Aim: This study is an attempt to elucidate the positive laboratory profile of serologically diagnosed dengue patients so as to facilitate early diagnosis, treatment, management. Methods: This was a descriptive study with analysis of patients who were admitted for dengue fever in the Department of Medicine, BMIMS, Pawapuri, Nalanda, Bihar, India for duration of 6 months. This study was conducted on 100 indoor patients. Patients presenting to the emergency department, outpatient department (OPD) with complaints of fever and clinical features of dengue with positive NS1 antigen test or dengue antibody serology IgM or IgG or both were included in the study. Results: Most of the cases were seen in the 20-30 years age group followed by 31-40 years age group. Majority of the patients were males compared to females and the male to female ratio was 2:1. Fever was the most common presentation and was seen in 40 cases (40%) cases. Present study showed hemoglobin range of 6 gm% to 17 gm% (Table 3). Raised hematocrit (>47%) was noted in 15 (15%) of patients at presentation and the hematocrit ranged from 20-51%. The total leukocyte count ranged from 1500 cells/cumm to >11000 cells/cumm. Leucopenia with less than 4000 cells/cumm was present in 25% cases. In the present study out of 100 cases of dengue fever, 90% cases had thrombocytopenia and 10% cases had severe thrombocytopenia (<20,000/cumm) with bleeding manifestations. Conclusion: Hemoconcentration, leucopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that dengue cases can be diagnosed in their initial stages. This facilitates early treatment and aggressive fluid replacement therapy with good nursing care so that fatality rates can be reduced.

Aim: The study was planned to compare changes in respiratory function after laparoscopic and conventional open cholecystectomy. Methods: The study was analytical, carried out in the department of surgery Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar, India On a total of 100 patients admitted in hospital for symptomatic were included. Results: There was no significant difference between the groups in age, gender, height and weight. Preoperative respiratory functions and capillary blood gas analysis were normal. There was a decrease in respiratory functions in the postoperative period in both groups. Postoperative change in all parameters when compared to preoperative values was highly significant (p<0.001). Difference in all parameters between the groups was significant (p<0.05). Conclusion: It was concluded that laparoscopic cholecystectomy offers improved pulmonary function compared to the open technique.

Aim: The aim of this study was to evaluate the outcomes of tubeless mini‑ percutaneous nephrolithotomy (PCNL) for the treatment of large (>20 mm) renal stones. Methods: The study included consecutive adult patients who underwent mini‑PCNL for large (>20 mm) renal stones for the period of 2 years at Sri venkateshwar institute of medical sciences, Tirupati, India. Preoperative, operative, postoperative, and follow‑up data during outpatients’ visits were prospectively recorded and maintained using a computer database. The data were retrospectively analyzed. The study included 200 patients in the study. Results: The study included 200 patients with mean age 42.9 ± 13.8 years (range 18–79) and mean stone size 30.2 ± 9.6 mm (range 20–70). Mean operative time was 61.8 ± 30.1 min (range 25–180). The average number of tracts per renal unit was 1.26. The stone‑free rate following the single‑session of mini‑PCNL was 86% (n = 172).  Mean hospital stay was 2.9 ± 0.9 days. The overall intraoperative and 30‑day postoperative complication rate was 8% (n = 16), with the majority being Clavien classification Grades I and II (n = 15). Minor Grade (I–II) complications included postoperative fever requiring antibiotics in cases, postoperative haematuria requiring blood transfusion in two cases, severe postoperative pain requiring prolonged opioid analgesia in two cases, and perinephric hematoma that was managed conservatively in two cases. Conclusion: Mini‑PCNL is a safe and effective treatment for the management of adult patients with large renal stones. Stones located in multiple sites inside the PCS is the only predictor of unsuccessful outcome.

Aim: The aim of the present study was to compare the effect of fentanyl and tramadol as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Methods: This prospective, randomized double-blind study was conducted in the Department of Anaesthesiology at AIIMS, Patna, Bihar, India for six months. After obtaining approval from the ethical committee of the Institute, an informed written consent was obtained from all the patients undergoing the study. 100 patients of either sex aged 20-60 years, belonging to ASA physical status I or II undergoing upper-arm surgery were recruited for this study. Results: There was no statistically significant difference among the two groups in demographic characteristics. Majority of study participants were males but there is no statistical difference among two groups. The demographic status and data before the block were comparable among two groups (P > 0.05). Mean ± standard deviation for onset of complete sensory block prolonged from group RT (17.59 ± 1.07 min) and to Group RF (20.14 ± 1.50min). There was statistically significant difference in onset of complete sensory block among the groups RF p < 0.001.  Mean ± standard deviation for onset of complete motor block prolonged from Group RT (18.6 ± 1.86min) to group RF (n ¼ 21, 25 ± 1.50min). Conclusion: In conclusion, tramadol when used as adjuvant with local anaesthetic in peripheral nerve block provides better surgical anaesthesia and analgesia. Therefore, its use should be promoted for routine addition to local anaesthetics in peripheral nerve blocks.

Aim: The present study was undertaken to evaluate thrombocytopenia and variations in platelet indices in neonatal sepsis. Methods: This hospital based prospective observational cross-sectional study was conducted in Department of Pathology, Government Medical College, Bettiah, West Champaran, India over a period of 12 months. A total of 200 Neonates under the age of 28 days admitted in NICU, were studied and 100 at risk neonates ‘were detected and included in our study. Results: Most common presentation in EOS is respiratory distress, and in LOS is refusal of feeds, and over all common presentation is refusal of feeds. Total 200 neonates were examined. 100 neonates (50%) were at risk. 12 (12%) were had no sepsis (NOS), 40 (40%) were Early onset sepsis (EOS) and 48 (48%) were Late onset sepsis (LOS). In EOS, thrombocytopenia was found in 80%, whereas it was 83.34% in LOS. It was seen that thrombocytopenia was the most sensitive marker (83.08%) followed by MPV and PDW in detecting neonates with culture‑positive sepsis. However, it has a low specificity (20.33%). But when we combine MPV and PDW or combined all the three markers (MPV + PDW + PC), the specificity increased to 46.34%. Conclusion: NNT can be used as screening tool in NNS as it is easy and cost effective. It requires further large scale studies and meta-analysis to validate. Mortality in sepsis cases increases with severity of thrombocytopenia.

Aim: The aim of the present study was to assess effects of enhanced recovery after surgery protocol vs conventional care in patients undergoing caesarean section in a tertiary care centre. Methods: This was a prospective comparative study conducted in the department of obstetrics and gynecology,   Sri Devaraj URS Medical College, R.L. Jalappa Hospital And Research Centre, Tamaka, Kolar, Karnataka, India, following approval from institutional ethical committee of R. L. Jalappa Hospital and Research Centre, over a period of one year from January 2021 to December 2022. Based on the calculation a total of 150 pregnant women divided in to ERAS group (n=75) and conventional group (n = 75). Grouping was done using alternate sequence. Results: The bulk of the subjects in both the conventional and ERAS groups were between the ages of 19 and 24. Majority of subjects in both conventional and ERAS groups were primigravida. Between the two groups, there was no statistically significant difference in age and parity. 97.3% of subjects in conventional got catheter removed after 24hours and all in ERAS group has catheter removed after 8 hours. 4 (5.3%) subjects in conventional and 3 (4.0%) subjects in ERAS group reported to have abdominal distention. However the association was not found to be statistically significant. 4 (5.3%) subjects in conventional and 2 (2.7%) subjects ERAS group reported to have persistent nausea. The difference between the two groups in nausea was found to be statistically significant. 4 (5.3%) subjects in conventional and none in ERAS group reported to have urinary tract infection. 4 (5.3%) subjects in conventional and none in ERAS group reported to have wound complication. The difference between the two groups in UTI and wound complication was found to be statistically significant. Conclusion: The present study showed that ERAS protocol can be effectively and safely implemented for caesarean section with less postoperative complications without an increase in the hospital readmission rates. It was observed that ERAS protocols when implemented on patients, it was observed that there was reduced urinary tract infection and wound complication in post-operative patients.

Aim: The aim of the study was to study the association between Serum Vitamin D and Serum Ferritin levels in children with ADHD. Methods: The study was conducted in the Department of Pediatrics, RIMS-Ranchi, India for the period of 2 years. A total of 60 children meeting the inclusion criteria were enrolled in the study. Subjects included all new or follow-up patients with diagnosed or suspected ADHD and healthy children of the comparable sex and age group attending the pediatric outpatient department (OPD) were taken as controls. Informed and written consent was taken from parents and assent from children above 12 years of age to participate in the study. Results: 25 cases were diagnosed with ADHD and their results were compared to age and sex matched controls. Serum Ferritin and Vitamin D levels were measured in both cases and controls. Since we matched age, similar age distribution was present in controls. The study found a significant difference in the mean value of serum ferritin levels in cases and controls (p−0.035). No significant difference in the mean value of serum Vitamin D in cases and controls (p–0.550) was noted. Conclusion: ADHD is a common neurobehavioral disorder presenting in pediatric OPD with higher prevalence in males than females. Combined type was found to be the most dominant type of ADHD in the study population. We observed a significant difference in the levels of Serum Ferritin in children with ADHD and controls.

Aim: The study was designed to assess the clinico-pathological profile and to estimate immediate hospital outcome of acute pancreatitis patients admitted into a tertiary care hospital. Methods: This study was done in Department of General Medicine, BMIMS, Pawapuri, Nalanda, Bihar, India for one year. Informed written consent from the patient or relatives were taken. It was a Cross-sectional type of observational study. Consecutive sampling was used. Total 100 patients were included in the study. Results: Among 100 patients, mean age was 42.5 ±11.3 years. Highest age was 68 years and minimum age was 22 years. Majority of the patients (40%) were from age group 31-40 years. All of the patients complained abdominal pain. 45% patients had vomiting and 32% had fever. The common location of pain was in epigastric region (75%) with radiation to back in 20% patients. Pain was severe agonizing in nature in 75% cases. Laboratory findings of study population showed that, all the patients had leukocytosis and raised C-reactive protein. Hypocalcemia was prevalent in 35% patients. Total duration of hospital stays were found 3 to 16 day. Conclusion: Acute pancreatitis patients most commonly present with abdominal pain, abdominal distension along with anorexia. Although a larger portion of the patients had no identifiable cause but gall stone was the most common etiology. Pain commonly located in epigastric region with radiation to back.

Aim: The aim of the present study was to assess the challenges in management of Major Depression in patients with co-morbid medical conditions. Methods: The present study was conducted in the Department of Psychiatry, Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India for one year and 100 patients with depression were included in the study. Results: The rates of fatigue, insomnia and nausea among patients with depression have been reported to be 86 %, 79 %, and 51 %, respectively. MDD is considered an important risk factor for physical diseases. Patients who were older, had lower incomes, were unemployed, were less educated and had had depression for a longer duration was at higher risk of developing various medical disease. Musculoskeletal diseases were found in 20% of patients with MDD. Conclusion: Therefore, optimal treatment for MDD should include collaboration focussed on comorbid physical diseases, rehabilitation aimed at restoring social functioning, and pharmacotherapy designed to ensure complete remission including psychological and physical symptoms, as well as functional recovery.

Aim: The aim of the present study was to evaluate the analgesic efficacy of Epidural ropivacaine 0.2% and 0.125% bupivacaine in postoperative pain relief. Material & methods: After obtaining written informed consent, a routine data based observational study was conducted at department of Anesthesiology, AIIMS, Patna, Bihar, India for eight months. which involved 100 patients of ASA1, ASA2 who received Epidural 0.2% Ropivacaine and 100 patients who received Epidural 0.125%bupivacaine postoperatively. All patients were monitored for postoperative pain by the visual analogy scale (VAS), requirement of rescue analgesia, hemodynamic parameters and adverse effects. Results: In the present study, there were 70% male and 30% female in Bupivacaine 0.125% group and 65% male and 35% female in ropivacaine 0.2% group. According to visual analogy score, 2.16 score on day 1 in Bupivacaine 0.125% group and 2.40 in ropivacaine 0.2% group. 46% patients required rescue analgesia in Bupivacaine 0.125% group and 60% in ropivacaine 0.2% group. In the present study, 8% had hypotension adverse effect in Bupivacaine 0.125% group and 2% in ropivacaine 0.2% group. Conclusion: Ropivacaine 0.2% and bupivacaine 0.125% were equally efficacious in terms of VAS pain scores, rescue analgesic requirement, but ropivacaine had a better safety profile in terms of less hypotension and lesser motor block.

Aim: The purpose of this prospective study was to prove the promising outcomes of proximal fibular osteotomy in treatment of medial compartment knee osteoarthritis. Material & Methods:  A prospective observational study including 36 patients in Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for one year . The following clinical parameters were used: VAS, KSS, KFS. The following radiological parameters were used: MJS, LJS, HKA Angle. post-operative physiotherapy protocol was followed. Discharge was planned based on patients comfort and mobility, that was usually on day 4 or 5. They were followed up at 6 weeks, 3 months, 6 months, 9 months and 12months. Results: In the present study, most of the patients belonged to 50-60 years age group. In the present study, there were 12 males and 20 females, with male to female ratio 2:3 approximately. The mean age of patients was 51.68 year (age range = 40-70 years). In this study patients included who has BMI>30.and most of patients lie in between 25 to 29.9 BMI i.e. most of them fall in overweight category. Osteochondral defect was found in all cases with various grade, 20(50%) knees with grade 1, 12(30%) knees with grade 2, 6(15%) knees with grade 3,and 2 (5%) cases with grade 4. Average visual Analogue scale (VAS) score significantly decreased from 8.20 pre-operatively to 3.256 in 1 year of follow up. Knee society score improved from 45.25 pre-operatively to 71.77 in 12 month of follow up. Knee function score improved pre-operatively 49.50 to 75.55 in 12 month of follow up. Medial joint space increased from 1.62 pre-operatively to 3.56 in 12 month of follow up. Lateral joint space decreased from 6.68 pre-operatively to 5.38 in 12 months follow up. The correction of alignment Hip knee ankle angle (HKA) after PFO was seen after 12 months. Conclusion: Proximal fibular osteotomy [PFO] is a simple, safe and affordable surgery to reduce pain and improve joint function and the medial compartment space in medial compartment osteoarthritis of knee joint. It may be a promising alternative surgery in most developing countries because of their financial and healthcare delivery limitations that may be used as an alternative surgery for patients of osteoarthritis knee who cannot undergo.

