Despite limited evidence, to support movement and weight limitations following median sternotomy, sternal restrictions are routinely prescribed. This systematic review aims to determine what the literature defines as sternal restrictions, how sternal restrictions are applied and progressed; what are the less restraining sternal restrictions, revised sternal restrictions, and uniformity in the prescription of sternal restrictions. (N=2027) studies were identified. Databases screened were CINAHL (1957), PubMed (47), EMBASE (06), ICTRP (04), and COCHRANE (13). After including scholarly articles, screening records, removing duplicates, and including potentially relevant articles, Five (n = 5) studies were included in the qualitative synthesis. Studies included papers written in English. A precautionary approach, rather than a restraining attitude would expedite better healing and practicable recovery post-median sternotomy. This comprehensive analysis clearly supports the fact that patients need progressive rehabilitation after surgery to enhance thoracic motion, pulmonary function, symptoms, and functional status.

Ventriculoperitoneal shunt (VPS) insertion is the most widely performed surgical procedure for the treatment of hydrocephalus across all age groups but is associated with several complications. The objectives of the present review were to review the demographics, clinical characteristics, operative procedures executed, postoperative major complications, and outcome of the cases published on the management of migration of the distal VPS catheter into the urinary bladder with or without per-urethral extrusion. PubMed, Medline, PubMed Central, Embase, ResearchGate, and Google Scholar database online search was performed to retrieve the published/available literature relating to the above-mentioned complication. Literature/Case reports were retrieved from the year 1974 to June 30, 2020, and those were available in the English language. Thirty-seven cases were included for review, and included n = 20 (54.05%) male, n = 15 (40.54%) female and gender details were not available for n = 2 (5.4%) of the cases. The mean age of the cases at the time of diagnosis of the above complication was 15.27 years. The mean interval from the VPS insertion to the diagnosis of the complication for the entire case was 4.7 years and ranged from 1 day to 26 years. Surgical procedures were performed for the management and were in order of frequency as; (a) removal of entire VPS catheter n = 20, (b) removal of distal VPS catheter n = 10, (c) removal/relocation of distal VPS catheter n = 6, and (d) details not available n = 1. Migration of the distal VPS catheter into the urinary bladder with or without per-urethral extrusion occurred across all the age groups. Seventy percent of the cases were children below the age of 15 years. In 50% of the cases, the complication was documented within 24 months after the VPS insertion. In two-third of the cases, repair of the urinary bladder perforation was not done and that healed spontaneously after the removal of the intra-vesical migrated VPS catheter.

Background: Blood group determination is done by the slide test and tube test. Grading/scoring of hemagglutination reactions is performed through the naked eye and microscopy to detect spurious (false positive and negative) reactions. Objectives: In our observational study, comparative scoring of ABO and Rh hem-agglutination reactions was done based on degree of hemolysis and agglutination through the macroscopic and microscopic technique. Materials and Methods: The determination of blood group of 209 participants was done by the porcelain slide method using commercially prepared antisera (manufactured by TULIP DIAGNOSTICS (P) LTD.) containing anti-A, anti-B, and anti-D monoclonal antibodies followed by scoring/grading based on degree of hemolysis and red blood cell clumping. The data were statistically analyzed using the Chi-square test and Z-test of proportion. Results: ABO hemagglutination reactions showed significantly higher score ([A-Macro Z = 7.153, Micro Z = 4.65] [B-Macro Z = 11.17, Micro Z = 21]) (Z >2.5, P < 0.001) than Rh hemagglutination reactions. B hemagglutination reactions showed insignificantly higher score (B-Macro Z = 1.29, Micro Z = 1.816) (Z <1.95, P < 0.05) than A hemagglutination reaction. Conclusion: ABO hemagglutination reactions showed significantly higher score than Rh hemagglutination reactions as ABO system agglutinin are pentavalent (immunoglobulin M) binding 10 agglutinogens while that of Rh system are bivalent binding 4 agglutinogens. B hemagglutination reactions showed insignificantly higher score than A hem-agglutination reaction which required further evaluation.

