Brucellosis caused by species of Brucella, is among the most prevalent zoonotic disease that can involve any organ. Here we present a case of deep vein thrombosis as a complication of brucellosis.  We reported a 44 years old male patient diagnosed with brucellosis with deep vein thrombosis on his bilateral legs with features of polyarthritis. The patient was treated with anticoagulants. The patient was discharged with warfarin therapy and antibrucellosis treatment. Although rare, some infectious agents may cause vascular pathologies. Patients presenting with symptoms of DVT or similar vascular pathologies should be assessed for infectious agents, particularly in those coming from Brucella-endemic areas.

DOI: 10.5281/zenodo.

Background: Post-partum haemorrhage is the leading cause of maternal death in India. However, it is not accurately and adequately diagnosed resulting from inaccurate and suboptimal estimation of blood loss in absence of hemodynamic instability in low risk pregnancies. This study was undertaken to ascertain the incidence of undiagnosed occult post-partum haemorrhage in low risk pregnancies. Material & Methods: Total of 280 low risk pregnancies out of 957 deliveries at Command Hospital Air Force Bangalore for one year period was evaluated for more than 10% drop in haematocrit during pre and post-delivery period. Result: Incidence of occult post-partum haemorrhage was found to be 16.78% in low risk pregnancies. 57% of occult post-partum haemorrhage was seen in 19-30 years age group compared to 43% in 31-35 years age group. Majority (62%) of occult post-partum haemorrhage was seen in multiparous compared to primiparous (38%). Conclusion: Monitoring of post-natal mothers should invariably include haematological evaluation to look for significant drop in haematocrit and post-partum anaemia.

DOI: 10.5281/zenodo.

Background: The Robson classification also known as the 10 groups classification (TGCS) system is a global standard for assessing, monitoring and comparing caesarean section rates. Aim: The aim of the present study was to calculate the overall caesarean section rate and to identify group that contributed most to the overall caesarean section rate and to analyse caesarean rate within groups in our institute. Methods: A retrospective observational study conducted for a period of 1 year from June 2022 to Dec 2023.All pregnant women with gestational age of more than 28 weeks were classified according to Robson’s classification. Results: The overall caesarean section rate was 42.6 %.Group 5, all multiparous women with at least one previous uterine scar, with a single cephalic pregnancy, > 37 weeks gestation was the largest contributor to overall caesarean section rate (19.74%). Conclusion: Women with previous caesarean contribute to majority of cesarean section rates. Proper and strictly adherent labor protocols can reduce cesarean section rates among nullipara thereby reducing numbers in group 5 in future.

DOI: 10.5281/zenodo.

Klebsiella pneumoniae, a Gram-negative bacterium of the Enterobacteriaceae family, possesses a rod-shaped morphology. Exhibiting opportunistic behavior, it thrives in individuals with compromised immune systems. This study aims to ascertain the presence of the CTX gene within Extended Spectrum Beta-Lactamase (ESBL) enzymes in Klebsiella pneumoniae isolates from clinical samples. Identification of these isolates was carried out using a conventional disc diffusion technique alongside the combined double disc method, while ESBLs were screened accordingly. Analysis of antimicrobial susceptibility patterns revealed notable resistance rates, with CAZ, CTX, exhibiting the highest resistance percentages. The majority of the ESBLs positive isolates were from Pus 100 (45.66%). The CTX genes were 61.8% recorded respectively.

DOI: 10.5281/zenodo.

Introduction: This research examined the possible correlation between the severity of Retinopathy of Prematurity (ROP) and neurodevelopmental issues in children. Upon doing data analysis, a distinct pattern emerged: there was a clear and substantial rise in the likelihood of problems such as Cerebral Palsy and cognitive impairments as the severity of ROP escalated. Although ROP is often linked to visual impairment, it may also have an influence on motor abilities, speech, and auditory functions. Material and Methods: A statistical analysis was performed on N=50 normal and abnormal groups of children having ROP disease. The objective included the analysis of different types of neurological disorders occurring in children leading to preterm defects. The inclusion criterion included preterm births with ROP disease, and the exclusion criterion included any other retinal eye defects. Results: Timely identification and medical intervention (during Stages 1-2) might be pivotal in mitigating these hazards. In addition, the analysis of ROP stages indicated that the control group had better identification of early-stage ROP, while the abnormal group had a more significant occurrence of ROP throughout all stages. This underscores the need for vigilant monitoring and action to avert advancement. Conclusion: Present research provided evidence for the correlation between abnormal ROP and visual impairment. In summary, the results indicate a significant association between the severity of retinopathy of prematurity (ROP) and neurodevelopmental problems in children. This highlights the crucial role of early intervention in enhancing outcomes.

DOI: 10.5281/zenodo.

The foundation of the herbal medication business is the ethnomedical values of plants. In order to create herbal medications with minimal side effects, India has contributed its expertise in traditional system medicines (Ayurveda and Siddha). These plants have historically been utilized by tribal communities in India as extracts, powders, or pastes to cure conditions including anti- microbial activity, cough and colds, fever, stomach, kidney, and liver diseases, pain, inflammation, and wounds. According to WHO data, plant extracts are used to treat more than 80% of the world’s population for fundamental ailments. Natural remedies are popular in Asian nations provides a full overview of past human plant connections. Traditional medicinal plants have a diverse spectrum of bio-active compounds that are used to treat both chronic and infectious ailments.
The objective of the present study is to formulate and evaluate a polyherbal ointment. Ointment was formulated using ethanolic extracts of Carica Papaya and methanolic extract of Leptadenia Pyrotechnica. The total phenolic content (TPC) was determined by Folin-Ciocalteu method and total flavonoids content (TFC) were determined using aluminum chloride method. Formulations were prepared using different ointment bases with different concentrations of the extracts such as 1% and 2% w/w. Formulations were tested for its physicochemical properties like pH, spreadability, extrudability and viscosity. The TPC in Carica Papaya and Leptadenia Pyrotechnica extract were found to be 105.5 mg/gm of extract and 104.5 mg/gm of extract respectively. TFC in Carica Papaya and Leptadenia Pyrotechnica extract were found to be 20.5 mg QE/gm of extract and 22.5 mg QE/gm of flavonoid in dry extract respectively. Ointment was formulated using simple ointment base with 2 %w/w of dry extracts was found to most stable in its physicochemical properties. The ointment consisting of 2% extract of Carica Papaya and Leptadenia Pyrotechnica shows satisfactory physical properties and stability.

DOI: 10.5281/zenodo.

Fungal infections pose a significant health concern globally, with a rising incidence of resistance to conventional treatments. Topical drug delivery systems offer a promising approach to enhance the efficacy and safety of antifungal agents while minimizing systemic side effects. This review explores the design, development, and optimization of bigel-based topical drug delivery systems containing Amphotericin-B and Fluconazole for the treatment of fungal infections. It discusses the challenges associated with current treatment modalities, the rationale for utilizing bigel formulations, and recent advances in this field. Additionally, the review highlights the optimization strategies, including formulation variables, rheological properties, and in vitro/in vivo evaluation methods, aimed at enhancing the therapeutic outcomes of these novel formulations.

DOI: 10.5281/zenodo.

Purpose: The purpose of this study was to investigate the efficacy of ultrasound-guided measurement of skin to epiglottic distance (SED) at the level of the thyrohyoid membrane in predicting difficult direct laryngoscopy. Methodology: The study was designed as a cross-sectional investigation conducted within the Department of Anaesthesiology at the Government Medical College, Idukki, over a period of six months following clearance from the Institutional Ethics Committee (IEC). Result:  The study’s demographics indicate that the majority of participants were aged between 36 to 55 years (40%), with a female predominance at 68%. Body Mass Index (BMI) analysis showed 54% at a healthy weight, 28% overweight, 14% underweight, and 4% obese. Physiologically, participants had varying vital measurements, including weight (average 59.826 kg), height (average 158.62 cm), systolic blood pressure (average 122.04 mmHg), diastolic blood pressure (average 74.58 mmHg), heart rate (average 69.88 bpm), and skin to epiglottis distance (average 19.56 cm), indicating diverse airway anatomy. The comparison of sonographically assessed skin to epiglottic distance (SED) and Cormack-Lehane grades revealed a significant association (χ2 = 35.737, p = .000), with SED showing potential as a predictor of difficult laryngoscopy. However, Modified Mallampati classification did not correlate significantly with Cormack-Lehane grades (p = 0.439). Conclusion: In our study, we found that the Modified Mallampati classification did not show a significant association with Cormack-Lehane grades. In contrast, sonographically assessed SED emerged as a better predictive tool for difficult laryngoscopy compared to Mallampatti classification alone. This suggests that SED may offer more reliable insights into preoperative risk assessment and patient safety during intubation procedures.

DOI: 10.5281/zenodo.

Background: The incidence of distal radius fractures has increased due to longer life expectancy and a higher occurrence of road traffic accidents and sports-related injuries among young people. These fractures account for about one-sixth of all fractures treated. This study aims to analyze the clinical outcomes of open reduction and internal fixation of these fractures using volar plates and screws. The current study aimed to determine the clinical outcomes of intra-articular and extra-articular distal radius fractures treated with open reduction and internal fixation through a volar approach. Methods: This prospective, hospital-based study was conducted at the Department of Orthopedics. It included patients from the Department of Orthopaedics diagnosed with distal radius fractures who met the specified criteria and consented to surgery and participation in the study. A total of 25 patients were enrolled in this study. Postoperative evaluation of clinical and functional outcomes was conducted using Gartland and Werley’s demerit system. All patients were followed up postoperatively for a minimum of 12 months, with assessments at 6 weeks, 6 months, and 12 months. The results were analyzed both clinically and radiologically. Results: Most patients (36%) belonged to the 18-30 year age group. Motor vehicle accidents were the most common cause of injury (84%). Locking implants were the preferred choice for volar plating (92% of patients). The treatment approach resulted in mostly favorable clinical outcomes (good or excellent) for all fracture classifications (72.0% – 88.0%). There might be a slight trend towards less favorable outcomes with more complex fractures. All patients (100%) achieved good or excellent radiological outcomes, regardless of fracture classification or implant type. There was no statistically significant difference in clinical outcomes between patients who received locking vs. non-locking implants. Both groups achieved similar results. Conclusion: This study suggests that volar plating with locking implants might be an effective treatment option for various distal radius fractures, resulting in mostly favorable clinical outcomes and excellent radiological outcomes. However, further research with larger and more balanced patient groups might be necessary to confirm these findings and explore the potential benefits of different implant types for specific fracture characteristics.

DOI: 10.5281/zenodo.

Background and Aim: There has been a significant increase in interest surrounding antibiotic coatings in orthopedic procedures in recent years. There are various coating strategies available for clinical use, including antibiotic-coated nailing, cements, beads, and on-demand antibiotic release. Multiple studies have demonstrated a decrease in implant-related infections with the use of antibiotic-coated implants. Material and Methods: This study was conducted in the Department of Orthopaedics at a medical college and associated hospital. During a span of one year, a group of 60 patients received treatment using a tibia interlocking nail coated with gentamicin. Sixty patients were selected with open fracture of shaft tibia, treated operatively with antibiotic coated intramedullary interlocking nail and were followed up for a minimum of six months duration. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Results: According to the findings of the study, there were a significantly higher proportion of males, which accounted for 83% of the total. After a period of three months, the majority of patients, twenty-two in total, had an RUST score of eight. Patients who received a score of 10 came in a close second, while the population of patients who received a score of 4 was the least numerous. The length of time spent in the hospital was, on average, fifteen days. Although the majority of patients had a functional outcome that was satisfactory, there were sixteen patients who had a positive outcome. Conclusion: The combination of two procedures into one, antibiotic cement impregnated nailing, provides a dependable solution for infection control and stability. When treating open tibial fractures, one treatment option that may prove to be beneficial is the utilization of an antibiotic-coated tibia interlocking nail.

DOI: 10.5281/zenodo.

Transverse maxillary discrepancies are the most common. The narrowed upper arch is the most prevalent problem an orthodontist encounter while treating adolescent and adult patients. Maxillary expansion is a technique used to increase the upper arch’s transverse dimension to apply forces to widen the upper arch. For young children, a narrow maxillary arch has to be corrected using orthopedic and orthodontic treatments. In an orthodontic treatment plan, it is crucial to update transverse maxillary defeat. There are various clinical manifestations associated with a transverse maxillary deficiency which include a narrow palate, crossbite mainly seen in posteriors (unilateral or bilateral), severe crowding in anterior teeth, and cone-shaped hypertrophy can be seen. Some frequently used therapies for constricted upper arch include slow maxillary expansion, rapid maxillary expansion, and surgically assisted rapid maxillary expansion. Slow maxillary expansion requires light and constant force, whereas rapid maxillary expansion needs heavy pressure for activation.

DOI: 10.5281/zenodo.

Introduction: Nearly 75% of the total length of the gastrointestinal tract is occupied by small intestine (duodenum, jejunum and ileum) and it constitutes more than 90% of the mucosal surface area and the sites for broad array of diseases. The large intestine is composed of 4 parts. It includes the cecum, ascending colon, transverse colon, descending colon and sigmoid colon. The large intestine performs an essential role by absorbing water, vitamins, and electrolytes from waste material. Clinical and radiological findings of these lesions are non-specific therefore, biopsy is requiring for diagnosis of lesion. Thus, the present study was conducted to find out the profiles of various histological lesions of the small intestine and large intestine. Methods: This was a retrospective study conducted in the Department of Pathology, C.U. Shah medical college, Surendranagar on received specimen with intestinal lesions over a period of five year. Results: Of the total of 100 cases, 58 were from small intestine, 27 were from large intestine and 15 from Meckel’s diverticula there were 63 males and 37 females with a male to female ratio of 1.8:1. 24 lesions were neoplastic, while 76 non-neoplastic. The majority of lesions had inflammatory pathology, which constituted 76 cases in all. 10 lesions were malignant and 14 were benign. The most common age group for non-neoplastic lesion was 51-60 years in male and in female; it was 61 -70 years. The most common age group for benign lesion in male was 0-30 year and in female it was 21-60 years. The most common age group for malignancy was 51-60 years in both males and females in the present study. Male to female ratio for malignancies is 2.3:1. Conclusions: In developing countries, infective etiology remains dominant cause of intestinal obstruction and perforation. Intestinal resection in older age group demands effective preventive measures in this part of world to prevent morbidity and mortality. Histopathological examinations of resected intestine provides definite evidence of underling etiology guiding better healthcare planning for preventive measures.

DOI: 10.5281/zenodo.

Background: Neonatal respiratory distress syndrome is leading cause of hospital admission of newborn. Diagnosis of cause of respiratory distress is challenging. Chest X – ray only imaging modality and we had to depend on clinical sig and symptoms in past. We have now USG along with X- ray for diagnosing cause of respiratory distress in NICU set up now days. In this study we attempted to compare the sensitivity and specificity of X ray and USG in diagnosing NRDS and evaluating them their efficacy in ruling out or excluding other causes of respiratory distress in newborn. Method: 52 patients, who are clinically suspected of NRDS, are included in this study. USG and X- ray were done to all Neonates. Sensitivity and specificity were calculated, for X-ray and USG. Results: 40 cases out of 52 cases show “Pleural line abnormality”, and do not show features of any other disease like Meconium aspiration syndrome or TTN by Chest X-ray. These 40 cases were finally diagnosed to have NRDS. Out of these 40 cases 33 were found to be positive for “Sub pleural consolidation”. Only 25 cases show reticulo granular or ground glass pattern. Sensitivity and specificity of “Pleural line abnormality”, “Sub pleural consolidation” and “Chest X-ray” were calculated. Conclusion: Chest X-ray was used as the only imaging mode for diagnosis in past. Hence forth we consider Chest X ray as the gold standard for diagnosing NRDS. Ultrasound was found to be more sensitive whereas X-ray found to be more specific. “Pleural line” and “Sub-pleural consolidation” were found to be positive in most cases of clinically suspected cases of NRDS.

DOI: 10.5281/zenodo.

Nutraceutical have emerged as a vital frontier in healthcare, offering innovative solutions that bridge the gap between food and pharmaceuticals. Nutraceuticals are mainly characterized into dietary products supplements and functional foods that provide the body with medical or health benefit. This article review provides a comprehensive overview of the recent advancements in nutraceutical medicines, focusing on their potential to revolutionize the way we approach health and well-being. We delve into cutting-edge research and clinical studies that highlight the efficacy of nutraceuticals in preventing and managing various health conditions. The review also explores the evolving regulatory landscape and consumer trends shaping the nutraceutical industry. As we navigate the ever-expanding landscape of nutraceutical medicine, this review sheds light on the promising developments and challenges that lie ahead, emphasizing their potential to reshape the future of healthcare. Nutraceuticals are dietary supplements that have shown to provide biological advantages or to offer some defence against long-term illnesses. Nutraceutical have become a billion-dollar industry in US, Europe and Japan with multiple factors contributing to the growth of nutraceutical industry in India. The Indian nutraceutical industry has been growing at 25% annually during the pandemic.

DOI: 10.5281/zenodo.

A Series of newer 5-substituent N-(substituent phenyl)-5-(3,4,5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine analogues 4a-f was subjected to molecular properties prediction by mol soft and Molinspiration software and was synthesized in satisfactory yields. All the compounds followed the Lipinski “rule of five “which makes them potentially active agents. 3 Compound (4a, 4b & 4f) were evaluated for their anticancer activity in one dose assay and showed moderate activity on various cell lines. Compound N-(4-chlorophenyl)-5-(3,4,5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine (4b) showed maximum activity with growth percent (GP) of 59.73 on SR (Leukemia), 72.77 on  NCI-H522 (Non-Small Cell Lung Cancer A549/ATCC) and mean growth percent (GP) of 96.31. and Compound N-(2-methoxyphenyl)-5-(3,4,5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine (4f) showed maximum activity with growth percent (GP) of 66.70 on T-47D (Breast Cancer), 68.96 on NCI-H522 (Non-Small Cell Lung Cancer A549/ATCC), 75.64 on SNB-75 (CNS Cancer) and mean growth percent (GP) of 92.62. Compound N-(4-bromophenyl)-5-(3, 4, 5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine (4a) could be considered as lead further discovery and could be modified to potentiate the anticancer activity.

DOI: 10.5281/zenodo.

A Series of newer N-(substituent phenyl)-5-(3,4,5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine analogues 4a-f was subjected to molecular properties prediction by mol soft and Molinspiration software and was synthesized in satisfactory yields. All the compounds followed the Lipinski “rule of five “which makes them potentially active agents. 3 Compound    (4a, 4d & 4f) were evaluated for their anticancer activity in one dose assay and showed moderate activity on various cell lines. The compound N-(2,4-dimethylphenyl)-5-(3,4,5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine (4d) showed maximum activity with mean growth percent (GP) of 97.75 followed by N-(2,4,6-trimethylphenyl)-5-(3,4,5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine (4f) showed mean GP of more than 85.81. The compound 4f was highly active on T-47D (Breast Cancer) [GP=66.70], NCI-H522 (Non-Small Cell Lung Cancer A549/ATCC) [GP=68.96], SNB-75 (CNS Cancer) [GP=75.64]. The compound 4d showed maximum activity on A498 (Renal Cancer) [GP=78.31], SF-268 (CNS Cancer) [GP=83.14], TK-10 (Renal Cancer) [GP=84.77]. The compound 4d showed maximum activity on SR (Leukemia) [GP=59.73], NCI-H522 (Non-Small Cell Lung Cancer A549/ATCC) [GP=72.77], LOX IMVI (Melanoma) [GP=76.63], MCF7 (Breast Cancer) [GP=81.32]. The maximum activity was observed with 4a on SR (Leukemia) with GP=59.73. The compound N-(phenyl)-5-(3,4,5-trimethoxyphenyl)-1,3,4-oxadiazol-2-amine (4a) could be considered as lead further discovery and could be modified to potentiate the anticancer activity.

DOI: 10.5281/zenodo.

The exploration of oxadiazole derivatives as promising anticancer agents holds significant promise for the development of novel therapeutics. Through extensive research and experimentation, these compounds have demonstrated remarkable potential in targeting cancer cells with high specificity and efficacy. The diverse structural modifications available for oxadiazole derivatives offer a wide range of opportunities for further optimization and fine-tuning of their anticancer properties. Despite the challenges ahead, continued investigation and refinement of oxadiazole-based compounds are essential for advancing cancer treatment strategies and ultimately improving patient outcomes. With ongoing efforts, the therapeutic potential of oxadiazole derivatives in combating cancer remains a compelling area of research warranting further exploration and development.

DOI: 10.5281/zenodo.

Introduction: Beyond being little copies of adults, infants are unique. Individuals differ in terms of their illnesses, symptoms, priorities, and therapy requirements. Adolescents may not experience typical adult outcomes. Since the majority of birth disorders are self-limiting, transient, and physiological, treatment is not necessary. Parents who experience anxiety often seek advice from their child’s physician regarding skin imperfections. For this reason, it’s critical to recognise which skin lesions require immediate attention and to have a thorough awareness of both common and unusual newborn cutaneous lesions. Material and Method: Since the lesion was discovered, ambient light from windows letting natural light into the building was used to inspect it first visually and then under a magnifying lens. For a more precise description, the maximum length and width of the lesion were measured in cm using a ruler. Result: To detect skin lesions in babies admitted to a sick newborn care unit or a neonatal intensive care unit, taking into account the kind, extent, size, and relationship of the lesion to sex, gestational age, and sociodemographic variables. The purpose of this study was to examine the clinical characteristics of various skin conditions in a group of infants from India who were admitted to a level III neonatal care facility, taking into account the previously described criteria, and to analyse a few of the most noteworthy instances. Conclusion: The current study was conducted at the paediatrics and skin and VD departments of the SCB MCH & SVPPGIP, Cuttack, Odisha, from May to October 2014. Over the course of the research period, 3161 neonates were admitted to hospitals; of them, 1480 developed skin lesions and spent an average of 22 days there. It was notable that the skin lesion proportion was 46.82% when compared to the newborns admitted for other causes. At birth, there are more males than females: 1063 (71.82%) compared to 417 (28.18%). The current study discovered a total of 27 distinct types of skin diseases, with an average of about 0.018 skin issues per neonate.

DOI: 10.5281/zenodo.

