death increased irrespective of the sex (Odds ratio: 3.034, 95% Confidence Interval: 1.7-5.2, p<0.001), however, increased proportion of women (32% vs. 25%) were died. Further, multiple incidences of delta infections were noted following complete vaccination. Conclusions and RelevanceThe increased involvement of young (0-19 year) and women, lower mean age for contracting infection and symptomatic illness/hospitalization, higher mortality, and frequent incidences of post-vaccination infections with delta variant compared to wild type strain raises significant epidemiological concerns. Key PointsO_ST_ABSQuestionC_ST_ABSDid SARS-CoV-2 B.1.617.2 (Delta) variant infections show varied demographic characteristics in comparison to wild type strains? FindingsIn this cross sectional study viral genomic sequences of 9500 COVID-19 patients were analyzed. As the key findings, increased involvement of young (0-19 year) and women, lower mean age for contracting infection and symptomatic illness/hospitalization, higher mortality, and frequent incidences of post-vaccination infections with delta variant in comparison to wild type (WT) strain (B.1) were observed. MeaningThe findings of this study suggest that delta variant has varied demographic characteristics reflecting increased involvement of the young and women, and increased lethality in comparison to wild type strains.
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India recently witnessed a devastating second wave of COVID-19, which peaked by the end of the first week of May 2021. We aimed to understand formation and spread of the second wave in the country. We analyzed time series distribution of the genomic sequence data for SARS-CoV-2 and correlated that with the epidemiological data for new cases and deaths, for the corresponding period of the second wave. Further we analyzed the phylodynamics of the circulating SARS-CoV-2 variants in the Indian population in the period of study. Our analysis shows that the first indications of arrival of the second wave were observable by the end of January 2021, and by the end of March, 2021 it was clearly indicated. B.1.617 lineage variants drove the wave, particularly B.1.617.2 (a.k.a. delta variant). Based on the observations of this study, we propose that genomic surveillance of the SARS-CoV-2 variants augmented with epidemiological data can be a promising tool for forecasting imminent COVID-19 waves.
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BACKGROUND: Effective postoperative analgesia leads to early mobilization, fewer pulmonary complications, and shorter hospital stay. AIMS: We compared the analgesic effects of ultrasound-guided intercostal nerve (ICN) blocks, subcostal transversus abdominis plane (SCTAP) block, and a control group in open cholecystectomy. SETTINGS AND DESIGN: This was a prospective, randomized controlled, double-blind, multi-arm and parallel study. MATERIALS AND METHODS: The study was conducted on patients of American Society of Anaesthesiology Physical Status Classes I and II, either sex, 18-60 years of age, and body mass index 18-30 kg.m-2. Exclusion criteria were infection at the injection site, coagulopathy, thrombocytopenia, and allergy to the drugs used. Group I (n = 41) received ICN blocks, Group T (n = 41) SCTAP block, and Group C (n = 41) no postoperative block. The duration of analgesia was the primary outcome, and the analgesic consumption, the pain intensity, adverse events, and patient satisfaction were the secondary outcomes. STATISTICAL ANALYSIS: For the continuous data, analysis of variance was used for multiple group comparison and intergroup data were analyzed by Student's t-test. Kruskal-Wallis and Mann-Whitney U tests were applied for ordinal data. P = 0.05 or less was considered statistically significant. RESULTS: The duration of postoperative analgesia was significantly longer in the ICN (mean = 441.6 min; 95% confidence interval [CI], 407.71, 475.49) and SCTAP block (mean = 417.6 min; 95% CI, 390.94, 444.26) as compared to control (mean = 33.98 min; 95% CI, 26.64, 41.32) (P = 0.00) with no significant intergroup difference between the two intervention groups (P = 0.278). The cumulative analgesic consumption was not significantly different between the intervention groups but was significantly reduced in the study groups when compared with the control group (P < 0.001). No notable adverse events were observed. Patients with both the techniques were very satisfied in comparison with the control group (P = 0.00). CONCLUSION: Both the ICN and SCTAP blocks have similar results in terms of analgesia and patient satisfaction for cholecystectomy.
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Monkey and other hominids species have 5 sacral segments in 10% cases. The similar frequencies for each 6-segmented and 4-segmented sacra in human are known as lumbo-sacral transitional vertebra (LSTV). Achieving the erect posture in human has necessitated much skeletal modification, but these are more apparent in the lumbosacral region. Sacral kyphosis is a distinguishing feature of the human sacrum, which helps to differentiate them from the animal. The monkey has a sacral index near 80, and humans a sacral index is near 100. The sacral index was 88 in six-segmented sacra with negligible sacral kyphosis, having sacralisation of the 5th lumbar vertebra. Therefore, SI is 88 and lack of sacral kyphosis challenge its human origin. On the contrary, gross morphology, actual sacral index, and comparison with apes gave sufficient evidence of human origin. Later excluding 5th Lumbar vertebra, the sacral index is 107.34 and might belong to a male which corresponds with bone bank record
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Humanos , Animais , Região Lombossacral/anatomia & histologia , Cifose/complicações , Sacro/anormalidades , Sacro/anatomia & histologia , Região Lombossacral/anormalidades , Antropometria , Sacro/diagnóstico por imagem , Primatas/anormalidadesRESUMO