Background and Aims: Orthopedic operation theater staff is exposed to primary and scattered radiation during various fluoroscopy-assisted operative procedures during their routine working hours. This exposure is associated with significant health hazard. This prospective study is designed primarily to determine the level of radiation exposure among them and to compare it with the current safety guidelines and secondarily to measure the cumulative scattered radiation exposure inside operation theater complex. Subjects and Methods: Total 15 thermoluminescent dosimeters (TLDs) were used during the study. Seven TLDs were used per team and per procedure at designated position. Participating staff were instructed to use personal protective equipment and to wear the TLDs at all times during their study period. TLDs were analyzed at the end of 6 months. Results: The mean value of radiation exposure of anesthesia machine, orthopedic surgeon, anesthetist with TLD above lead apron, anesthetist with TLD below lead apron, and scrub nurse was 0.05, 1.85, 0.1, 0, and 0.625 mSv units, respectively. The highest individual values for orthopedic surgeon, anesthetist with TLD above the lead apron, and scrub nurse were 2.75, 0.1, and 0.7 mSv units, respectively. All these readings were within permissible limit. Conclusions: If standard safety precautions were followed, cumulative ionizing radiation exposure to participating staff as well as scattered radiation exposure within operation theater complex is minimal and within permissible limit. Routine personal dosimetric monitoring is desirable in staff working with fluoroscopy-guided procedure along with the use of personal protective equipment. Periodic training on radiation risk and protection should be conducted for them to heighten the awareness.

Background: Diarrheal disease, injuries, and respiratory infections form the major chunk of diseases among adolescents. Hence, this study was carried out to study the seasonal variation among these three diseases. Aim: To study the seasonal variation among three diseases. Methods: A record-based retrospective study was conducted among students of a medical college in Western Maharashtra who reported to the General OPD. The data were collected for a period of 7 years from Jan 2012 to Mar 2019. The diseases were characterized under three board headings based on the predefined criteria. Results: All 10,881 sick reports of students reported during the period were included in the study. After exclusion, the data were analyzed for 6,322 sick reports. A total of 67% of the cases were of upper respiratory tract infection (URTI), followed by injuries (19%). On analyzing the seasonal variations among the three categories, it was observed that there was an increase in the cases of diarrhea in the postmonsoon months of September and October. Injuries were maximum from August to September. The seasonal trend could be seen in URTI cases with a maximum number of cases from January to March and August to October. Conclusions: The burden of these diseases could be reduced if we take measures to detect the changes in their trend through the implementation of surveillance programs.

Introduction: India is experiencing health transition with a rising burden of noncommunicable diseases (NCDs). There is a need to study risk factors of NCDs among poor and underprivileged section of the society. Methodology: A cross-sectional study was done among adults in an urban slum in Pune using the World Health Organization's STEP wise approach to surveillance (STEPS). Two hundred individuals selected by simple random sampling participated in this study. Information regarding dietary habits, physical activity, and tobacco and alcohol consumption was obtained. Physical measurements of height, weight, waist and hip circumference, and blood pressure were also done. Nominal and numerical variables in different groups were compared by Fisher's exact test and Student's t-test, respectively. Logistic regression was used to determine the association of various factors with high blood pressure. Results: Tobacco and alcohol consumption was observed in 22.5% (95% confidence interval [CI]: 16.9%–28.9%) and 11.5% (95% CI: 7.4%–16.8%) of individuals, which was significantly higher among males. 40.0% (95% CI: 33.2%–47.1%) of participants were doing less than recommended physical activity. 47% (95% CI: 40.0%–54.2%) of individuals were overweight or obese. The prevalence of high blood pressure was found to be 43.9% (95% CI: 36.6%–51.3%). Significant positive correlation was observed among different anthropometric variables. Multivariable logistic regression showed that there was significant positive association of high blood pressure with age (adjusted odds ratio [aOR] = 1.05 [95% CI: 1.02–1.08]) and waist hip ratio (aOR = 1.45 [95% CI: 1.01–2.09]). Conclusions: There is a high prevalence of risk factors for NCDs among residents of urban slum. Behavior change communication is required for adoption of healthy lifestyle and prevents NCDs in urban slums.