Introduction: Cytopathology is a specific subspeciality of Pathology in which Fine needle aspiration cytology (FNAC) always play a crucial role in early detection abnormal cell morphology. FNAC Procedure is fast, safe and help in early detection of Head and Neck Lesions with more than 90% accuracy. Material and Methods: This is retrospective observational study including 415 cases having Head and neck Lesions. This study was conducted in Department of Pathology, ASMC Firozabad. FNAC procedure was performed by aspiration and non-aspiration techniques and cytological diagnosis was given and confirmed by Histopathology where ever it is indicated. Findings were also correlated with Clinic radiological findings. Results: The most common age group affected was 05-78 years with mean age group 41.8 years. Male to female ratio was 0.87 spectrum of these lesions was including ReactiveLymphadenitis132(65.3%), GranulomatousLymphadenitiswasfoundin70 (34.6%), Epidermal inclusion cyst 98, Necrotising Lymphadenitis 49  followed by salivary gland Lesions 14 cases. Out of theses 14 cases pleomorphic Lesions were most common (09). This study shows 380 cases (91.56%)  were benign and the malignancy was seen only in 35 cases (8.43%). Conclusion: This study concluded out that role of FNAC in finding out early pathological changes in Head and Neck Lesions is very crucial. FNAC is very simple, safe and with minimal invasive procedure is sufficient to differentiate between Benign and Malignant Lesions and avoid unnecessary Tests and Financial burden on patients

DOI: 10.5281/zenodo.

Spiral CT angiography is a new, minimally invasive technique for vascular imaging that is made possible by combining two recently developed techniques: slip-ring CT scanning and computerized three-dimensional (3D) reconstruction. CT angiography done to diagnose and evaluate blood vessel disease or related conditions, such as aneurysms or blockages, Arteriovenous malformation (AVM), hemangioma, stenosis, AV fistula, aortic dissection, pulmonary embolism, thoracic outlet syndrome etc.
Over the past decade, noninvasive imaging of the arteries has evolved into a highly reliable alternative to invasive digital subtraction angiography. Here we presents few rare cases where diagnosis was made possible by CT Angiography.
(1) Bilateral renal AVM with aneurysmal dilatation of feeding arteries on left side, which was diagnosed by renal CT Angiography. (2) Cerebral arterio-venous malformation involving left temporo-parietal lobes, diagnose by carotid CT Angiography. (3) Takayasu arteritis (Type-V), diagnosed by Aortogram. (4) Arterio-venous malformation involving postero-lateral aspect of middle third of left leg, diagnosed by peripheral CT Angiography. (5) Non-calcified soft tissue plaque seen at the proximal part of LAD near its origin results in moderate luminal stenosis with negative remodeling, diagnosed by Cardiac CT Angiography.
CT angiography is a type of medical test that combines a CT scan with an injection of a special dye to produce pictures of blood vessels and tissues in a part of our body. The dye is injected through an intravenous (IV) line started in our arm or hand. Before Multi-Detector Computed Tomography (MDCT), the main barriers to the clinical implementation of CT angiography (CTA) were acquisition speed and both spatial and temporal resolution.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the histopathological features of various lesions in the urinary bladder. Methods: The present study was conducted in the  Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of 1 year. 50 cystoscopic biopsies from patients attending Darbhanga Medical College and Hospital, Darbhanga, Bihar, India were studied. Results: Among 50 cases, 35 were neoplastic, 15 non- neoplastic and one was classified as biopsy specimen inadequate or unsatisfactory for evaluation. There was clustering of cases between 41-80 years with maximum cases seen in 51-70 years of age together having 21 cases. Hematuria was the most frequent complaint that the patients presented with followed by Dysuria, increased frequency of micturition, urgency and pain abdomen. Among the non-neoplastic lesions 11 were chronic non-specific cystitis, 2 were Acute or chronic cystitis, 1 granulomatous cystitis of tubercular etiology and 1 was polypoidal cystitis. In our study out of 35 cases, 1 was inverted papilloma’s, 2 were Papillary urothelial neoplasms of low malignant potential, 12 were Low grade papillary urothelial neoplasms. 10 were high grade papillary urothelial neoplasms, 8 were Invasive urothelial neoplasms and one case each of Squamous cell carcinoma and Sarcomatoid carcinoma. Conclusion: Urinary bladder biopsy is one of the most common biopsies in urology practice. In our study bladder tumors were the commonest lesions seen in cystoscopic biopsies and TCC was the predominant tumor type. Hematuria was a common symptom in our series and the clinicians showed a keen awareness to the dangers of this symptom and investigated these patients further, which led to discovery of the urothelial tumors.

DOI: 10.5281/zenodo.

Aim: This study was undertaken to study the various histopathological patterns of ovarian lesions, their classification and relative distribution of these lesions. Methods: The study was undertaken as a retrospective study using existing patient data retrieved from the records of the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India during the period of 12 months. 200 ovarian mass specimens were received for evaluation, either as solitary specimens, or as part of total abdominal hysterectomy (TAH) specimens. Results: Majority of the Patients were in the age group of 10-39 years. A total of 170(85%) cases were unilateral while 20(15%) cases were bilateral. 39 cases were asymptomatic. Associated findings in specimens of Hysterectomy with salpingo-oophorectomy were also found. Most common was leiomyoma either alone or in combination with adenomyosis. Other associated findings were chronic cervicitis, carcinoma endometrium, carcinoma cervix; hydrosalpinx etc. Other non-neoplastic lesion were Cystic follicle (14 cases), Follicular cyst and Parovarian cyst (6 cases each), hemorrhagic cyst, ectopic gestation, Torsion ovary, Inclusion cyst and oophoritis. Conclusion:  Ovarian lesion comprises of wide spectrum of lesions and their presenting clinical, radiological and gross features are very similar. Hence Histopathology forms the mainstay of definitive diagnosis and categorization of these lesions.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyze the post-operative pain management in elective laparotomies in a tertiary care centre. Methods: This prospective observational study conducted in the Department of General Surgery, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of one year. All patients who underwent elective laparotomy were provided details about the study and method. Informed written consent was obtained. A total of 200 patients were included. Detailed history of the patient, condition, surgery performed, analgesics used were documented. NRS score was calculated. Results: A total of 200 patients were included among which 40 (40%) were female and 120 (60%) were the male patients. The patients who underwent elective laparotomies were aged between 20-70 years and 80 (40%) patients were in the age group of 40-50 years. The 20 different types of surgeries were recorded. The most common surgery performed in our study was open appendectomy which included 42 (21%) patients followed by open cholecystectomy (for carcinoma gall bladder and other indications) which included 18 (9%) patients. Most common was general anaesthesia with transverse plane block which was used in 76 (38%) patients, followed by general anaesthesia with quadratus lumborum block which was used in 42 (21%) patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural. Severity of pain gradually reduced from post -operative days 1-3 with the use of various analgesics. Conclusion: Multimodal analgesia was used in most of the patients for management of post – operative pain combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

DOI: 10.5281/zenodo.

Introduction: Haematological disorders constitute a broad spectrum in which patients can present with various clinical presentations. Megaloblastic anemia is deficiency anemia, the reason is that DNA synthesis is inhibited in the red blood cell production process. The disease state of megaloblastosis is characterized by the presence of many large, immature, and dysfunctional red blood cells in the bone marrow with excessive division of neutrophils. Material & Methods: Total 60 patients with indications of bone marrow evaluation referred to Department of Pathology, Gandhi Medical College Bhopal, were included in the study. Only patients with Known serum Vitamin B12 levels, PS findings and bone marrow aspiration were included. Pregnant females, patients with blood transfusion, medication or any bleeding disorders were excluded. Serum vitamin levels, PS and marrow findings were studied and compared. Observation & Results: Total 60 patients were included. It was found that mean hemoglobin level (6.2 gm%) WBCs count (3400/cumm) and platelet count (0.80 lakh/cumm) was least in elderly age group. Mean serum Vitamin level was least in elderly age group i.e. 96pg/ml. Vitamin B12 level was found borderline low in younger age group (148 pg/ml). Peripheral examination and morphology typing shown pancytopenia in 19 patients followed by anemia with thrombocytopenia in16, bicytopenia 13 and dimorphic anemia 12 patients. Conclusion: Megaloblastic anemia is a common anemia most commonly caused by Vitamin B12 deficiency.  Prevalence of this anemia is higher in our society due to strict vegetarian diet in various communities of our country. Marrow erythroid shows erythroid hyperplasia and megaloblastosis pointing towards the increased erythroid activity of bone marrow. Prompt diagnosis and timely treatment can prevent the serious neurological effects of Vitamin B12 deficiency.

DOI: 10.5281/zenodo.

Introduction: The COVID-19 pandemic has posed an increased burden on the health care delivery system in India and has been associated with a wide range of opportunistic bacterial and fungal infections. Amis and Objectives: To know the prevalence of fungal infections among the post covid patients. Material and Methods: A total number of 482 samples from clinically suspected mucormycosis cases attending various departments and transported to department of Microbiology, All samples are processed according to standard Microbiological procedures. Results: In a total of 482 clinically suspected individuals, fungal culture and microscopy were used to evaluate mucormycosis. Out of 482 samples analysed in this study, 263 cases (54.5%) were found to have fungal elements with a 10% KOH mount, while 219 cases (45.5%) were found to be negative. Out of 482, 247 (51.2%) samples were positive for culture, and 235 (48.8%) samples were sterile. Of the 247 fungal isolates, 91 (36.8%) are Mucorales, of which 90 are Mucor species. But one of them was identified as Rhizopus, while the remaining 112 (45.4%) are Aspergillus species, 43 (17.4%) are Candida species, and 1 (0.4%) is a Penicillium species. Conclusion: Despite the hype, mucormycosis cases were well handled by using simple microbiological methods for an early diagnosis and initiation of antifungal therapy in our hospital.

DOI: 10.5281/zenodo.

AI applications include precision diagnostics, therapies, and medicine, which use machine learning and deep learning to improve clinical procedures. Effective AI systems require a problem-solving, human-centered strategy that addresses issues such as data quality, infrastructure, ethics, and regulations. Future breakthroughs include augmented care and AI-enabled healthcare personnel. Furthermore, they help to forecast disease development, guide treatment approaches, and enable personalized medicine for more effective therapies. AI and machine learning have the potential to transform healthcare delivery and management by optimizing hospital operations, reducing administrative procedures, and allocating resources more efficiently. Furthermore, AI-powered chatbots and virtual assistants improve accessibility and patient engagement by giving personalized health advice, answering patient questions, and providing triage support. AI simplifies medical procedures and offers quick assistance. Ethical considerations are critical to responsible AI use. Emerging medical technologies have the prospect of revolutionizing healthcare delivery. Collaboration is vital for incorporating AI into healthcare. Furthermore, AI helps to accelerate drug research by assessing biomedical data and optimizing medication compositions. AI can significantly improve clinical research and personalized health product development by discovering relevant interventions and assessing their efficacy. The effective deployment of personalized medicine depends on the improvement of assays and procedures for data management, including storage, aggregation, access, and integration. Artificial intelligence (AI) in healthcare improves efficiency and accuracy in medical processes including diagnosis and treatment planning. AI is fast evolving because to breakthroughs in computing power, large data, and machine learning. ChatGPT is a significant AI tool for natural language processing.

DOI: 10.5281/zenodo.

Background and Aim: Distal radius intraarticular fractures can have a significant impact on clinical outcomes. Treatment of intraarticular fractures is a topic of debate in the medical community, with varying outcomes reported in the literature. Our study aimed to assess the effectiveness of radius bone plate fixation in the treatment of radius bone fractures. Material and Methods: A group of fifty patients who had fractures in the distal part of their radius underwent treatment using the fixed angle plate fixation method. Patients were monitored through radiographs, physical examination, ASA and VAS score. Results: Among the 50 patients, 30% (15) were found to have 2R3A1, while 22% (11) were found to have 2R3B1. Out of the total number of patients, 20% (10) were found to have 2R3B1. Out of the 28 patients, 14 were diagnosed with 2R3A2.1 types of fracture based on the AO fracture classification. According to this retrospective study, fractures were found to occur more frequently on the left side of the radius (56%) compared to the right side (44%). Based on data from the American Society of Anaesthesiologists (ASA), the majority of patients (84%) were classified as grade 1, indicating that they were normal and healthy. A smaller percentage of patients (16%) were classified as grade 2, indicating that they had mild systemic disease. Conclusion: The utilization of radius plates in the treatment of unstable distal end radius fractures has been found to result in favorable functional outcomes and few complications.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the efficacy of Intravenous (IV) opioids in attenuating the stress response and serum cortisol levels during endotracheal intubation. Methods: This study was undertaken in the Department of Anaesthesiology & Critical Care, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India .90 patients, with 30 in each group, in different age group, either sex, belonging to ASA I and ASA II scheduled for elective surgical procedures under General Anesthesia were included. Results: There was equal distribution of male and female in all the three groups. The mean age in Fentanyl Group, Morphine Group and Nalbuphine Group was 33.2, 32.08 and 29.12 respectively. The rise in blood pressure was much less in fentanyl group as compared with morphine and nalbuphine group at all measured time intervals. The rise in Diastolic blood pressure was much less in fentanyl group as compared with morphine and nalbuphine group at all measured time intervals. The result showed no statistical significance in serum cortisol levels between the three groups at SCL_0. Serum cortisol levels are statistically significantly lower at SCL_1 and SCL_2 among all the three groups. Conclusion: At the dose used in this study, fentanyl was significantly reducing stress response during laryngoscopy and intubation followed by morphine and nalbuphine Hence Intravenous Fentanyl given at the dose of 2 mcg/kg effectively attenuates the stress response after laryngoscopy and intubation as compared to Morphine 0.1mg/kg and nalbuphine0.2mg/kg in that respective order.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the effects of yogic practice on cardiovascular system in apparently healthy volunteers at tertiary health care center. Methods: This was a cross sectional study carried out in the department of physiology  during the six-month period. 100 apparently healthy individuals were selected out of these with written and explained consent 50 individuals were instructed and trained in the yogic practices (Yogic group n=50) and rest 50 individuals were control (Non yogic group n=50). Results: The age was comparable 35.55 ± 4.36 and 36.18± 5.35 (p>0.05). There was male predominance. The Pulse rate (beats/min) was significantly lower. Systolic B.P. (mm Hg) significantly lower and Diastolic B.P. (mm Hg) was significantly in Yogic as compared to non-yogic apparently healthy individuals. Conclusion: It can be concluded from our study that the yogic individual were having significantly lesser Pulse rate, Systolic and diastolic BP as compared to non-yogic individuals hence Yoga should be practiced for prevention of hypertension and its complications.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the Diffusion-weighted imaging effects of intravascular contrast agent on apparent diffusion coefficient measures of ovarian neoplasms. Methods: This was a Prospective Study was conducted on 50 patients at department of Radiology, with Study population being women with newly diagnosed ovarian tumors who underwent CEMRI study to evaluate the nature of tumor and extent. Results: Most of the patients belonged to >60 years of age. 30 were benign and 20 were malignant. Most of the patients had size of tumor from 101-200 mm. In benign ovarian tumors, Pre contrast mean ADC was 1.49± 0.47 and Post contrast mean ADC value was 1.42±0.68 with statistically insignificant P value. In malignant ovarian tumors, Pre contrast mean ADC was 0.91±0.20 and post contrast mean ADC value was 0.94±0.23 with statistically insignificant P value. Conclusion: ADC measures using our approach were not significantly changed after contrast administration for ovarian tumors at 1.5T. Our findings support the possibility that DWI optimized may be obtained before or after DCE-MRI without compromising important clinical information. Benign ovarian tumors had higher ADC values compared to malignant tumors, consistent with some of the previous studies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the efficacy of vacuum-assisted biopsy (VAB) excision system for the removal of benign breast lesions in terms of complete excision rate and incidence of complications. Methods: The prospective study was done in department of Interventional radiology from December 2022 to November 2023. 8 patients with 12 Fibroadenoma (4 patient’s single lesion, 4 patients-2 Lesions) were included in the study. Patients were followed up at 1, 6 & 12 months. Results: The mean age of the patients was 27.5 years. Hematoma formation was not statistically significant related to size of lesion. The correlation between hematoma developments was clinically significantly related to occurrence of pain intra- procedural, although there was not significant difference between hematoma and post-procedural pain statistically. Conclusion: The study showed that the use of vacuum-assisted biopsy excision system could provide a safe method for complete excision of fibroadenomas, with low rate of complications as incomplete excision, pain, and hematoma formation.

DOI: 10.5281/zenodo.

Introduction: Sleep is a vital physiological process, which promotes and maintains good health. Sleep curtailment has increased widely especially among the students at medical colleges who have recently shifted to hostels. Sleep loss has been shown to result in metabolic and endocrine alterations. Hence, it is essential to correlate sleep quality with its adverse impacts like obesity and excessive daytime sleepiness so that timely corrective measures can be taken to create healthy future doctors. Objectives:  1) to assess the sleep quality of the first year MBBS students. (2) Examine the correlation of sleep quality with BMI. Methods:  This is a Descriptive and Cross Sectional study. Study subjects are the first professional MBBS students, who are willing to participate in the study. BMI is calculated as per the standard protocol. Sleep quality is assessed by the “Pittsburgh Sleep Quality Index (PSQI)” questionnaire administered to the students via the Google forms. They are given instructions on how to correctly answer the questionnaire. Results:  No significant difference was detected in the PSQI sleep scores and sleep duration of the different BMI categories as tested by ANOVA. Pearson correlation coefficient showed a weak positive correlation between PSQI scores and BMI. Although the study does show, a trend towards longer sleeping hours in normal BMI subjects. Conclusion: Present study shows the presence of low sleeping duration in overweight and obese population. PSQI scores were not significantly different among the different BMI categories. However, the PSQI scores were towards poor side for all the categories showing that the sleep quality is poorer in our students.

DOI: 10.5281/zenodo.

Background and Aim: Intrathecal adjuvants have gained popularity for prolonging duration and quality of subarachnoid block. Hence, this study was undertaken to evaluate the effect of addition of magnesium sulphate with bupivacaine (hyperbaric) in spinal anesthesia for prolongation of analgesia. Material and Methods: This randomized controlled study enrolled 80 patients, comprising both males and females with American Society of Anesthesiologists physical status I or II, who were scheduled for lower limb orthopedic surgeries. Patients were randomly allocated in two groups and were given following drug intrathecally as per group. Group BM – bupivacaine 15 mg(0.5% heavy) with magnesium sulphate (100 mg) Group B – bupivacaine 15 mg (0.5% heavy) with 0.5 ml normal saline. Parameters monitored were onset of sensory and motor block, duration of analgesia, hemodynamic parameters, sedation score and intra and postoperative complication. Data analyzed by student’s t test and chi square test. Results: The time of onset of sensory block was comparable in both the group, the time of onset of motor block was delayed in group BM (77.37 ± 8.69) compared to Group B (72.50 ± 12.40). The mean duration of motor blockade was 322.25 ± 23.91 min in group BM and 272.50 ± 23.01 min in group B. It was statistically significant. The postoperative analgesia was found to be prolonged with addition of intrathecal magnesium sulphate (24 hr VAS score 2.13 ± 1.17 in BM group, and 3.40 ± 1.79 in Group B) and it provided better hemodynamic stability. Conclusion: The addition of 100 mg of magnesium sulfate to hyperbaric bupivacaine has effectively extended analgesia duration, influenced motor blockade onset, and improved hemodynamic stability without notable adverse effects, making it a valuable adjunct in lower limb orthopedic postoperative pain management. Additional research and trials are warranted to fully understand its therapeutic benefits and optimize its clinical utility.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the hand grip strength & fine motor skills in skilled & non skilled persons. Methods: The current investigation was carried out in the Department of Physiology. We enrolled a cohort of 200 physically fit individuals between the ages of 20 and 40 who shown no difficulty in complying with the researcher’s instructions, possessed enough muscular strength to do the assigned activity, and exhibited no restrictions in joint mobility. Results: There were no statistically significant differences between the groups in terms of general characteristics (p > 0.05). There were no notable differences between the groups in the time it took to complete the CMT assessment before and after the intervention. There were no notable differences between the experimental and control groups in terms of the duration of the pre-intervention PPT time and post-intervention PPT time (experimental group: 52.80 ±6.31 s; control group: [missing value]). Conclusion: When opposed to those who are not competent, skillful individuals have a decrease in their muscular strength, which results in an improvement in fine motor skills such as FT and PDT.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to study effect of amlodipine, atenolol, enalapril and chlorothiazide on arterial blood pressure, heart rate and renal function tests. Methods: The study was carried out in the Department of Pharmacology in collaboration with Department of Medicine, Darbhanga Medical College, Darbhanga, Bihar, India. Total 160 patients with hypertension were included in the study. These patients were assigned to one of the 4 groups randomly. There were 40 patients in each group. Patient prescribed with tablet amlodipine 5mg or 10 mg was be considered as Group I, likewise, prescription of tablet atenolol 25 mg or 50 mg was be considered as group II, prescription of tablet enalapril 2.5 mg or 5 mg was considered as group III and prescription of tablet thiazide diuretics 12.5 mg or 25 mg was be considered as group IV. Results: The effects of drugs on systolic blood pressure (mmHg) before & after were studied. Mean change in systolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease in blood pressure was seen by Enalapril followed by thiazides, Atenolol & Amlodipine. The effects of drugs on diastolic blood pressure (mmHg) before & after were studied. Mean change in diastolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease was seen by Atenolol followed by amlodipine, enalapril & thiazide. The effects of drugs on mean heart rate before & after were studied. Mean change in blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease was seen by Atenolol followed by enalapril, amlodipine & thiazides. Conclusion: Antihypertensives have effect on blood pressure, heart rate, renal functions. Patient’s renal function, heart rate should always be considered while prescribing antihypertensive drugs.

DOI: 10.5281/zenodo.