Aim: The objective of the study was to conduct histopathological analysis of lymph node biopsies at a tertiary care centre. Material & methods: This was a retrospective observational study of all the patients with lymph node biopsies seen in department of General Surgery, NMCH, Patna, Bihar, India from Jan 2022 to December 2022. As the study was retrospective duration-based design, patients for whom the biopsy samples were available in one year were included in the study. Ethical approval from the Institutional Ethics Committee was obtained for this study. Histopathology reports of lymph node biopsies of patients required at NMCH, Patna, Bihar, India were included in the study. The total number of cases of lymph node biopsies available was 100 over the period of one year. Results: Out of the total 100 cases, females account for 60 (60%) cases which are in majority as compared to males which account for 40 (40%) cases. Tuberculous lymphadenitis was most commonly observed in 40 females as compared to 28 males. Cancer cases which accounted for 18 (18%) cases formed the second most common diagnosis in which 12 females accounted for most cases as compared to 6 males. Out of the total 100 cases of lymph node biopsies, 56 cases were reported at the cervical location. Tuberculous lymphadenitis at cervical were found to be most at cervical location. This was followed by 15 cases of cancer. Based on age grouping, the age group of 21-30 contained 33 cases of lymph node biopsies. Overall, in every age group, the maximum number of cases was of tuberculous lymphadenitis. Conclusion: Enlarged lymph nodes should undergo fine needle aspiration cytology (FNAC), truecut biopsy and/or excisional biopsy for correct diagnosis. The diagnostic spectrum ranges from benign reactive to TB and also malignancies.

Aim: The objective of the present study was to investigate novel technique for nasogastric tube insertion in intubated patients using endotracheal tube. Methods: The study was conducted after obtaining a proper informed consent, in a total of 20 patients, who were studied in ICU and OT of Department of Anaesthesiology, Critical Care and Pain Management, SRMS-IMS from August 2022 – September 2022. Using laryngoscope with minimal positioning, appropriate size endotracheal tube was used as conduit after cutting it transversely throughout its length and was advanced till it reached oesophagus following which nasogastric tube was passed through more patent nostril and was directed into conduit endotracheal tube till full length and following conduit was removed. Results: 20 patients were enrolled into this study. There were no statistically significant differences in the demographic data (age, gender, height, weight, and ASA physical status classification). The heart rate and mean arterial pressure before and after the procedure were found comparable. The overall success rate was 85%. Kinking of the NGT and nasal mucosal bleeding were the most common complications. Kinking of the NGT occurred in 2 patients. Conclusion: The technique is easy and helpful for nasogastric insertion in unconscious intubated patients. Additionally, it neither alters vital responses nor increases intracranial pressure like with laryngoscopy. It is worth considering this approach as one of the maneuver in intubated patients (whether easy or anticipated difficult airway) for nasogastric tube insertion as first and last resort.

Aim: The aim of the present study was to assess the impact of intravenous lignocaine and intravenous paracetamol on intra-operative hemodynamics, post-op pain scores, and post-op analgesic requirement in patients undergoing exploratory laparotomy. Methods: This randomized single-blinded observational study was conducted in The Department of Anaesthesiology, critical care, and pain management at SRMS Institute of Medical Sciences, Bareilly, after obtaining prior approval from the ethical committee and after written, informed consent was obtained from the patient. The study was conducted from 1st Feb 21 to 31st July 22.  The sample size for this study was 72 patients i.e., 36 patients in each group. Results: The mean ± SD of age (years) in group I was 38.42 ± 10.8 and in group, II was 37.86 ± 10.62 with no significant difference between them. No significant difference was seen in weight (kg) (p value=0.448), height (cm) (p value=0.75), and body mass index (kg/m²)(p value=0.739) between group I and group II. Mean ± SD of weight (kg), height (cm), body mass index (kg/m²) in group I was 61.06 ± 5.82, 161.61 ± 7.34, 23.78 ± 2.33 respectively and in group II was 62.19 ± 6.82, 161.08 ± 6.66, 23.96 ± 2.09 respectively with no significant difference between them. No significant difference was seen in heart rate, systolic, diastolic blood pressure, VAS scores and SPO2. Conclusion: The present study demonstrated lignocaine as a superior analgesic drug with context to paracetamol for postoperative pain relief in an exploratory laparotomy.

Aim: The aim of the present study was to determine the usefulness of patient education and if AR control was affected by different methods of teaching of nasal spray usage. Methods: The Present study was conducted at department of ENT, SKMCH, Muzaffarpur, Bihar, India for one year and patients were recruited aged 18 and above with clinical symptoms suggestive of mild persistent or moderate-severe persistent AR (ARIA guidelines 2008). Total 100 patients were included in the study. Results: Patients were between 20 to 60 years old (mean=32.4 years) and among them 40 (40%) were male patients and 60 (60%) were female patients. Based on the 2008 ARIA guidelines, 88 (88%) patients were diagnosed with moderate-severe persistent (MSP) AR, 4 (4%) had moderate- severe intermittent (MSI) AR while 8 (8%) had mild persistent (MP) AR. Assessment on the techniques during the 2nd (visit 2) showed that none of the participants were able to show a correct technique on the usage of INCS. During the 3rd visit despite re-education, only 26% of participants were able to show the correct techniques. There was statistically significant association between ARIA classification and severity of TNSS during V1-V3. Majority of patients with MSP AR had severe TNSS during V1 and subsequently improved to moderate symptoms during V2 and mild/very mild during V3. Conclusion: Our study showed the importance of educating patient regarding the use of INCS. Both objective and subjective assessment of improvement after each method of patient education showed statistically significant outcome.

Aim: The aim of the present study was to determine the characteristics, diagnoses, interventions and outcome of obstetric patients with pregnancy induced hypertension admitted in our Critical care unit (CCU). Methods: It was a prospective, observational study conducted in 100 obstetric patients diagnosed with PIH who got admitted to the CCU in Department of Anaesthesiology and Critical Care at SNMMCH, DHANBAD, Jharkhand, India for one year. after approval from the Institutional Scientific and Ethics Committee after meeting the inclusion and exclusion criteria. Results: It was observed that 70% (n=70) of our study population were diagnosed with severe preeclampsia alone (Group 1), while 20% (n=20) of them were diagnosed with eclampsia (Group 2), 8% (n=8) were Eclampsia with HELLP syndrome and 2% (n=2) were HELLP syndrome without eclampsia). 80% (n=80) of the patients belonged to the age group of 21-30 years, while 12% (n=12) were less than 20 years of age and 8% (n=8) were more than 30 years of age. 54% (n=54) of the women were nulliparous and the remaining were multiparous. 85% (n=85) of the women had unregistered status and 15% (n=15) were booked from the initial time of pregnancy. It was seen that blood pressure was raised among all the study groups and this increase is statistically significant with a P value of 0.03 and 0.01 for systolic blood pressure and diastolic blood pressure respectively. Overall, mortality was 10% (n=10) and the remaining 90% (n=90) were discharged. Conclusion: It was observed that preeclampsia, nulliparity, unbooked status, and lower segment cesarean section were prevalent among the subjects. Most common intervention required was transfusion of blood products. Pulmonary edema and HELLP syndrome were the most common complications. Overall mortality was low. Neonatal mortality was more in severe preeclampsia patients with term gestation.

Aim: The aim of the present study was to assess the cardiotoxicity profile of our patients receiving trastuzumab in adjuvant and maintenance settings in breast cancer patients. Methods: The present study was a prospective, conducted in Department of Medical Oncology, IGIMS, Patna, Bihar, India over a period of 2 years. 50 patients were included in the study. Results: The median age of presentation was 46 years (range: 24 to70 years). All patients were of the female sex. Majority of the patients (56%) belonged to the age group of 41–50 years. Majority of the patients had no known comorbidities such as hypertension (HTN) or diabetes mellitus (DM). Out of 50 HER2 new‑positive patients, 21 cases (42%) were triple positive, 28 (56%) were hormone receptor (HR) negative, while 1 (2%) were estrogen receptor (ER) positive but progesterone receptor (PR) negative. According to the stage‑wise distribution, majority of patients (n = 28; 56%) presented at Stage IIB followed by Stage IIA (n = 19; 38%). In the present study, 26 patients received prior anthracycline‑based chemotherapy while 24 patients received nonanthracycline‑based chemotherapy. During treatment, a drop of >10% was considered a clinically significant drop and treatment was temporarily halted till the cardiac function was restored. Adequate cardiology consultation and intervention was done. Over 1‑year period of trastuzumab therapy, all the patients experienced some kind of drop in LVEF and a significant drop in LVEF (>10%) was observed in 17 (34%) out of 50 patients. Conclusion: Identifying women at risk of developing trastuzumab related cardiac dysfunction when starting adjuvant trastuzumab treatment continued to be an ongoing challenge. The discovery of trastuzumab has changed the paradigm of treatment for the HER2‑expressed breast cancer patients who otherwise have an aggressive tumor biology.

Aim: The purpose of this study was to evaluate the detection rate of pulmonary nodules in ultrashort echo time (UTE) lung magnetic resonance imaging (MRI) and to compare it with computed tomography (CT) in oncology patients.
Methods: The study was performed at Department of Radiology, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India for one year. Approval of the thesis was taken by the Institutional Ethical Committee and the study was performed according to standard protocols. In this study of comparison of UTE lung MRI and HRCT lungs for detection of pulmonary nodules in oncology patients, 50 patients were subjected to HRCT lungs and UTE lung MRI using the sequence Fl3d_spiralvibe cor 1.25mm iso. Results: 50 patients who underwent both a spiral 3D UTE examination of the lungs and thin-section chest CT were included (35 men and 15 women; mean age, 62.2 years; range, 30–79 years). The mean duration between chest CT and MRI was 22.4 days (range, 0–30 days). Among the total number of nodules detected in both lungs of all patients, nodules detected by CT were 241, and nodules detected by MRI were 212. The nodule detection rate by MRI was 87.96%. Conclusion: Our study results indicate that lung MRI had a near-complete detection rate for nodules equal to or more than 5 mm in size. Hence, in oncology patients who are undergoing regular follow-up of the lung nodules, lung MRI using UTE can replace low-dose CT, which in turn reduces the radiation dose to the patient.

Aim: The aim of the present study was to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss. Methods: The present analytical cases control study was conducted in Department of ENT, SKMCH, Muzaffarpur, Bihar, India, for period of 12 months. The present study was conducted on 200 type 2 diabetes patients and age and gender matched 200 non- diabetic controls in the age group of <50 years. Results: In the present study, 68% were females and 32% were male. The mean age of patients was 44.16, mean fasting blood sugar was 130.60±28.62, mean PP blood sugar was 172.18±42.28 and mean HbA1c was 7.40±0.45. Mean age of patients was 36.60, mean fasting blood sugar was 108.02±3.16, mean post-prandial blood sugar was 126.54±9.99 and mean HbA1c was 6.004±0.220. It showed that only 50 patients had normal hearing and 150 patients had SNHL whereas 32 patients in this group had minimal hearing, 38 had mild SNHL, 48 had moderate, 12 had severe SNHL and 20 patients had profound SNHL. 140 patients had DPOAE refer whereas 60 patients had DPOAE pass. Conclusion: This study concluded that the diabetics are at definite risk of developing auditory dysfunction, therefore it is recommended that all newly diagnosed diabetic patients should undergo a complete audiological evaluation at the time of diagnosis and a regular half yearly or yearly follow up is warranted for early detection of damage to auditory functions. Although factors other than diabetes contribute to hearing loss, early glycemic control for type 2 diabetic patients may reduce the incidence rate of this disease.

Aim: This study aims to determine the association of dyslipidemia of obesity with anthropometric indices. Methods: This case-control study was carried out in the Department of Physiology, Narayan Medical College, Jamuhar, Sasaram, Bihar, India For the period of 1 year. Total 50 cases and 25 age and gender matched controls were taken. WC was measured, in cm, midway between the lower costal margin and iliac crest during the end expiratory phase, with a non-elastic tape. Hip circumference was measured, in cm, at the level of the greater trochanters, with the person standing and relaxed muscles. Results: Mean age of obese group and non-obese group was 40.5 ± 8.28 years, 38.5 ± 8.37 years respectively. Mean body weight of obese group and non-obese group was 93.78 ± 4.78 kg, and 91.66 ± 5.47 kg, respectively. Mean height of obese group and non-obese group was 160.7± 3.78 cm, and 158.1 ± 4.15cm, respectively. Mean BMI of obese group and non-obese group was 28.11 ± 2.5kg/m2 , and 23.35 ± 2.7 kg/m2, respectively. Mean WHR of obese group and non-obese group was 0.95 ± 0.10 cm, and 0.78 ± 0.07 cm, respectively. In present study, based on WC 70% of study population were categorized in obese group and 30% as non-obese group. On basis of WHR 60% of subjects were grouped as obese and 40% as non – obese. Further, 54% of subjects were grouped under obese category and 46% as non-obese based on BMI values. Anthropometric indices and serum lipid profile values showed a significant (p<0.001) increase in obese group when compared to non-obese group. Of all the 35 obese subjects, WC has correctly identified 29 subjects as obese with abnormal serum lipid profile (table 2). Further, based on percent sensitivity and specificity of anthropometric parameters in predicting dyslipidaemia WC was more sensitive in terms of diagnostic accuracy, i.e. correctly identified the obese with dyslipidaemia, (68%) and WHR showed higher positive predictive value considering the diagnostic power, i.e. ability to correctly predict occurrence of dyslipidaemia (PPV % – 92%) in healthy study subjects. Conclusion: Obesity strongly correlates with dyslipidemia and altered lipid profile status. Furthermore, from this study, we can say that WHR is the most specific parameter that can be used in the clinical setup to identify within obese subjects those who are more predisposed for developing CVD and treated appropriately.

