Background: Primary dysmenorrhea (PD) is characterized by cramping lower abdomen pain that may radiate to the lower back and upper thigh and commonly associated with stress, headache, and diarrhea, and thereby decreases the quality of life. It occupies 20%–90% of the female population in reproductive age. Many conservative treatment methods such as yoga asana, physiotherapy through gym ball/therapy ball/Swiss ball exercises, etc., are available to treat them. More efficient among them is not known. Purpose: The aim is to compare the efficacy of yoga asana and gym ball/therapy ball/Swiss ball exercises in the management of female with PD. Methodology: A total of 30 female with PD were recruited by the simple random sampling to participate in this two group pretest-posttest, single-blinded randomized clinical study. Recruited female with PD were randomly allocated into two groups, Group A and Group B. Group A were provided with yoga asana for 60 s duration × 5 repetition/session/day × 3 days/week × 12 weeks. While Group B received set of gym ball exercises for 10 s hold ×12 times/set × 3 sets/day × 3 days/week × 12 weeks. Level of menstrual distress (MOOS Menstrual Distress Questionnaire [MDQ]) and pain scores (visual analog score ([VAS]) were documented at baseline and 12^th week after intervention and analyzed. Results: Group B demonstrated significance difference (P < 0.05) in MDQ and VAS when compared to Group A. Conclusion: Twelve-week gym ball exercises have the sufficient potential to decrease level of menstrual distress and related pain among female with PD when compared to yoga asanas.

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Background: Central obesity has been established to be linked with increased cardiometabolic health risks. Waist circumference (WC), conicity index (CI), and A Body Shape Index (ABSI) are anthropometric proxy for central obesity. Maximal aerobic capacity (V̇O_2max) provides an estimation of cardiorespiratory fitness of an individual. Decrease in V̇O_2maxhas also been established to be associated with increased health risk. Aim: The aim of the study was to find out correlation between central obesity parameters and V̇O_2max. Materials and Methods: A cross-sectional study was conducted with 154 young adults (male = 90 and female = 64) who were in daily exercise. WC, height, and weight were measured to calculate CI and ABSI according to formulae. V̇O_2maxwas estimated by submaximal exercise test – 1.5 mile run test. Pearson's correlation coefficient was used to find out correlation between central obesity parameters and V̇O_2max. Results: Mean age of male and female was 21.89 ± 3.65 years and 21.06 ± 2.92 years, respectively. Correlation coefficient between WC and V̇O_2maxwas r = −0.61 (P < 0.001), ABSI and V̇O_2maxwas r = −0.46 (P < 0.001), and CI and V̇O_2maxwas r = −0.59 (P < 0.001). Conclusion: Central obesity anthropometric parameters were negatively associated with V̇O_2max. WC showed higher negative correlation with V̇O_2maxthan CI and ABSI. Hence, CI and ABSI are not better predictor variable in comparison with simple WC for V̇O_2max. Further studies are needed to explore this association for general population.

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Background and Objectives: Tubercle of Zuckerkandl (TZ) is the posterior or posterolateral extension of thyroid gland. Recurrent laryngeal nerve (RLN) is related to TZ either on its posterior or posteromedial aspect in the deeper fascial plane. The objective of this review is to report separately the prevalence of TZ as noted by anatomists and surgeons. Materials and Methods: An extensive search for articles with TZ either in the title or keywords was done using PubMed, ScienceDirect, Google Scholar, SciELO, EMBASE, and Web of Science databases. The search terms were restricted to TZ, Zuckerkandl tubercle, posterolateral extension of thyroid, RLN, and thyroid surgeries. Results: Out of 39 records, 25 studies, reported total number of sides where TZ was studied with prevalence percentages (n = 4231 sides). This included 6 cadaveric studies and 19 surgical studies. Combined pooled prevalence of TZ was found to be 76.5%. Prevalence in cadaveric and surgical studies was 84% and 69%, respectively. Overall, 15 studies reports RLN is related to posterior or posteromedial to TZ. Conclusions: The prevalence of TZ is 76.5%. When present, it is a useful guide for locating, dissecting, and preserving RLN. Cadaveric studies report a higher prevalence of 84%, while surgical studies report an average of 69% TZ. Most surgical studies report higher right-sided prevalence.