Aim: The current research set out to examine the clinical characteristics of tertiary hospitalized patients experiencing acute sensorineural hearing loss. Methods: The ENT department of Zydus Medical College and Hospital in Dahod, Gujrat, India, provided the setting for the current retrospective investigation. Two hundred case records were reviewed. This study used case records from the last three years to look at individuals who had sensorineural hearing loss that came on suddenly. Results: All patients were compared by recovery. The recovery rate was 40% in 80 patients and 60% in 120 individuals. 43% of patients were 41-60 years old, followed by 30% from 21-40. Patients with recovery had a significantly higher mean age (42.88 ± 8.32 years) compared to those without recovery (51.52 ± 11.79 years) (p<0.05). No significant gender difference was seen among total patients or those with or without recovery (p>0.05). Hypertension (35%), diabetes (20%), dyslipidemia (20%), and thyroid disease (8%) were common comorbidities. The difference in vertigo between patients with and without recovery was statistically significant (p<0.05). Patients with recovery (40%) and those without recovery (60%) had similar tinnitus (p>0.05). The majority of patients had flat, U-shaped, reverse U-shaped (45%), descending (40%) and ascending (15%) audiogram curves. Hearing loss was modest (8%), moderate (10%), fairly severe (20%), severe (25%), and profound (37%). A significant difference (p<0.05) was seen in the incidence of individuals without recovery with increasing hearing loss severity. Conclusion: Individuals under the age of 40 who experience sudden sensorineural hearing loss may have a higher chance of recovery if they start therapy within 14 days of onset, do not have any other medical conditions, and have a less severe degree of hearing loss.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the effect of nutritional variables in children with iron deficiency anemia in Bihar population. Methods: The present study was conducted in the Department of Paediatrics,  In the current study, the main variable was IDA, which is a categorical variable. Blood samples of 250 randomly selected children (6-59 months) living in the urban and rural areas were taken. Children who had history of liver infectious disease, liver cancer or high fever were excluded from the study. Results: There were 3 groups among them; majority of families had 1-2 children. Highest range of IDA was seen in the families with 6-9 children. 23.6% of rural families with IDA child had 6 or more children in their family while in the urban areas IDA was mostly seen in the families with 1-2 children. Logistic regression analysis indicated the association in the families with more than 6 children and IDA. Conclusion: The prevalence seems to be the same in urban and rural areas and similar in both sexes. Statistically it was proven that young mothers and families with 6 or more children were the best predictors for increased prevalence of IDA among fewer than 5 years old children in this research. It was shown that there are several main risk factors for iron deficiency and anemia in the children.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the Correlation of Hs Troponin I & Uric Acid in patients of Myocardial Infarction. Methods: 200 patients who came to cardiac emergency in the Department of Medicine, Nalanda medical College and Hospital, Patna, Bihar, India. Serum samples were taken for Hs Troponin I and Uric Acid for patients of Myocardial Infarction and run on VITROS 5600/7600 which is based on dry chemistry. Results: Among the 200 patients of more than 40 years of age 120 were males & 80 were females. For both males & females age mean & SD was 60.6±11.72 and 58.6±12.70. For Hs Trop I males were 22.78±46.84 & females 15.75±54.56. For uric acid for males were 6.534±3.750 & for females 6.316±1.860. For Hs Trop I males were 22.78±46.84 & females 15.75±54.56. For uric acid for males were 6.534±3.750 & for females 6.316±1.860. Therefore Hs Trop I & uric acid were both significant when compared with age P value was 0.0040.Whereas when compared with sex that is male and female to both Hs Trop I and uric acid then Hs Trop I was more significant with P value 0.0001. Conclusion: In acute MI, patients with hyperuricemia had higher mortality. Serum uric acid levels correlated with Killip classification in acute MI. Serum uric acid can be used as a marker of short term mortality in patients. Hyperuricemia is an indicator of poor prognosis in acute MI. Uric acid is an economical biomarker that is readily, quickly and reliably obtainable, it can be one of the predictable prognostic indicator in acute Myocardial Infarction.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate and compare the efficacy and hemodynamic stability of ketamine / fentanyl along with propofol and also assess recovery profile, post-operative analgesia and complications in patients undergoing Dilatation and Curettage. Methods: The present study was carried out in the Department of Anaesthesia, BMIMS Pawapuri, Nalanda, Bihar, India.  the study was conducted in 50 patients, aged 18-35 years of ASA Grade 1&2 scheduled for Dilatation and Curettage procedures lasting up to 30 minutes. Results: Pre-induction heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, spo2 were comparable in both the groups with a statistically no significant difference between them (p<0.05). Conclusion: It may be concluded from our present study that propofol with ketamine as an adjuvant in the dose of 0.75 mg/kg compared to propofol with fentanyl as adjuvant in the dose of 2 mcg/kg provides deep sedation. But propofol-ketamine group is more efficacious and provides better peri-operative hemodynamic stability during anaesthesia as compared to propofol-fentanyl group. Also the propofol-ketamine combination produces good analgesia with less requirement of rescue drug in post-operative period with fewer peri- operative complications than propofol-fentanyl combination. We have not encountered any psychotomimetic effects of injection Ketamine in the 0.75mg/kg dose. Hence propofol-ketamine combination is a better choice especially when hemodynamic stability is of great importance in patients undergoing dilatation and curettage.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the influence of malnutrition in development of tuberculosis in BCG vaccinated children in age group of 2 months to 12 years. Methods: The Present study was a prospective study carried out at Nalanda Medical College and Hospital, Patna, Bihar, India. Study population was children in the age group of 2 months to 12 years with symptoms suggestive of tuberculosis. In our study, we studied 100 patients. Results: Majority of the patients belong to 1 to 5 years (40%) followed by 6 to 10 years (26%). Patients less than 1 year were 17%. In our study, positive history was shown by 22% population and 78% showed negative history for tuberculosis. The predominant symptoms of presentation are Fever 66 (66%) and cough 59 (59%). 37 (37%) had initial presentation as seizures. 36% had weight loss or poor weight gain, significant lymphadenopathy was observed in 25 (25%) cases and 14 (14%) had wheezing. 21 (21%) had Grade I, 16 (16%) had Grade II PEM, 14 (14%) had Grade III PEM and 5 (5%) had Grade IV PEM according to IAP Classification of Malnutrition. 44 (44%) cases had normal nutritional status.  Disseminated and Milliary TB was more in children with Grade III and Grade IV malnutrition. 5 cases of TBM had normal nutrition whereas 3 cases each had grade I and grade III malnutrition. 1 case of abdominal tuberculosis had normal nutrition and 1 case had grade I malnutrition. Conclusion: Protective benefit of BCG vaccine against the dissemination of tuberculosis is children in possible only if they have normal nutrition.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the association of serum homocysteine with pregnancy- induced hypertension (PIH). Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India. The study group included 100 pregnant subjects, including 50 subjects with hypertensive disorders of pregnancy presenting in outdoor or emergency as cases and 50 normotensive subjects enrolled for normal antenatal care as controls. Results: In our study, among the 50 hypertensive subjects (cases), 36 (72%) had a normal serum homocysteine (< 15 µmol/L), while 14 subjects (28%) had hyperhomocysteinemia (> 15 µmol/L). On comparing this with 30 normotensive subjects (controls), 48 subjects (96%) had serum homocysteine within the normal range, while only 2 subjects had hyperhomocysteinemia. This comparison was found to be statistically significant. We found that the mean value of serum homocysteine was 14.65 + 9.247 µmol/L among the 30 cases (hypertensive subjects), whereas the mean serum homocysteine was 8.63 + 3.71 µmol/L in controls (normotensive subjects). This difference was statistically significant. All the normotensive subjects had a mean serum homocysteine of 8.41 + 3.57 µmol/L. The mean serum homocysteine of Gestational hypertension was 8.18 + 3.79 µmol/L, whereas who had mild preeclampsia had a mean serum homocysteine of 8.85 + 5.57 µmol/L. On analysis, these data were not found to be statistically significant. Conclusion: Since hypertensive disorders of pregnancy are one of the leading causes of maternal and neonatal morbidity and mortality, it is important to identify and reduce the modifiable risk factors associated with them; one of them being hyperhomocysteinemia, which has been shown to have implications in adverse maternal and neonatal outcomes.

DOI: 10.5281/zenodo.

Aim: The current study aimed to focus specifically on objectively assessed physical activity & and dietary habits among adolescents of BIHAR. Methods: The present study was conducted at department of community medicine and cross-sectional data were collected. Data were obtained from adolescents (11-16 years) standard selected recruited from three secondary schools in Bihar. Staff at participating schools selected a subset of their classes for participation. All students from nominated classes (n = 415) were eligible and received written information on the project. Consent was sought from parents prior to the study and adolescent participants provided assent before completing written surveys during class. Results: In total, 393 pupils provided consent and completed the questionnaire (95.85% response rate). Of these, 150 (38.16%) provided usable accelerometer data. Comparison of these 150 adolescents with those who did not provide usable accelerometer data (n = 150) showed no significant differences in age, SES, ethnicity or fruit and vegetable consumption. However, a significantly (p < 0.01) higher proportion of those with usable accelerometer data were girls, compared to boys (53% compared to 37%), and ate breakfast on more days per week (4.7 days compared to 3.5 days). Thus, our figures likely underestimate the prevalence of not meeting the breakfast recommendations. The final sample composition was 150 adolescents, with 70 boys, 80 girls, 68 younger adolescents and 50 older adolescents. The mean age of younger adolescents was 14.3 years and of older adolescents was 14.6 years. Conclusion: Many adolescents fail to meet multiple diet and physical activity recommendations, highlighting that physical activity and dietary behaviours do not occur in isolation. Future research should investigate how best to achieve multiple health behaviour change in adolescent boys and girls.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the different pattern of risk factors, clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer. Methods: This was a hospital based prospective observational study conducted in the Department of General Surgery, Shri Ramkrishna Institute of Medical Sciences, Durgapur, West Bengal, India for the period of 1 year. Total 100 patients were included in this study. Results: Among study subjects the mortality rate was 20% (20 cases) and 80 (80%) were survivors. The mean age of study subjects with perforated peptic ulcer was 52.68±16.44 years. The mean age of survivors was 48.82±14.66 years and for non survivors it was 68.62±12.68 years. Among study subjects 62 were males and 38 were females. Among non-survivors 12 were male and 8 were females. Whereas among survivors 50 were males and 30 were females. Among study subjects the most common risk factor seen was alcohol (68%) followed by smoking, peptic ulcer disease and NSAIDs ingestion whereas the most common presentation was abdominal pain (100%) followed by signs of peritonitis (88%), abdominal distension (84%), severe nausea (49%) and vomiting. In present study among cases most common Post operative complication was SSI (41%) followed by pulmonary infection (14%), post operative sepsis (10%), burst abdomen/wound dehiscence (5%) and fistula formation (2%). The relative risk is maximum in APACHE 2 score >25 (7.4) followed by in group with APACHE 2 score 21-25 (6.84), APACHE 2 score 16-20 (3.7), APACHE 2 score 6-10 (0.85), APACHE 2 score 11-15 (0.38), APACHE 2 score 0-5 (0.07). Conclusion: The present study concluded that perforated PUD is a life- threatening disease with high morbidities and mortalities. Male predominance was seen due to smoking and alcohol consumption. Pain in abdomen and abdominal distention were the common symptoms. Hospitalization stay was high among survivors. Mortality was higher as the age increases and late presentation and initiation of treatment increases risk of mortality. Higher APACHE 2 score was useful in assessing the risk of mortality.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to estimate oxidative stress and antioxidant status in tropical chronic pancreatitis (TCP) and alcoholic chronic pancreatitis (ACP) and correlate with zinc status. Methods: The present study was conducted in the Department of Gastroenterology, Big Apollo Spectra Hospital Patna, Bihar, India and Chronic pancreatitis patients were recruited for the study and was diagnosed on the basis of presence of pancreatic calcification (US/CT) and/or parenchymal or ductal changes on imaging. 100 patients were included in the study. This study was approved by the Institutional Ethics Committee and written informed consent was obtained from the subjects before enrollment. Results: Of the 100 patients, there were 50 TCP patients and 50 ACP patients. The mean age of all CP patients was comparable with the age of controls; however, TCP patients were younger than ACP patients. The mean body mass index was comparable in all three groups. The erythrocyte GSH, GPx, SOD, and plasma vitamin C levels were lower, and erythrocyte TBARS was higher in both TCP and ACP patients as compared to healthy controls. Plasma vitamin C was lower whereas, erythrocyte TBARS was higher in TCP patients as compared to ACP patients. Erythrocyte GSH level was significantly low in ACP as compared to TCP patients. We found lower values of erythrocyte GSH, GPx, SOD, and plasma vitamin C and higher erythrocyte TBARS in both diabetic and non-diabetic CP patients as compared to healthy controls. However, we did not find differences between diabetic and non-diabetic TCP patients or between diabetic and non-diabetic ACP patients. Conclusion: The study corroborates the role of oxidative stress in CP and suggests some differences in oxidative status in TCP and ACP patients. Zinc deficiency appears to affect oxidative status in CP patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the morphological findings of the red blood cells (RBCs) in peripheral blood smear in order to categorize different types of anemia and to compare it with RBC indices measured with an automated hematology analyzer. Methods: The present study was a prospective study conducted in Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India over a period of one year. 200 patients were included in the study. The cases included were newly diagnosed cases undergoing treatment and follow up. Results: Our study included that out of total 200 cases; males were 96 cases (48%), while females were 104 (52%). Our study included patients spanning a wide age range, from 8 days to 75 years old. Among the study population, the largest proportion of patients (34%) fell within the age group of 31-45 years, followed closely by those aged 16- 30 years (32%). In this study 70 cases (70%) were diagnosed as microcytic anemia by automated analyzer which constituted major portion of study population. In our study on peripheral smear examination maximum number of cases (52%) belonged to microcytic anemia and normocytic anemia (30%) and 7% cases belonged to dimorphic anemia, 2% cases belonged to macrocytic anemia and 3% hemolytic anemia and 0.5% Red Cell Agglutinins (cold) and 1.5% cases belonged to Thalassemia. The results of our study indicate that a normal histogram (bell shape) was observed in only 17% of cases, while the majority (82%) exhibited a broad base curve, including cases with a left shift, right shift, bimodal, and multiple peaks. Specifically, a left shift was observed in 72% of cases, while a right shift was present in only 4% of cases. Bimodal histograms were observed in 2% of cases, and multiple peaks were seen in only 1% of cases. Conclusion: Histograms are an essential tool for the initial morphological analysis of blood samples, especially when combined with the concept of the normal curve and knowledge of CBC parameters like RDW and red cell indices.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the completeness of vaccination in children of age 12 months to 23 months age and reasons of dropouts in tertiary care. Methods: The present study was conducted in the Department of Paediatrics, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India From January 2023 to December 2023. The study was conducted on children of age group 12- 23 months. 500 subjects were included in the study. Results: Majority of the patients who were fully immunized had age between 18-20 months. Partially immunized majority had age between 18-20 months. Nonimmunization was equally distributed among the age group of 12-14, 15-17 and 18-20 months. Full immunization was more common among males compared to females. Partial immunization was prevalent in males compared to females. Majority of the fully immunized children belong to urban class III class followed by urban class II class. Of the children who were partially immunized, majority were from the urban class III class followed by urban class II. Of the non-immunized children majority were from the rural class IV and rural class III. The distribution of socioeconomic with Immunization status of the child was highly significant as revealed by the p value of 0.001 for rural are and <0.001 for the urban area. Conclusion: The consistent efforts needed in slum population so that immunization coverage could be achieved to desired level. Regular follow up of children in the vulnerable age group and education of mothers regarding the immunization schedule will go a long way in reducing the dropout rate and ensuring full immunization. Improvement in the income of the poor, proper health services and quality environment are more important in reducing the morbidity and mortality in slums.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical evaluation of perfusion index (PI) as a predictor of post spinal hypotension in lower segment caesarean section (LSCS). Methods: The present study was conducted in the Department of Obstetrics and Gynecology, Gauri Devi Institute of Medical Science & Hospital, Durgapur, West Bengal, India. Informed & written consent was obtained from every parturient who came for caesarean section. A total of 50 subjects were analyzed. Results: Out of 7 parturient had high standard PI (PI>3.5), 6 parturient foster hypotension, though out of 43 parturient had low pattern PI (PI≤3.5), 10 parturient foster hypotension. The parturient with high & low standard PI, systolic pulse diminished altogether after spinal infusion. However, more prominent reduction in systolic pulse at 5-10 min & 25 min in parturient having high benchmark PI had after spinal infusion than parturient having low standard PI. Conclusion: Perfusion Index (PI) can be used to predict post spinal hypotension in healthy parturient undergoing lower segment caesarean section. Parturient higher risk of developing post spinal hypotension with baseline PI more than 3.5 compared to those with baseline PI less than 3.5.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the risk factors, clinical presentation and management in incisional hernia. Methods: The present study was conducted in the Department of General Surgery, Patna Medical College and Hospital Patna, Bihar, India and having incisional hernia are included in our study by applying the following inclusion and exclusion criteria. The study was conducted during the period and total number 100 cases were taken for study. Results: The study shows that incisional hernia is more common in females than males. Most of the patients belonged to 21-60 years. The study showed that all the patients (100%) presented with swelling in the abdomen. 25% Patients had associated pain in the swelling. In the present study, 45% had obesity and 25% had anemia. 32% underwent elective surgery and 68% underwent emergency surgery. In the study 15 patients had surgical site infection and 15 patients had seroma formation. 10 patients had Respiratory tract Infection. Almost half the patients in the study group were followed for complications, including recurrence. 20 patients were followed up for up to one year duration. Conclusion: Incisional is more common in females, especially the multiparous. Incisional hernia is more common in patients who underwent the previous surgery on an emergency basis. Cough impulse was present in all the cases and the swelling reduced on lying supine. Seroma formation and surgical site infection were the common complications in the post-operative period. No recurrence was seen in the follow up of the patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the pregnancy outcomes in first trimester vaginal bleeding. Methods: The present study was a sectional- analytical research that was performed on 50 pregnant women with vaginal bleeding in the first trimester of pregnancy in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India for the period of one year. Results: Majority of the women belonged to 25-34 years of age and 36 women had moderate bleeding in current pregnancy. According to parity, 56% belonged to 0, 34% had history of bleeding and 16% had history of abortion. Premature labor and placental abruption were the obstetric complications noted in the women. 20% underwent abortion and 56% delivered through NVD. Conclusion: Considering the results of present study and first trimester bleeding can be a predicting factor in terms of mother and infant consequences of pregnancy and it is necessary to increase the knowledge of pregnant women in this regard for closer care. Also, because the clinical interventions of attentive physician has important role in not only the continuance of pregnancy but also reducing the fetal complications in these high risk pregnancies, precise management and planning by physicians is required.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find out the incidence of maternal complications, perinatal mortality and morbidity in postdated pregnancies. Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology for 12 months. Total 200 patients in the antenatal ward and labour room were selected for the study and they were divided into two groups, Control group with Gestational age 37-40 weeks and Study group with Gestational age >40 weeks. Results: Maximum number of patients belonged to the age group of 25-30 years both in cases (45%) and control group (52%). The maximum number of patients in the study group (80%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. 65% of the patients in study group were primigravida and in the control group 55% were primigravida. The percentage of LSCS was 30% which was higher than in the control group where it was 15%. Incidence of instrumental delivery was also higher in the study group as compared to control group (13% as compared to 7%). Among the indications for LSCS, the most common indication among the study group was acute foetal distress which includes meconium stained liquor followed by cephalopelvic disproportion. In the control group, most common indication was non progress of labour followed by acute foetal distress and non-reactive CTG. Maternal complications like LSCS, PPH and sepsis all were higher in the study group as compared to the control group. 17% of infants in the study group had asphyxia as compared to only 7% in the control group. 15% infants of the study group had to be admitted to the NICU as compared to 10% in the control group. 3% was the percentage of intrauterine deaths in the study group as compared to none in the control group. Conclusion: Postdated pregnancy remains a clinical dilemma for an obstetrician. The choice is between watchful expectancy for labour to start or induction in postdated patients. According to our study, postdated pregnancies are related with higher rate of LSCS and instrumental deliveries.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the spectrum of congenital heart diseases in a tertiary care centre in Bihar Region. Methods: The present study was conducted in the Department of Pediatrics, Government Medical College Bettiah, West Champaran, Bihar, India form feb 2019 to Jan 2020 and 200 patients were studied. Results: We studied 200 patients in age group 0 to 5 years with clinical suspicion of CHD out of which 116 were male and 84 were female and maximum patients belonged to 1-12 months of age. The difficulty in breathing emerged as the most common presenting complaint, followed by feeding difficulty. The cases with VSD were found to be 32%, ASD were 30%, PDA were 8%, TOF were 5%, 13% cases were combination of multiple defects. Conclusion: We concluded that VSD 32% was the commonest heart disease, followed by ASD 30%, congenital heart diseases showed male preponderance. VSD was the commonest acyanotic heart disease and TOF was the commonest cyanotic heart disease. The majority of patients were seen in the age group 1 to 12 months of age. Difficulty in breathing was the most common presenting complaint followed by feeding difficulty.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical profile of patients of cerebral palsy and to assess the spectrum of functional disability. Methods: The present study was done in the Pediatric Department of NMCH, Patna. The present study is the observational study conducted for a period of one year. A total of 200 patients diagnosed with cerebral palsy attending the OPD of the pediatric department were included in the study. All the patients belonged to the age group of upto 12 years. Results: In the present study, most of the participants belonged to 2-5 years of age and 65% were male. According to nutritional status, majority of the patients belonged to grade III. Among them, 49% were generalized tonic-clonic seizures, myoclonic seizure (29%), febrile seizure (6%), refractory seizure (9%) and status epilepticus (7%). GMFCS score 5 was seen in 28% (mostly quadriplegic), followed by GMFCS level 1, 23% (mostly hemiplegic), others mostly diplegic in level 3 (21%), level 2 and 4 (14%). Conclusion: In present study, children between 2 to 5 years with male preponderance were mainly noted. Diplegic CP patients were most common and equally distributed between GMFCS 2 to 4. Perinatal factors (asphyxia) were main etiological risk factor. Multidisciplinary CP clinic also provide more satisfaction thus compliance for rehabilitation.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find the rate of caesarean deliveries and various indications of the procedure. Methods: The present study was conducted in the Department of Obstetrics and Gynecology, SKMCH, Muzaffarpur, Bihar, India conducted this retrospective study on women who underwent LSCS over a period of 6 months.  Out of the 445 deliveries, 200 were delivered by cesarean section. All the mothers who underwent LSCS in this hospital in the designated period were included in this study. Results: The LSCS prevalence was 44.94% in our institution. We have assessed the common indications of LSCS performed in this study population. In our study group, the range of age varies from 18 to 43 years with an average of 27.37±4.21 years, 30% of the women aged between 18-25 years, majority, i.e., 60% belongs to the age group of 26-35 years and only 10% observed in the higher age group. Out of the 200 cases, parity was distributed almost equally in this study group, i.e., 45% were primigravidae, and 55% were multigravida. 5% of the LSCS occurred at <32 weeks of gestation and 25% between 32-36 weeks. The majority of the LSCS were delivered between 37-40 weeks (70%) of gestation. Mode of conception was spontaneous for 97%, and 3% received infertility treatments. Mode of conception was spontaneous for 97%, and 3% received infertility treatments. LSCS was mostly done for ‘previous LSCS’ indication (42%), followed by failure of induction of labor (25%). Fetal distress was an indication in 40 cases (8%), Breech presentation in 6%, PPROM in 5%, CPD in 4%. Other indications such as preeclampsia, placenta previa, unfavorable cervix, multiple gestation, abruptio placenta, LSCS on demand etc., was 1%. Conclusion: Although LSCS indications seen in our institute are the same in most institutions worldwide, efforts should be made to focus on reducing the primary LSCS rates thereby reducing the most common indication of previous LSCS in subsequent pregnancies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the benefits and harms of sugammadex and neostigmine in obese patients and its post-operative efficiency. Methods: The present study was conducted in the Department of Anaesthesia & Intensive Care, Nalanda Medical College and Hospital, Patna, Bihar, India. 100 obese patients were included in the study. Results: Demographic and baseline characteristics including gender, age, race, ASA physical status, and preoperative diagnosis were similar between groups. The median age was 49 [44, 65] years old in Group N and 57 [47, 63] years old in Group S (p = 0.72). Moreover, 56% of patients in Group N were males, whereas 60% in Group S were females. The median body mass index (BMI) was slightly higher in Group S when compared to Group N. The median time elapsed from neuromuscular blockade reversal administration to extubation was slightly shorter in the Group S when compared to Group N. Overall, the median time elapsed from neuromuscular blockade reversal administration to OR readiness-for-discharge was similar between Group S and Group N. Cholecystectomy was the most common procedure performed in both groups. There were no statistically significant differences in median length of anesthesia or surgery between groups. The median length of hospital stay (Phase II and/or hospitalization) was similar between groups (166 [102, 245] min for Group N versus 118 [83, 175] min for Group S; p = 0.11). In addition, the total time of hospitalization for Group N was 543 and 466.5 min for Group S. The overall incidence of adverse events was 23% and there were not statistical difference among groups. However, postoperative nausea and vomiting, urinary retention, and shortness of breath were the most common perioperative complications. Conclusion: Sugammadex offers a significantly faster, predictable, and safer recovery profile from neuromuscular blockade than neostigmine   in   patients   undergoing   outpatient surgical abdominal procedures in obese patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to explore the perceptions of high-risk pregnancy among women with high risk factors. Methods: A community-based study was undertaken in the district. The study was conducted for the period of 2 years. In-depth interviews were conducted with 50 participants using semi- structured interview schedule. Results: The women’s mean (standard deviation) age was 23.7 years (6.04) and age ranged from 14 to 36 years. All the participants belonged to Muslim religion and majority had extended family. Majority of them were uneducated and home maker. Majority of the participants were first or second birth order with anemia being the most common risk factor among them. Conclusion: Women must understand their risk in the same way as their healthcare providers otherwise they may not follow the recommended advice for birth preparedness. Women are willing to deliver at home in spite knowing they are at high risk. Sociocultural practice and belief that pregnancy/delivery is a normal event affects women’s decisions for seeking care. Government have implemented various programmes and schemes to reduce maternal/perinatal mortality (like incentives, free diagnostics and medications for institutional deliveries), but to avail them pregnant women must understand their risk and change their behavior.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyse the thyroid profile, hs-CRP and lipid profile in newly detected hypothyroid adults in comparison to controls and also to compare the above parameters in subclinical and clinical hypothyroid cases. Methods: The present study was conducted in the Department of Medicine, Ford hospital and research centre Pvt. Ltd, Patna, Bihar, India. A total of 100 subjects (50 hypothyroid cases and 50 euthyroid (controls), visiting General Medicine OPD Bengaluru were consider for study. Results: The mean age of cases and controls in our study was found to be 36.44±12.48 years and 35.95±10.25 years respectively (p = 0.65). BMI values in the study were higher in cases (26.34 ± 4.86 kg/m2) compared to controls (25.85 ± 4.52 kg/m2) and was statistically significant (P = 0.07). In the study, the mean TSH levels of cases were high compared to controls and were statistically significant. The mean serum hs -CRP levels in both the study groups was within the reference range, but it was high and statistically significant in cases than in control. The mean LDL- c value in cases and control was high in cases and the difference was statistically significant. The triglyceride levels of cases were significantly higher than that of control and were statistically significant. hs -CRP levels were in within reference range for 78% of cases and 92% controls whereas above the normal range was seen in 22% cases and only 6% controls. As per the Pearson’s correlation, there was a significant positive correlation between serum TSH and hs – CRP levels in cases (r = 0.265, p < 0.001). There was a significant increase in serum TSH in CH as compared to SCH. The difference was statistically significant. hs -CRP levels though high in CH than SCH were statistically insignificant. TSH and hs- CRP when compared between SCH, CH and controls showed a statistically significant difference between groups with p value <0.001. Conclusion: This study concluded that hypothyroidism is associated with dyslipidemia and low grade inflammation. Subclinical hypothyroidism was found to be more common than clinical hypothyroidism. Hypertriglyceridemia and at risk hs – CRP levels though seen in hypothyroid cases were more prominent in CH cases than SCH.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the lumbosacral transitional vertebrae and its clinical implications. Methods: The present study included an examination of 100 adult sacra (75 male and 25 female) available in the Department of Anatomy, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for the presence of LSTV. Results: In the present study of 100 sacra, 75 (75%) were male and 25 (25%) were female. Only 20 showed Lumbosacral Transitional Vertebrae and 80 were normal sacra. Out of 75 male sacra, 12 and out of 25 female sacra, 8 were found to be Lumbosacral Transitional Vertebrae. Out of 20 LSTV, 15 sacrum showed complete sacralisation of 5th lumbar vertebrae, 2 sacrum showed simultaneous sacralisation of 1st coccygeal vertebrae and incomplete lumbarisation of 1st sacral vertebrae and 3 sacrum showed complete lumbarisation of 1st sacral vertebrae. Out of total 20 Lumbosacral Transitional Vertebrae, 15 fall in Type III of Castellvi classification, all of which were bilateral (IIIb). 5 fall in Type IV (mixed) cateogory of Castellvi classification in which we found unilateral pseudarthrosis with the adjacent sacral ala on the left side and complete fusion with the adjacent sacral ala on the right side. Conclusion: LSTV is a benign anatomical variation of the lumbosacral spine that is most frequently encountered by the spinal surgeon. The list of differential diagnosis should always include Bertolotti’s syndrome, when investigating back pain in young patients. Knowledge of the biomechanical alterations within the spine caused by LSTVs will aid the radiologist in understanding and recognizing the imaging findings seen in patients with low back pain and a transitional segment.