Background: Tramadol administered intravenously has been demonstrated to decrease post operative pain. In this study, the effect of intravenous tramadol administration on pain relief after caesarean section has been studied. Methods: 100 Women following elective/emergency caesarean section were included and were divided into two groups, 50 in each. Group A received IV 100ml normal saline infusion over 15-20 minutes. Group B received 50 mg Tramadol intravenous infusion (1ml ampule in 100ml NS over 15-20 minutes). Post caesarean pain was assessed by visual analogue scale and by examining the patient at start of recruitment and 15mins, 1hour, 2hours, 3hours and 4hours post section. Drug was administered 2 hours post section or 4 hours post spinal (considering average effect of spinal anaesthesia as 2 hours). Results: Mean pain intensity assessed on VAS was significantly better for tramadol group compared to placebo group at all the time points. Maximum fall in pain intensity score was also significantly superior in the tramadol group as compared to the placebo group. No patients required rescue medication in Tramadol group. Conclusion: Tramadol has more pronounced analgesic effect. Thus, Tramadol can be considered as an effective analgesic in treatment of post operative pain in post caesarean patients.

Background: Lead is associated with many diseases including psychiatric disorder and schizophrenia is one of them. Aims: To find out serum level of Lead in schizophrenic patients and compare it with stage of disease and PANSS score. Methods: This study was done in Dept of Biochemistry and Dept of Psychiatry, SMS Medical College, Jaipur. Serum lead was estimated on Atomic Absorption Spectrophotometer ECIL AAS 4141A. Results: Serum lead levels were significantly higher in schizophrenic patients when compared to healthy subjects (P <0.05). Though there was increased level of lead in chronic patients when compared with acute cases but this relation was not significant. When we Correlated serum Lead & PANSS among Total, Acute and Chronic cases, none of these correlations were statistically significant (p > 0.05). Conclusions: A significant alteration in level of serum lead were found in schizophrenic patients when compared to the control group and comparison of serum Lead with the stage of disease and PANSS score was unable to find significant relation. This indicates that serum Lead may has important role in schizophrenia but furthermore studies on number of patients are required to show definite correlation of serum Lead with stage of disease and PANSS score.

Background: Prior research indicated that primary cancers of the lungs are infrequent in India. But the trajectory is shifting, and lung cancer cases are rising. This descriptive observational study was conducted to determine the risk factor profile of lung cancer patients. Materials and Methods: At the Department of pulmonary medicine at MKCG Medical College, Berhampur, patients diagnosed with carcinoma lung Histologically or cytologically participated in this descriptive epidemiological study from a single center using a prospective observational design. Detailed information about the patient’s age, sex, residence, smoking history, environmental tobacco smoke exposure, and indoor pollution. Results: The most prevalent symptoms patients in this study reported were a productive and dry cough, which occurred in 38 instances (82.60%), chest pain in 31, and shortness of breath in 21, respectively. Dysphagia was observed in 2 cases (4.34%) and fever in 18 cases (39.13%) as additional symptoms. In 34 patients (73.39%), Pallor was the most prevalent condition, followed by clubbing in 19 cases (41.30%), Gynecomastia, and Hepatomegaly in one case (2.17%). Three cases (6.52%) of vocal cord paralysis were reported. The study shows that 24 males (77.41%) and one females (6.66) smoked, whereas only seven males case (22.58%) and fourteen female cases (93.33%) did not. Pleural effusion was seen in 27 cases (58.69%) of the chest exams, followed by masses in 14 cases (30.43%). Conclusions:  This study provides information on the risk factor profile of lung cancer patients in Berhampur, which can be used for future comparison with other Indian studies to educate the community and raise awareness about the prevalent lung cancer risk factors.

Topical administration is applied to deliver a drug instantaneously at the point of application, so enough drugs is depleted into the systemic circulation to cause medicinal effects. To develop an effective drug absorption through an intact skin, several topical preparations are used one of that is “Gels”. Gels basically used for the purpose of topical dosage form a lot which is to deliver drug across a localized area of the skin.  Gel formulation contributes for better approach concept and product stability in respect to ointment, paste and cream. Administration of topical gel drug has a limited drug delivery process anywhere in the body system through skin route, vaginal route, rectal route and ophthalmic route as darmal routes. Generally gels used in wide range as applications in food products, cosmetics products, biotechnology. Most of the gels may be designed according to their nature of the liquid phase, for example, Organic solvent containing are organogels (oleogels) and water as solvent phase called hydrogels. Recent research studies have reported many types of gels for topical drug application, like aerogel, bigel and emulgel.  Topical dosage forms like Gels are evaluated with following standard parameters such as pH of formulation, homogeneity of preparation, grittiness of active drug content, extrudability and spreadability of formulation, skin irritation studies, in-vitro release and Stability studies.

Topical administration is applied to deliver a drug instantaneously at the point of application, so enough drugs is depleted into the systemic circulation to cause medicinal effects. To develop an effective drug absorption through an intact skin, several topical preparations are used one of that is “Gels”. Gels basically used for the purpose of topical dosage form a lot which is to deliver drug across a localized area of the skin. The main aim of present study was to develop a recent advanced Bigel topical drug delivery of Amphotericin-B to improve patient compliance, to avoid the side effects, first pass metabolism and increase local onset absorption and action. polyene antifungals, amphotericin B associates with ergosterol, the main component of fungal cell membranes, forming a transmembrane channel that acts as monovalent ion (K+, Na+, H+ and Cl−) leakage, which is the primary effect resulting in fungal cell death. Methods: Topical Bigel formulations development of Amphotericin-B was prepared by using Different-different concentration of polymers to enhance the stability and viscosity. Nine different formulations of Amphotericin-B were prepared and evaluated standard parameters with their colour, Spreadability, viscosity, determination of pH, drug content of formulations, in vitro drug release studies, and stability studies. Results: DSC of the drug samples represents the purity of drug. FT-IR study show that there were no any interaction between the both drugs, Polymers, and other excipients. All the designed and developed formulations of Amphotericin-B show acceptable standard physical properties. The drug content and percentage yield were higher for BG1 formulation among all formulation. BG1 shows the best drug release. Stability study of the best formulations BG1 with Carbopol polymer was found with best results. Conclusion: From the above observation results concluded that formulation BG1 may be more effective topical formulation for the healing and treating of fungal infections.

According to studies, continuous deterioration process is the result of skin aging because of protein & cellular DNA damage. The main purpose of this work is to formulate an anti-aging herbal cream by using natural ingredients. The natural ingredients are pomegranate, curcuma longa, amla, hibiscus, green tea, vitamin E, coconut oil, olive oil, aloe vera, basil oil, mint oil. Oil based cream is formulated using natural ingredient. The creams were created in various concentrations, ranging from F1 to F4. During stability trials, the creams was stable according to ICH criteria. For 1 months, 30± 20C / 45±5 percent RH and 40±20C / 75±5% RH were used. It can be determined that multi-herbal creams are beneficial with multiple effects and excellent spreadability and minimal irritancy.

Aim: The aim of the present study was to assess the outcome of sonography and Mammography in women with breast pain. Methods: All women with diffuse & focal breast pain referred to the department of Radio-diagnosis, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India, for six months were included in the study. During the study period, a total of 450 patients underwent Breast Imaging. Pain alone was mentioned as the reason for referral in 100 cases (22.22%). Results: The mean age of patients in the study was 36. 23 (range 17-60 years). 20 patients (20%) had a family history of breast cancer, and 10 (10%) had a history of Hormone use at the time of examinations. The Imaging findings on the painful; breasts were: 70 (70%) normal, 28 (28%) Benign and 2 (2%) had suspicious imaging findings of malignancy.  The findings in the rest of the breasts were mild alteration in density and echo texture. FNA cytology examination was suspicious for cancer in 2 patients, and 30 were benign. The negative predictive value in our study was 90%. Conclusion: The primary use of sonography and Mammography in women with breast pain seems reassuring for the patients and clinicians. The primary value of breast imaging in women with painful breasts seems to be that of reassurance, as no abnormalities are usually detected, radiological abnormalities classified as benign do not generally have any clinical consequences, and the prevalence of cancer in a painful area is low.

Aim: The aim of the study was to assess quality of sleep and related factors among medical students, residents, interns and staff nurses. Material & methods: A cross sectional study was conducted for approx. 12 months period among Medical students, Residents, Interns and Staff nurses enrolled at department of Psychiatry Jawaharlal Nehru Medical College, Bhagalpur, Bihar. Total 400 samples were collected from study population, among them 100 Medical students, 100 Residents, 100 Interns and 100 Staff nurses. Results: In this study mean (standard deviation) age for Medical students were 21.7(1.01), Interns were 24(1.60), Staff nurses were 24.34(1.60), residents 26.8(0.98). Among study population,70% female and 30% male in Medical students, 50% male and same male in Interns, 55% male and 45% female in Staff nurses, 74% male and 26% female in Residents. There were 85% Staff nurses had rotation shift work or duty, 70% Interns and 38% Residents had rotation shift duty. Coffee or Caffeinated drink intake were reported by 75% Staff nurses followed by 70% Residents, 55% Medical students and 45% Interns. There was significant sleep quality score among them (p<0.001). There were significant association between global poor sleep quality score and Daytime dysfunction among Medical students, Residents, Staff nurses (p<0.00001). In component of Daytime dysfunction score, there were daytime dysfunction were found higher 70% in Medical student followed by 68% in Staff nurses, 64% in Residents and 35% in Interns. Conclusion: Sleep quality was poor among medical students, residents, staff nurses. Poor sleep quality association with daytime dysfunction was found among Medical students, Residents, Staff nurses. Poor quality sleep score was reported among demographic variable like Rotation shift, Mobile use, Cigarette smoking and caffeinated drink intake. But some variables were not significant statistically. Further research is needed for identifying factors affecting poor quality to prevent consequences of disturbed or poor quality of sleep.

Aim: This study evaluated the role of primary cemented hemiarthroplasty in the treatment of unstable trochanteric fractures in elderly and physiologically elderly patients. Methods: A  study was conducted in the Department of Orthopaedics Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. 20 elderly patients who were above 60 years of age with unstable osteoporotic intertrochanteric fractures, who underwent cemented bipolar hemiarthroplasty were studied prospectively from September 2020 to November 2022. Patients who were less than 60 years of age, non-ambulatory before injury and patients with stable intertrochanteric fractures, pathological fractures cognitive impairment were excluded from the study. Fractures were classified based on Boyd and Griffin classification. All the patients were treated with cemented bipolar prosthesis through direct lateral approach by coxofemoral bypass with standard non modular fixed bipolar prosthesis. Mean follow up period was 12 months. Patients were assessed using modified Harris hip score. Results: In our study, mean age of the patient was 69.4 yrs,18 cases were of type 2 fractures, 2 cases were type 3 fracture.8 patients had limb shortening of less than 2 cm, whereas1 patient had limb shortening of 3 cm. 5 patients had abductor weakness. As assessed by modified Harris hip score, excellent to fair results were obtained at 12 months follow up in 15 cases (75 %), 2 cases (10%) had poor results. 3 patients died postoperatively due to unrelated causes. One patient had superficial infection and was treated with I.V. antibiotics. In our series, we had no complications like stem loosening, periprosthetic fractures, and prosthetic dislocations. Conclusion: Primary cemented hemiarthroplasty for unstable osteoporotic elderly trochanteric fractures appears to be a good alternative treatment modality. Early full weight bearing and rehabilitation is a definitive advantage of this method.

Aim: The aim of the present study was to report the neonatal outcomes and congenital anomalies in pregnancies affected by hypothyroidism. Methods: We conducted a cross-sectional retrospective chart review of neonates of hypothyroid pregnant patients delivered at the DMCH, Laheriasarai, Darbhanga, Bihar, India for two years (Dec 2020-Dec 2022). Among 532 hypothyroid women recruited, 470 had live births. Out of 470 births, 459 were singleton, 16 were had twin pregnancy and 3 were had triplet pregnancy. Total 500 neonates were in the study. Data was collected by trained medical students. Results: The mean gestational age at delivery was 37.5 weeks (SD 2.1). Single session phototherapy was required in 16% of neonates. Neonates with total bilirubin <255 mmol/L, requiring phototherapy were total 80. Out of these, 390 had appropriate birth weight and born at term and 105 had low birth weight at term. Women diagnosed before conception had significant association with low birth weight and congenital anomalies in the neonates. However, there was only marginally significant association of premature birth and sepsis in the neonates, with respect to these two groups. Other neonatal outcomes had no clinically significant association with respect to the timings of diagnosis of hypothyroidism in pregnant women. Conclusion: In conclusion, our study described hyperbilirubinaemia as the most common neonatal outcome and cardiovascular defects as the most common major congenital anomaly. There was significant association of congenital anomalies and low birth weight with the timing of diagnosis of hypothyroidism in women.

