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Our aim was to assess the preliminary clinical outcomes of interventional radiology for salivary duct obstruction in relation to salivary duct strictures or calculi. A retrospective analysis of consecutive patients referred for endoluminal procedures by ENT surgeons during a 4-year period were identified. The procedure was performed by a single interventional radiologist under fluoroscopic guidance using wire baskets and angioplasty balloons. Between June 2004 and October 2008, 50 sialoplasties were performed in 43 patients (30 female and 13 male). Twenty-six patients were prepared for 32 procedures for extraction of calculi (13 submandibular and 13 parotid), and 17 patients had 18 procedures for strictures (16 parotid and 1 submandibular). One patient in the group with calculi was judged unsuitable for intervention because the stone had migrated outside the salivary duct. Information was collected regarding the clinical indication; duration and type of symptoms; technical factors; follow-up; and success or failure of reintervention. Complete stone removal was achieved in 18 of the 26 patients (69%), with success on the first attempt in 14 patients (54%). Redo procedures were required in 4 patients (15%), with subsequent complete clearance of calculi. In this cohort, 20 patients were symptomatically improved (77%). Of the 6 patients (26%) with continuing symptoms, 2 patients had mild symptoms; two had moderate symptoms; and two patients opted to have surgery for unremitting symptoms. In the stricture group, 18 procedures were performed in 17 patients, with a successful outcome in 16 patients after the initial sialoplasty. Only 1 patient required repeat intervention (6%) and later opted to have surgery for continuing symptoms. In this group, 14 patients (82%) were symptomatically improved, and 3 remained symptomatic despite a good immediate result due to restenosis. Two patients experienced early complications: One had a transient facial nerve palsy, and the other had sialadenitis treated with antibiotics. Preliminary results suggest that symptom resolution at first intervention is higher in patients with acalculous strictures. Patients with calculi are more likely to require a repeat procedure for complete clearance.

Rotator cuff tears are a common cause of shoulder pain and can result in prolonged periods of pain, disability and absence from work. Rotator cuff repair surgery is increasingly used in an attempt to resolve symptoms but has failure rates of around 40%. There is a pressing need to improve the outcome of rotator cuff repairs. Patch augmentation increasingly being used within the NHS in an attempt to reduce repair failures. The aim of this survey was to determine current UK practice and opinion relating to the factors that influence choice of patch, current patient selection and willingness to assist with generation of improved evidence. An online survey was sent to the surgeon members of the British Elbow and Shoulder Society (BESS). Questions covered respondent demographics, experience with patches, indications for patch augmentation and willingness to be involved in a randomised trial of patch augmented rotator cuff surgery. The response rate was 105/550 (19%). 58% of respondents had used a patch to augment rotator cuff surgery. 70% of patch users had undertaken an augmented repair within the last 6 months. A wide surgical experience in augmentation was reported (ranging 1 to 200 implants used). However, most surgeons reported low volume usage, with a median of 5 rotator cuff augmentation procedures performed. At least 10 different products had been used. Most of the patches used were constructed from human decellularised dermis tissue, although porcine derived and synthetic based patches had also been used. Only 3-5% stated they would undertake an augmented repair for small tears across ages, whereas 28-40% and 19-59% would do so for large or massive tears respectively. When assessing patient suitability, patient age seemed relevant only for those with large and massive tears. Half of the surgeons reported an interest in taking part in a randomised controlled trial (RCT) evaluating the role of patch augmentation for rotator cuff surgery, with a further 22% of respondent's undecided. A variety of patches have been used by surgeons to augment rotator cuff repair with a wide range of operator experience. There was substantial uncertainty about which patch to use and differing views on which patients were most suitable. There is a clear need for robust clinical evaluation and further research in this area.