DOI: 10.5281/zenodo.

Aim: The objective of this study was to study the maternal and fetal outcome among pregnant women presenting with thrombocytopenia. Methods: The present study was conducted at  department of obstetrics and Gynaecology NMCH, Patna, Bihar, India for the period of 7 months. Pregnant women with singleton pregnancy with period of gestation 28 week onwards who attended ANC & found to have thrombocytopenia after screening were included. Sample size 100 patients were included in study. Results: Mean gestational age was 38.42 ± 1.69 weeks. 15% were < 37 weeks, 70% were in 37 to 40 weeks and 15% were >40 weeks. The mean platelet count was 106907±30136/ μL. Majority of women had mild thrombocytopenia (62%). 36% women had moderate thrombocytopenia and only two had severe thrombocytopenia. Association of thrombocytopenia with other medical illness was evaluated in our study. It was found that anemia was associated in 8 women, four women had ITP and hypothyroidism was found in only two women. Rest all women have no diagnosed other medical illness. In our study it was found that PIH was associated with 25% of thrombocytopenic women. Among the 25 women who had PIH, majority of them had gestational hypertension in 60% followed by pre-eclampsia in 24%. Severe pre-eclampsia was noted in two (8%) women. Only two had eclampsia (8%). Conclusion: Most common cause of thrombocytopenia during pregnancy was gestational thrombocytopenia but other underlying causes must be considered as well. A careful examination and simple laboratory test are needed so that a serious condition that may require specific and urgent management (examples HELLP syndrome, severe pre-eclampsia, TTP, HUS, AFLP) is not missed. Management of pregnant women with platelet disorders requires a multidisciplinary approach.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical profile and outcome of chronic ectopic pregnancy in tertiary care hospital. Methods: This prospective observational study was undertaken in the Department of Obstetrics & Gynecology, NMCH, Patna, Bihar, India on pregnant women with persistent chronic ectopic pregnancies . During the study period of nine months , 9940 patients were delivered to the institute. 85 patients were diagnosed with ectopic pregnancy. Hence, the incidence of ectopic pregnancy was 0.85% in our study. Only 10 patients were diagnosed in chronic ectopic frequency (CEP). Results: 30% cases were aged ≤ 30 years while rest of the cases was aged more than 30 years. The mean age was 34.56 ± 5.0 years. 40% (4 cases) were nullipara, 60% (6 cases) were primipara and none of cases were multipara. Our center being tertiary center, 40% (4 cases) were referred from other centers while 60% (6 cases) were diagnosed at our hospital. Majority of the patients 60% (6 cases) presented at 6 to 8 weeks of gestation followed by 40% (4 cases) at less than 6weeks of gestation. Amenorrhea and pain abdomen was the most common complaint seen in 100% (7 cases) followed by Vaginal Bleeding/Spotting (60%) and Fainting Attack (30%). 80% cases were positive UTP. All of the patients were positive in Culdo/Paracentesis. The beta-HCG levels of more than 5000mIU/ml was observed in 10% (1 case), beta-HCG of less than 1500mIU/ml was in 60% (6 cases, and beta-HCG in the range of 3000-5000 mIU/ml was in 30% (3 cases). All of the patients had hemoglobin range of 7-10 gm/dl. Conclusion: Chronic ectopic pregnancy is rare and is often misdiagnosed preoperatively. Chronic ectopic pregnancy should be the provisional diagnosis in a young multiparous woman with AUB and/or abdominal pain, if the ultrasound shows the presence of a heterogeneous mass in the POD and/or adnexa, with no internal vascularity on CD.

DOI: 10.5281/zenodo.

Aim: This study was aimed at assessing the frequency of elevated CRP in children with acute bronchiolitis and outcome according to CRP levels. Methods: This was a retrospective, cross-sectional, and analytical study where the electronic medical records of all patients with a clinical impression of acute bronchiolitis and were admitted to the Department of Pediatrics, IGIMS, Patna, Bihar, India for the period of one year were retrieved. During the study period, a total of 200 patients were admitted with a clinical presentation of acute bronchiolitis. 50 (25%) patients were excluded due to of unavailability of data of CRP levels. The remaining 150 (75%) patients were included in the study. Results: 85 (53.34%) patients were males. The most common clinical presentation was cough (120 (80%) patients) followed by fever (105 (70%) patients). Antibiotics were used in 80% patients. 6% patients required intensive care, 2 % had surgical intervention, 2% required endotracheal intubation, and 1 (1%) died. Patients with high CRP were older at presentation (P < 0:0001) and had more fever (P < 0:0001) and cough (P = 0:002), but lower hemoglobin level (P < 0:0001) compared to those with normal CRP. Fever (P = 0:016) and hemoglobin level (P = 0:002) were independent factors. Conclusion: Most children with acute bronchiolitis had high rate of elevated CRP values that did not correlate with the rate of bacterial coinfection. High CRP levels were found in older children, those presented with more fever and cough, and had a lower hemoglobin level despite that those factors were previously reported to be associated with disease severity and bacterial coinfection.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the obstetrics outcomes of uterine fibroids and their consequences in a tertiary hospital. Methods: The present study was a retrospective study was undertaken in the Department of Obstetrics and Gynecology, AIIMS, New Delhi, India. The study was conducted for one year. 200 pregnant women who had USG findings of fibroid were enrolled in this study. Results: Most patients (42%) were in the 26-30 age range, followed by 31-35 (32%). The mean age was 31 years with a standard deviation of 5.85. 9% were under 25 and 3% were over 40. 42% of patients were primigravida, 38% were second or third, and 20% were fourth. Submucous fibroids were found in 18% of individuals and subserous fibroids in 73%. Most patients had fundus fibroid (74%), and 13% had pedunculated. Two to three fibroids were found in 47%. This research found 80% term deliveries. Caesarean section (62%), vaginal birth (25%), and instrumental and aided breech delivery were the most prevalent. Significant pregnancy problems included imminent preterm labour (22%), abortion (17%), PPH (10%), and blood transfusion (21%). Conclusion: Uterine fibroid pregnancy is often asymptomatic and accidental. Early pregnancy abortion, term pregnancy PROM, and postpartum PPH are linked to fibroids. Also, malpresentation is more likely. Pregnant uterine fibroid patients have significant caesarean section rates. So, uterine fibroids render a normal pregnancy high-risk.

DOI: 10.5281/zenodo.

Aim: To evaluate the functional effect of transforaminal steroid injection in patients with prolapsed intervertebral disc. Material and methods: This retrospective study was conducted in the Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India for seven months. Patient with age between 18 to 65 years. Patient with low back pain and leg pain and/or with tingling. Patient with single intervertebral disc involvement (confirmed on MRI). Patient with unilateral symptoms. Patient with failed conservative management for more than 6 weeks. Patient and/or his/her legally acceptable representative willing to provide their voluntary written informed consent for participation in study. Routine blood investigations were done, the VAS and ODI score were assessed pre-injection. Results: The mean VAS score for L3-L4 was 7.500 ± 0.548, for L4-L5 was 7.458 ± 0.743 and for L5-S1 was 7.500± 0.798. At 48 hours the mean VAS score for L3-L4 was 4.333 ± 0.516, for L4-L5 was 4.042 ± 1.220 and for L5-S1 was 3.583 ± 0.669. At 1 month the mean VAS score for L3- L4 was 2.833 ± 0.408, for L4-L5 was 2.600 ± 1.031 and for L5-S1 was 2.583 ± 0.793. At 3 months the mean VAS score for L3-L4 was 2.333 ± 0.516, for L4-L5 was 2.136 ± 0.668 and for L5-S1 was 2.250 ± 0.754. At 6 months the mean VAS score for L3-L4 was 2.167 ± 0.408, for L4-L5 was 2.068 ± 0.695 and for L5-S1 was 2.083 ± 0.900.  The overall mean VAS at presentation was 7.470 ± 0.728, at 48 hours it was 3.985 ± 1.116, at 1 month it was 2.619 ±0.941, at 3 months it was 2.177 ± 0.666 and at 6 months it was 2.081 ± 0.708. the mean ODI score for L3-L4 was 65.000 ± 2.098, for L4-L5 was 61.500 ± 5.589 and for L5-S1 was 62.000 ± 3.908. At 48 hours the mean ODI score for L3-L4 was 54.667 ± 4.676, for L4-L5 was 50.250 ± 8.451 and for L5-S1 was 51.000 ± 4.221. At 1 month the mean ODI score for L3-L4 was 42.333 ± 4.633, for L4-L5 was 34.222 ± 9.883 and for L5-S1 was 34.833 ± 5.937. At 3 months the mean ODI score for L3-L4 was 38.667 ± 4.320, for L4-L5 was 29.500 ± 6.642 and for L5-S1 was 31.667±5.646. At 6 months the mean ODI score for L3-L4 was 36.667 ± 4.320, for L4-L5 was 27.000 ± 6.198 and for L5-S1 was 29.667 ± 6.706. Conclusion: The results of our study indicate that transforaminal steroid injections are effective in reducing pain and improving functional outcomes in patients with prolapsed intervertebral discs. The significant decrease in VAS and ODI scores over six months post-injection demonstrates the procedure’s efficacy. These findings are in line with other studies, which have consistently shown the benefits of this minimally invasive treatment option.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the effect of intrathecal fentanyl as an adjuvant to 1% 2-chloroprocaine (2-CP) in parturient undergoing elective lower segment caesarean section (LSCS). Methods: This retrospective study was in the Department of Anesthesiology, IGIMS, Patna, Bihar, India for 6 months. One hundred parturient (50 in each group) with term pregnancy (≥36 weeks), belonging to the American Society of Anesthesiologists (ASA) physical status II, aged between 18 and 35 years, scheduled to undergo low-risk elective caesarean section under SAB were enrolled in the study. Results: The parturient in both groups were similar with respect to demographic data and duration of surgery. The difference in HR, BP and SpO2 was not statistically significant in both the groups throughout the perioperative period. The time to achieve block height of T10 (onset of sensory block), time to achieve block height of T6, maximum dermatomal cephalad spread, the onset of motor block and the duration of motor block were comparable in both the groups. The mean duration of sensory block was prolonged in group CF in comparison to group CS, with the difference being statistically significant (101.1 ± 14.61 versus 72.13 ± 10.33 min, P < 0.0001). The mean duration of analgesia was prolonged in group CF compared to group CS, with the difference being statistically significant (115.20 ± 25.54 min versus 79.59 ± 10.74 min, P < 0.0001). The adverse effects namely hypotension, bradycardia, nausea, vomiting, pruritus, shivering, sedation and respiratory depression were comparable in both the groups. Conclusion: Our study concluded that intrathecal preservative-free 1% 2-chloroprocaine (30 mg) with fentanyl (25 μg) as an adjuvant results in a prolonged duration of sensory blockade and postoperative analgesia, with similar duration of motor blockade and incidence of complications when compared to preservative-free 1% 2-chloroprocaine (30 mg) without an adjuvant, in patients undergoing elective lower segment caesarean section.

DOI: 10.5281/zenodo.

Aim: To assess the functional result of clavicle fractures treated with open reduction and internal fixation utilizing plate and screws. Method and Materials: This study was conducted in the department of Orthopaedics, NMCH, Patna, Bihar, India. The total number of cases included in the study was 60. Patients with age more than 18 years and less than 65 years and Fracture displacement more than 2 cm were included in this study. A detailed clinical history and evaluation including routine blood investigations and proper radiographic evidence with X – Ray of chest with bilateral shoulder AP view and 45-degree-cephalic tilt view of the involved side was done. Allman classification was used to classify clavicle fractures. Allman Classification-Group I- middle 1/3, Group II – lateral 1/3 (acromial) and Group III – medial 1/3 (sternal). Result: A prospective review of experience with clavicle fracture fixation was performed. 60 clavicle fracture fixations using locking compression plate (LCP) and recon plate were performed for patients with fresh fractures over a period of 18 months. The patients (40 men and 20 women) ranged in age from 18 to 60 years (mean age of 39). 34 patients were reported to have right clavicle fracture while the remaining 26 cases were of left clavicle fracture. The most common mode of traumas recorded in our study were road traffic accident (28 cases), fall from height (24 cases), followed by fall from standing height (7 cases). Sports injury was reported as the cause of trauma in one patient. All patients satisfying surgical intervention indications underwent open reduction and internal fixation (ORIF) procedure. After evaluation of the type/site of injury it was determined that 15 patients had displaced medial-third clavicle fractures providing enough indication for intervention. Fixation using recon plate was approved for 12 patients while the remaining 3 patients of this group were cleared for fixation using locking compression plate (LCP). Conclusion: Internal fixation of these fractures contributes to preservation and restoration of the anatomy while providing stability through implant fixation like locking compression plate (LCP) and recon plate. Plates and screws are favored because of the increased stability they provided and incidence of vascular trauma during surgery is very rare due to minimal contact between the plate and cortical bone. Surgical intervention also helps in speedy recovery with early pain resolution, early union, good ROM, decreased incidence of complications and satisfactory cosmetic results. We observed a reduced rate of complications in our patients (13%). Minor complications were identified and treated during follow-up resulting in complete recovery.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess healthcare workers’ needle-stick injury (NSI) knowledge, attitudes and practices. Methods: We carried out our study among male and female HCWs in Department of Microbiology, Madhubani Medical College and Hospital, Madhubani, Bihar, India. Infection control practices are routinely followed and taught in this hospital. All healthcare workers exposed to needle-stick injury risk with varying experience were included. Results: A total of 260 healthcare workers: 100 doctors, 80 nurses, 30 technical staff and 50 attendants responded. Males and females were equally distributed. Most respondents were aged between 20-40 years, worked in the ICUs and were either graduates or postgraduates. Most respondents had a good work experience in their respective fields. Almost most of them had experienced an NSI and more doctors had been exposed to blood or body fluids. Regarding attitude related questions, appropriate responses varied amongst professional groups. More technical staff followed the NSI prevention precautions. Conclusion: The most effective way to protect workers from infectious diseases transmitted by NSI is a comprehensive prevention program; including employee training, following recommended infection control practice guidelines, effective disposal systems, surveillance programs, improved equipment design and encouraging accident reporting. We should have a staff health service facility in place, which maintains records, registers NSI incidence and has protocols for managing and following-up NSI cases. This is most important in all large healthcare facilities with a high patient-turnover and NSI rates. Our study revealed important information regarding HCW knowledge, attitude and practice concerning NSI.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to correlate duration of disease with attention, executive function and visual reaction time in type 2 diabetes patients and to correlate HbA1c with attention, executive function and visual reaction time in type 2 diabetes patients. Methods: This was a retrospective study done on 100 type 2 diabetes mellitus subjects of either sex under the age group of 40-60 years in the Department of Physiology, Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India. The subjects who are able to understand English were enrolled for the study. Written informed consent was taken and each subject was explained about the whole procedure and objective of the study. Results: The mean age and BMI of the patients were 58.06±4.48 and 24.56+1.94 respectively. There were 55 male and 45 females in the present study. Duration of disease was positively correlated (r=0.34) with score of Digit Vigilance Test and p value statistically significant (0.016). A positive correlation (r=0.24) was also seen with Visual Reaction time and p value statistically significant (0.046). Stroop test score also shows a positive correlation (r=0.16) but without any statistical significance. HbA1c was positively correlated(r=0.56) with the score of Digit Vigilance Test and p value statistically significant (0.01). A positive correlation (r=0.36) was also seen with Visual Reaction time and p value statistically significant (0.01). Stroop test score also shows a positive correlation (r=0.16) but without any statistical significance. Conclusion: With increase in duration of the disease and poor glycemic control, sustained attention and executive functions are declining. Also there is an increase in visual reaction time. Diabetes is a disease which requires proper self-care and monitoring. The decline in cognitive functions can affect their activities like glucose monitoring, medications or insulin injection patterns, diet and exercise timing.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the functional outcome of intertrochanteric fractures femur managed by trochanteric fixation nail (TFN) in the elderly population. Methods: A retrospective study of intertrochanteric fracture femur that was managed with TFN was conducted in the Department of Orthopedics Madhubani Medical College and Hospital, Madhubani, Bihar, India for one year. The study includes 50 patients. Results: Majority of the patients belonged to 31-40 years of age and there were male predominance. The mechanism of injury in 19 patients was due to fall and 31 patients had road traffic accident. Majority of the factures were A2.1 followed A1.3. 50% had excellent outcome, 40% had good outcome. Conclusion: The present study concluded that TFN is a good choice in managing the intertrochanteric fractures provided proper patient selection, surgical method and proper instruments are used, and having higher bone union rate and less union time. The period of immobilization is decreased, early weight bearing and less complications makes TFN more preferable for intertrochanteric fracture fixation.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to role of locking humerus plating for early mobilization of fractures of proximal humerus in adult at tertiary care center. Methods: The Present study was single-center, prospective, observational and descriptive study, conducted in Department of Orthopaedic, ESICMCH, Bihta, Bihar, India. Study duration was of 2 years. In present study, 80 cases satisfying study criteria were studied. Results: Majority were males (70%), > 60 years age (52.5%), mode of injury due to RTA (72.5%), injury on right side (60%) and had co-morbidities such as hypertension (32.5%), diabetes mellitus (20%), coronary artery disease (15%). Majority were 2 part fracture (47.5%) as compared to part 3 (30%) and part 4 (22.5%). The Neer’s scoring system of the severity of pain, function, range of movement, anatomy, was done to determine the end results. In present study excellent, satisfactory and unsatisfactory results were noted in 25%, 60% and 15% patients. Complications noted were Plate impingement (7.5%), Varus malunion (6.25%) and Stiffness (6.25%). Conclusion: Locking compression plate for management of fractures of proximal humerus is beneficial mainly due to stable fixation, angular stability and early functional aftercare is possible. It helps patients for early mobilization, to regain good shoulder function and resume normal activities much earlier.