Aim: The aim of the study was to compare effect of 0.0625% bupivacaine with 2% fentanyl and 0.125% bupivacaine with 2% fentanyl epidural infusion on haemodynamic parameters for 48 hrs in infraumbilical surgeries and VAS as the secondary objective with preserved hemodynamic parameters. Methods: The proposed study was conducted at Department of Anaesthesia, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for one year. A total of 50 patients with consenting candidates who satisfy necessary inclusion/exclusion criteria during the 18 months period were included. Patients accepted in ASA I and II in whom surgeries were performed by infra umbilical incision and required epidural infusion were included. Valid Written Informed Written Consent of patient was taken. Results: Among study population, 21 (42%) of them had diagnosis of Carcinoma Ovary and 20 (40%) had diagnosis of Fibroid Uterus followed by 3 (6%) had diagnosis of Carcinoma Endometrium. There was no statistically significant difference between two groups in parameter Pulse Rate, Respiration rate, Diastolic Blood Pressure (P>0.05). There was no statistical difference of mean systolic pressure between two groups at starting period, 3 hrs, 6 hrs, 9 hrs, 12 hrs, 15 hrs, 18 hrs, 21 hrs, 24 hrs and 48 hrs (p>0.05) of infusion. There was no statistical difference of mean diastolic pressure between two groups at starting period, 3 hrs, 9 hrs, 12 hrs, 15 hrs, 21 hrs, 24 hrs and 48 hrs (p>0.05). There is statistical difference between two groups at 6 hrs and 18 hrs. Conclusion: The study showed that the infusion of 0.125% bupivacaine with 2 μg fentanyl lead to stoppage of infusion in 12 patients in view of Hypotension and no significant changes in VAS score was noted in two groups of patients.

Aim: The aim of the present study was to determine the role of diabetes mellitus in causing cataracts, especially posterior subcapsular cataracts. Methods: The present study was conducted in Department of Ophthalmology, Bhagwan Mahavir Institute of Medical Sciences for one year  and patients were included who were suffering from cataract eye diseases. The consecutive sampling method used in this study the overall data of cataract patients treated at Bhagwan Mahavir Institute of Medical Institute, Pawapuri, Nalanda, Bihar, India. This data was a medical record containing a history of diabetes mellitus and the types of cataracts suffered by 200 patients. Results: There were 80 patients with a history of diabetes mellitus (40%) and history of non-diabetes Mellitus as many as 120 patients (60%). As for 200 patients who suffer from cataract eye disorders or diseases in this study, it was found that 40 patients or 20%, had PSC type cataracts, and 160 patients, or 80%, had non-PSC type cataracts. From the cross-section analysis results, it is known that as many as 38 patients or 19% had a history of diabetes mellitus and had PSC cataracts, while two patients or 1%, did not have a history of diabetes mellitus but had PSC cataracts. In addition, the results of the analysis also showed that there were 42 patients, or 21% had a history of diabetes mellitus and had non-PSC cataracts, while 118 patients or 59%, did not have a history of diabetes mellitus experiencing non-PSC cataracts. Overall, there were 80 patients, or 40% had a history of diabetes mellitus and had cataracts, and there were 120 patients or 60% who did not have a history of diabetes mellitus but had cataracts. Conclusion: In conclusion, this study demonstrated that incidence rates of cataract diagnosis in patients with diabetes are higher than among diabetic-free patients, particularly at younger age. The overall approximately twofold increased risk of cataract diagnosis associated with diabetes increases with diabetes duration. Patients with diabetic macular edema are at an increased risk for a cataract diagnosis.

Aim: The aim of this study was to identify the proportion of COVID-19 patients who died due to any cause within 6 months of discharge from our tertiary COVID-19-care hospital. Methods: All the adult patients (age ≥18 years) who had been discharged from Banaras Hindu University in Varanasi, Uttar Pradesh, India. after initial hospitalization for COVID-19 was included. After obtaining ethical committee approval, we embarked upon this observational telephonic survey-based study. Clinical and laboratory data of hospitalization for COVID-19 were retrieved from the medical records department of our hospital. Results: 30 patients (15%) were still symptomatic with complaints of either cough dyspnea, or fatigue. Dyspnea or breathing difficulties were noted to be the most common symptoms seen in 7% of total responders, followed by fatigue in 6%, and cough was noted in 5%. Some patients reported sleep disturbances (4%), and headaches (3%). Of all the patients who responded, 16 patients (8%) required expert medical consultation for these symptoms. 18 patients out of the 200 (9%) required re-hospitalization for post-COVID-19 complications within 6 months of discharge. A total of 4 patients (2%) succumbed within 6 months of their discharge from our hospital. Most of the patients who had recovered after a mild infection, remained symptom-free (asymptomatic) (70% vs 40%, p <0.00001). Patients with moderate COVID-19 illness were more symptomatic (50% vs 26.48%, p <0.00001) in the 6 months after discharge. Analyzing the comorbidities present in patients who had been discharged, we found that no particular comorbidity specifically influences whether a patient would remain symptomatic or asymptomatic. However, patients who had received oxygen therapy during their stay were more symptomatic post-discharge than those that did not need any oxygen (p <0.005). Conclusion: A significant proportion of patients had persistent post-COVID-19 symptoms after discharge from the hospital in our study. Breathing difficulty was the most common symptom noted, closely followed by fatigue. We did not find any significant correlation between any specific comorbidity or laboratory value that could predict the persistence of the COVID-19 symptoms after discharge.

Aim: The aim of the present study was to determine the etiology of vitreous hemorrhage in cases reported to our tertiary care hospital. Methods: A cross-sectional study was conducted among the patients presenting with ocular complaints presenting to Department of Ophthalmology, Anugrah Narayan Magadh Medical College and Hospital, Gaya,Bihar, India for one year. Institutional Ethical approval was obtained for the study. Hundred patients were included in the study. Written consent was taken from all the patients in the study. A thorough history was taken before a methodical eye examination was performed. The relative afferent pupillary defect, best corrected visual acuity, neovascularization of the iris, and neovascularization of the angle were recorded. Results: One hundred patients were enrolled in the study. Out of which, 70 were males and 30 females. The mean age group of overall patients presented with vitreous hemorrhage was 48.90years± SD 18.40 years (range 2-84 years). Unilateral presentation is more than bilateral (98% vs 2%). Most common presenting complaint of VH in our study was sudden loss of vision in 48% cases, slowly progressive loss of vision in 30% and floaters in 22% cases. Most of the patients (52%) presented with VA <1/60- PL (perception of light). 10% presented with good vision 6/6-6/18. Only 1 patient (1%) presented with no perception of light (NPL). The most common systemic illness associated was found to be hypertension (40%), diabetes (22%) and hyperlipidemia (2%). 33% patients had no systemic disease. The most common etiology of VH was proliferative diabetic retinopathy in 25% of cases followed by retinal vasculitis in 20%. The third most common etiology was closed globe injuries in 12% of cases. Conclusion: It can be concluded that the common reason for an unexpected, painless loss of vision is a vitreous hemorrhage. Bilateral involvement is less typical than unilateral involvement. In younger age groups, retinal vasculitis (Eales’ disease) and ocular trauma are the most frequent causes of vitreous hemorrhage, whereas, in older populations, proliferative diabetic retinopathy, retinal vein blockage, posterior vitreous detachment, and retinal tear are the most frequent causes.

Aim: To assess the impact of introducing a year-long MSK education programme in terms of increasing MSK knowledge and confidence in managing common MSK conditions in general practice, delivered through an ECHO programme. Methodology: The MSK ECHO trial in ANMMCH ran for one year. The 90 minute sessions ran monthly, with the first session focusing on introducing the participants to the protocols, and the final session based on evaluation and reflection. Ethical approval was not required for this study as it was an evaluation of a new method of teaching. The range of topics was determined by the participants and included the: knee; shoulder; fibromyalgia; inflammatory arthritis in primary care; radiology in primary care; hand and wrist; foot and ankle. 23 GPs participated in the MSK ECHO trial. Prior to starting, each participant completed a questionnaire covering demographic details, prior MSK experience, confidence in examining, treating and diagnosing various MSK complaints, and confidence injecting common joint areas. They were also asked about their satisfaction with the quantity and quality of MSK education opportunities currently available for GPs. Finally, the participants were asked what they would like addressed during the programme and what they would like to gain from it. Results: 20 of the original 23 GPs completed the final evaluation questionnaire, giving a response rate of 86.96%. At baseline, the majority were male (73.91%; 17 males, 6 females) and the average age was 46.5 years (range 35-60 years old). The participants’ average number of years working as a GP and/or GP Partner was 11.7 years (range 6-27 years). Only 30% of those who completed the evaluation, had experience in MSK prior to this ECHO educational programme. Overall, a total of 15 case presentations discussed. The mean weighted average confidence prior to starting the programme was 3.21 (range 2-3.85), and following ECHO was 4.26 (range 3.1-4.45); an improvement of 1.05. 60% GPs reported that they were very confident in injecting joint areas after ECHO, whereas only 25% were confident prior ECHO. 60% of GPs strongly agreed that participation in the MSK ECHO network had enhanced understanding between the participating primary care, secondary care, and allied professionals whereas no one disagreed to this statement. Conclusion: This research demonstrates that engagement of practitioners in ECHO can increase their understanding and confidence of common MSK complaints in general practice with minimal economic impact.

Aim: The aim of the present study was to identify maternal and neonatal risks associated with COVID-19 in pregnancy. Methods: This case–control study was conducted at the Department of Obstetrics and Gynecology BMIMS, PAWAPURI, Nalanda, Bihar, India. All COVID-19 positive women who delivered for the period of two years were included. During the study period, 2020, around 235 pregnant women were COVID-19 positive, of which 30 were discharged undelivered and 5 were spontaneous abortions, so were excluded, 200 were included in the study. Results: According to disease severity, there were mild 192 cases, moderate 6 cases, and severe 2 cases. Cases were mostly from urban areas showing the trend of positivity in urban areas. Mean gestational age in the cases (37.13 ± 2.32weeks) was comparable to controls (38.42 ± 2.88 weeks). While in the moderate/severe category shortness of breath, fever, and cough were the commonest symptoms. Cases (30) had more co-morbidities than controls (16) which were statistically significant. Cases (55%) had more co-morbidities than controls (30%), which were statistically significant. More cases (54%) had caesarean delivery than controls (30%). This was also statistically significant.  While maximum cases in the mild category had hospital stay ≤7 days which was comparable to controls. Among labor complications, 3 cases and 4 controls had an antepartum hemorrhage, 3 cases and 3 controls had a postpartum hemorrhage, 2 cases had retained placenta. Conclusion: The results suggested that the majority of the COVID-19 infected women are asymptomatic, mild category and no adverse maternal–neonatal outcome due to disease at this phase of the pandemic. The adversity of maternal and neonatal outcomes depends on the severity and severity of the disease depends on advanced maternal age and the presence of co-morbidities.

Aim: The aim of the present study was to know the maternal and fetal outcome in oligohydramnios after 34 weeks of gestation. Methods: This study was carried out in the Department of Obstetrics and Gynaecology at JLN Medical College and Hospital, Bhagalpur, Bihar, India over a period of 2 years. 200 consenting pregnant women who had presented to our department in OPD or Labour room for antenatal care after 34 weeks of gestation and diagnosed with oligohydramnios with AFI ≤5 cm was enrolled in this study. Outcome was observed in terms of type of delivery, low birth weight, prematurity and NICU admissions and neonatal mortality. Results: In present study, most of patient presented after term pregnancy (70%), the incidents of preterm pregnancies was (30%), while no patient was presented after 42 weeks of gestation. In present study, most of patient had AFI between 1-4 cm (71%) while 15% patient had AFI of 0-1cm. Mean AFI in my study was 2.08 cm. Out of 200 delivery of oligohydramnios patients, 48% had vaginal and 52% had LSCS. This shows that incidence of LSCS is higher in patients having oligohydramnios (52%). In present study, the incidence of LBW was 53%, 2.40 kg was mean birth weight. Out of 200 deliveries of oligohydramnios patients, 54% required NICU admission and remaining 46% do not required NICU admission. In present study, most common neonatal complications are Low birth weight (50%) and prematurity (30%).In others, 9% had Transient tachypnea of newborn, Meconium aspiration syndrome in 8%, Respiratory distress syndrome (6%), sepsis (5%), and less common complications were jaundice (2%) and hypoglycemia (1%) and out of them, more than half were associated with low birth weight and prematurity. There was no early neonatal death reported in this study. Conclusion: Oligohydramnios is a frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. AFI is an important component of biophysical profile scoring and its assessment in early third trimester helps to identify women who need more ante partum surveillance so that proper management can be done for the improvement of maternal and perinatal outcome.

Aim: The aim of this study was to shed the light on the most common predictive factors for the occurrence and rate of complications associated with hernia repair. Material & Methods: A prospective study with total 500 patients were included, conducted at Department of General Surgery, Government Medical College, Bettiah, Bihar, India. The study was conducted for the period of one year. Results: 375 patients were females and 125 males in the present study. The mean age of patients was 36.4 with the oldest patient in our study being 80 years. The mean BMI for the studied population was 32.8. The mean duration of hospital stay was 3.5 days. Previous abdominal wall surgery was the most common risk factor (275 of the patient) followed by pregnancy (175 patient), chronic constipation (75 patient), chronic cough (25 patient). There was a significant correlation between age of patients and duration of admission (p value 0.003) however no significant correlation between gender and duration of admission was found. Para umbilical hernias were the most common operated hernia in my study (175 hernia) followed by umbilical (150 hernia), incisional (110 hernia). Type of hernia did not have a significant effect on outcome or duration of hospital stay, nor on the risk of recurring emergency surgery. Most common complication was seroma/hematoma developing in 50 of patients and 20 patients had a recurrence within the follow up period. Conclusion: In conclusion, this study only looked at one center’s experience with ventral hernia repair, so it’s clear that more work has to be done to reduce the prevalence of ventral hernias and the complications they can cause.