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Introduction: Hyoid bone fracture is one of the most integral parts of internal examination during autopsy of hanging, ligature strangulation, or a throttling case. The reasons why some hyoids fracture and others do not may be related to the nature, magnitude, and position of the force applied to the neck, age of victim, nature of instrument (ligature or hand) used to strangle, and intrinsic anatomical features of the hyoid bone, such as rigidity and shape of the bone and symmetry of greater horns. Materials and Methods: The material for the present study comprised of 30 dried hyoid bones (M:F: 15:15). Their outline was drawn on the graph paper to study the symmetry and isometry of the bone. Results: Forty percent of the hyoids bones were symmetrical, while 60% were asymmetrical. Similarly, the number of anisometric bone is more (86.6%) as compared with isometric bone (13.3%) in both the sexes. Conclusion: Hyoid bone is not bilaterally symmetrical bone. The incidence of asymmetrical and anisometric bones is more as compared with symmetrical and isometric bones in both the sexes.

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Introduction: Prosthodontic rehabilitation aims to achieve the best possible facial esthetic appearance for a patient. Attaining facial symmetry forms the basic element for esthetics, and knowledge of the midline of face will result in a better understanding of dentofacial esthetics. Currently, there are no guidelines that direct the choice of specific anatomic landmarks to determine the midline of the face or mouth. Most clinicians choose one specific anatomic landmark and an imaginary line passing through it. Thus, the clinician is left with no established guidelines to determine facial midline. Objective: The purpose of the study is to digitally determine the relationship of facial landmarks with midline of face and formulate a guideline for choosing anatomic landmark among Punjabi population. Materials and Methods: Three commonly used anatomic landmarks, namely nasion, tip of the nose, and tip of the philtrum, were marked clinically on 100 participants (age range: 21–45 years). Frontal full-face digital images of the participants in smile were then made under standardized conditions. Midline analysis was carried out digitally using an image analyzing software. The entire process of midline analysis was done by a single observer and repeated twice. Reliability analysis and one-sample t-tests were conducted. Results: The results indicated that each of the four landmarks deviated uniquely and significantly (P < 0.001) from the midlines of the face as well as the mouth. Conclusions: Within the limitations of the study, the hierarchy of anatomic landmarks closest to the midline of the face in smile was as follows: (1) Intercommissural midlines, (2) Tip of philtrum, (3) Nasion, (4) Tip of the nose, and (5) Dental midlines. The hierarchy of anatomical landmarks closest to the intercommissural/mouth midline was: (1) Tip of philtrum, (2) Tip of the nose, (3) Nasion, and (4) dental midline.

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Objective: The main objective study was to evaluate the new-onset cases of pleural effusion with respect to etiology/causation. Materials and Methods: A total of 1000 patients were included in the study aged between 18 and 70 years. The patients with earlier diagnosis of pleural effusion or those who had undergone thoracocentesis were excluded from the study. All the patients were subjected to thorough clinical examination, chest radiography, chest and abdominal sonography, pleural fluid analysis, and pleural fluid cytology, and in select cases, pleural biopsy was done. The results were assimilated and tabulated, observations thereby drawn by. Results and Observations: Out of total 1000 patients, 69.5% had tuberculosis followed by malignancy (16%) with the systemic causes forming about 15% bulk of the patients with pleural effusion. It was found more in males, associated with smoking, and majority of patients had unilateral effusion. Eighty-nine percent of patients had exudative effusion. Conclusion: The results of the study revealed that tuberculosis is still the most common cause of pleural effusion and efforts need to be stepped up to control tuberculosis. The national programs for control of tuberculosis need to be revisited to assess the magnitude of the problem, and the patients need to be counseled for the compliance of the therapy. Furthermore, malignancy is trending upward in the etiology of pleural effusion.