Background Focal entrapment of the common fibular (peroneal) nerve (CFN) is the most common nerve entrapment in the lower extremity. Accurate diagnosis can be difficult due to co-existent pathology such as low back pathology. A 1% lidocaine block of CFN is often used to confirm the local entrapment pathology and demonstrate possibility of pain relief. A surprising, unexpected and temporary strengthening of CFN supplied ankle and foot muscles is occasionally produced, termed the Phoenix sign. Aetiology of this phenomenon has been puzzling, but restoration of neural circulation and nutrition via improved local blood flow has been postulated to be responsible. Methods This is a double-blinded, randomized, prospective controlled trial of 20 patients, comparing 2 vasodilating agents and their ability to produce the Phoenix effect. Ultrasound guided infiltration of 0.3 mL 1% lidocaine or papaverine HCl 10 mg/mL was executed adjacent to CFN. Motor strength pre- infiltration and 4 min post-infiltration were measured for anterior compartment muscles utilizing MRC manual motor testing reported on a 0–5 scale. The extensor hallucis longus (EHL) muscle proved to be the most significant. Results Average motor strength of the EHL improved from 2.2 (+/-0.40) to 4.9 (+/-0.32).) in the lidocaine group. In the papaverine group, pre-infiltration EHL motor strength averaging 2.1 (+/-0.93) improved to 4.4 (+/- 1.01) post-infiltration. Papaverine and lidocaine produced similar statistically significant increases in muscle strength (p = < 0.05). Conclusion There was no difference between small local infiltrations of lidocaine or papaverine in production of increased anterior compartment EHL motor strength. It is most likely that the Phoenix Effect is explained by temporary local improvements in the microcirculation of the CFN vasa nervorum. Trial Registration NCT06637046 10/10/2024 Retrospectively registered.

It can take several years to become proficient at direct ophthalmoscopy; the instrument’s single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient’s perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method.

The Consumer Protection Act (CPA) 2019 represents one of the most important updates to India’s consumer rights framework since the original law was enacted in 1986. This paper takes a close look at how the revised Act reshapes the relationship between consumers, businesses, and regulators at a time when digital transactions are becoming the norm. It outlines the key features of the new law, including the introduction of e-commerce rules, product liability provisions, and tougher action against misleading advertisements. By comparing the 2019 Act with its 1986 counterpart, the paper shows how the legal system has shifted toward a more modern and responsive approach that better reflects today’s consumer behavior. To support this discussion, the study uses charts and tables that trace patterns in consumer complaints, growth in online shopping, and the performance of dispute-redressal forums at various levels. These visual elements help illustrate how consumer issues have changed, especially with the rapid rise of digital commerce. The paper also includes real-world case studies that demonstrate how the new provisions work in practice and how they have strengthened consumer rights.  The findings suggest that CPA 2019 has made the consumer protection system more transparent, more accountable, and better equipped to deal with the challenges of modern markets. However, the study also notes that the Act’s impact will depend heavily on continued public awareness, efficient grievance-handling systems, and stronger regulatory capacity. Overall, the research concludes that while the 2019 Act is a major improvement, its long-term effectiveness will require ongoing commitment from both consumers and enforcement agencies.

Acyclovir is an antiviral drug that is frequently prescribed for the herpes virus. However, the drug requires frequent dosing due to limited bioavailability (10–26.7%). The rationale of the present study was to develop a self-dissolving microneedle system for local and systemic delivery of acyclovir using a topical lyophilized wafer on microneedle-treated skin to provide the drug at the site of infection. The microneedles prepared with hydroxypropyl methylcellulose (HPMC) (8% w/w) or HPMC (8% w/w)-polyvinyl pyrrolidone (PVP) (30% w/w) penetrated excised rat skin, showing sufficient mechanical strength and rapid polymer dissolution. The topical wafer was prepared with acyclovir (40% w/w; equivalent to 200 mg of drug), gelatin (10% w/w), mannitol (5% w/w), and sodium chloride (5% w/w). The uniform distribution of acyclovir within the wafer in an amorphous form was confirmed by differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA). No polymer–drug interaction was evident in the lyophilized wafer as per Fourier transform infrared spectroscopy (FTIR) analysis. The wafer showed a sufficiently porous structure for rapid hydration as per scanning electron microscopy (SEM) analysis. During ex-vivo analysis, the skin was pre-treated with a self-dissolving microneedle array for 5 minutes, and the wafer was placed on this microporated-skin. Topical wafer provided ∼7–11 times higher skin concentration than the ID99 reported with a lower lag-time. Based on in-vivo testing, ∼2.58 µg/ml of Cmax was achieved in rabbit plasma during 24 hours’ study. Our findings suggest that the self-dissolving microneedle-assisted topical wafer, proposed for the first time, would be efficacious against the infection residing in the skin layer and for systemic therapy.