Aim: The aim of the present study was to evaluate the role of Chest Radiography for evaluation and Severity Scoring in COVID-19 Pneumonia. Methods: The present study was conducted at the Department of Radio-diagnosis, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India, for 10 months, and 500 patients were included in the study. The study was approved by the review board of the institutions, and the requirement for informed consent was waived since the study had no risk and would not adversely affect the subjects’ rights or welfare. Results: 500 patients were retrospectively enrolled in our study. There was male predominance (60% men and 40% women). History of contact with positive patients could be traced in 50% of patients. 40% of patients in our study were clinically asymptomatic. Amongst the symptomatic group, the most common symptoms at onset were fever, cough and dyspnoea, seen in 165, 150 and 130 patients, respectively. Other less common symptoms included sore throat (4%), chest discomfort (1.8%), diarrhea (1.2%), hemoptysis (0.2%) and miscellaneous manifestations (10%). The most common comorbidity seen amongst patients was hypertension (25%), followed by diabetes mellitus (15%), chronic renal disease (3%), COPD (1.6%) and chronic liver disease (1%). 200 patients with alveolar opacities, 100 with consolidation and 50 patients with consolidations and alveolar opacities co-existent in the same radiograph were found. We also found nonspecific signs of COVID-19 pneumonia as pleural effusion, nodules and pneumothorax. Conclusion: The features of coronavirus disease 2019 (COVID-19) on chest radiographs and proposed a severity scoring for rapid triage of patients to aid in appropriate management. As the COVID-19 pandemic threatens to overwhelm healthcare systems worldwide, highlighting the usefulness of a simple radiograph as a tool for identifying and stratifying cases of COVID-19 is justified. Determination of radiological severity can aid in effective patient categorization and enforcement of appropriate clinical management.

Background: Prostate cancer is the second most common type cancer in men accounting >15% of all diagnosed cancers. Early detection with early-stage disease is of very importance for patients to detect certain risk groups. New ISUP group grade is a powerful prognostic marker at time point of diagnosis. Patients are screened for prostate cancer with serum P.S.A. which shows highest specificity 96.4%. Objective: To study of Serum P.S.A. level as screening method use for detection of prostate cancer in patients and Histopathological examination of TURP and TRUS guided core needle biopsies of prostate are the gold standard for diagnosis of prostate cancer. Material and method: It’s a prospective observational study included 50 samples. Results: 50 patients included in study. Most of the age group from 37 to 100 years, with a mean of 69+11 years. The age range of 66-75 years (36%) were the highest percentages of age group distributions among the patients in the present study. The mean serum PSA concentration is 77.98 ng/ml (range 16.02–119.82 ng/ml). New ISUP grade group 4 is most common in our study with 24 (48.0%) of our patients falling in this category while grade groups 1, 2, 3 and 5 has 7 (14.0%), 6 (12.0%), 7 (14.0%) and 6 (12.0%) respectively. Conclusion: This study concluded that in patients with prostatic adenocarcinoma, there is a statistically significant association between serum PSA levels and newly introduced (2016) Gleason grade group of prostatic carcinomas.

Background: Acute myocardial infarction is characterized by elevated levels of inflammatory cytokines, platelet activity, and leukocytosis. Platelets and inflammatory markers are the important regulatory players in the complicated mechanism involved in myocardial infarction. Our study aimed to evaluate the inflammation markers concentrations, and platelet biomarkers parameters in the group of ACS patients (STEMI, NSTEMI, and UA) as compared to the control group. Methodology: This was a cross-sectional study conducted at Pathology department, NSCB Medical college, Jabalpur from January 2021 to June 2022. Total of 230 patients, 180 cases and 50 controls were taken for this study. Data was collected after taking informed written consent. All patients underwent a standard 12 lead ECG examination, which was interpreted by an expert cardiologist regarding the standard ischemic ECG changes. Data analysis was done through IBM SPSS software version 21. Ethical permission was been taken before commencement of the study. Result:  In our study out of 230 study subjects, 180 were cases and 50 controls. Out of 180 cases of ACS includes three main clinical categories, i.e., STEMI (ST-elevation myocardial infarction) includes 23 cases (41.1%), NSTEMI (non-ST-elevation MI) includes 74 cases (133%), and unstable angina includes 83 cases (149%). It was found that inflammatory markers like CRP, was found to be statistically significant with ACS (p<0.001), mean value of CRP ACS cases was 31.56 ± 23.14 and controls mean CRP value was 5.92 + 2.04. The area under the curve for PLT was 0.95 with SE = 0.014 and 95% CI ranging from 0.921 to 0.975 (P<0.05); for CRP was 0.98 with SE=0.008 and 95% CI ranging from 0.959 to 0.991 (P<0.05); and for D-DIMER was 0.91 with SE = 0.020 and 95% CI ranging from 0.867 to 0.947 (P<0.05). In our study, CRP cut off 8.85 mg/L predicted ACS the best with both sensitivity and specificity being (93%) and (88%). Conclusion: We would like to conclude in our study that platelet parameters mainly MPV, PLT, LPLT and PTC were significantly raised in the patients admitted with ACS to the tertiary care hospital. We also conclude that the inflammatory markers mainly, CRP and D-DIMER have good predictive power with AUC = 0.900.

Background: Phenylephrine is the first-line choice for prevention and treatment of hypotension during spinal anaesthesia for caesarean section. In a quest for new drug, we compared norepinephrine with phenylephrine boluses to treat hypotension following spinal anaesthesia during caesarean section. Materials and Methods: After obtaining institutional ethics committee clearance (Reference No:EC138), CTRI/2O22/08/044705, informed consent was taken, and the study was conducted on 60 patients of 20-35years age group. Patients were randomized in to two groups of 30 each. Group N received norepinephrine (6 mcg) and Group P receives phenylephrine (100 mcg) to treat hypotension following spinal anaesthesia. The primary outcome was to compare number of boluses of each vasopressor required to treat hypotension following spinal anaesthesia. The secondary outcome was to compare APGAR score in the newborn. Results: 27 mothers in phenylephrine group and 28 mothers in norepinephrine group developed hypotensive episodes. In Phenylephrine group, mean number of vasopressor boluses needed were 1.185 ± 0.388 and in Norepinephrine group they were 1.107 ± 0.309 with p value 0.3926. The Number of boluses of vasopressor required to treat hypotension was lower in Norepinephrine group when compared to phenylephrine group. There was no statistically significant difference in Number of Vasopressor Boluses needed between two groups. Maternal complications such as nausea and vomiting were comparable between the groups. Neonatal outcome APGAR scores were above 7 in all newborn babies. Conclusion: Single bolus of 6mcg norepinephrine was found as effective as phenylephrine in the management of hypotension following spinal anaesthesia during caesarean section. The neonatal outcomes were similar in both the groups.

Introduction: Regional Anaesthesia is an excellent choice which provides effective intra & post- operative analgesia with a single technique which is being possible due to the availability of long-acting amide local anaesthetics like Ropivacaine and by the addition of adjuvants like clonidine and Dexmedetomidine. Aims: We compared the effects of Clonidine (0.5mcg/ kg) with Dexmedetomidine (0.5mcg/kg) as an adjunct to Epidural 0. 75% Ropivacaine in lower limb surgeries in adult patients. Materials and Methods: This randamized study was carried out in the department of Anaesthesiology. This study 60 patients undergoing elective lower abdominal surgeries and lower limb surgeries, aged between 18-45 years of either gender, belonging to ASA grade I and II randomly divided into two groups by lottery method.  After taking written informed consent from patients, they were subjected to epidural catheterization with 16 or 18 G touhy`s needle and epidural anaesthesia given. Results: The mean time of onset of sensory blockade in Dexmedetomidine group is significantly less than Clonidine group. The 2 segment regression time in Dexmedetomidine group was significantly higher than Clonidine group. The mean duration of sensory blockade and onset of motor blockade was significantly higher with Dexmedetomidine group than Clonidine group. The mean time and duration of onset of motor blockade was significantly less in Dexmedetomidine group than Clonidine group than control group. The duration of analgesia was significantly prolonged and highest in the Dexmedetomidine group compared to Clonidine group.  Both groups were similar in haemodynamic stability and side effects (P > 0.05, statistically not significant). Conclusion: Dexmedetomidine is a better adjuvant than clonidine in epidural anaesthesia as far as patient comfort, stable cardio-respiratory parameters, intra-operative and post-operative analgesia is concerned.

Background:  Dengue is an Aedes mosquito-borne viral disease brought about by an arbovirus. There are an estimated 2.5 billion people who are at risk for contracting dengue, of whom about 100 million do so each year. Dengue fever is an acute febrile illness with frontal headache, retro-ocular pain, muscle pain, joint pain, and rash, even though other signs and symptoms could also be present. Aim to  study  clinical profile of dengue cases in tertiary care hospital of central part of India. Methodology: Prospective observational study was carried over a period of 1 year month from July 2021 to June 2022, patient were admitted in R D Gardi medical college Ujjain, Madhya Pradesh, India. About 130 cases were included in study. The information regarding demographic details, clinical symptoms and complications, and epidemiological details were collected from the records using a questionnaire. Result: Maximum cases of dengue was seen in 19-44 year of age group (60%) and in male (62.31%). Only 16.15% had more than 7 days of hospital stay. It was found that 66.92% of dengue cases were DENGUE NS1 positive. Only 10.77% were IgM positive. It was observed that in study about 71 cases were having severe thrombocytopenia. It was observed that 27 cases had platelet transfusion. Conclusion: Dengue is a difficult infectious disease that poses a serious public health risk. The reduction of mortality and morbidity requires more vigilance on the part of healthcare professionals while dealing with a case. To meet this issue, hospitals must be prepared with the proper public health measures.

Aim: The aim of the present study was to assess epidemiological, clinical characteristics and comorbidities among deceased patients with COVID-19 infection. Methods: The Retrospective study among deceased patients with COVID-19 infection at Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for COVID-19. The study included patients who succumbed to COVID-19 for the period of two years. Results: The mean age was 58.02 years and there was a male (70%) preponderance among the study population. Majority of patients were elderly, 61–80 years of age group (41%). The mean duration of illness was 5.5 days. The most common comorbidities among the deceased were diabetes (46%) and hypertension (40%) followed by chronic kidney disease (26%), coronary artery disease (8%), and COPD (12%). The mean duration of hospitalization was 4.2 days. Among clinical parameters, majority (65%) of patients had tachycardia (heart rate >100/min). Most of the patients who presented to the hospital had respiratory rate >24/min (92%) and mean oxygen saturation of 68% at room air. The most common symptoms at the time of presentation were breathlessness (93%) and fever (75%) followed by cough (35%), myalgia, and fatigue (24%). Conclusion: Majority of the patients who contracted the illness and died due to COVID‑19 were elderly, males with diabetes and hypertension. At the time of presentation, the majority had respiratory distress of acute onset. Elderly population with comorbidities is more prone to disease and has higher chances of respiratory failure and death.

Aim: The aim of the present study was to determine the usefulness of patient education and if AR control was affected by different methods of teaching of nasal spray usage. Methods: The Present study was conducted at  Department of ENT, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for two years  and patients were recruited aged 18 and above with clinical symptoms suggestive of mild persistent or moderate-severe persistent AR (ARIA guidelines 2008). Total 100 patients were included in the study. Results: Patients were between 20 to 60 years old (mean=32.4 years) and among them 40 (40%) were male patients and 60 (60%) were female patients. Based on the 2008 ARIA guidelines, 88 (88%) patients were diagnosed with moderate-severe persistent (MSP) AR, 4 (4%) had moderate- severe intermittent (MSI) AR while 8 (8%) had mild persistent (MP) AR. Assessment on the techniques during the 2nd (visit 2) showed that none of the participants were able to show a correct technique on the usage of INCS. During the 3rd visit despite re-education, only 26% of participants were able to show the correct techniques. There was statistically significant association between ARIA classification and severity of TNSS during V1-V3. Majority of patients with MSP AR had severe TNSS during V1 and subsequently improved to moderate symptoms during V2 and mild/very mild during V3. Conclusion: Our study showed the importance of educating patient regarding the use of INCS. Both objective and subjective assessment of improvement after each method of patient education showed statistically significant outcome.

Aim: The aim of the present study was to assess compare the pain sensitivity and functional outcome in patients of early osteoarthritis knee when treated with intra-articular steroids versus intra-articular hyaluronic acid. Methods: This study was conducted at department of Orthopaedics, JLNMCH, Bhagalpur, Bihar, India to analyze the pain sensitivity and functional outcome in patients of early osteoarthritis knee when treated with intra-articular steroids versus intra-articular hyaluronic acid using VAS and WOMAC scoring system for the period of 1 year. A total of 100 patients were included in the study of which 50 patients were given intra-articular steroid injection and 50 patients were given hyaluronic acid. Results: A major number of patients in steroid Group were in the age group 60 – 65 years i.e. 56%. On the other hand, 48% of patients in H.A. group were in the age group 60 – 65 years. A major number of patients in steroid Group were in the age group 60 – 65 years i.e. 56%. On the other hand, 48% of patients in H.A. group were in the age group 60 – 65 years. In steroid group, male population accounted for 36% and female was 64%. In HA group, male population accounted for 46% and female was 54%. In steroid Group, 23 patients (46%) that were given treatment were right side as compared to 11 patients (22%) on left side while 16 where bi- lateral (32%). In H.A. Group, 26 patients (52%) that were given treatment were right side as compared to 12 patients (24%) on left side while 12 where bi- lateral (24%). In steroid Group, 14 patients (28%) were of grade I while 36 patients (72%) were of grade II. In H.A. Group, 18 patients (36%) were of grade I while 32 patients (64%) where of grade II. In steroid Group, 16 patients (32%) having mild activity level while 23 (46%) having moderate and 11 (22%) having heavy activity level. In steroid Group, 14 patients (28%) having mild activity level while 23 (46%) having moderate and 13 (26%) having heavy activity level. Conclusion: In conclusion, our study showed that the Pain sensitivity and functional outcome of Intra articular therapy performed via H.A. group are similar till three months in comparison to Steroid group. Persistance of decreased pain sensitivity and improved functional outcome was shown in H.A. group up to one year.