Purpose: Magnetic resonance imaging has revolutionized the evaluation of acute onset sensorineural hearing loss (SNHL). This study was carried out with an aim to diagnose the causes of acute onset SNHL with an attempt to compare the accuracy of high-resolution three-dimensional (3D) T2-weighted sequences with postcontrast 3D volumetric T1-weighted imaging. Materials and Methods: Two hundred and fifty-five cases of acute onset SNHL were evaluated using noncontrast sequence for brain and 3D DRIVE for seventh and eight cranial nerves. Postcontrast 3D volumetric T1 sequence was done for the whole brain. Results: Poor visualization of the semicircular canal (confirmed as labyrinthitis ossificans on computed tomography) was the most common cause of acute onset SNHL, followed by vestibular schwannoma. 3D DRIVE sequence was not able to detect seven cases of small intracanalicular vestibular schwannoma and enhancement of the seventh-eighth cranial nerves. However, these cases were detected on postcontrast sequence. Conclusion: As the sensitivity of the 3D DRIVE sequence was only 74.1%, it cannot be used as a screening tool for the evaluation of acute onset SNHL. 3D postcontrast sequence will detect even small vestibular schwannomas and inflammatory/infective causes of acute onset SNHL, which might have an impact on the management of the patient.

Background: Papillary carcinoma thyroid is the most commonly occurring thyroid neoplasm which can be diagnosed by its characteristic cytological features by fine-needle aspiration procedure. Due too few limitations in fine-needle aspiration cytology (FNAC) technique, there are false-positive and false-negative diagnoses in papillary carcinoma thyroid lesions. Aim: In our study, we would like to evaluate the accuracy of thyroid FNAC and to determine the reasons for cytopathological discrepancies. Materials and Methods: Two hundred and twenty-three cases were collected from archives of our Department of Pathology. Slides were retrieved for which cytohistopathology correlation differed and reviewed. Statistical analysis for False positive/ negative rates, positive predictive value, sensitivity and specificity were done. Results: For 170 cases, cytohistopathology correlation, 27 cases were discordant which accounted for 15.2% of false-negative rates. 87% sensitivity, 96.6% positive predictive value and 10.6% false positive were calculated. Conclusion: FNAC is a reliable screening procedure in spite of having few pitfalls. Awareness of these pitfalls, while reporting by cytopathologist can minimize false-positive and false-negative reporting on thyroid lesions.

Background: People with epilepsy are more likely than the general population to have comorbid psychiatric disorders. There are several studies addressing the issue using various tools, but very few studies have been done on Indian population. Country-specific studies are necessary for proper and more accurate evaluation of psychiatric disorder in patients with epilepsy. Aim: To study the prevalence and correlates of psychiatric comorbidity in patients with epilepsy. Materials and Methods: This study was carried out in the Neurology Outpatient Department of a tertiary care hospital and research centre attached to a medical college, from September 2018 to September 2020. By purposive sampling, 140 patients diagnosed with epilepsy by neurologist and attending neurology outpatient department were included in the study with their consent. Equal number of age- and sex-matched subjects without physical or psychiatric morbidity were selected as controls. Patients and participants were assessed on sociodemographic questionnaire, MINI international neuropsychiatric interview, quality of life in epilepsy, Depression Anxiety Stress scale, and Big five inventory. Results: Significantly more patients with epilepsy (n = 64;45.71%) as compared to the control group (n = 45;32.14%) were diagnosed with psychiatric disorders (Chi-square = 5.423; P = 0.019). Depression was seen in 33.57% of people suffering from epilepsy. Anxiety was seen in 25.714% of cases compared to 14.28% among controls.Stress is present in 9.28% of patients with epilepsy. The quality of life is poor in patients with epilepsy in comparison with participants from the control group. Epilepsy was associated with significantly lower scores on extraversionand significantly higher neuroticism scores. Conclusion: The prevalence of psychiatric disorder is significantly more in patients with epilepsy in comparison with the general population.Epilepsy had a negative impact on quality of life of the subjects.