DOI: 10.5281/zenodo.

Aim: To compare between the expenses and benefits of procalcitonin testing in the diagnosis of early onset neonatal sepsis. Material and Methods: This research was conducted at the Department of Paediatrics at NMCH in Jamuhar, Sasaram, Bihar, India for 12 months.100 neonates who were born at or after 37 weeks of gestational age and were hospitalized to the Neonatal Intensive Care Unit (NICU) within 72 hours of delivery due to clinical symptoms or indications of sepsis, as well as those with risk factors for Early-Onset Neonatal Sepsis (EONS). All patients involved in the research had a comprehensive blood test, including a complete blood count with differential (CBC), CRP, blood culture, and procalcitonin, upon admission to the NICU. These tests were repeated after 8 hours, except for CRP which was repeated after 24 hours. Other cultures from other places, such as cerebrospinal fluid (CSF), were obtained, and appropriate chest x-rays and imaging studies were performed. Results: The primary manifestation seen in this research was hypothermia, which occurred in 63% of cases. Hypoactivity and mottling were also common, reported in 54% of cases, followed by food intolerance in 43% of cases. 37 individuals had positive blood cultures, indicating that they had proved sepsis. Klebsiella was detected in 14 patients, E. coli in 10 patients, and group B streptococcus in 8 individuals. Three individuals were found to have Pseudomonas infection, while two patients tested positive for MRSA (methicillin resistant staphylococcus aureus). Out of the total number of patients, 42% had a non-reactive first CRP (CRP1). In the sepsis group, 42% had a non-reactive initial procalcitonin (PCT1), with 32% having a PCT1 value of less than 2.6, 20% having a value between 2.6 and 10, and 6% having a value higher than 10. The sensitivity of the test is 93.5%, meaning it correctly identifies 93.5% of the true positive cases. The specificity is 54%, indicating that it correctly identifies 54% of the true negative cases. The positive predictive value (PPV) is 66.3%, which means that 66.3% of the positive test results are true positives. The negative predictive PCT2: The sensitivity of the test is 96.8%, meaning it correctly identifies 96.8% of positive cases. The specificity is 88.7%, indicating that it correctly identifies 88.7% of negative cases. The positive predictive value (PPV) is 91.1%, Conclusion: The cost of doing PCT testing twice is lower than the cost of a single day’s hospitalization in the Neonatal Intensive Care Unit (NICU) in impoverished nations. Implementing such a policy might be beneficial in reducing the duration of hospitalization in the Neonatal Intensive Care Unit.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the awareness and knowledge about cervical cancer, Pap smear testing and its use and HPV among women living in urban women in Bihar region. Methods: A questionnaire-based survey, using face-to-face interviews, was carried out at Department of obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar, India for one year. Women aged 16 years and above were approached in different public sites thus increasing the chance of covering women from different social groups. A total of 1000 women agreed to voluntarily participate in the study. The women were interviewed by two trained researchers who had extensive knowledge of cervical cancer, screening and HPV. Results: Of the interviewed women, 51% reported never being married, 63% had a university level of education and 52% were employed. The majority of the women were of low income (70%). Of the 1000 participating women, 92% had heard of cervical cancer. Among these women, 64% felt moderately/extremely concerned about cervical cancer. Only 20% of women reported knowing the causes of cervical cancer. The most frequently cited causes of cervical cancer were abortion and sexually transmitted infection (including HPV) respectively in 30% and 28%. The less frequently cited causes of cervical cancer were early pregnancy and high parity (2%).When asked about the possibility of developing cervical cancer one day, 40% of women believed they had no risk. Participating women acquired information about cervical cancer mostly from either foreign media or medical workers was 28% and 27% respectively. Conclusion: Our study highlights the lack of knowledge about cervical cancer in women. There is a real necessity to inform women about cervical cancer screening. Education campaigns involving the local media may be a good approach to inform women.

DOI: 10.5281/zenodo.

Aim: The aim of the present study to explore the possible diabetogenic effect of statins, the mechanism of this effect, and various comorbidities associated with this causation. Material & Methods:  It was a retrospective observational study carried out in the Department of Pharmacology, Anugrah Narayan Magadh Medical College and Hospital Gaya, Bihar, India from May 2019 to April 2021. Written informed consent was obtained from all the participants before their inclusion in the study. A total of 140 patients were recruited and 100 completed the entire study. Study was conducted according to the Declaration of Helsinki. Results: Male patients were nearly twice higher than females (65/35%). Majority of the patients were in between the age group of 60-65 years. Hyperlipidaemia (94%) was the main aetiology for prescribing statins followed by ischemic heart disease (55%). Nearly 72% of patients had hypertension as a concomitant disease. A total of 72% patients received ACEIs/ARBs as concomitant drugs followed by low dose aspirin (65%). Different strengths of HMG-COA inhibitors were prescribed, out of which Atorvastatin 40 mg was most frequency prescribed statin followed by atorvastatin 20 mg. Statin treatment on insulin resistance was interpreted by using homeostatic model assessment and quantitative insulin sensitivity check index (HOMA) value of greater than 2.27 was considered as insulin resistance. All patients who developed NODM had >2.27 which could be indicate that statin users developed insulin resistance is might be a probable mechanism. QUICKI score of<0.357 was considered as severe insulin resistance; again, all patients who developed NODM had severe insulin resistance in the present study. A total of 55 (55%) study participants developed mild to moderate drug related adverse effects (ADRs). Statin‑induced myalgia (54.54%) was the most common ADR, followed by headache (36.36%), GI complaints (25.45%). ADRs associated with statin treatment were classified according to the WHO‑UMC causality assessment scale. Conclusion: Statins have a mild-to-moderate risk of developing NODM. The dose of statins is an important factor that increases the risk of diabetes in statin users.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to identify various factors contributing to failure of medical management in patients with chronic rhinosinusitis. Methods: This was a Prospective observational study with sample size of 50 conducted in the Department of ENT, Nalanda medical college and Hospital, Patna, Bihar, India. Patients above the age of 15 years and below the age of 65years, with regular follow up and not on any steroids for last one month were included in to this study. Results: Diagnostic Nasal endoscopy revealed that DNS was the most common finding in both groups with highest incidence in group B, followed by Mucin and Middle turbinate hypertrophy. Among these, Deviated nasal septum and Mucin were high in non-responders comparatively and is significant statistically. Non Contrast Computed tomography of nose and paranasal sinuses showed statistically significant result (p<0.05).In our study, Fungus was seen more in group B but was statistically insignificant. Immunocompromised status was more in group B which was statistically significant (p <0.05). Conclusion: The study emphasized that presence of Deviated nasal septum, Mucin, Aspergillus niger and compromissed immune status contributed for failure of medical management in chronic rhinosinusitis.

DOI: 10.5281/zenodo.

Aim: to investigate the prevalence of dental caries and the impact of dental education programs on school children’s knowledge and attitudes regarding dental caries and its management. Materials and Methods: The research employed an evaluative approach with a one-group pre- and post-test design to collect data. The prevalence of dental caries was assessed using the decayed, missing, filled teeth (DMFT)/decayed, missing, filled surface (DMFS) index based on the World Health Organization’s 1997 criteria. Following ethical clearance and informed consent, children underwent dental screenings using mouth mirrors, and WHO probe in classroom settings under natural light, with children seated on stools. Subsequently, a dental education program was administered. Results: The prevalence of dental caries among government and private school students was found to be 31 (77.5%). The mean DMFT score was 2.47 with a standard deviation of 2.184, while the mean DMFS score was 5.38 with a standard deviation of 6.436. A majority of 31 (77.5%) school children exhibited dental caries, while 9 (22.5%) had no tooth decay. Prior to the educational intervention, all school children (100%) had insufficient knowledge about dental caries. Following the program, 10% of students showed adequate knowledge. Similarly, all children initially had an unfavourable attitude toward dental caries, with 45% showing moderately favourable attitudes post-intervention. Conclusion: The difference in knowledge and attitudes between pre- and post-intervention scores was statistically significant among the school-aged children. These findings suggest the potential for organizing school-based dental programs aimed at promoting routine oral hygiene practices and regular dental check-ups for children and their parents, thereby fostering healthier lifestyles.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the Functional outcome of Intramedullary Interlocking Nail and Minimally Invasive Plate Osteosynthesis. Methods: The present study was conducted in the Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India for one year  and 50 patients with confirmed Extra articular distal tibial fractures were included in the study. Results: The age of the patients ranged from 19 to 74 years with a mean of 42.3 years and standard deviation (SD) of 15.4 years. Majority of the patients belonged to 36-45 years of age and 60% were male. 48% had transverse fracture followed by 44% oblique. 58% underwent nailing and 42% underwent 42%. 48% had transverse fracture followed by 44% oblique. 58% underwent nailing and 42% underwent 42%. The average time for full weight bearing was 10.09 ± 1.41 weeks which was statistically significant (P < 0.0001). The average time of union was 18.26 ± 2.49 weeks (range 15–24 weeks) which comes out to be very significant (P < 0.0001). Conclusion: Both ILN and MIPO are reliable methods of fixation and are helpful in maintaining most of the osseous vascularity, fracture hematoma which are most useful in providing biological repair. Both are less invasive and in both soft tissue dissection is less.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the preoperative risk factors, type of cataract surgery, cataract grade, and final visual outcome in patients undergoing descemetopexy for descemet membrane detachment (DMD). Methods: This was a retrospective interventional study conducted on cases with DMD following cataract surgery who presented to Netaji Subhas medical college and Hospital, Bihta, Patna, Bihar, India during the period of 1 year. Out of the approximately 19000 MSICS and 1000 phacoemulsification surgeries that were performed during the study period, a total of 20 eyes (0.10%) underwent descemetopexy for Descemet detachment repair. Results: The mean age of the patients was 61.19±6.4 years. 16 cases (80%) were after manual small incision cataract surgery (MSICS) and 4 (20%) were post phacoemulsification. 13% (n=3) cases had pre-existing corneal opacity and 26% (n=6) cases had climatic droplet keratopathy. The number of clock hours of DMD ranged from 3 to 12 hours with a mean of 6.9 hours. The most common site of DMD was total (35%), temporal (30%) followed by superior (25%). 65% (n= 13) that underwent descemetopexy were recorded to have a cataract of grade 4 or higher (LOCS III) at the time of cataract surgery. Conclusion: This study highlighted the importance of identifying important preoperative risk factors like cataract grading and pre-existing corneal pathology that increase the chance of DMD during cataract surgery. Moreover, early postoperative intervention with either air or SF 6 can help achieve good final anatomic and visual acuity outcomes in patients developing this complication.

DOI: 10.5281/zenodo.

Aim: A retrospective analysis of maternal mortality at a tertiary care facility. Material and Methods: This investigation was conducted at Department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya,Bihar, India  as a retrospective analysis. Duration of study 07 months.  Data pertaining to demographics and other relevant information was gathered from individual case records, and the maternal death review process was included. The research eliminated deaths resulting from suicide and murder from the definition of maternal death. A comprehensive analysis was conducted on a total of 120 cases of maternal mortality. Detailed history regarding demographic characters, previous antenatal care along with type of delay noted. Causes of death, Level of ANC care, and referral hospital and referral time noted along with duration of care received at this hospital and time of death. Results: Hemorrhage was identified as the leading cause of maternal death, responsible for 33.33% of the cases. Sepsis followed, accounting for 25.0%, while eclampsia was the cause in 16.67% of the cases. Obstructed labor caused 12.5% of the deaths, complications from abortion accounted for 8.33%, and other causes were responsible for 4.17%. In terms of antenatal care (ANC) and referral details, 16.67% of the women had received no ANC, while 41.67% had inadequate ANC. Another 41.66% had received adequate ANC. A majority of the women (58.33%) were referred to the tertiary care center, while 41.67% were not referred. Among those referred, 35.71% experienced a referral time of 3-6 hours, 28.57% had a referral time of 1-3 hours, 21.43% experienced a delay of more than 6 hours, and 14.29% had a referral time of less than 1 hour. Regarding the duration of care received at the tertiary care center, 29.17% of the women received care for 12-24 hours, and 25.0% were under care for more than 24 hours. Care duration of 6-12 hours was noted in 20.83% of the cases, 1-6 hours in 16.67%, and less than 1 hour in 8.33% of the cases. Conclusion: Currently, the majority of maternal fatalities occur among women residing in rural regions, with lower levels of education, who have not made prior arrangements for medical treatment and come from poor socioeconomic backgrounds. These women sometimes have to undertake extensive trips to access specialized medical facilities. Furthermore, there is a lack of recognition of indicators of potential complications throughout pregnancy. It is important to identify situations that have a high risk.

DOI: 10.5281/zenodo.

Aim: To examine the maternal and perinatal outcomes in women experiencing vaginal bleeding during the first trimester of pregnancy. Materials and Methods: The present study is a retrospective study which was conducted in Department of obstetrics and Gynecology, JLNMCH, Bhagalpur, Bihar, India   for 9 months. 50 pregnant women with vaginal bleeding in the first trimester of pregnancy were admitted in. All patients whose pregnancy was confirmed were studied chemically. Exclusion criteria was women with diabetes and hypertension with an infertility history or missed obstetrical history. Sonography in 8-10 weeks was conducted on all patients. Follow up of all patients was taken every two weeks in the first 6 months of pregnancy, weekly in 7th and 8th months and twice per week in last month of pregnancy. Results: The highest percentage of patients (56%) were in the age group of 26-35 years. Bleeding volume in pregnancy was highest (80%) in moderate section. 64% had 0% parity. 36% had history of bleeding in previous pregnancies and 16% of patients had abortion history. Premature labor was found to be highest complication during first trimester vaginal bleeding which was 28%, other complications were premature membrane rupture (8%), placental abruption (14%), intrauterine death (2%), intrauterine growth retardation (4%) and there were no complication in 14%. Out of 50 pregnant women, 34 ended pregnancy successfully. 10% developed diabetes during pregnancy and 25% developed hypertension. The duration of pregnancy in 21% of pregnant women with first trimester vaginal bleeding was between 40-38 weeks 35% of pregnant women was between 38-20 weeks. 7 women had abortion. 40 newborns were evaluated. 6% of newborn had weight of more than 3500 gms, 67% had weight between 2500- 3500 gms and 27% had a weight of <2500 gms. Conclusion: The present study concluded that predicting factors of mother and infant consequences of pregnancy might be first trimester vaginal bleeding and pivotal role is played by physician precise planning and management in continuation of pregnancy and in reducing fetal complications.

DOI: 10.5281/zenodo.

Guillain-Barre Syndrome (GBS) is a temporary autoimmune disorder affecting the peripheral nervous system. Typically, it is instigated by viral or bacterial infections or other factors. This condition manifests as sensory alterations or pain, primarily in the back, and entails muscle weakness that originates in the hands and feet before progressing to the upper body.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyse the different patterns of diabetic macular edema in OCT and to observe the visual outcome of intravitreal anti-VEGF injection. Methods: A Retrospective study was done in the Department of Ophthalmology, Department of Ophthalmology, SKMCH, Muzaffarpur, Bihar, India. A total of 50 patients were included in the study. Results: 72% were males and 28% were females. 3% were in the age group of 30-40 years, 24% were in 41- 50 years of age, 38% were 51-60 years of age, 25% 61-70, 10% were >70years of age. 32% had <5 years of diabetes, 64% had 5-10 years, 4% had >10 years of diabetes mellitus. There was a significant reduction in macular edema and improvement in visual acuity between pre and post-injection in Cystoid macular edema and diffuse retinal thickness. Conclusion: OCT is an essential tool for the quantitative assessment of macular edema. Chronic hyperglycemia is the major cause of diabetic macular edema. Hence the early diagnosis of diabetic macular edema using OCT plays a vital role in preventing permanent vision loss in diabetes patients. CME and DRT have a good visual prognosis for anti-VEGF injections than Posterior hyaloid traction and subretinal detachment. Oct plays a vital role in deciding the treatment modality, explaining prognosis to patients and for predicting the visual outcome.

DOI: 10.5281/zenodo.

Aim: The aim of the study was to assess the outcome of concomitant fixation of the ipsilateral femoral neck and shaft fracture using single versus dual implant osteosynthesis. Methods: The retrospective study was conducted in the Department of Orthopedics, ESIC Medical college and Hospital, Bihta, Patna, Bihar from May 2021 to Feb 2024. Out of 837 cases of femur fracture, 25 cases of concomitant ipsilateral femoral neck and shaft fractures were identified and included in the study. Results: The mean age was 36.9 ± 10.3 years, with males representing most of the cases (84%). The mechanism of injury was fall from height in 21 cases (84%), while 4 cases (16%) had fractures secondary to road traffic accident. All cases were operated on within an average of 5.6 ± 6.3 days after injury. Femoral neck fractures were basicervical in 12 cases (48%) and transcervical in 13 cases (52%). Displacement was found in 9 cases of neck fractures (36%), while the remaining 16 (64%) were either Garden’s grade I or II. The mean Pauwels’s angle was 61.7 ± 12.5 degrees. Regarding the shaft fractures, they were located in mid-shaft in the majority of the cases (72%). The average neck- shaft angle was 126.9 ± 4.7 degrees. Upon comparing the patients who were managed with single (N = 16) versus dual (N = 9) implants, none of our prognostic factors showed significant difference. Conclusion: Ipsilateral femoral neck and shaft fractures are uncommon high-energy trauma that required a high level of suspicion and planned early management. Early surgical fixation of both fractures was associated with good outcome results. Single versus dual implant fixation were not found to significantly affect the radiological outcomes or complications.

DOI: 10.5281/zenodo.

Aim: A clinical investigation on non-venereal genital dermatoses in adult male. Material and Methods: This study was conducted Department of Dermatology, GMCH, Purnia, Bihar, India for 18 months. A series of 200 male patients over the age of 18 years with non-venereal dermatoses of external genitalia were screened among the patients. Patients having any venereal disease were excluded from the study. After informed consent from the patient, detailed history regarding age, education, marital status, sexual practices, circumcision, trauma, drug intake, application of topical creams, recurrence, initial site of affection, duration and progression of the disease, associated medical and skin disorders was taken. Preliminary general and systemic examination was done. Results: The overall prevalence of non-venereal genital dermatoses during the study period was found to be 30.8 per 10,000 male patients attending the department of dermatology. The age of the patients ranged from 18 to 78 years with the mean age of 48years. Majority were in the age group of 21-30 years (60%) followed by 31-40 years (54%). Infections and infestations group formed the majority (37.5%) followed by inflammatory disorders (30%), Benign variants (16%), Miscellaneous conditions, Malignancies (1.5%). The most common disorder was scabies which accounted for 38% followed by candidiasis and vitiligo 12% each, pearly penile papules (10.5%). The patients were grouped into four categories based on the site of involvement of the lesions Table 3. Exclusive involvement of the genitalia was significantly higher (52.5%) than genitalia being involved as a part of generalised eruption (47.5%). Conclusion: Knowledge about the prevalence, clinical and etiological characteristics of various non-venereal genital dermatoses is helpful in arriving at a diagnosis and also creating awareness among patients to improve their personal hygiene and social habits.

DOI: 10.5281/zenodo.

Aim: To examine the food habits and physical activity patterns of teenagers attending schools in the Bihar area. Materials and Methods: This study was conducted in the department of Community Medicine, JNKTMCH, Madhepura, Bihar, India from February 2021 to January 2022. A questionnaire based retrospective study. A total of 1600 participants between 10-19 years of age whose parents gave informed consent were included in the study. Participants on any long-term medication and those who were absent on the day of visit were excluded from the study. Results: The nutritional status of male participants revealed 71% were thin, 3.9% were overweight/obese. Among female participants, 64.5% were thin and only 2.6% were overweight/obese. This difference between male and female participants was statistically significant (p<0.001). A 75.9% of participants belonged to early adolescent age were thin while 50% of participants from late adolescent age were thin which was also statistically significant (p<0.0001). The habit of taking milk, milk products and fruits were low among the males and early adolescent age group. In Chi-square test was applied to find whether there was any significant difference in the eating habits between the age group and gender of adolescents. Except for the eating habit of consuming three main meals of cereal or intake of milk or milk products rest other food habits were found to be significant between the age group. There is no significant difference associated with faulty dietary habits of skipping meals/eating junk food/buying eatables from street shop between male and female participants. Conclusion: The dietary gap was more pronounced in female participants and participants in the early adolescent age group. The gap in the diet of adolescents influences their nutritional status and BMI. The poor choice of dietary habits significantly affects the physical development among school-going adolescents.

DOI: 10.5281/zenodo.