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Context: Patients are fasting for inappropriately long duration preoperatively despite the American Society of Anesthesiologists (ASA) recommendations for liberal fasting guidelines. There is paucity of data on preoperative fasting duration in the day care patient population from India; hence, we studied the preoperative fasting status in the day care patient population. Aims: This study aims to study the preoperative fasting duration for solids and clear fluids and to compare the fasting times in the patients posted for the morning slot and the afternoon slot. Settings and Design: This was a prospective, observational, cross-sectional study at a tertiary care, teaching institute. Subjects and Methods: All Consenting adults, ASA grade 1 or 2, of either gender, presenting for day care surgery were included in the study. Data collected included the demographic profile, duration of fasting for solids, and clear fluids. The patients rated their hunger and thirst on a ten point numeric rating scale. We compared the fasting durations for solids and clear fluids in the patients presenting for the morning slot and afternoon slot for surgery. Statistical Analysis Used: T-test was used for analysis of continuous data with normal distribution and Mann–Whitney U-test for data with nonnormal distribution. Chi-square test was performed for categorical variables. Differences were considered significant at P < 0.05. Results: The mean duration of preoperative fasting for solids was 12.58 ± 2.70 h and for clear fluids was 9.02 ± 3.73 h. The mean fasting duration for solids in the patients presenting for the afternoon slot was significantly longer (P < 0.0001) than those presenting for the morning slot. The mean preoperative fasting duration for clear fluids was comparable among these patient groups (P = 0.0741). Conclusions: Patients are following inappropriately prolonged fasting routines, and there is a need to enforce liberal preoperative fasting guidelines to improve patient care.

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Canalicular adenomas (CAs) are uncommon benign salivary gland neoplasms of the oral cavity. They are typically located on the upper lip, buccal mucosa, and infrequently found on the palate and derived from minor salivary glands. Due to benign character of the tumor, CAs rarely present with bone erosion. Histologically, trabecular type of basal cell adenoma, pleomorphic adenoma, and polymorphous low-grade adenocarcinoma should be discriminated from CAs. A-36-year-old female patient with CA was presented. The lesion was managed surgically under local anesthesia, and 2 months follow-up was uneventful.

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Background: Overweight and obesity are important addendum to the pool of risk factors for noncommunicable disease (NCD) among the elderly. Objectives: The objectives of this study were to find (1) the proportion of overweight and obesity and (2) the distribution of overweight and obesity based on sociodemographic characteristics and four major risk factors for NCDs (smoking, alcohol consumption, unhealthy diet, and physical inactivity) among the elderly attending the out-patient department/NCD clinic of a Urban Health and Training Centre (UHTC). Materials and Methods: This facility-based descriptive study was conducted among 181 elderly attending one UHTC, in Puducherry during June and July 2015. A pretested interview schedule was used to obtain information on sociodemographic details and history of NCD risk factors after obtaining verbal informed consent. Anthropometric measurements were taken as per standard procedures prescribed by the World Health Organization. Body mass index (BMI) was calculated and classified using BMI classification for the Asian population. Results: Among the elderly, 18% were overweight and 51% were obese. The proportion of obesity was more among females than males. Obesity was found to be decreasing with increase in age. Overweight and obesity were found to be significantly inversely related to chronic disease status. Overweight and obesity were proportionately more among elderly who were consuming alcohol and doing less physical activity than prescribes. However, the proportion of overweight/obees elderly with no tobacco use and not having unhealthy diet was found to be more than their counterpart. Conclusion: Overweight and obesity are important public health problems in the study population. Hence, interventions should be implemented targeting elderly as well as the adult to decrease the obesity and overweight among the elderly.

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Introduction: Biomedical Waste Management (BMW) Rules came into legislation in 1998 with periodic amendments; two in 2000, one in 2003 with latest revision of rules in 2016. It is essential to assess the level of awareness of health personnel regarding revisions in health related policies so that they are updated adequately for provision of quality health care services. Methodology: A cross sectional study was undertaken in November 2016 among 203 nursing students students to ascertain their level of understanding of recent amendments in BMW management rules. A 35 item, self administered, pretested, structured, closed ended, anonymous questionnaire was used for data collection. Results: The scores of the majority (86.2%) of the participants fell in poor category, 13.3% in fair, only 0.5% in good while none in excellent category. The scores gradually increased from second to final year; 9.80 ± 2.36, 11.38 ± 2.48 and 12.02 ± 2.79 respectively (P < 0.001). Nearly 60.3% and 86.2% of the participants showed positive attitude and safe practice habits respectively. Conclusion: For effective implementation of biomedical waste management practices in the hospitals; periodic sensitization and continuous training programs focusing on the recent amendments and advances should be made mandatory.

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A majority of unsafe abortions are performed by untrained quacks leading to multiple complications which contribute to significant maternal morbidity and mortality. We report an unusual and late complication of unsafe abortion, where a red rubber tube which was believed to be left in the patient's body during an abortion conducted at home about 1 year ago, later got extruded out of the patient's body, through abdomen and eroding the pelvic bone, but fortunately causing no damage to any abdominal organs.