Aim: To assess the outcome of drug induced medical abortion. Materials and Method: The present prospective clinic-observational study was conducted in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar. 110 women who fulfilled the criteria for the investigation were interviewed. After confirming gestational age by ultrasound the following regimen was followed mifepristone 200 mg stat dose and then after 24 h admitted and started on misoprostol 600 mcg in the posterior vaginal fornix, followed by 400 mcg sublingually until abortion or a maximum of five doses. Results: Majority of the women were multiparous (83.6%) and the average duration of bleeding was found to be 6.23 days. Majority of the women (89.1%) had Induction Abortion Interval of less than 4 hr. the success rate reported was 98.2%. Conclusions: Mifepristone-misoprostol medical abortion can complement available surgical services and help meet the pressing need for safe, effective and acceptable abortion services in the developing country like India.

Aim: The aim of this study was to study clinical predictors of hypoxemia in patients of acute lower respiratory infections in children. Material & Methods: The observational prospective study was conducted in the General Pediatric Ward and Pediatric Intensive Care Unit of Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India for 1 year. The sample size taken for this study was 100. All children admitted with acute lower respiratory tract infections between the age group of 2 month to 5 years of age and diagnosed with pneumonia or bronchiolitis were included in the study. Results: A total of 100 cases were enrolled in the study, out of which 70 were male and 30 were female.  Out of the 100 cases enrolled, 48 were below the age of 12 months and 52 were above 12 months of age. The mean age was 16.4 months. The most common and significant symptoms were rapid breathing and difficulty breathing. The least common symptom was noisy breathing and pain in the abdomen. Tachypnea (88%), pallor (86%) and nasal flaring (80%), crepitations (80%), supraclavicular (76%) and subcostal retractions (70%) had better sensitivity for detecting hypoxemia. However, these signs had low specificity for hypoxemia. Head nodding (95%), intercostal retractions (82%), and cyanosis (85%) were highly specific for predicting hypoxemia. Males 68 out of 70 were significantly more hypoxemic than females 27 out of 30. Most cases have moderate hypoxemia which includes 80%. 35 cases out of the total 100 were diagnosed to have bronchiolitis, whereas 65 cases had pneumonia. Conclusion: It was observed that a combination of clinical signs and symptoms can be used to predict hypoxemia when facilities of pulse oximetry and arterial blood gas analysis are not available, especially in low-resource settings.

Background: This search engine provides a simple way to access ”peer-re­viewed papers, theses, books, abstracts, and articles from academic publishers’ sites, professional societies, preprint repositories, universities and other scholarly organizations”. However, several authors suggest that Google Scholar should not be the first or sole choice when searching for patient care information, clinical trials, or literature reviews. Aim: To assess and compare the literature retrieved from Google Scholar and PubMed database using oral health related keywords. Materials and methods: A cross-sectional observational study was carried out. The official home pages of PubMed and Google Scholar were searched using ten oral health related keywords to identify and extract information regarding the various characteristics of these databases. All the keywords were searched with use of parentheses (“ ”) as a Boolean operator to limit the search to required area of focus. Results: In nine of the ten searches, Google Scholar returned larger retrieval sets than PubMed. Most items retrieved by Google Scholar were journaled articles. Items in other formats included: journal article, book citation, book reviews, and others. These results yielded few gray literature items. Conclusion: Google Scholar does not appear to be a replacement for PubMed, though it may serve effectively as an adjunct resource to complement databases with more fully developed searching features.

Introduction: The Geriatric Oral Health Assessment Index (GOHAI) has proven to be an excellent tool for detecting oral disorders. On the other hand, the relative responsiveness of this measure to detect clinically meaningful change is not entirely clear .The GOHAI is a 12-item self-reported index, validated first in the United States in an elderly Caucasian sample and subsequently in Hispanic, African American, Chinese, French and Spanish samples. Aim and objectives: To provide necessary data for oral health administrators to plan comprehensive programmes to improve quality of life in elderly population. Methodology: All elderly individuals in these old age homes formed the study population. WHO Oral health assessment, 1997 and GOHAI was used in the study. Results: About 29.3% (n=66) said that they were sometimes able to eat without feeling discomfort while 5.3% (n=12) were often able to eat without discomfort. About half of the participants i.e. 50.7%(n=114) said they never did while 2.7% (n=6) said they often or always had limit their contacts with people. About 42.7% (n=96) said they never were, while 4% (n=9) said they seldom were pleased with the looks of their teeth, gums or dentures. Conclusion: The study focus on the need to conduct similar studies with more diverse population and influence the policy makers in the country to include geriatric oral health care needs in National Oral Health Policy.

Introduction: An individual’s prior life experiences as well as their cultural, social, and historical background will affect their self-perceived oral health status. Therefore, individuals with the same oral health status may perceive their oral health-related quality of life (OHQoL) differently. Older adults who perceive poor oral health but at the same time have poor expectations may not view oral health as having an impact on their quality of life. Aim and Objectives: To assess dental caries, periodontal status and prosthetic status among elderly individuals aged 60 years and above. Methodology: All elderly individuals in these old age homes formed the study population. WHO Oral health assessment, 1997 and GOHAI was used in the study. Results: About 29.3% (n=66) said that they were sometimes able to eat without feeling discomfort while 5.3% (n=12) were often able to eat without discomfort. About half of the participants i.e. 50.7%(n=114) said they never did while 2.7% (n=6) said they often or always had limit their contacts with people. About 42.7% (n=96) said they never were, while 4% (n=9) said they seldom were pleased with the looks of their teeth, gums or dentures. Conclusion: Oral health status showed 10.9 mean number of missing teeth per patient, this highlights on the loss of functional edentulism and poor oral health of the elderly institutionalized patients. There was statistically significant association between age and socioeconomic status.

Introduction: In most cases, prophylaxis is used for prevention of endocarditis. Therapeutic antibiotics are prescribed, in most cases, to treat diseases of the hard and soft tissues in the oral cavity after local debridement has failed. [2] Antibiotics are prescribed for oral conditions related to endodontic, oral surgical, and periodontal manifestations. Aim and Objectives: To assess the knowledge regarding antibiotic prescription use among dental practitioners in Chittorgarh, Rajasthan. Methodology: A total sample size of 25 was calculated based on the pilot study conducted. Convenient sampling technique was used. Practicing dentist in Chittorgarh registered with Indian dental association and dentists in academic institution were considered as study samples. Results: The response rate was 92% (n = 23/ 25) More than half of the participants were male (54.8%). Around 40% of practitioners had experience of 1 -5 year while only 3% were having 15 years or above. The sample included a total of 23 dentists with 70% BDS and 30% MDS. Most of the dentist commonly used broad spectrum antibiotics (78.2%). Conclusion: The knowledge on the safe antibiotics to be used during pregnancy was not satisfactory. Practitioners reported good number of patients doing self-medication. Microorganisms specific antibiotic knowledge was lacking. Empirical use of antibiotics can lead to drug resistance, which majority of the practitioners were aware.

Background: In this study, we wanted to determine the histopathological types of the malignancies of the oral cavity along with the clinical presentations in individual sites. Methods: This study was done at Travancore Medical College, Kollam, over a period of 5 years from January 2017 to December 2021, among 325 patients who presented with malignancies of the oral cavity in the depart of ENT-Head and Neck surgery. All patients were appropriately investigated. Results: 76.6 % of patients presented in an advanced stage (stage III or stage IV). Majority of the patients presented with complaints of ulcer, pain, or local swelling. 39 % of the patients had anaemia on presentation. Tongue was the most common site involved followed by buccal mucosa. Squamous cell carcinoma was the most common type of malignancy in the oral cavity with well-differentiated SCC present in 48.62 % of the cases. Conclusion: Most patients present in stage III or stage IV. Early diagnosis is the key to effective treatment of oral malignancies.

Background: Anemia refers to a condition where there is a decrease in the number of red blood cells or decrease in the amount of haemoglobin in the blood. Anemia is a common consequence of iron deficiency, iron deficiency itself can manifest before anemia develops. Aim and Objectives: we have undertaken this study to know  clinical spectrum in patients with Iron deficiency without anaemia and its complication. Material and Method: This was a cross-sectional study carried out in department of General medicine at Guntur Medical College, Guntur.  included the clinical profile of 200 cases in both outpatient and inpatient to General medicine department during the study period, after getting ethical approval and satisfying inclusion and exclusion criteria. Results: Among all the patients we have observed there were 61 patients without Anemia and 139 patients were with Anemia with iron deficiency. mean difference in age between NAID and AID was not statistically significant, but mean difference of others parameters like haemoglobin, serum ferritin, were statistically highly significant and mean difference of total bilirubin was statistically significant between NAID and AID. Comorbid conditions and other sign and symptoms were statistically significant with ferritin level. Conclusion: Two thirds of iron deficiency patients were in iron deficiency anemia group and one third of patients presented with non-anaemic iron deficiency group who presented with symptoms.

Background and Objectives: Iron deficiency is a prevalent global nutritional insufficiency that often leads to antenatal anemia. This study aims to evaluate the effectiveness and safety of intravenous Ferric Carboxymaltose (FCM) compared to intravenous Iron sucrose complex (ISC) in managing iron deficiency anemia during pregnancy, as per the classification of the World Health Organization (WHO) based on hemoglobin levels below 11 g/dL, with severe anemia defined by hemoglobin levels below 9 g/dL. Materials & Methods: An interventional prospective study was conducted at the Department of Obstetrics and Gynecology, Government Medical College from Central India. The study enrolled a total of 100 antenatal patients diagnosed with anemia, characterized by hemoglobin levels ranging from 5 to 9.5 g/dL. The participants were randomly assigned to two groups: the first group received a total of 1000 mg of intravenous iron sucrose administered in five divided doses on alternate days (200 mg per dose), while the second group received 1000 mg of intravenous ferric carboxymaltose. Results: The majority of patients in our study belonged to the low socioeconomic group. A significantly higher number of women in the ferric carboxymaltose (FCM) group achieved a rise in hemoglobin levels of more than 2 g/dL, which was highly significant. The mean rise in hemoglobin was 2 g/dL in the FCM group and 1.7 g/dL in the iron sucrose group, which was also statistically significant. Furthermore, the ferric carboxymaltose group exhibited a greater increase in serum ferritin levels compared to the iron sucrose group. Conclusion: Ferric carboxymaltose emerges as an effective and preferable alternative to Iron Sucrose in the treatment of iron deficiency anemia during pregnancy. It offers the advantage of a single-dose regimen with reduced incidence of side effects.

Aim: This study was conducted to evaluate the diagnostic accuracy of the existent clinical scoring systems in combination with ultrasound imaging in the diagnosis of acute appendicitis in our patients. Materials & Methods: All 100 patients with clinical diagnosis of acute appendicitis and who underwent emergency appendectomy in the Department of General Surgery, Bhagwan Mahavir Institute of Medical Science, Pawapuri, Nalanda, Bihar in between two years were included in the study. A detailed history of presenting illness was elicited and clinical examination, relevant blood investigations and abdominal ultrasonography were done. All patients were scored according to MAS, RIPASA and AIRS. Histopathology was taken as the gold standard. Results: Out of the total 100 patients, 90 (90%) were found to have acute appendicitis on histopathology while 10 (10%) were normal on histopathology. This gave a negative appendectomy rate of 10%. RIF pain was the most consistent symptom present in 100% of the patients. Leucocytosis (Total leucocyte count >10000/mm3) was present in 88 patients (88%) and 12 patients (12%) had normal TLC. Elevated CRP in the range of 10–49 mg/l was seen in 90 patients (90%) while CRP was ≥50 mg/l in 10 patients (10%). The chi-square test shows that migratory pain (p=0.003), nausea (p<0.001), vomiting (p<0.001), guarding (p<0.001), rebound tenderness (p<0.001) and raised TLC >10000/mm3 (p<0.001) were statistically significant indicators of acute appendicitis. MAS was ≥7 in 78 patients (78%) and <7 in 22 patients (22%). On further analysis with histopathology; it was found that MAS could diagnose 77 patients out of 90 histopathologically positive acute appendicitis patients thereby yielding a sensitivity of 85.56%. RIPASA score was ≥7.5 in 84 patients (93.34%) and <7.5 in 6 patients (6.66%). Conclusion: If ultrasonography is used in conjunction with current clinical scoring systems, then the diagnostic accuracy is enhanced. Therefore, USG should be done in all cases being evaluated for acute appendicitis; irrespective of the score being used.