Background: OCD is characterized by disruptions in brain circuits impacting cognitive and metacognitive functions. The neuroanatomical hypothesis suggests that irregular activity in fronto-striatal networks contributes to OCD symptoms. Methodology: This cross-sectional comparative study enrolled 30 OCD patients and 30 matched controls. Participants were evaluated using the Y-BOCS scale and P300 auditory event-related potentials. Ethical considerations and statistical analyses were addressed meticulously. Results: Significant differences emerged between case and control groups in family history of OCD (36.7% vs 10%, p = 0.015). OCD patients exhibited shorter mean P300 latencies compared to controls (248.743 vs 295.399, p=0.011). Moreover, correlations were observed between P300 latencies and illness duration and YBOCS scores. Discussion: Demographic characteristics in the case group aligned with previous studies, indicating a diverse representation. Notably, the study found a higher prevalence of OCD patients from rural backgrounds, possibly indicating increased psychiatric awareness. The severity of OCD symptoms correlated with P300 latencies, implying cognitive alterations in patients. Familial OCD history also demonstrated an impact on cognitive processing. Conclusion: OCD patients exhibit cognitive processing differences reflected in shorter P300 latencies. P300 latency variations relate to illness duration and severity. Emphasizes investigating cognitive markers for understanding OCD and potential clinical implications.

DOI: 10.5281/zenodo.

Aim: To investigate the clinical characteristics of chronic adenoiditis in children aged 0-12 years. Material and Methods: This study was conducted in the department of ENT, Shri krishna medical college and Hospital, Muzaffarpur, Bihar, India. A total of fifty cases were studied, who attended ENT Department, who was diagnosed to have bilateral SOM confirmed by otoscopy, PTA, impedance audiometry, and adenoid hypertrophy confirmed by X-ray Nasopharynx and diagnostic nasal endoscopy (DNE). During the study period, all the individuals with bilateral SOM confirmed by otoscopy, those who satisfied the study protocol were considered. Patients aged 0 – 12 years, chronic cases of bilateral SOM with adenoid hypertrophy were included in the study. Results: In this report, a total of 50 SOM cases with adenoid hypertrophy was studied. The incidence of secretory OM was highest (60%) in the 0-7 years age group (Table 1). The average age of secretory OM was 7.5 years of age. Gender-wise, 28 (56%) were males and 22 (44%) females; the male-female ratio was 1.2. All patients (100%) in this study were presented with nasal obstruction/snoring. This is followed by nasal discharge (80%; 40), hard of hearing (66%; 33), sore throat (36%; 18), and fullness of ear (24%; 12) (Table 2). When associated morbidity was considered, 36% (18) members had associated tonsillitis and 18% (9) were features of sinusitis. Otoscopic findings of the tympanic membrane ™ showed the dull, lustreless, amber color was the most common (78%; 39) common finding followed by retraction (50%; 25) and air bubbles (10%; 5) Impedance audiometry findings showed that all patients had B type curve in either of the ears and stapedial reflex was absent in all the cases. Ear examination revealed that 14% (7) were classified as peak and 86% (43) as no peak category (Table 4). In the treatment modality, adenoidectomy alone was conducted in 32 (64%) cases and Adenoidectomy (Ad) cum tonsillectomy (T) in 18 (36%) cases. Conclusion: SOM is one of the common causes of hearing loss in children. The chronicity of SOM may be due to under-treatment or conditions like adenoid hypertrophy, recurrent URTI, sinusitis causing relative dysfunction of ET. In cases where spontaneous resolution does not occur or when medical treatment fails and effusion persists, surgical treatment is usually advocated.

DOI: 10.5281/zenodo.

Aim: To investigate bacteraemia, sepsis  and their correlation with haematological abnormalities in renal failure patients on haemodialysis. Material & Method: The study was conducted in the Department of Medicine at GMC, Azamgarh, Uttar Pradesh, India. A total of 100 haemodialysis patients of both sexes, diagnosed with renal failure (including acute kidney injury (AKI) and chronic kidney disease (CKD)), were included. Detailed histories and examinations were conducted, followed by evaluations of complete blood count, serum electrolytes, kidney function, blood culture, urine culture, catheter tip/port culture, to assess sepsis. Setting and Design-This study is a hospital based cross-sectional observational study conducted in Department of Medicine at GMC, Azamgarh, Uttar Pradesh, India. All haemodialysis patients of diagnosed with renal failure (including acute kidney injury (AKI) and chronic kidney disease (CKD)), were included. Results: In our study among 100 patients of renal failure on haemodialysis the mean age in our study was 44.76±14.46 years with 65 male patients. Out of 100 patients 20 (20%) had positive blood and catheter tip culture and 80 (80%) of patients had negative blood and catheter tip culture. Out of 20 patients with sepsis 4 (20%) were in the age group between 15–25 years, 4 (20%) were in the age group between 26–35 years, 3 (15%) were in the age group 36–45 years and 9 (45%) were above 45 years of age. All 20 (100%) patients had episode of fever with chills and rigor, 9 (45%) patients had redness and pain at haemodialysis catheter site, 6 patients (30%) were confused, disoriented or comatose and 4(20%) patients had hypotension. Among 20 patients of renal failure with sepsis, none had TLC less than 4.8/cumm (leucopenia), 5 (25%) patients had count between 4.8–10.8/cumm and 15 (75%) patients had TLC more than 10.8/cumm. Conclusion: Patients requiring haemodialysis, who are having non modifiable risk factors like age, sex other risk factors for infection should be controlled to reduce incidence of infection.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the knowledge, attitude, and practice (KAP) of pharmacovigilance among medical students. Methods: The present study was conducted at Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. It was questionnaire-based cross-sectional study aimed at assessing the KAP toward ADR reporting. In this study, a total of 220 students were assessed regarding their knowledge about pharmacovigilance, of which 100 were 2nd year students, 70 were pre-final year students, and 50 were interns. Results: The pre-final students seemed to know the actual definition of an adverse drug reaction than the other two groups. Out of 220 students, 81 2nd year students, 60 pre-final year students, and 27 interns were aware of who can report ADRs. Among all the participants 60.52% of the respondents (47 second year students, 62 pre-final year students and 29 interns) knew about the existence of pharmacovigilance programme of India. The overall attitude of the undergraduate students toward pharmacovigilance and ADR reporting 185 participants totally agreed that ADR reporting is necessary. However, 93 2nd year students, 62 pre- final year students, and 46 participants supported that reporting of ADRs to be a professional obligation. About one-third of the total responders said that they had witnessed an ADR in their clinical postings but only 150 out of 220 had seen an ADR form, and 66 pre-final year students had filled ADR form, whereas only 12 2nd year students and 18 interns had filled an ADR form. Conclusion: The present study concluded that the overall knowledge and attitude are definitely better among the undergraduate students. The practice of pharmacovigilance and ADR reporting has to improve, and it can be done so by including pharmacovigilance throughout the entire course of medical curriculum and incorporating better, efficient and interesting methods to teach, sensitize, and practice pharmacovigilance.

DOI: 10.5281/zenodo.

Aim: To determine the impact of intravascular contrast agent on apparent diffusion coefficient measurements of ovarian neoplasms using diffusion-weighted imaging. Materials and Methods: A Retrospective Study was conducted in the Department of Radiodiagnosis, Patna Medical College and Hospital, Patna, Bihar, India from January 2018 to December 2018. 36 patients selected based on universal sampling, with Study population being women with newly diagnosed ovarian tumors who underwent CEMRI study to evaluate the nature of tumor and extent. Women referred from gynaec OPD for evaluation of ovarian neoplasms and with normal RFT were included in this study. Patients with Failed to follow up in our institute with HPE reports and Pregnant women were excluded from the study. Results: In benign ovarian tumors, Pre contrast mean ADC was 1.48± 0.46 and Post contrast mean ADC value was 1.40±0.62 with statistically insignificant P value. So it can be concluded that the contrast agent did not make much difference for measurement of ADC values in benign tumors. In malignant ovarian tumors, Pre contrast mean ADC was 0.91±0.20 and post contrast mean ADC value was 0.94±0.23 with statistically insignificant P value. So, it can be concluded that the contrast agent did not make much difference for measurement of ADC values in malignant tumors. ADC values of solid and cystic components in both benign and malignant tumors before and after administration of contrast, did not make statistically significant difference. Conclusion: ADC measures using our approach were not significantly changed after contrast administration for ovarian tumors at 1.5T. Our findings support the possibility that DWI optimized may be obtained before or after DCE-MRI without compromising important clinical information. Benign ovarian tumors had higher ADC values compared to malignant tumors, consistent with some of the previous studies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to study clinical spectrum of dengue patients admitted in a tertiary care hospital in Bihar. Methods: The present study was conducted in the Department of Medicine, Katihar Medical College and Hospital, Katihar, Bihar, India, undertook this one-year research. Our research included 100 dengue-diagnosed hospitalized patients (age >15 years). Results: Mean presentation age was 38.52 (18-65). The 30-40 age group had the most instances. The average presentation duration was 7 days (4-14). Patient is mostly poor. From 100 cases with antigenic presentation, 55% were NS1 positive, 30% were IgM positive, 10% were NS1 & IgM positive, 3% were IgM and IgG positive, indicating secondary infections, and 2 were all Dengue positive.

Conclusion: With dengue fever on the increase, it’s important to understand its symptomatology, platelet counts and bleeding, complications, and antigen antibody variance. This research does so.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess variables such as respiratory distress, hypoglycaemia, probable and proven sepsis and hyperbilirubinemia, in the first week of life, and the risk of these morbidities as the gestational age regresses compared to the full-term newborns. Methods: The present study was conducted in the Upgraded Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India from January 2012 to December 2012. Results: Out of 1470 newborns included, there were 1341 term infants (91.22%) and 129 late preterm (8.77%). Most of the term infants are adequate for gestational age, most of the late preterm are small for gestational age. Majority of the risk factors were preterm labour followed by PROM and hypertensive disorders. 16.2% of late preterms have respiratory distress compared to 1.26% of term infants which is statistically significant and they are 15 times more likely to develop respiratory distress compared to the term infants. 9.3% of late preterms have hypoglycemia compared to 1.26% in term infants which is statistically significant and they are 8 times more likely to develop hypoglycaemia compared to the term infants 14.7% of late preterms have probable sepsis compared to 1.71% in term infants which is statistically significant they are 10 times more likely to develop probable sepsis compared to the term infants 5.4% of late preterm had proven sepsis compared to 0.82% of term infants which is statistically significant, and they are 7 times more likely to develop sepsis compared to the term infants. 39.5% of late preterms have hyperbilirubinemia compared to the 12.3% in term infants which is statistically significant, and late preterm have 4 times more risk of developing hyperbilirubinemia than term infants. Conclusion: Late preterm infants are more likely to develop proven sepsis compared to the term infants. The risk increases with decreasing gestational age, with those born at 34 weeks having an eleven times greater risk than a term newborn. Considering significant morbidity in late preterm compared to the term infants they must be considered as preterm infants and need to be monitored carefully. Appropriate discharge criteria and discharge advice, follow up plan are required for late preterm infants.

DOI: 10.5281/zenodo.

Aim: To examine the efficacy of Antepartum Cardiotocography (CTG) in high risk pregnancies and its influence on fetal outcomes. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology, NMCH Patna, Bihar, India for 12 months. A total of 100  patients having gestational age ≥ 36 weeks were included in the study. Patients with high-risk pregnancy conditions such as pregnancy-induced hypertension (PIH), eclampsia, diabetes, intrauterine growth restriction (IUGR), thyroid disorder, heart disease, anemia, bad obstetric history (BOH), oligohydramnios, post-dated pregnancy, diminished fetal movements, and premature rupture of membranes lasting more than 6 hours were included. Results: The distribution of fetal heart conditions, as measured by cardiotocography (CTG), showed that 73% of the subjects had normal CTG results, whereas 27% had abnormal CTG results. This difference was statistically significant with a p-value of 0.002. The relationship between CTG results and the method of delivery, it was found that 42.5% of vaginal deliveries had normal CTG results, and 7.4% had abnormal results. In contrast, 57.5% of caesarean section deliveries had normal CTG results, while a significant 92.6% had abnormal CTG results, with a p-value of 0.001, indicating a significant association. The relationship between CTG results and birth weight indicated that among those with a birth weight less than 2.5 kg, 27.4% had normal CTG results, and 63% had abnormal results. For those with a birth weight over 2.5 kg, 72.6% had normal CTG results, while 37% had abnormal results, with a p-value of 0.01, showing a significant correlation. Lastly, the relationship between CTG results and the APGAR score at one minute showed that among those with an APGAR score of 7 or less, only 4.6% had normal CTG results, while 81.2% had abnormal results. Conclusion: The cardiotocograph may be effectively used as a reliable screening technique for fetal monitoring. If the cardiotocography (CTG) displays an aberrant pattern, it is recommended to supplement CTG with other test before any intervention.

DOI: 10.5281/zenodo.

Aim: A comprehensive investigation of non-fermenting gram negative bacilli at a tertiary care hospital, focusing on both clinical and microbiological aspects. Material and Methods: This study had a retrospective design and was conducted at Department of Microbiology, Darbhanga Medical College and Hospital, Laheriasarai , Darbhanga, Bihar, India from January 2021 to December 2021. A total of 4025 clinical samples including urine, pus, blood, wound swab and body fluids were received in the laboratory and inoculated on blood and MacConkey agar or CLED agar and incubated aerobically at 37°C for 18 to 24 hours. The isolates which were non-lactose fermenting and showed alkaline change (K/NC) reaction in triple sugar iron agar media were provisionally considered as NFGNB. Results: Acinetobacter baumannii was the predominant isolate, 211 (51.34%) followed by Pseudomonas aeruginosa 173 (42.09%) and Burkholderia cepacia complex (BCC) 18 (4.38%). Burkholderia pseudomallei, Acinetobacter lwoffii and Stenotrophomonas maltophilia altogether accounted for 2.19%. Among the NFGNB isolated from high-risk areas including intensive care units and dialysis units, A. baumannii (60.36%) was the most prevalent pathogen, followed by P. aeruginosa (28.40%). Chi-squared (χ2) value is 9.341 and p-value <0.05. In other clinical areas P. aeruginosa accounted for 51.65% followed by A. baumannii (45.04%). A. baumannii was more prevalent in high-risk areas (ICUs and Dialysis Units) in comparison to other clinical areas. Chi-squared (χ2) value is 9.341 and p-value < 0.05. Similarly, P. aeruginosa is more prevalent in other clinical areas, than in high-risk areas. Chi-squared (χ2) value is 22.069 and p-value < 0.05. Conclusion: To conclude, despite earlier being regarded as contaminants, NFGNB are now emerging as important pathogens causing a wide range of nosocomial infections. Identification of NFGNB and monitoring of their susceptibility profiles are essential due to their variable sensitivity patterns and to help in proper management of the infections caused by them.

DOI: 10.5281/zenodo.

Aim: Investigate the visual functions in patients with age-related cataract who have had phacoemulsification surgery, comparing the outcomes of multifocal and mono focal intraocular lenses. Materials and Methods: This study was conducted in the department of Ophthalmology, Patna medical college and hospital, Patna, Bihar, India for 6 months. 40 eyes of patients reporting to outpatient services of our tertiary eye care health institute, with decreased vision due to age related cataract for cataract surgery and intraocular lens implantation. Patients between 40-80 years reporting with cataract (less than grade 3), managed by phacoemulsification and willing for implantation of multifocal IOLs and having astigmatism less than 1.5D cylinder were included in the study. Post-operative exclusion criteria included persistent corneal oedema, excessive post operative inflammation and absent fundal glow. Detailed pre operative history regarding age, sex, type of cataract, history of trauma and any associated ocular or systemic diseases having effect on vision was recorded. Results: On post-operative day 1, the UCVA was found to be 6/12 in 6 patients (30%), 6/9 in 4 patients (20%), 6/18 in 4 patients (20%), 6/24 in 4 patients (20%) while 6/6 in 2 patients (10%) while in mono focal it was 6/9 in 8 patients (40%) and 6/12 in 7 patients (35%) while 6/18 in 3 patients (15%) and 6/6 in 2 patients (10%). At the last follow-up, there were 9 patients (45%) with 6/9 vision, 7 patients (35%) with 6/12, and 4 patients with 6/6 vision while in mono focal group 10 patients (50%) had 6/12 vision, 8 patients (40%) had 6/9 vision while only 2 patients (10%) had 6/6 vision (Table 1). However, both at first post-operative day and last follow-up the two group’s visual acuity was found to be statistically insignificant with p-value less than 0.05. Post-operatively at day 1, 5 patients (25%) had visual acuity of N10, also the same number had N18 visual acuity while 3 patients (15%) had N6 and N8 visual acuity, only 2 patients had N12 visual acuity while 1 patient (5%) had N24 and N36, but later at the last follow-up there were 7 patients (35%) with visual acuity N6, 7 patients (35%) with N8, 3 patients (15%) with N12, 2 patients (10%) with N10 and only 1 patient (5%) with N18 visual acuity, thus signifying an overall improvement in visual acuity with the course of time. Conclusion: Thus, our results demonstrate that a new generation, refractive-diffractive design, multifocal IOL decreases the spectacle dependence of patients without compromising the subjective visual functions.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the correlation of age and BMI with peak expiratory flow rate in children aged 10-15 years. Methods: The present study was conducted in the Department of Pediatrics, JLNMCH, Bhagalpur , Bihar, India for 12 months and 200 children were included in the study. Results: Around 54% of the children were Male and 46% of them were female. Majority of the children 24.5% were 13yrs, followed by 20.5% were 12yrs, 18.5% were 11yrs, 14.5% were 14yrs, 12.5% were 10yrs and only 9.5% were 15yrs. Majority of the children 75% had normal BMI, followed by 12% were underweight, 9.5% were overweight and only 3.5% were obese. Majority of the children 26% had PEFR 250-280, followed by 21% had PEFR 311-340, 17% had PEFR 281-310, 14% had PEFR 341-370, 14% had PEFR 200-249 and only 8% had PEFR 371-400. There was a positive correlation between PEFR and age with r value 0.423 and this correlation was statistically significant. PEFR and Female age had more positive correlation than Male age. There was a positive correlation between PEFR and weight with r value 0.652 and this correlation was statistically significant. PEFR and Female weight had more positive correlation than Male weight. There was a positive correlation between PEFR and Height with r value 0.509 and this correlation was statistically significant. PEFR and Male Height had more positive correlation than Female Height. There was a positive correlation between PEFR and BMI with r value 0.471 and this correlation was statistically significant. PEFR and female BMI had more positive correlation than Male BMI. Conclusion: The study emphasised maintenance of normal BMI in children and adolescents in order to prevent future risk of obstructive respiratory diseases. Prevention of malnutrition by dietary counselling, school health programmes, early detection of malnutrition by regular growth monitoring, health supplements and Obesity prevention by regular exercises and appropriate diet is important in maintaining normal PEFR.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to check the sensitivity and specificity of total leukocyte count in diagnosis of acute appendicitis and to check the sensitivity and specificity of CRP in diagnosis of acute appendicitis and to determine TLC and CRP efficacy in diagnosis of acute appendicitis. Methods: The study was conducted in Department of Surgery at Bhagwan Mahavir Institute of Medical sciences, Pawapuri, Nalanda, Bihar, India from may 2022 to April 2023. A total number of 200 cases were taken diagnosed as acute appendicitis. Results:  62 (31%) were female and 138 (69%) were male. Patient’s age group ranged from 14 years to 59 years. Maximum group of patients belonged to 21-30 years (68 patients i.e., 34%). Group A had inflamed appendix (75%) and the negative appendectomy rate in this study was 25% in Group B. Distribution of cases by histopathology correlation in sex Group A 100 males and 46 females had inflamed appendix. Group B 38 males and 16 females had normal appendix. Among 150 Inflamed appendix cases, CRP was found to be raised in 120 cases and normal in 30 cases. Among 50 normal appendix cases, CRP was found to be raised in 14 cases and normal in 36 cases. Among 150 inflamed appendix cases, TLC was found to be raised in 118 cases and normal in 32 cases. Among 50 normal appendix cases, CRP was found to be raised in 20 cases and normal in 30 cases. Conclusion:  TLC and CRP are useful in diagnosis of acute appendicitis. Appendicitis is common in adult and children. In the present study association of CRP and acute appendicitis has shown to be significant, but it cannot replace surgeon’s clinical acumen.

DOI: 10.5281/zenodo.

Aim: To investigate the correlation between blood pressure, serum electrolyte levels, and ejection fraction in individuals with acute myocardial infarction. Materials and Methods: This study was done in the Department of Physiology and Pathology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India from March 2018 to February 2019. A total of 52 patients of AMI were included in this study. All patients were male. This study was a longitudinal, interventional study. Patients with any of the conditions such as anemia, valvular heart disease, myocarditis, and cardiac tamponade, endocrinal disorders such as thyroid dysfunction, vitamin deficiency such as Vitamin B1 deficiency, pericardial effusion, and atrial fibrillation were excluded to minimize the possibility that these conditions may influence the outcome of study. Results: 50% of patients have normal systolic BP while 40.4% have high SBP and few (9.6%) have low SBP. All patients have normal diastolic BP. About 80.8% of patients with normal SBP showed improved EF after PCI while 80% of patients with low SBP and 76.2% of patients with high SBP showed improvement in EF. Hence, it is found that those patients who had abnormal SBP showed less improvement in EF (P = 0.93). We found that 75.9% of patients who have normal serum calcium level showed improvement in EF and 81.8% of hypocalcemia patients showed improved EF after PCI. There was only one patient with hypercalcemia and he showed improvement in EF. Hence, it is found that those patients who had normal serum calcium level showed less improvement in EF (P = 0.76). 69.2% of cases have normal serum potassium level, while 21.2% of cases have hyperkalemia and 9.6% of cases have hypokalemia. It has been found that all the five hypokalemia patients showed improvement in EF while 83.3% of the patients having normal serum potassium level showed improvement in EF. Conclusion: The study’s results indicate that higher levels of serum sodium and potassium are linked to a worse prognosis in patients with acute myocardial infarction (AMI) following PCI. Conversely, younger age and a normal body mass index (BMI) are related with a better prognosis in these patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical profile of the patients with acute hepatic encephalopathy in a tertiary health care center. Methods: The present study is a retrospective study carried on patients with acute hepatic encephalopathy patients attending OPD and emergency in Department of Medicine, Mata Gujari Memorial Medical College, Kishanganj, Bihar, India from February 2019 to January 2020. Total 100 patients with inclusion criteria were studied. Results: Majority of the patients were in the age group of 41- 50 years (35%) followed by 31-40 years (24%). Patients were less in the age group below 20 years (4%). %). Out of total 100 patients 75 were male and 25 were females. In our study alcoholic liver disease was most common etiological factor (44%). Hepatitis B infection was seen in 32% and Hepatitis C infection in 13% patients. Six patients showed alcoholic liver disease with hepatitis B infection. Unknown etiology was observed in 6% patients. According to Child Pugh score, 58% patients were in group A followed by Group B (33%) and Group C (9%). Majority of the patients were in Grade IV (36%), followed by Grade III (32%). Grade I included 20% patients and Grade II included 12%. Our study revealed majority patients were of type C (80%) Hepatic encephalopathy followed by type A (19%). Conclusion: Factors affecting mortality in hepatic encephalopathy were Male sex, alcohol intake, Child-Pugh Class C, Grade III and IV hepatic encephalopathy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the impact of conservative endodontic access cavity on root canal transportation by single file system in maxillary molars using cbct and in vitro study. Materials and Methods: The present study was conducted in the Department of Dentistry, NMCH, Jamuhar, Sasaram, Bihar, India. In the present study, 50 mesiobuccal roots of extracted maxillary first molar teeth with completely formed apices were collected. Teeth having root curvature ranging from 15° to 30° were selected. Results: During mechanical preparation, neither instrument fracture nor loss of working length was encountered in any of the teeth. A high degree of reliability was found between the two readings for transportation. The single ICC was 0.972 with a 95% confidence interval from 0.945 to 0.985 (F(59,59) = 81.420, p < 0.001) (Table 1), and was 0.999 with a 95% confidence interval from 0.998 to 0.999 (F(59,59) = 1725.500, p < 0.001) for centering ability (Table 2). Conclusion: Wave One Gold single reciprocation file respected original canal anatomy better than Neoniti single continuous file.