Context: Frozen shoulder is a common condition which is seen in 2%–5% of the general population. It is a self-limiting condition which affects the range of motion of the patients in a capsular pattern. Aims: Although Pune Shoulder Rehabilitation Programme (PSRP) is being used for treating this condition still no study has been documented to find its efficacy as compared to conventional physiotherapy methods. Settings and Design: This was a quasi-experimental study and the study was done at Smt. Kashibai Navale General Hospital and Physiotherapy Outpatient Department, Pune. Institutional ethical clearance was taken on 7/8/2018 ref no. SKNCOPT/IEC/16/2018 before the commencement of this study. Subjects and Methods: Based on the study's inclusion criteria, 32 subjects were selected. The PSRP exercises were taught to each subject and given 10 repetitions with a hold of 10 s. For at least 45 min, each patient was treated. Patient's shoulder range of motion and visual analog scale were taken at the pretreatment, 2^nd week, 4^th week, and 6^th week, respectively. Statistical Analysis Used: The data were analyzed using Primer software with a level of significance P < 0.05. Repeated measure ANOVA was used to compare the outcome measures within the group. Results: The findings showed that over the 6^th-week protocol, statistically significant improvements were found in pain and shoulder range of motion. Conclusion: PSRP exercise protocol is effective in increasing the range of motion and decreasing the pain in the shoulder caused by frozen shoulder.

Background: The premenstrual period is a vulnerable phase for prevalence of bodily and psychological signs and symptoms named the premenstrual syndrome (PMS). There is a paucity of Indian work in this area. Aim: The aim was to study the prevalence and psychological correlates of PMS and premenstrual dysphoric disorder (PMDD). Materials and Methods: This cross-sectional study was carried out in a tertiary care hospital after obtaining the institute ethics committee clearance. Written informed consent was obtained from participants. By purposive sampling, 587 females from urban areas of Pimpri and Alandi were interviewed and subjected to the sociodemographic pro forma and the Premenstrual Symptoms Screening Tool, Menstrual Symptom Questionnaire, Pittsburgh Sleep Quality Index, and Depression Anxiety Stress Scale-21. From this sample, 140 subjects meeting diagnostic criteria of PMS or PMDD were included in the study group. An equal number of age-matched healthy controls with no known psychiatric disorders after clinical interview were included in the control group. All the questionnaires were scored as per the test manuals. Statistical analysis was performed using the SPSS. Results: It was observed that 63.57% of the total cases are moderate PMS, 30.71% are severe PMS, and 5.71% are PMDD. Overall, the more common type of dysmenorrhea was the spasmodic type, but among the PMS/PMDD cases, the more common type of dysmenorrhea was the congestive type. There is significantly higher stress, anxiety, and depression and poorer sleep quality in the cases of PMS and PMDD as compared to the controls. Stress, anxiety, and depression have a significant positive correlation with poor sleep quality. Conclusions: The prevalence of PMS was 22.49% and that of PMDD was 1.36%. Congestive kind of dysmenorrhea was more frequently seen in cases of PMS. There is significantly higher stress, anxiety, depression, and disturbed sleep in females suffering from PMS and PMDD as compared to the controls.