Aim: The study aims to find out the clinical profile and outcomes of patients with diabetic foot infections (DFI). Methods: This prospective observational study was conducted at the Department of Surgery JLNMCH, Bhagalpur, Bihar, India. 100 patients with diabetes attending general surgery ward for diabetic foot ulcer management at Jlnmch, Department of General Surgery, JLNMCH, JLNMCH, Bhagalpur, Bihar, India, were included during the study period for the period of 18 months. Results: 100 patients were diagnosed as diabetic foot. In diabetic foot, the age of patients ranged from 19 to 80 years. 20 (20%) patients were between 21 to 40 years; 42 (42%) patients were between 41 to 60 years and 38 (38%) patients were above 60 years. Out of 100 patients with diabetic foot, 90 patients were treated by debridement, in which 35 patients had deranged lipid profile and 55 had normal lipid profile. Out of 100 patients with diabetic foot, 10 patients were treated by amputation, out of which 8 patients had deranged lipid profile and 2 had normal lipid profile. Patients with deranged lipid profile had increased chances of amputation. The hospital stay and serum creatinine values were significantly higher in patients with HbA1c>8.5. Out of 100 patients with diabetic foot; 30 (30%) patients had pseudomonas; 24 (24%) patients had E. Coli; 22 (22%) patients had Klebsiella; 21 (21%) patients had staphylococci and 3 (3%) patients had no growth on aerobic culture media. Conclusion: Diabetic foot pathologies are common in diabetics and pose serious health problems for developing countries. They seem to affect both sexes equally. The present study highlighted the significance of patients with DFU in tertiary care hospital in India context where diabetes is poorly controlled, there was also little awareness for foot care and delay in seeking treatment, as this will worsens the extent of tissue destruction.

Aim: The aim of this study was to analyse the frozen section results and compare it with final paraffin sections and evaluate the diagnostic accuracy. Material & Methods: A retrospective study of 100 specimens of intra operative FS were carried out in histopathology section of IGIMS, Patna, Bihar, India in between July 2016 to Jan 2018. The diagnoses given on frozen section were compared with the final diagnosis given on permanent paraffin sections. The results were categorized into concordant and discordant. Results: In this retrospective study, total 100 cases were received for intraoperative consultation (frozen section) in 30 months. In all cases, cryostat sections (FS) plus squash smears were prepared. The ages of the patients ranged from 1 month to 75 years. Out of 100 cases, 52 were males and 48 were females. Out of 100 cases, 70 (70%) cases were concordant, 30 (30%) cases were discrepant with diagnostic accuracy of 70%. Conclusion: Frozen section is a rapid diagnostic process which helps surgeons to choose   best therapeutic approach. It confirms various benign and malignant lesions. When unexpected disease process is found and require a definite diagnosis and to take a definite decision on extent of surgery frozen section is very much helpful. However, one needs to be aware of its limitations. By avoiding its limitation diagnostic accuracy can be improved.

Aim: The aim of the present study was to see the prevalence, etiology, clinical profile, and immediate outcome of community-acquired acute kidney injury (AKI) in a pediatric critical care nephrology setup. Methods: This observational study was conducted over a period of 2 and half years at department of Pediatrics, AIIMS, Patna, Bihar, India. A total of 640 critically ill children with different kidney diseases along with fluid electrolytes and acid-base imbalances were admitted to the CCN and D unit during this study period.  Among 640 patients, 500 were with AKI. Age ranged from 5 days to 17 years. Results: Most (48%) of the study patients were from lower-income families, 25% were from lower middle-income families, 16% from middle-income families, and 11% from higher-income families. Among the 500 cases of AKI, 325 (65%) were pre-renal, 90 (18%) were renal, and 85 (17%) were post-renal. Overall 37% died, 48% improved and 15% had taken LAMA. Of 136 neonatal AKI, 70 died. Among 223 infants, 85 had died, between 1-year and 5-year age group 18 had died, among 62 children in older than 5 years group, 12 had died. The highest recorded mortality was found in neonates and infants. Among the neonatal AKI, neonatal sepsis was the most common cause. The overall outcome was worst and the highest mortality was seen in all cases. Conclusion: Higher number of severe AKI was found to be associated with high mortality especially in neonates and infants in critical care nephrology setup. Post diarrheal hypovolemic AKI was the most common cause, followed by sepsis, GN, HUS, and PUVs. AKI with CCF, hypertensive crisis, severe hypernatremia, and severe metabolic acidosis needs to be managed adequately with early dialysis support.

Aim: The aim of the present study was to evaluate the safety and efficacy of mini percutaneous nephrolithotomy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of kidney stones 20–30 mm. Methods: This was a randomized prospective study of 100 patients presented to the department of urology in Indira Gandhi institute of Medical sciences, Patna, Bihar India , with calyceal or pelvic kidney stone (20–30 mm) for the period of 2 years. Patients were randomized using computer based program into 2 groups; group A (Mini PCNL), and group B (RIRS) with 50 patients in each group. Results: The Mean of age was 35.25 ± 12.68 years in group A & 34.6 ± 11.49years in group B, with no statistically significant difference (p value was 0.44).  In group A, The lower calyx stones were in 21 (42%) patients & 13 (26%) patients in group B, while stones in lower calyx and pelvis were in 3 (6%) patients in group A & 8 (16%) patients in group B, Pelvic stones were in 19 (38%) patients in group A& 17 (34%) patients in group B, middle calyx in 7 (12%) patients in group A & 12 (24%) patients in group B, with no statistically significant difference (p value < 0.18). The stone size was 20.22 ± 2.6 mm in group A & 20.7 ± 2.2 in group B, with no statistically significant difference (p value < 0.22). The operative time in group A was 62.38 ± 18.32 min and in group B was 80.20 ± 15.75 min with statistically significant difference ( p value < 0.001).We also observed that mean postoperative hemoglobin was 12.58 ± 0.92 g/dL in mini PCNL, 12.82 ± 0.92 g/dl in RIRS with no statistically significant difference (p value < 0.60). Conclusion: RIRS and mini PCNL can be an effective and alternative option for treatment of renal stones 2–3 cm. Both techniques have relatively similar SFR but RIRS showed more operative time, on contrary Mini PCNL has more operative and postoperative complications. However, mini-PCNL is more cost-effective making it a viable alternative to RIRS.

Aim: The aim of the present study was to evaluate the role of local irrigation of 0.25% bupivacaine in alleviating the post-operative pain. Methods: This was an observational study conducted on 100 patients who had undergone MRM in department of Anesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya, India, in between one year. All those who fulfilled the inclusion and exclusion criteria and those who were willing to participate were included as study participants. Results: The mean age and weight of the study population were comparable between both the groups before the start of the study. There was no significant difference in means between both the groups. The duration of surgery and dose of fentanyl given was more or less similar in both the groups. Both the groups were similar with respect to ASA status and mallampati score. Post-operative nausea and vomiting was present in 4 in study population and 20% in control group. The result was statistically significant. Conclusion: Irrigation of wound with 0.25% Bupivacaine is found to reduce the pain sensation with minimal side effects without systemic compromise.

Aim: The aim of the present study was to compare the efficacy and tolerability of oxaceprol, in comparison to the relatively weak opioid tramadol, in the treatment of symptomatic knee osteoarthritis. Material & Methods: A parallel group, double‑blind, randomized controlled trial was carried out in the Dept. of Pharmacology at DMCH, Laheriasarai, Darbhanga, Bihar, India for one year.  This comparative study was carried among patients diagnosed as Osteoarthritis.A total of 200 patients were included in the study with knee joint pain intensity of at least 35 mm on a 100 mm visual analog scale (VAS) present for at least preceding 3 months and with confirmed degenerative changes in knee skiagram. Results: In tramadol group, 47% were males and 53% were females and mean age of participants was 52.48 years whereas in Oxaceprol group 49% were males and 51% were females and mean age of participants was 51.39 years. No statistically significant difference was observed between groups for WOMAC scores. Significant reduction in pain, stiffness and physical function was observed between Oxaceprol and tramadol group at baseline and after 6 months follow-up. No statistically significant difference was observed between groups for WOMAC scores. Significant reduction in pain, stiffness and physical function was observed between Oxaceprol and tramadol group at baseline and after 6 months follow-up. Conclusion: Efficacy and tolerability of oxaceprol were comparable to tramadol, and the drug can be considered as an alternative to low‑potency opioids in the management of knee osteoarthritis.

Aim: The aim of the present study was to assess epidural or intrathecal morphine for post-operative analgesia following laparoscopic endometriosis surgery. Methods: The present study was department of Anesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya, India for 15 months  and 100 patients were included in the study. Results: Majority of the patients (26%) were belonged to overweight (25.00–29.99) category followed by 24% Obesity class III (≥40). 78% cases completed ≤12 years of school and 68% were married. 66% had no analgesia followed by 32% non-opioid analgesia. Mean pain scores were significantly higher at one week (1.62, 𝑃 < 0.0001), four weeks (0.63, 𝑃 = 0.02), and six months (0.27, 𝑃 = 0.04), but not at three months following surgery. During the first two postoperative days, opioid analgesia (98%, 𝑃 = 0.09) and NSAIDS (60%, 𝑃 = 0.7), a significantly higher proportion of patients required Paracetamol (95%, 𝑃 = 0.03). At 3–5 days after surgery. Analgesic use was comparable between groups after 60 days after surgery. Conclusion: The results of this study showed that laparoscopic surgery for endometrial cancer is associated with less need for epidural and postoperative analgesic prescription compared with open surgery, saving on costs of analgesia and highlighting a further significant benefit to patients and the healthcare system of laparoscopic treatment over traditional open abdominal surgery.

Aim: The present study was conducted to assess gynecological disorders among geriatric women. Material & Methods: The present prospective, observational study was conducted in the Department of Obstetrics and Gynaecology, PMCH, Patna, Bihar, over a period of one year which comprised of 200 women aged >65 years old. All subjects were enrolled after they agreed to participate in the study after signing written informed consent. Ethical clearance was obtained from institutional review and the Ethics Committee. Results: Out of 200 patients, 85% belonged to age group 65-74 years. The study population was 60% from rural and 40% urban areas. Only 30% of the patients were literate. Geriatric women had higher number of pregnancies. Their mean age at menopause was 49.11±4.40 years and mean duration of menopause was 21.14±5.85 years. Something coming out of vagina (SCOV, 25%) and Postmenopausal bleeding (PMB, 32%) were the two major presenting complaints. Amongst the co-morbidities, Hypertension was the single most common followed by Anaemia, Diabetes mellitus, Thyroid disorders, Heart diseases. The most common gynaecological disorder was genital tract malignancies (34%), followed by POP (25%) and urogenital infections (16%). Of those with genital malignancies, 32 had carcinoma cervix, 18 had carcinoma ovary, 14 had carcinoma endometrium, and 2 had carcinoma vulva. Conclusion: Pelvic organ prolapse and genital malignancy are the major gynaecological causes of hospital admissions in the patients above 60 years. Post-menopausal bleeding is the commonest complaint. Ovarian and endometrial cancer was showing a rising trend in this age group. Though cervical cancer were the second most common malignancy in this group, most of these patients presented at advanced stage and hence were inoperable.

Aim: The aim of the present study was to investigate antiepileptic-drug (AED) serum level and inflammatory biomarkers assessed during epilepsy treatment for effective seizure control and their correlation with seizure recurrence (SR) following AED-tapering. Methods: This prospective longitudinal observational study was carried out at DMCH, Laheriasarai, Darbhanga, Bihar, India for one year. Results: AED dose was reduced by a fixed amount (LEV 250 mg, CBZ 50 or 100 or 150 mg, VPA 100 or 200 mg, and PHT 50 or 100 mg) at a time without taking into consideration the dose just before the commencement of tapering. The amount of dose tapered constitutes about 6.67%–50.0% (median 25%) of the dose just before the commencement of tapering. The median interval between dose reductions was 2 months (range 2–6 months). There was no significant difference in AED levels at SR/stoppage of AED/at 6 months between SR and NSR group in any of the AED monotherapy groups. PWE, in both SR and NSR groups and individual AED monotherapy groups, had significantly high levels of inflammatory mediators (TNF-α, IL-1 β, IL-6, IL-10, and HMGB1) as compared to healthy control subjects at the onset of tapering. The SR group had significantly higher IL-1 β and TNF-α as compared to the NSR group (P = 0.001 and 0.02, respectively). Conclusion: Low serum AED levels (especially levetiracetam) and raised levels of TNF-α and IL-1 β during tapering commencement had a higher association with SR following AED-tapering.

Aim: The aim of the present study was to compare efficacy and safety of Hydroxychloroquine (HCQ) and Teneligliptin in patients of T2DM who are refractory to concomitant Metformin and Glimepiride over a period of 3 months, to evaluates percentage of patients reaching treatment targets i.e., HbA1C <7.5% and/or reduction in HbA1C by 0.5% and/or 1%, FBS -126mg/dl and PPG- 180mg/dl and changes in BMI and to assess quality of life. Methods: This was a prospective, randomized, open label study conducted in Department of Pharmacology in collaboration with department of medicine,  Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for one year. A total of 100 patients suffering from T2DM visiting the outpatient department of medicine and fulfilling the inclusion criteria were recruited in the study after taking an informed consent. Results: In this present study we have analyzed a data of 100 patients. 44% were males and 56% were females out of the entire patient population. At the end of 90 days, Group A had shown statistically better (p<0.005) effect in improving the BMI as compared to Group B. A highly significant (p<0.01) reduction was seen over 90 days in both the groups in Glycaemic parameters i.e., FBS, PPG and HbA1c. Both groups had comparable (p>0.05) safety profile with no serious adverse effects and no significant change (p>0.05). There was highly significant improvement (p<0.001) in VAS scale indicating improvement in quality of life in Group A and B over a period of 90 days. Conclusion: On the basis of effects of HCQ on the glycaemic parameters and BMI, HCQ may be preferred over Teneligliptin in patients of T2DM who are refractory to concomitant Metformin and Glimepiride.