DOI: 10.5281/zenodo.

Aim: Admission Cardiotocography screening test to Predict foetal outcome and mode of delivery in IGIMS. Materials and Methods: This observational study was conducted in the Department of Reproductive Medicine, IGIMS, Patna, Bihar, India for two years. A total of 100 patients were included in the study. Patients with high-risk pregnancy conditions such as pregnancy-induced hypertension (PIH), eclampsia, diabetes, intrauterine growth restriction (IUGR), thyroid disorder, heart disease, anemia, bad obstetric history (BOH), oligohydramnios, post-dated pregnancy, diminished fetal movements, and premature rupture of membranes lasting more than 6 hours. Gestational age between 33 to 42 weeks were included in this study. Patients with normal pregnancy, Multifetal pregnancy, Gestational age less than 32 weeks, High-risk pregnancies that progressed to labor and Pregnancies with congenital fetal anomalies were excluded from the study. Results: The distribution of fetal heart conditions, as measured by cardiotocography (CTG), showed that 73% of the subjects had normal CTG results, whereas 27% had abnormal CTG results. This difference was statistically significant with a p-value of 0.002. The relationship between CTG results and the method of delivery, it was found that 42.47% of spontaneous deliveries had normal CTG results, and 7.41% had abnormal results. In contrast, 57.53% of caesarean section deliveries had normal CTG results, while a significant 92.59% had abnormal CTG results, with a p-value of 0.001, indicating a significant association. The relationship between CTG results and birth weight indicated that among those with a birth weight less than 2.5 kg, 27.40% had normal CTG results, and 62.97% had abnormal results. For those with a birth weight over 2.5 kg, 72.60% had normal CTG results, while 37.03% had abnormal results, with a p-value of 0.01, showing a significant correlation. Lastly, the relationship between CTG results and the APGAR score at one minute showed that among those with an APGAR score of 7 or less, only 4.6% had normal CTG results, while 81.2% had abnormal results. Conclusion: The rate of prompt resuscitation and admission of the infants to the newborn care unit was greater among this group. The cardiotocograph may be effectively used as a reliable screening technique for fetal monitoring. If the cardiotocography (CTG) displays an aberrant pattern, it is recommended to complement the antepartum CTG with a biophysical profile. In addition, the intrapartum CTG should be complemented with fetal scalp blood collection to assess the acid-base status before any intervention is performed.

DOI: 10.5281/zenodo.

Aim: To determine the prevalence of antepartum hemorrhage and its impact on mother and perinatal outcomes in a tertiary hospital. Materials and Methods: This study was conducted in the Department of Obstetrics and Gynecology, JLNMCH, Bhagalpur, Bihar, India. The records of one hundred and thirty-five pregnant women who had antepartum haemorrhage. Data collection form (study proforma) was designed and used to collect data from obstetric records in department of Obstetrics and Gynaecology. The following variables were considered: women’s socio- demographic characteristics (age, parity, educational status, religion, booking status), mode of delivery, birth weight, management outcomes (alive or dead), and sequelae. Antepartum haemorrhage was defined as bleeding from or into the genital tract after 28 weeks and before delivery of the baby. Results: The mean age ±SD of the participants was 32.25 ±4.78, (95% confidence interval: 31.44,33.06), modal age group was 30-34 years. The mean gestational age was 36 ±3 weeks, 95%CI: 35.52,36.55. The modal parity was para-1, range 0-5. Majority were multipara 67 (49.6%), booked 104 (77%), Christians 129 (95.6%) and had formal education 134 (99.3%). Preterm delivery occurred in 60 cases (44%) of APH. One hundred and twenty women (88.9%) had blood transfusion either intrapartum or postpartum due to anaemia following acute blood loss. Seventy-five (75) of the parturient had at least one unit of whole blood transfused. Majority of the foetus had normal birth weight 95 (70.4%) while low birth weight accounted for 25.2%. Mean birth weight of the foetus was 2.9 SD 0.71kg, 95% CI: 2.78, 3.03. Majority of the parturient had blood transfusion 120 (51.5%). This was followed by preterm delivery (25.8%), postpartum anaemia (19.3%). The most common foetal complication was admission into neonatal intensive care unit which accounted for 35.9% of the complications recorded in this study. Conclusion: Antepartum haemorrhage is common with an increased blood transfusion requirement. The commonest cause was placenta praevia accounting for more than half of the cases; followed by abruption placentae. APH remains a major contributor to maternal and perinatal morbidity and mortality. The main maternal and perinatal sequelae of antepartum haemorrhage from our study were blood transfusion, preterm delivery, anaemia, sepsis and admission to NICU, birth asphyxia, and low birth weight. Early diagnosis, prompt management and adequate blood transfusion services will improve foeto-maternal outcome.

DOI: 10.5281/zenodo.

Aim: To determine the prevalence of antepartum hemorrhage and its impact on mother and perinatal outcomes in a tertiary hospital. Materials and Methods: This study was conducted in the Department of Obstetrics and Gynecology, JLNMCH, Bhagalpur, Bihar, India. The records of one hundred and thirty-five pregnant women who had antepartum haemorrhage. Data collection form (study proforma) was designed and used to collect data from obstetric records in department of Obstetrics and Gynaecology. The following variables were considered: women’s socio- demographic characteristics (age, parity, educational status, religion, booking status), mode of delivery, birth weight, management outcomes (alive or dead), and sequelae. Antepartum haemorrhage was defined as bleeding from or into the genital tract after 28 weeks and before delivery of the baby. Results: The mean age ±SD of the participants was 32.25 ±4.78, (95% confidence interval: 31.44,33.06), modal age group was 30-34 years. The mean gestational age was 36 ±3 weeks, 95%CI: 35.52,36.55. The modal parity was para-1, range 0-5. Majority were multipara 67 (49.6%), booked 104 (77%), Christians 129 (95.6%) and had formal education 134 (99.3%). Preterm delivery occurred in 60 cases (44%) of APH. One hundred and twenty women (88.9%) had blood transfusion either intrapartum or postpartum due to anaemia following acute blood loss. Seventy-five (75) of the parturient had at least one unit of whole blood transfused. Majority of the foetus had normal birth weight 95 (70.4%) while low birth weight accounted for 25.2%. Mean birth weight of the foetus was 2.9 SD 0.71kg, 95% CI: 2.78, 3.03. Majority of the parturient had blood transfusion 120 (51.5%). This was followed by preterm delivery (25.8%), postpartum anaemia (19.3%). The most common foetal complication was admission into neonatal intensive care unit which accounted for 35.9% of the complications recorded in this study. Conclusion: Antepartum haemorrhage is common with an increased blood transfusion requirement. The commonest cause was placenta praevia accounting for more than half of the cases; followed by abruption placentae. APH remains a major contributor to maternal and perinatal morbidity and mortality. The main maternal and perinatal sequelae of antepartum haemorrhage from our study were blood transfusion, preterm delivery, anaemia, sepsis and admission to NICU, birth asphyxia, and low birth weight. Early diagnosis, prompt management and adequate blood transfusion services will improve foeto-maternal outcome.

DOI: 10.5281/zenodo.

Aim: Evaluation of Epistaxis/nasal bleeding during pregnancy. Material and Methods: This study was conducted in the department of ENT, PMCH, Patna, Bihar, India. 300 pregnant patients admitted Hospitals’ labor rooms for delivery and 115 non-pregnant individuals attend Hospitals’ outpatient. The gestational age of the pregnant women ranged from 36 to 40 weeks, while their ages ranged from 28 to 40. The reproductive age of the non- pregnant women ranged from 26 to 46 years. All patients signed a form of informed consent. Results: On 300 pregnant patients and 115 non-pregnant patients, the final data analysis was carried out. The average age (standard deviation) of pregnant women was (32±8) years. The average age (standard deviation) among non-pregnant women was (36± 8) years. 38 ±2 weeks was the average gestational age. Pregnancies terminated by cesarean section were 36.33 percent of the time, while vaginal delivery was 63.66 percent of the time. Pregnant and non-pregnant patients, there is statistically significant difference in the incidence of epistaxis (<0.05). Conclusion: Epistaxis is a common complication during pregnancy. Eliciting this history of active nosebleeds may aid to identify women at elevated risk for disrupted hemostasis, just as it does in the nonpregnant population. With this in mind, obstetricians and obstetric anesthesiologists may be better prepared to deal with postpartum bleeding, such as by getting preoperative blood bank specimens and having uterotonics on hand in the delivery room.

DOI: 10.5281/zenodo.

Aim: Assess the effectiveness of using warm versus regular room temperature Seitz bath in perineal wound healing. Material and Methods: The present hospital-based study conducted by the department of General Surgery at Jawaharlal Nehru Medical college and hospital, Bhagalpur, Bihar, India for 10 months. A total of 120 patients, ranging in age from 18 to 57 years, were included in this research. The patients had various conditions including haemorrhoids, fissure, perianal fistula, pilonidal sinus, perianal abscess, and episiotomy wounds. All patients were instructed to do a Seitz bath, using either warm water or a conventional room temperature Seitz bath with povidone iodine solution added, 3 to 4 times per day until the wound is fully healed and the patient achieves the required pain relief. Among the 120 patients, 70 chose to have a warm water Seitz bath (Group A), whereas the remaining 50 patients (Group B) opted for a Seitz bath at standard room temperature. Results: For haemorrhoids, Group A had 15 cases (21.43%) compared to 10 cases (20.00%) in Group B, making it slightly higher in Group A. Similarly, for fissure, both groups had an equal number of cases (10 each), but this represented a higher percentage in Group A (14.29%) compared to Group B (20.00%). Perianal fistula cases were slightly higher in Group A with 10 cases (14.29%) compared to 8 cases (16.00%) in Group B. Pilonidal sinus cases were comparable, with 10 cases (14.29%) in Group A and 7 cases (14.00%) in Group B. Perianal abscess cases were evenly distributed with 15 cases (21.43%) in Group A and 10 cases (20.00%) in Group B. Finally, episiotomy wounds were more prevalent in Group A with 10 cases (14.29%) compared to 5 cases (10.00%) in Group B. Conclusion: The selection of a Seitz bath that a patient prefers is mostly influenced by the psychological image formed in the patient’s head, prior experiences, socioeconomic standing, and guidance from a consultant.

DOI: 10.5281/zenodo.

Aim: To determine the connection between proliferative diabetic retinopathy and type 2 diabetes mellitus, with a focus on hypothyroidism. Materials and Methods: This research was done at the Department of Medicine at IGIMS, located in Patna, Bihar, India for 10 months. 60 T2 DM patients who agreed to participate were examined and compared using the study proforma. To achieve the study’s goal, two groups of 30 patients were compared. All patients had thyroid function testing, and two groups were formed: diabetics with thyroid dysfunction and those without. Results: Thyroid dysfunction patients had diabetes for 1–20 years, with a mean of 8.62 years and a standard deviation of 4.4 years. Patients without thyroid dysfunction had diabetes for 6 months to 13 years, with a mean of 6.27 years and a standard deviation of 3.29 years. Patients with thyroid dysfunction had 42.8% retinopathy, whereas those without thyroid dysfunction had 30.4%. The difference was negligible. Patients with thyroid dysfunction had considerably increased rates of proliferative diabetic retinopathy. Conclusion: Diabetics with hypothyroidism had a statistically significant connection with proliferative retinopathy, but not overall.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the correlation of Fasting & PP C-peptide with HbA1C in patients of T2 Diabetes Mellitus in population of Bihar region. Methods: 100 patients admitted in the Department of Biochemistry, Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India for one year. Serum samples were taken for fasting & PP C-peptide and HbA1C for patients of T2 Diabetes Mellitus and run on VITROS 5600/7600 which is based on dry chemistry. Results: Mean & SD for fasting C-Peptide for males was 1.348±1.072 & for females 2.448±2.56. Mean & SD for Post prandiol C-Peptide for males was 4.210±5.025 & for females 2.995±2.134. It was significant for fasting C- Peptide with P value 0.0634 and non significant for PP C peptide with p value 0.4405. Mean & SD for fasting C-Peptide for raised was 3.379±1.791 & for unraised 0.718±0.512. Conclusion: Insulin secretion estimated by measurement of Fasting C- Peptide was either normal or raised in newly diagnosed T2dm subjects in my study indicating predominant role of insulin resistance in the etiology.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess stress and psychiatric morbidity among a group of pregnant versus non-pregnant women in the reproductive age group using validated research tools. Methods: This was a retrospective study among 200 pregnant and 100 non-pregnant using an interviewer-administered questionnaire at Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for 6 months. The study was conducted among women aged 18 to 45 years. Results: A total of 300 women of which 200 were pregnant and 100 were non-pregnant participated in the study. Their mean age were 30.1 ± 5.4  and  29.6 ± 8.4 years respectively. A significantly higher proportion 160 (80%) of the pregnant women compared with 52 (52%) were in the 25–39 age category (p < 0.001). A higher proportion of the pregnant women were married 190 (95%) compared with the non-pregnant women 60 (60%) which was statistically significant (p < 0.001). Among pregnant women, sociodemographic factors significantly associated with psychiatric morbidity. The highest proportion of psychiatric morbidity was found in women attending tertiary facilities, followed by secondary facilities and the least was in women from primary care facilities. In non-pregnant women, correlates of psychiatric morbidity were mainly family characteristics. Conclusion: The study concluded both working and non-working antenatal mothers were at more risk of developing stress. All antenatal mothers participated in this study had mild stress and there was significant difference between working and non-working antenatal mothers stress score. Psychiatric morbidity is high among women of reproductive age group with higher rates among pregnant women.

DOI: 10.5281/zenodo.

Aim: To assess the importance of maternal serum ferritin as a predictive marker for intrauterine growth restriction. Material and Methods: This study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India.  A total of 326 pregnant women attending the prenatal clinic were included in the research during the 25th week of pregnancy. The exclusion criteria included a body mass index (BMI) below 18, placental anomalies such as velamentous insertion, antepartum hemorrhage, multiple pregnancies, patients with acute infection, patients with a positive C-reactive protein (CRP) test result, elevated total leukocyte count (TLC), congenital deformity, and fetuses with chromosomal or genetic syndrome. Gestational age was determined by counting the completed weeks from the start of the previous menstrual period. If there was a discrepancy of more than two weeks between the dates and the ultrasound reports, the ultrasound dated from the first trimester was used to calculate the gestational age. Results: The patients were categorized into three groups based on their serum ferritin levels. The data above indicates that the subgroup of women who had a mean serum ferritin concentration of >20 ng/ml during pregnancy had the highest proportion of growth limited kids. The results presented indicate that women with a mean serum ferritin level over 20 ng/ml had a 6.26 times higher likelihood of having kids with asymmetric growth restriction and a 4.47 times higher likelihood of having babies with symmetric growth restriction, compared to women with a serum ferritin level below 20 ng/ml. The study yielded a statistically significant result (P<0.0001) for asymmetrical growth restriction as an outcome and a statistically significant result (P<0.05) for symmetrical growth restriction as an outcome. A blood ferritin value of 20.2 ng/ml was found to have the greatest Yuden’s index, indicating that it may be used as a threshold for screening prenatal patients for the risk of fetal growth limitation. This threshold has a sensitivity of 61.5% and a specificity of 80.1%. Conclusions: Our investigation revealed a negative connection between the levels of serum ferritin and neonatal birth weight. In the future, a comprehensive randomized control study is necessary to establish a correlation between maternal blood ferritin levels and intrauterine growth restriction (IUGR).

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the effectiveness of dexmedetomidine and propofol in attenuating the hemodynamic response to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Methods: This retrospective, randomized study was done in the Department of Anesthesia, Vardhman Institute of Medical Science, Pawapuri, Nalanda, Bihar, India from March 2017 to Feb 2018. Written informed consent was taken before enrolling the patient into the study. 100 ASA I and II patients undergoing laparoscopic cholecystectomy under general anesthesia between the ages of 20 and 50 years of both sexes were randomly divided into two groups of 50 patients each using a sealed envelope method, with Group D to receive dexmedetomidine infusion and Group P to receive propofol infusion. Results: The groups were comparable with respect to age, weight, gender ratio and ASA status of patients. There was a significant difference in postoperative mean HR between two groups with HR being lower in dexmedetomidine group. At most of the study stages lower values of mean SBP were observed in the dexmedetomidine group, thus suggesting better control of SBP with dexmedetomidine compared to propofol. Postoperative mean SBP also showed better control in dexmedetomidine group as compared to propofol group. Postoperative DBP was comparable between two groups. Total duration of pneumoperitoneum in dexmedetomidine group was 52.76±12.67 minutes and in propofol group was 57.36±15.34 minutes with p value of 0.155. The time to extubating was 16.80±4.26 minutes in dexmedetomidine group and 14.98±5.42 minutes in propofol group and was statistically insignificant with p-value of >0.05. Conclusion: Dexmedetomidine infusion without loading dose is effective in attenuating hemodynamic response to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy and is better alternative to propofol in such patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to review the anatomy of nasolacrimal duct in relation to the lateral nasal wall. Methods: Thirty sagittal sections of head and neck of formalin fixed adult cadavers present in the Department of Anatomy, Nalanda Medical College, Patna, Bihar, India were selected for the study. Out of thirty, sixteen sections were of left side and fourteen were of right side. The sections with damaged lateral nasal wall were not included in the study. Nasal septum was removed, the orifice of Naso lacrimal duct (NLD) was identified and exposed. The duration of study from March 2023 to February 2024. Results: In our study the average length of the NLD irrespective of the side was 19.8±1.57mm. The intranasal orifice of the NLD was observed to be located on an average of 24.5±2.6mm from the anterior nasal spine, ranging from 5.5-2. 9mm.The average distance from the nasal roof was found to be 32.2±1.67mm and 16.08±1.71mm from nasal floor. In addition, the average distance from the anterior attachment of inferior nasal concha was found to be 14.82±2.37mm. Posteriorly the NLD has close relationship with the uncinate process and the maxillary sinus ostium. In our study the NLD was an average of 4.08±0.67mm anterior to MSO at the level of the anterior attachment of the MT. On Comparing right and left side The NLD was found to be slightly longer 22.7 in comparison of 22.2 mm on left side. The other distances of NLD from MSO were also found to be larger on left side. The distances of NLD-ANS, NLD NR, NLD -AIT and NLD- NF were also longer on left side. Conclusion: This study attempts to provide information regarding the position and location of the NLD in relation to the important landmarks in the lateral wall of the nasal cavity. These observations in the lateral wall of the nasal cavity are important during the endoscopic interventions. In our study, average length of the NLD was 19.8mm.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to study the variability in morphology of the renal vein and to measure length of renal vein and to observe the variations in renal vein. Methods: The dissection was done in 30 embalmed cadavers in the Department of Anatomy, Patna Medical College, Patna, Bihar, India for seven months. They included 20 male and 10 female cadavers. They were collected from the dissection hall of department of Human Anatomy of various medical colleges. Results: Tributaries that emerge from the kidney and join to form renal vein are called primary tributaries. These were present in 9 in right and 12 in left specimens. Statistically significant association was not found between presence of primary tributary of renal vein and side. Statistically significant difference found between length of renal vein of right and left side. Average length was more on left side (62.44 mm) than that of right side (26.98 mm). Conclusion: Detailed knowledge of variations of these vessels will definitely improve outcome of various urological, renal transplantation and laparoscopic surgeries. This knowledge will be of immense help to radiologists and oncologists who are dealing with this region. Also, a detailed knowledge and understanding of major congenital anomalies of the renal veins variations will provides safety guidelines for endovascular procedures.

DOI: 10.5281/zenodo.

Aim: The study was planned in the department of forensic medicine, to analyse and evaluate in detail, pattern of head injury and skull fractures in victims of road traffic accidents undergoing autopsy. Material & Methods: The present study was conducted in the Department of Forensic Medicine and Toxicology, SKMCH Muzaffarpur, Bihar India from June 2019 to May 2020 and it included assessment of consecutive 100 victims using non-probability purposive sampling who died in road traffic accidents and underwent post-mortem examination in Department of Forensic Medicine and Toxicology, SKMCH, Muzaffarpur, Bihar India. Results: Highest incidence of 44% cases was noticed in age group of 21 to 30 years. On considering sex profile 15% cases were those of females and 85% was that of male. In road traffic accidents when data was analysed among the type of road users, two wheeler motor vehicle occupants were maximum, which accounted for 60% cases, 35% were pedestrians, 3% were four wheeler and 2% were other types of road users like bicycle riders. Most common injuries were noticed was laceration in 52% cases followed by abrasion in 34% cases. On considering types of fracture sustained to skull most common being fissured in 48% cases followed by comminute fracture in 36% cases. Meningeal involvement commonly is subdural haemorrhage that was in 64% cases, subarachnoid haemorrhage was seen in 58% cases. On considering injuries to brain contusion was commonly noticed in 20% cases, followed by laceration and contusion. Parietal lobe of brain is commonly involved followed by frontal bone. Cause of death was shock and haemorrhage is most cases followed by coma, then there are other causes which includes instantaneous, respiratory failure, cerebral oedema, infection, brain stem dysfunction. Conclusion: Head injury due to RTA is a recognized public health problem causing death and disability. It is required from concerned government authority to take appropriate and immediate measures for reducing the incidence of head injury. At the same time, people should be educated for taking good preventive actions to avoid head injury.