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Background: Childhood diabetes mellitus (DM) has been described among children in developed world, with a very scant report among African children, especially those in rural areas. Aim: This study aimed to describe the prevalence, presentation, and outcome of DM among children seen in a rural tertiary hospital in North-West Nigeria. Materials and Methods: This was a 10-year retrospective study of children with DM seen in the Pediatric Department of Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria. Relevant demographic data, clinical presentation, and outcome were extracted and analyzed. Results: Nine of the 6269 of the children admitted during the study period had Type 1 DM, giving a prevalence of 1.4/1000 admissions. The mean age was 12.7 years, with a slight female preponderance. The mean duration of symptoms prior to presentation was 13.7 days and all the patients presented with diabetes ketoacidosis (DKA). All the patients recovered fully and were discharged to endocrine clinic, but only three children are being followed up. Conclusion: DKA was the only mode of presentation among children with DM in this series, with surprisingly excellent outcome but a high default rate.

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Background: Prescription orders serve as a source of communication linking the physician, patient, and pharmacist. However, inappropriate prescriptions may result in medication errors, thus may worsen clinical outcome and economic burden of the patient. Therefore, this study aimed at evaluating the quality of prescription orders in terms of completeness, appropriateness, and authenticity at a tertiary health-care facility in Nigeria. Methods: A retrospective, cross-sectional review of prescription orders from the Outpatient Pharmacy of the Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria. Data collection was done using a data collection form adopted from the World Health Organization (WHO) guideline for good prescription practice. This study was carried out between July and December 2012. Descriptive statistics were used for the purpose of analyzing extracted data. Results: Five hundred prescriptions were used in the study. Prescriptions containing the name of the prescribers and patients name and address were 0.8% and 97.8%, respectively. The age and body weight of the patients were documented in 17.6% and 38.8% of the prescriptions in that order. Thirty-five percent of the drugs were written in generic names, while most of the prescription orders had well-documented dosage form (95.6%), date of prescription (90.6%), and prescriber's initials or signature (83.0%). The direction for use by the physician was clearly written in <1½ (38.8%) of the prescriptions. Conclusion: Our findings suggest deviation from complete adherence to the basic principle of good prescription writing recommended by the WHO among medical practitioners in the study setting.

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Background: Occupational risk of human immunodeficiency virus (HIV) transmission creates barriers in the surgical health care of patients with HIV infection. Poor awareness, prevalent misconceptions, and associated stigma lead to discrimination against HIV-infected patients. This study was carried out to assess effectiveness of a “HIV awareness program” (HAP) to educate and motivate health-care workers to provide equitable and ethical health care to HIV-infected patients. Methodology: An interventional study was conducted at a secondary level mission hospital in Central India from April 2014 to August 2015. Change in knowledge, awareness, and attitude following a multimedia “HAP” was analyzed with a “pre- and posttest design.” Seventy-four staffs and trainees participated in the program. Z-test and t-test were used to check the statistical significance of the data. Results: The mean pretest score was 19.31 (standard deviation [SD]: 6.0, 95% confidence interval [CI]: 17.923–20.697) and the mean posttest score was 30.84 (SD: 4.8, 95% CI: 29.714–31.966). This difference was statistically significant at the 5% level with P < 0.001. Conclusions: “HAP” was effective in changing the knowledge, awareness, and attitude of the staffs and trainees of the secondary hospital toward surgical care of HIV-infected patients.

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Urinary stones are one of the most common complications of urinary diversions. We report the case of a 40-year-old man with renal and ureteric stones after radical cystectomy and ileal conduit. Normally renal stones are fragmented and removed through the ureters and urethra. However, in this patient with ileal conduit, the neo ureteric orifices being extremely narrow and because of the delicate wall of the ileum percutaneous nephrolithotomy has become the best option of treatment.

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Persistent sciatic artery (PSA) is a rare but pertinent clinical entity that may pose a threat to the viability of the lower extremity. The incidence of PSA has been estimated to be between 0.01% and 0.05%. PSAs are prone to high incidence of aneurysm formation, thrombosis, distal embolization, and rupture. Early detection of a PSA as the main vascular supply to the lower limb helps in early surgery and avoids potential severe complications such as limb ischemia. We report a case of a female patient who was diagnosed with a case of lumbar disc compression and sciatica but had a PSA aneurysm with thrombosis and distal embolization leading to acute limb ischemia.

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