Aim: The aim of this study was to determine clinical predictors of hypoxemia in patients of acute lower respiratory tract infections in children.  Material & Methods: The study was conducted in the Department of Pediatrics, AIIMS, New Delhi in New Delhi region. This was a hospital-based study completed from April 2018 to March 2019. It was an observational prospective study. A total of 50 patients were enrolled in the study. All children admitted with acute lower respiratory tract infections between the age group of 1 month to 5 years of age and diagnosed with pneumonia or bronchiolitis were included in the study. Results: A total of 50 cases were enrolled in the study, out of which 32 were male and 18 were female.  Out of the 50 cases enrolled, 24 were below the age of 12 months and 26 were above 12 months of age. The mean age was 18.2 months. The most common and significant symptoms were rapid breathing and difficulty breathing. The least common symptom was noisy breathing (significant association) and pain in the abdomen (no significant association). Tachypnea (90%), pallor (88%) and nasal flaring (82%), crepitations (added sounds), and subcostal retractions had better sensitivity for detecting hypoxemia. However, these signs had low specificity for hypoxemia. Head nodding (98%), intercostal retractions (86%), and cyanosis (85%) were highly specific for predicting hypoxemia. Conclusion: It was observed that a combination of clinical signs and symptoms can be used to predict hypoxemia when facilities of pulse oximetry and arterial blood gas analysis are not available, especially in low-resource settings.

Aim: The aim of the present study was to assess the levels of lipoproteins and their role in Alzheimer’s dementia patients and compared with heathy control subject. Methods: The present study was carried out in the department of Biochemistry at Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India for one year. The blood samples was collected and analysed in clinical Biochemistry laboratory. The present study conducted on 70 healthy controls and 70 Alzheimer’s dementia patients by using standard methods. Results: There were no difference found in age, systolic, diastolic blood pressure, BMI between Alzheimer’s dementia subject and control group. The subjects in Alzheimer’s dementia groups had significantly lower MMSE score compare to control group. (P < 0.0001). Negative correlation was observed but not significant correlation between Total Cholesterol, HDL-C and MMSE in Alzheimer’s dementia subjects. In the control group of subject there was lower correlation between Total Cholesterol, Triglyceride, HDL- C, LDL-C and VLDL-C but not statistically significant. The Alzheimer’s dementia subjects had statistically significantly higher serum Total Cholesterol, Triglyceride, HDL-C, LDL- C and VLDL-C (P < 0.001) as compared to healthy controls. Conclusion: The determination of serum lipoproteins is a routine, not required invasive procedure and cheap method, therefore we suggest that monitoring lipoproteins in older subjects with dementia may be the additional tool to understand basic mechanism of nerve degeneration, memory loss by evaluating lipoprotein levels and their association in Alzheimer’s dementia.

Aim: The aim of the present study was to assess high-sensitivity C-reactive protein, malondialdehyde and their association with glycated hemoglobin in type II diabetes patients. Methods: A prospective evaluation study was carried out in the Department of Biochemistry, Netaji Subhas Medical College and Hospital, Patna, Bihar India for 10 months  and 100 type 2 diabetic patients of both sexes aged between 35-45 years on oral hypoglycemic drugs, attending Department of General Medicine were selected for present study. Results: In the present study, there were 60 male and 40 females. 55% patients belonged to 40-50 years of age group. The BMI and waist/hip ratio showed significant difference. The mean serum hs-CRP and MDA levels were significantly high in type 2 diabetic patients compared with healthy patients. Hs-CRP and MDA levels we are shown significant positive correlation with glycocylated hemoglobin (HbA1C), insulin resistance, triglycerides and negative correlation with HDL cholesterol. Conclusion: Elevated hs – CRP, MDA levels are potentially important diagnostic markers for the assessment of endothelial dysfunction in type 2 diabetic patients. Tight blood glucose control, regular monitoring of hs-CRP, MDA levels within normal range might be useful for reduction of vascular complications in type 2 diabetic patients.

Aim: The aim of the study was to assess the correlation of clinico-pathological factors in urolithiasis with special reference to urinary pH and urinary culture. Material & Methods: A prospective study was conducted in the Department of Microbiology in collaboration with Department of General Surgery and Biochemistry. A total of 100 patients having urolithiasis, admitted at Darbhanga Medical College and Hospital, Darbhanga, for elective stone removal between in between the duration of 1 year. Results: 70% patients belonged to 21-60 years of age group. There were 70% male in the study. In the study 55% of the patients belong to lower and 35% to middle socio- economic strata with only 10% belongs to higher. In our study positive family history was found in 60% of patients. Upper urinary tract stones in this pH range (4.5-6.5) were 60% and lower urinary tract stones constituted 20%. In renal, 35% had culture negative and 28% had culture positive. Conclusion: With the precise knowledge on epidemiological profile on urolithiasis, the involved risk factors and knowledge of the stone constituents, it may be necessary to take certain precautionary steps like improving socioeconomic status, literacy, inculcating hygienic habits, avoiding and treating urinary tract infection, maintaining asepsis during urinary catheterization / instrumentation and low calcium containing diet, which may all probably decrease the incidence and morbidity of patients suffering from urolithiasis. The patients with an episode of stone disease or with a family history of the same are at high risk and should be closely screened for presence of metabolic disorders and routinely followed up to prevent further recurrences.

Aim: The study evaluated the clinical, radiological, and functional outcomes of hip hemiarthroplasty in elderly with fracture neck of the femur. Methods: The study was conducted in the Department of Orthopedics at IGIMS, Patna, Bihar, India from March 2015 to February 2016. Data of patients above 60 years who were operated on for fracture neck of the femur by bipolar hemiarthroplasty for 1 year were retrieved from the Department of Orthopedics. The sample size was 100. Results: The predominant mechanism of injury was trivial falls in 68 (68%) patients followed by motorcycle accident in 27 (27%) patients and vehicular accident in 5 (5%) patients. 60 patients were female, and 40 patients were male. All the patients were ambulatory with or without support before the fracture. 94 patients received cemented femoral stems; the remaining 6 received press-fit ones. Majority of the patients had hypertension followed by diabetes. 18 patients had excellent Harris Hip scores, and 10 had fair scores. The remaining 72 patients had good Harris hip scores. Conclusion: The present study modular bipolar hemiarthroplasty provides better pain relief with early mobilization and a good level of return to daily routine activities with minimal complications. The overall complications following hemiarthroplasty were acceptable. Targeted medical intervention that focuses upon susceptible patient groups may reduce morbidity, mortality, and improve survival.

Aim: The aim of the study was to evaluate the technique of preperitoneal mesh repair of incisional hernias. Material & Methods: This prospective clinical study consists of 100 patients with incisional hernia managed by Preperitoneal mesh repair in Department of General Surgery, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India during the period of 1 year. Results: In the present study, there were 30 male and 70 females. Most of the patients belonged to 31-50 years age group. 50 (83.34%) patients had midlines incision causing the incisional hernia. This was followed by Pfannensteil incision in 6 (10%) and paramedian incision in 4 (6.66%) patients. Major wound infection was encountered in 5 patients (8.34%) but the mesh was not removed in any of the cases. Only 7 patients had seroma formation. There were no postoperative complications in 80% of cases. Conclusion:  Preperitoneal meshplasty found to be efficient method of incisional hernia repair with less post- operative complications.

Aim: The current research aims to formulate and evaluated medicated transdermal patches containing an antidiabetic drug. Material & Methods: In the present study was conducted by the Department of Pharmacology, DMCH, Laheriasarai, Darbhanga, Bihar, India. An attempt has been made to develop a matrix-type transdermal therapeutic system comprising of various PVP K30, MC ratios and solvent evaporation techniques. A good penetration enhancer would improve drug delivery from various polymer-based transdermal patches. Transdermal patches of the matrix type are made. All prepared formulations were tested for weight variation, thickness, drug content, moisture content, moisture uptake, flatness, and in vitro drug release. Bath F3 was optimised formula from all formulation baths shows linear zero order release for 24 hours, with a cumulative percentage of drug diffusion of 87.35% from 4cm2 patches. It has been determined that polymer concentration. Results: The formulated films were examined for colour, clearness, softness and elasticity. It was précised by digital Vernier calipers. Three reading were taken for standard deviation after thickness measured at five various site of patch. The thickness of Glimepiride patches were between112.48-124.26μm. The folding endurance of patches was found to be satisfactory between 121.49±2.36 to 128.42±0.46. This shows that patches would maintain their integrity and not break easily. The moisture content in the patches was ranged from 1.38 ± 0.26 to 2.80 ± 0.20% (for formulation F series and formulation respectively).  The weight variation of Glimepiride patches were in between 250 to 280 mg. This showed uniformity in weight of patches while the % drug content of Glimepiride in patches were between 96.00 to 95.15±0.85% this shows passable drug content in patches. Conclusion: When the concentration of PVP K30 increases in the primary layer, the in – vitro diffusion rate increases, and when the concentration of PVP K30 decreases, the drug diffusion decreases. It allows for more controlled drug release from the patch.

Aim: This study was conducted to correlate the histopathological diagnosis with habits and clinical findings in patients suffering from oral mucosal lesions. Material & methods: 100 patients with persistent oral lesions alone or oral lesions along with cutaneous lesions were taken up for study. Their detailed history, examination was recorded, relevant investigations were done. Based on clinical history and examination a clinical diagnosis was made. Oral biopsies were taken and sent for histopathological examination. All the findings were recorded and analyzed. Results: Out of 100 subjects, 25 (25%) consumed vegetarian diet while 75 (75%) consumed mixed type of diet. In India, people are seen to clean oral cavity with products like toothpaste, bamboo stick and mishri etc. The most common chief complaint was pain (75%). 52 subjects (52%) had oral ulcer as their primary complaint. 15 (15%) and 28 (28%) subjects presented with swelling and bleeding, respectively. The most common site of oral lesion in this study was buccal mucosa (50%). Aphthous stomatitis and Oral submucous fibrosis were found to be the most common benign and premalignant lesions, respectively. Most common malignant lesion was squamous cell carcinoma of buccal mucosa. Conclusion: The widespread habit of chewing dohra/paan masala is a major risk factor of OSF, especially in the younger age group. In this study, an increase in histopathological grading was found with severity and duration of addiction habit. However no significant correlation was found between clinical staging and histopathological grading.

Introduction: Oral health is a critical component of overall health and well-being, yet, oral disease remains a silent epidemic in part due to missed prevention opportunities. Research demonstrates an association between oral and systemic diseases such as, cardiovascular disease, Alzheimer’s disease, respiratory infection, and diabetes. Materials and Methods: MEDLINE/PUBMED and Google Scholar search was conducted for articles published from July 2013 to December 2013 to identify data focusing on two general categories: (i) Dentistry (ii) Health Promotion (e.g., health education, preventive health services). Result: The intervention methods varied across studies, and included individual instructions on oral hygiene, lectures, audiovisual presentations, and dental supplies. Oral Care Program provided toothbrush, fluoridated toothpaste, dental floss, and scheduled dentists appointments. provided fluoride varnish applications, mouthwash, oral hygiene instructions. Discussion: This systematic review examined the range, scope and impact of existing oral health promotion interventions during pregnancy. In addition, this review aimed to serve as an initial step toward identifying evidence-based interventions that translate prenatal oral–systemic research and guidelines into practice.

Aim: To evaluate the somatic growth of children with a very low birth weight. Materials and Methods: This prospective observational study was conducted in the Department of pediatrics, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India. VLBW babies (weight <1500 g), admitted within 72 h of life and discharged alive, were followed up prospectively. The baseline data were collected before discharge from the hospital and babies were followed up till 40 weeks postmenstrual age. Babies with major congenital malformations (major cardiac malformation, anencephaly, obstructive uropathy, congenital diaphragmatic hernia, and intestinal atresia) and syndromic babies were excluded from our study. Infants were classified SGA if the birth weight was below 10th centile as per Fenton’s growth charts. The weight, length, and head circumference (HC) were recorded at birth, discharge, and at 40 weeks post-menstrual age. Results: During the study period, around 53 infants were admitted to our hospital and around 42 were taken for consideration in this study. Of these 42 babies, 37 (70%) were male. The mean gestational age was 30 ± 2.5 weeks and the mean birth weight was 1199 ± 216 g. Demographic profile of the study population has been presented in Table 1. At 40 weeks post-menstrual age, 21% of VLBW infants were underweight. We did not find any association between the infant diet and growth failure. The mean time to reach full enteral feeds (200 ml/kg/d) was 7.11 ± 2.12. The mean Z scores for weight, length and HC at birth were –0.88, –0.59, and –0.64, respectively. At the time of discharge, the same were –1.12, –1.12, and –1.11, respectively, and –1.69, –1.03, and –0.73, respectively, at 40 weeks of post-menstrual age. Conclusions: In our study, 21% of LBW infants were underweight at 40 weeks post-menstrual age. Both SGA and AGA infants exhibited a growth lag as indicated by a fall in Z scores for all three parameters from birth to discharge. We did not find any association between the infant diet and growth failure. Furthermore, the rapid progression of feeds did not have any significant adverse effects in our study population.

Aim: The aim of the present study was to determine clinical and outcome profile of patients with peripheral vascular disease (PAD). Methods: This observational study was conducted by random selection of 100 cases with Peripheral Arterial disease of the lower extremities admitted to surgical wards of RIMS, Ranchi, Jharkhand, India for the period of Jan 2022 to Feb 2023. Results: Atherosclerosis was a more common presentation in this study. Among the 80 cases diagnosed with PAD due to Atherosclerosis in this study 70 were males and 10 patients were females. In this study all the 20 patients diagnosed with TAO were males. Majority of the cases in atherosclerosis were above the age of 50 yrs., while in the TAO group majority belong to the age group between 31 to 50 yrs. All patients had dry gangrene. Ischemic ulceration was present in 20 patients. Majority of the patients had popliteal disease in the atherosclerosis group, with TAO affecting more distal vessels and Atherosclerosis involving the more proximal arteries. Majority of the patients had an uneventful recovery, with complication rates being higher among the atherosclerosis group. In atherosclerosis group, 44 patients required secondary suturing of the surgical wound and two cases underwent revision amputation. Conclusion: TAO and Atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. TAO presented at a younger age group whereas atherosclerosis presented in the older age group.