Introduction: Osteoarthritis (OA) being a common condition is one of the leading causes of musculoskeletal pain and functional disability. Purpose: This purpose of this study was to find the effect of McConnell patellofemoral pain syndrome (PFPS) protocol in participants with Grade 2 tibiofemoral OA. Settings and Design: This was an experimental pilot study and on participants above 40 years of age. Fifteen patients with Grade 2 tibiofemoral OA of knee were included. Subjects and Methods: The participants were screened on the basis of diagnosed case by orthopedician with the help of X-ray. Participants above 40 years of age were selected including both male and female. The changes in the subject's pain and functional disability were evaluated by the Visual Analog Scale (VAS) and The Western Ontario and McMaster Universities OA Index (WOMAC) scale. Statistical Analysis Used: Shapiro − Wilk test was used to check the normality of data and as it was found to be normally distributed, paired t-test used to analyze within group differences by comparing pre- and postreadings of WOMAC and VAS. Results: Participants with grade 2 tibiofemoral OA of knee had a significant decrease in pain and functional disability as seen in VAS scale, P value was 0.0005 and for WOMAC, P value was 0.0001. Conclusion: This study concludes that McConnell PFPS protocol had an upper hand in reducing functional disability and pain in Grade-2 tibiofemoral OA of knee.

Background: Tuberculosis (TB) is a major health concern globally. Extrapulmonary tuberculosis (EPTB) accounts for around 20% of the total (EPTB) cases which are difficult to diagnose due to the lack of availability of diagnostic tools. Although pulmonary TB is most common presentation, EPTB is also an important problem clinically. Cartridge-based nucleic acid amplification (CBNAAT) test has a well-documented role in diagnosing pulmonary tuberculosis. The potency of CBNAAT in the diagnosis of EPTB cases is still debated. Aim: To establish the importance and role of diagnosing EPTB by CBNAAT. Settings: Conducted in Dr. D Y Patil Medical College Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pimpri, Pune-411018. Design: Retrospective cross-sectional study of suspected EPTB patients in a tertiary care center area from April 2020 to September 2020. Materials and Methods: Data of suspected EPTB patients were retrieved. Potency of CBNAAT in diagnosing EPTB was assessed. Statistical Analysis: All the statistical analyses were carried out using the Statistical Package for the Social Sciences (SPSS) version 20. Results: Samples collected from 556 suspected EPTB patients were subjected to CBNAAT. The collected samples included pus, pleural fluid, cerebrospinal fluid, gastric aspirate, peritoneal fluid, tissue biopsy, pericardial fluid, ascitic fluid, synovial fluid, drain fluid, para-spinal fluid. In CBNAAT results, 67 cases were positive for TB bacilli, rifampicin resistance detected in 4 samples. Conclusion: Xpert®MTB/RIF assay is a rapid and effective method for early detection of EPTB and can be used in conjunction with routine culture methods for detection of the same.

Introduction: Neurocysticercosis (NCC) is a common infection of the nervous system caused by ingestion of Tenia solium eggs in undercooked pork or contaminated water. Most children present with seizures particularly focal seizures with or without signs of raised intracranial pressure (ICP). Diagnosis is made by computed tomography/magnetic resonance imaging (CT/MRI) scan which shows single/multiple ring-enhancing lesions with perilesional edema. Management involves the use of anticonvulsants for seizures and steroids for edema. Objective: To establish a clinical profile of NCC patient in pediatric age groups. Material and Methods: The Department of Pediatric Neurology at our institute conducted a retrospective study of 15 children with ring-enhancing lesions on MRI who were managed at this centre. The observations were further analyzed. Results: Nearly 14 children presented with seizures, 50% of these children also showed signs of raised ICP. Only 1 child had presented with signs of raised ICP. All the children were treated with anti-cysticidal, anti-epileptic with pre-treatment steroids. At 6 months all children were seizure-free. Conclusion: NCC should be ruled out in children presenting with focal seizures, especially in a country like India where the disease is endemic. Apart from antiepileptics, anthelmintic – Albendazole and Praziquantel are very effective against NCC with pre-treatment with corticosteroids and have been very effective in managing the disease.

Papillary thyroid carcinoma is the most common form of thyroid cancer and is usually associated with a good outcome. However, there are some aggressive variants wherein the prognosis may not be as good as for a conventional papillary thyroid carcinoma. Three cases of aggressive variants of papillary thyroid carcinoma are reported in the present series, namely, tall cell, hobnail, and columnar cell variants. This series is being reported to highlight the characteristic histopathological features which help in diagnosing these variants, especially diagnostic challenge in recognizing columnar cell variant due to lack of the classical nuclear features of papillary thyroid carcinoma in this variant. This case series also highlights the clinical importance of recognizing these variants because, according to American Thyroid Association, these variants come under intermediate risk with a poor clinical outcome, requiring aggressive management with neck dissection, radioiodine ablation, and closer disease surveillance.

Movement disorders are a common presentation to the emergency department. Acute dystonic reactions pose a serious medical challenge because they are often under or misdiagnosed. This case report deals with an acute dystonic reaction following a single dose of oral levosulpiride presenting with torticollis, tongue protrusion, and truisms which resolved rapidly with the administration of intravenous promethazine.

Ethambutol is considered to be safest first-line antitubercular drug, and patient acceptability is rather good in both intensive and continuation phase of the tuberculosis treatment with daily regimen. The important adverse effect associated with ethambutol is optic neuritis, resulting in loss of visual acuity, color vision, and field defects. The incidence of optic neuritis is generally directly proportional to the dose and duration of ethambutol therapy and rarely reported in a low standard dose. Here, we report a case of a 40-year-old female patient with complaints of progressive diminished vision (especially during day time) with a low daily dose (15 mg/kg/day) of ethambutol. She got diagnosed with cervical tuberculous lymphadenitis and was receiving isoniazid, rifampicin, ethambutol, and levofloxacin. In rare instances, ethambutol ocular toxicity may present with cecocentral scotoma. In rare instances, plasma levels are performed. An estimated plasma level of ethambutol was found to be in higher end (5.6 μg/ml) of the reported therapeutic range (2–6 μg/ml). Bilateral retrobulbar neuritis with cecocentral scotoma adverse effect due to ethambutol can be seen in plasma therapeutic range.

Anorexia nervosa (AN) is one among the severe psychiatric disorders of adolescence. AN in boys is often overlooked by both physicians and psychiatrists since it is predominantly seen in females. Teenagers usually get over the disorder, but in some cases, AN can cause serious complications, including chronicity and death. AN is often encountered among females and more so in the affluent class. Here, we present an 11-year-old boy belonging to a middle-class Indian family, referred for psychiatric evaluation from the pediatrics department after ruling out all medical causes for the weight loss. The patient complained of loss of appetite along with weight loss of 14 kg in the last 3 months. In-depth psychiatric evaluation revealed significant distress of gaining weight as well as an intense disgust related to his body shape. A cluster of determined food refusal and weight loss triggered the exploration of other symptoms of AN. The patient responded to antidepressants and well-planned cognitive behavioral therapy. Results were seen in the form of return to the normal range of body weight, shape, and size along with its confident acceptance.

Gollop-Wolfgang complex (GWC) is a rare musculoskeletal anomaly consisting of unilateral femur bifurcation, ipsilateral tibial agenesis, and ectrodactyly. Only very few authors have reported GWC in neonates and mostly with the involvement of unilateral lower limb. Herein, we report a very rare case of neonate having bilateral femoral bifurcation and bilateral tibial agenesis with intact fibula.

The lower limb venous system is responsible for returning blood from the foot, leg, and thigh toward the heart. Chronic venous disease occurs by an inability of the blood to completely return due to structural or functional abnormalities of the veins of the lower limbs. Varicose veins are enlarged veins that have become tortious and abnormally swollen. This study was taken to evaluate, diagnose, and rehabilitate varicose veins by physiotherapy interventions. The patient presented at our outpatient department with severe varicose veins. She was assessed, and a patient-specific 2-month rehabilitation program was formulated. This study helps us to understand various aspects involved in the condition, its prognosis, and management by physiotherapy interventions.