DOI: 10.5281/zenodo.

Aim: This study aimed to determine the role of diabetes mellitus in causing cataracts, especially posterior subcapsular cataracts. Methods: The present study was conducted in the Department of ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India March 2016 to February 2017. The consecutive sampling method used in this study the overall data of cataract patients treated by the Department of ophthalmology. This data is a medical record containing a history of diabetes mellitus and the types of cataracts suffered by 100 patients. Results: In this study, 100 patients’ data were used; it is known that there were 36 patients with a history of diabetes mellitus (36%) and history of non-diabetes Mellitus as many as 64 patients (64%). As for 100 patients who suffer from cataract eye disorders or diseases in this study, it was found that 25 patients (25%), had PSC type cataracts, and 75 patients (75%) had non-PSC type cataracts. From the cross-section analysis results, it was known that as many as 21 patients had a history of diabetes mellitus and had PSC cataracts, while 4 patients, did not have a history of diabetes mellitus but had PSC cataracts. In addition, the results of the analysis also showed that there were 15 patients had a history of diabetes mellitus and had non-PSC cataracts, while 60 patients did not have a history of diabetes mellitus experiencing non-PSC cataracts. Overall, there were 36 patients (36%) had a history of diabetes mellitus and had cataracts, and there were 64 patients (64% who did not have a history of diabetes mellitus but had cataracts. Thus, it can be concluded that diabetes mellitus has a relationship with cataracts, especially PSC cataracts. This condition is proven by more patients with PSC cataracts who have a history of diabetes mellitus than patients who suffer from PSC cataracts but do not have a history of diabetes. Conclusion: As the number of people with DM is estimated to continue to increase, cataract surgery will remain important for diabetic patients. Patients with diabetes have multiple issues to be evaluated preoperatively, perioperatively, and in the postoperative period.

DOI: 10.5281/zenodo.

Aim: To determine the incidence  of Plasmodium vivax and falciparum malaria in patients admitted to a tertiary care hospital in North India. Materials and Methods: This study was conducted in the Department of Microbiology, Nalanda Medical College and Hospital, Patna, Bihar, India from Jan 2018 to December 2018. This study included consenting patients of age 18 years and above with either a smear positive for plasmodium species or malarial antigen positive by RDT (rapid diagnostic test). Categorization of severe malaria and treatment was carried out according to WHO guidelines. Diagnostic methods used were conventional Thick & thin Peripheral smear stained with Leishman stain, examined under oil immersion. The slide was considered negative when there were no parasites in 100 HPF. Rapid diagnostic tests were based on detection of specific plasmodium antigen, LDH (optimal test) for Vivax & HRP2 for falciparum. Results: It was found that P. vivax was the most prevalent species, affecting 53% of the patients. P. falciparum was identified in 28.3% of the cases, while mixed infections were observed in 18.7% of the patients. The most common symptom reported was fever, affecting 94.3% of the patients. This was followed by generalized weakness, nausea, or anorexia, which was present in 85.7% of the cases. Headache was reported by 71.3% of the participants, while vomiting was experienced by 48.3%. Pain in the abdomen affected 30% of the patients, diarrhea 18.3%, altered sensorium 10.9%, breathlessness 10%, and seizures were the least common symptom, occurring in 5.2% of the patients. Pallor was noted in 51.7% of the participants, jaundice in 45.2%, splenomegaly in 36.1%, hepatomegaly in 24.8%, hypotension in 17.4%, rashes in 15.7%, and tachycardia in 42.6% of the patients. Conclusion: Malaria is still at rampant in India with debilitating morbidity and mortality. In majority of cases P.vivex is most common causative organism of malaria followed by P. falciparum which is more prevalent in rural area in middle age group male population. Studying the clinical profile of malaria with proper antimalarial drug treatment helps to curb down the complications of malaria. Every healthcare facility should follow national and international guidelines and form its in-hospital guidelines regarding proper antimalarial selection.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to observe hemodynamic response in nasotracheal intubation under general anesthesia. Methods: The present study was conducted in the Department of Anesthesia, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, and 50 patients of either gender aged 18 to 60 years belonging to ASA I and II scheduled to undergo elective surgery under general anesthesia requiring intubation were included. Results: The mean age was 37.03 years and male to female ratio was 5:45 with mean weight being 59.08 Kg. Spo₂ was continuously monitored during intubation and it was found that patients maintained 100% saturation during induction, at the time of insertion of direct laryngoscope, at 3min, 5min and 10 min. 8 patients had lower reading immediately after intubation with mean SpO₂ of 99.96%. Mean time for intubation using laryngoscope was 18.2 sec. Epistaxis was seen in 2 of 50 patients. There was significant fall of all parameters after induction comparing with baseline (p<0.0001). At the time of insertion of DLS there was significant rise of heart rate (p<0.005), SBP, DBP & MAP (p<0.0001). HR, SBP, DBP & MAP remained high even after intubation and returned to baseline value at 3 min. HR, SBP, DBP & MAP continued to be below baseline at 5 min and 10 min. Conclusion: Direct laryngoscope nasotracheal intubation causes significant increases in blood pressure and heart rate. Nasotracheal intubation under general anesthesia has significant Hemodynamic effect.

DOI: 10.5281/zenodo.

Aim: A comprehensive assessment of ear, nose, and throat disorders in the bihar region. Material and Methods: A retrospective study was conducted in the Department of ENT, AIIMS, Patna ,Bihar, India from Oct 2017 to Dec 2018.The entire population of bihar region  were covered by changing the site of camp on each visit. Inclusion criteria for the study subjects were people who had given symptom of ENT diseases and those who had given his/her consent. Questionnaire method of data collection was used to know the pattern and prevalence of ENT diseases. Living environment conditions including overcrowding and inadequate cross ventilation were defined as per textbook standards. Results: Out of 515, 268 (52.1%) patients were male while 247 (47.9%) were females (Male: female ratio being 1.08:1). The age distributions of patients are shown in Figure 1. Most common age group affected was of 31-40 years (4th decade). The majority of patients were suffering from ear problems (54.8%; 282/515) while nasal and throat problem was seen in 14.9% (77/515) and 30.3% (156/515) respectively. Among the ear problems, chronic suppurative otitis media (safe type) was the commonest (41.8%; 118/282) followed by ear wax (25.2%; 71/282), otitis externa (9.6%; 27/282), acute suppurative otitis media (8.2%; 23/282), hearing loss (5.7%; 16/282), acute mastoiditis (4.3%; 12/282), otomycosis (1.8%; 5/282), foreign body (2 cases), trauma to ear (1 case) and others (7 cases). The ‘others’ category had all non-significant cases with chronic non-specific pain with normal findings and investigations. The pure tone audiometry was performed on 282 patients and hearing aid trail was given to 16 patients. Conclusion: Health camps conducted by medical experts act as an opportunity to screen people with various ailments of ENT in community. Also, they can orient medical graduates towards health need of common people. Being a community-based study, it reflects the exact magnitude and pattern of ENT diseases.

DOI: 10.5281/zenodo.

Aim: To analyze complication profile after pterygium excision, in primary and recurrent pterygia. Material & Method: The patients who had undergone pterygium excision in the Department of Ophthalmology, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, India, were retrospectively analyzed for complications after surgery over a period of 3 years. A total of 564 eyes in 500 patients were included in the study. Results: Out of total 500 patients presented with pterygium; 382 patients had primary pterygium (276 eyes had single head pterygium, 106 cases had double head pterygium), 118 cases had recurrent pterygium. 442 patients had unilateral pterygium; 58 patients had bilateral pterygium. Out of 500 patients, 185 patients were males and 315 patients were females. Graft edema was seen in 191 cases (50.0%) of primary pterygium and in 23 cases (19.5%) of recurrent pterygium, with a significant P value (P = 0.0621).  Recurrence was noted in 16 (4.2%) of primary pterygium cases and in 5 cases (4.2%) of recurrent pterygium, and the P value was significant (P = 0.0377). Dellen was seen in 10 cases (2.6%) of primary pterygium and 4 cases (3.40%) of recurrent pterygium, without a significant P value (P = 0.483). Conclusion: As noted here, a variety of problems might arise following pterygium surgery. Choosing the right method for a certain kind of pterygium and using the right graft fixation technique can result in a better outcome with fewer problems.

DOI: 10.5281/zenodo.

Aim: To illustrate the range of chest CT findings associated with coronavirus illness (COVID-19) in a rural community. Material and Methods: This study was conducted in the Department of Radiology, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri and Darbhanga medical college and Hospital, Darbhanga, Bihar, India for one year. We performed non-contrast chest CT in 179 non-consecutive RT-PCR confirmed SARS-CoV-2 infected patients. Bilateral, peripheral and basal ground-glass opacities with multilobe involvement have been described as the initial CT manifestations of COVID-19 pneumonia. During the intermediate stage of disease, progressive transformation of GGOs into consolidations occurs with the development of interlobular septal thickening producing characteristic crazy paving patterns. Results: We performed non-contrast chest CT in 179 non-consecutive RT-PCR confirmed SARS-CoV-2 infected patients. Among the total study population, 152 (84.9%) patients were symptomatic and 27 (15.1%) patients were asymptomatic. Among the symptomatic patients, the most common symptoms reported were fever (73%), cough (49%), myalgia (61%), fatigue (66%), sore throat (23%), breathlessness (9%), hyposmia/anosmia (4%) and dysguesia (3%). Conclusion: In conclusion, chest CT imaging reveals a spectrum of manifestations in COVID-19, ranging from early GGOs to extensive consolidations and interstitial changes. These findings reflect the dynamic nature of the disease and provide critical information for diagnosis, management, and prognostication.

DOI: 10.5281/zenodo.

Aim: A comparative analysis of different surgical approaches for the treatment of chronic pancreatitis. Material and Methods: It was retrospective study carried out at Department of General surgery, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for one year. Patients with chronic pancreatitis aged 18-65 yrs from our tertiary care institution was screened and selected to undergo modified lateral pancreatic jejunostomy. After obtaining valid written informed consent They was undergo either the conventional open procedure or the laparoscopic procedure according to the inclusion and exclusion participant. 50 patients of chronic pancreatitis was screened during the study period. Results: Of the total sample size of 50 participants, 23 underwent laparoscopic technique and 27 underwent open method. This is 46% of the population underwent laparoscopy and 54% underwent open surgery. Statistical software used was Statistical process control. Hemorrhage is the most common complication encountered intraoperatively. On an average the blood loss encountered during laparoscopy was 104 ml, while the blood loss seen in open surgery was 123 ml. On applying the chi square test, p value 0.011. Hence, this is significant. Alternate hypothesis is true, that is, there is a difference in the intraoperative efficacy of open and laparoscopic pancreatojejunostomy. Blood loss encountered during laparoscopic dissection is lesser. The post-operative complications which are expected post pancreatojejunostomy includes the following; Pancreatic fistula formation, Anastomotic leak, Paralytic ileus and Wound gape. P value at the end of the Chi test is 0.265, which implies that the null hypothesis should be accepted and that there is no difference in the possibility of development of post-operative complications irrespective of the operative techniques used. By using appropriate test for statistical analysis, the p value obtained was 0.0005. Hence, the alternate hypothesis has been accepted. Laparoscopic method has been found to be better than open method in terms of the postoperative day of starting oral feeds. Conclusion: The two methods of pancreatojejunostomy are comparable to each other. However, the laparoscopic method, has its advantages over the open technique in terms of lesser amount of blood loss encountered, faster onset of enteral nutrition and lesser duration of hospital stay. Intra and post-operative complication profile are similar for both methods. Post-operative endocrine insufficiency at the end of 6 months are similar for both techniques. Post-operative pain relief at the end of 3 months are also similar in both.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the correlation between new born size and maternal first trimester haemoglobin concentration. Methods: The prospective observational study, conducted in the Department of Obstetrics and Gynaecology from May 2023 to January 2024  included 200 mothers registered for antenatal care (ANC) and willing to continue till confinement were recruited after written informed consent as per routine protocol. Results: Out of 200 women patients, 55% had normal Hb level followed by mild 32% and 13% moderate. The correlation between hemoglobin concentration and birth weight and other anthropometric parameters was measured by using chi square test and student’s t-test. P-value was considered significant if it was below and highly significant in case <0.001. Conclusion: Increased incidence of low birth weight babies is seen if the mother is anemic in her first trimester with significant association when hemoglobin is less than 8 gm%. Increased incidence of preterm deliveries is seen if the mother is anemic in her first trimester. We observed better neonatal outcome in the form of weight and anthropometry if maternal hemoglobin is in range of 10 to 13 gm%.

DOI: 10.5281/zenodo.

Aim: A comprehensive examination of Glaucoma and Cataract in Pseudo exfoliation. Material and Methods: This study was conducted in the Department of Ophthalmology, PMCH, Patna, Bihar, India for one year. 137 Patients with pseudo exfoliation were included into the study and evaluated. After obtaining informed consent history and demographic data was collected and detailed ocular examination including Best corrected visual acuity, Slit lamp examination for presence of pseudo exfoliative material, Applanation tonometry, Gonioscopy, Visual fields analysis, Dilated fundus examination and examination of lens was performed. Diagnosis of pseudo exfoliation glaucoma was made based on the presence of: If IOP is > 21 mm Hg in either eye, Vertical cup disc ratio is >0.7:1 (or) Cup disc asymmetry >0.2 between the two eyes (or) Focal thinning, notching of neuroretina rim and Presence of glaucomatous visual field defects. Results: Total number of patients included in the study was 137. Total number of eyes included in the study was 220. Following were the observations made in our study. Out of total 2750 cases screened 137 Patients (220 Eyes) had pseudo exfoliation. Out of 137 patients, 79 (57.6%) were Males and 58(42.4%) were Females. Male: Female ratio was 1.36:1. Out of 137 patients 54 (39.4%) were having unilateral pseudo exfoliation, 83 patients (60.6%) were having bilateral pseudo exfoliation. Out of 220 eyes, 204 eyes (92.72%) had open angle of Grade III – IV. Out of 220 eyes, 154 eyes (66.82%) had intraocular pressure <21 mm Hg, 66 eyes (33.18 %) had intraocular pressure > 21mm Hg. 143 (65.00%) eyes had normal visual fields and optic disc cupping of <0.7:1CDR, 77 eyes (35.00%) had abnormal visual fields and glaucomatous cupping of >0.7:1CDR. Out of 220 eyes, 132 (60.00%) had nuclear cataract, 73 (33.18%) had senile immature cataract, 14 (6.37%) had senile mature cataract and one patient had hyper mature cataract. Conclusion: Pseudo exfoliation is a degenerative disease of basement membrane, which increases with the age, hence more commonly seen in older age group. Pseudo exfoliation initially starts as unilateral disease and progresses to other eye as the age advances.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical spectrum and outcome in children with nephrotic syndrome. Methods: This was a retrospective study conducted at Pediatrics Department at Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India from January 2018 to December 2018. 100 children who were diagnosed with nephrotic syndrome at Darbhanga Medical College and Hospital, Darbhanga, Bihar, India in whom steroid treatment was not started yet were included for study purpose. Patients with first attack and relapse both were included in this study. Results: 70% were male and 30% were females. In the present study, 100% had swelling followed by 88% had puffiness. 100% had pitting edema and 80% had ascites. The hemoglobin, serum albumin, serum creatinine was 10.5±1.46, 1.7±0.43 and 0.62±0.18 respectively. 34% had complete remission and 15% had relapse. Conclusion: In our study clinical and laboratory findings were in similarity with usual nephrotic syndrome in children. There was no any significant difference in pattern of nephrotic syndrome and response to treatment from other studies.

DOI: 10.5281/zenodo.

Background: Iron deficiency anaemia (IDA) is highly prevalent in pregnancy, representing the most common nutritional deficiency. To address the increased iron demands during pregnancy, prophylactic oral iron supplementation is recommended. However, in India, many women begin pregnancy with low haemoglobin levels, leading to a high incidence of moderate to severe anaemia that oral iron therapy alone may not adequately address. For pregnant women with moderate anaemia, parenteral iron therapy is recommended. This study aims to assess the efficacy and impact of intravenous iron sucrose therapy administered to pregnant women diagnosed with IDA. Methods: The study enrolled fifty patients diagnosed with iron deficiency anaemia, characterized by haemoglobin levels between 8-10 g/dL visiting Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi, India . The total iron deficit was calculated using a standard formula. The target haemoglobin level aimed for was 11 g/dL. Intravenous iron sucrose was administered in divided doses via infusion. Haemoglobin levels were reassessed three weeks after the completion of the intravenous iron sucrose treatment. Gestational age and socioeconomic distribution were calculated as percentages. Pre- and post-treatment haemoglobin levels were analysed using mean and standard deviation, and p-values were assessed. Results: The majority of patients (60%) were in the gestational age range of 32-34 weeks, with 30% between 29-31 weeks, and 10% between 26-28 weeks. The mean gestational age was 32.4 ± 2.7 weeks. Socioeconomic distribution revealed 40% from the lower class, 32% from the middle class, and 28% from the upper class. Intravenous iron sucrose therapy proved effective in 90% of patients without any reported side effects or allergic reactions. Conclusion: This study demonstrated significant improvement in haemoglobin levels among patients receiving intravenous iron sucrose infusion, achieving the target haemoglobin level of 11 g/dL. The treatment was well tolerated and deemed safe for use in pregnant women with iron deficiency anaemia.

DOI: 10.5281/zenodo.

Aim: To investigate the injury patterns seen in pedestrians who have died as a result of road traffic accidents. Materials and Methods: A Cross-sectional study was conducted in department of FMT, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India, on the pattern of injuries among pedestrian deaths autopsied. Information about the pattern of injuries sustained by the deceased was obtained from hospital case records (in admitted cases) and post mortem findings. The socio demographic profile of the deceased was obtained from police records and from the relatives of the deceased. Results: Among the pattern of injuries sustained by the pedestrians, 83% (68) cases had head injuries, 25 cases had abdominal injuries, 41 cases had chest injuries and in 42 cases injuries were seen in extremities. Abrasion was the most common external injury seen in 76 cases. Head injury was the commonest cause of death seen in about 54% of cases followed by shock and haemorrhage involving multiple vital organs was the cause of death in 30.5% cases. The most common offending vehicle resulting in pedestrian death in the present study was a two-wheeler with 18 cases (22%), followed by car with 16 cases (19.5%), heavy four wheelers (bus, truck, minivan, tractor) accounting for 19 cases (23.2%). Hit and run cases where the offending vehicle could not be traced amounts for 34.1% (28 cases). Among 82 pedestrian deaths, maximum deaths 38 (46.3%) happened in the outskirts (Belgaum rural area with kaccha roads), followed by 25 deaths (30.5%) on highways and 19 deaths (23.2%) occurring on intra city roads. During the study period of one and half yrs., 2670 cases of road traffic accident were admitted to BIMS hospital, out of which 255 cases expired, thus mortality rate being 9.6%. This data shows that timely medical aid saved 90% of lives in road traffic accidents. Conclusion: As the study clearly shows, timely medical help can prevent mortality to the extent of 90%, thus making fast and prompt accessibility of medical aid for the victims of road traffic accidents goes in a long way in preventing both morbidity and mortality. It is in the best interest of the pedestrians to construct over bridges or under pass for movements at all major junctions of the city. Foot paths which already exist in the city should be widened and strictly be meant only for pedestrians, not for parking vehicles or street vendors.

DOI: 10.5281/zenodo.

Aim: To determine the antimicrobial resistance pattern of bacterial isolates obtained from burn wound infections in a tertiary care hospital, RIMS, Ranchi. Material and Methods: This cross-sectional study was conducted in the department of microbiology at RIMS, Ranchi, Jharkhand, India for one and half year from January 2017 to June 2018. Burn wound samples of 180 burn patients who had nosocomial infection due to burn wound with a hospitalization period of more than 48 hours were studied. Infection was diagnosed by the attending physician, according to the standard definition of nosocomial infection of the wound. Swabs were taken on third postburn day from areas which appear deep, areas with discharge, thick eschar, etc. The bandages were removed, the remnants of the ointment were washed away and the wounds were swabbed and cultured as follows: A sterile cotton swab was moistened with sterile normal saline. This swab was rubbed onto the burn wound surface. The swabs were then transported for culture to Microbiology laboratory. Results: A total of 180 cases were selected for this prospective study. Out of 180 samples, 104 (57.8%) were from females and 76 (42.2%) were from males, with a mean age of 28 years and mean total body surface area of 15%. Out of 180 samples, 168 (93.3%) were culture positive and 13 (7.2%) were sterile. Single isolates were found in 148 (82.2%) samples, whereas 28 (15.5%) and 4 (2.2%) samples yielded double and triple isolates, respectively. Burn wound sampling revealed the prevalence of gram-negative bacilli 138 (76.7%) over gram-positive cocci 42 (23.3%). Pseudomonas aeruginosa 83 (46.1%) were the predominant isolates followed by Staphylococcus spp. 42 (23.3%), Escherichia coli 29 (16.1%), Klebsiella species 18 (10%), Proteus species 5 (2.7%), and Acinetobacter species 3 (1.6%). A total of 32 (17.7%) samples showed mixed bacterial growth. Among mixed isolates, Staphylococcus aureus + Pseudomonas aeruginosa were isolated in 18 samples, Coagulase-Negative Staphylococci + Pseudomonas aeruginosa in 8 samples, and E. coli + Klebsiella spp. in 6 samples. Out of the 42 gram-positive organisms, 22 (52.4%) were found to be MRSA, and the remaining 20 (47.6%) were MSSA. All the gram-positive organisms were sensitive to linezolid and vancomycin. All the MSSA strains were also sensitive to gentamicin, whereas MRSA strains showed 81.8% sensitivity to gentamicin. Conclusion: In conclusion, P. aeruginosa, Staphylococci spp., and E. coli were the most common species causing burn infection in our hospital. Antimicrobial therapy for burn patients should cover these pathogens although the resistance of bacteria (especially gram negative species) to the studied wide spectrum antimicrobials was too high. Preventive measures to essentially avoid infections in burn wounds should be considered by the infection control committee of hospitals.

DOI: 10.5281/zenodo.

Aim: Evaluation of Rapid diagnostic tests compared to peripheral smear in the diagnosis of malaria. Methods and Materials: This is a retrospective hospital-based study was conducted in the Department of pathology, NMCH, Patna, Bihar, India for 9 months. During this period, 1835 blood samples were received for malaria diagnosis from clinically suspected cases. Blood samples were collected in EDTA vacutainer tube. Peripheral smears were made on a clean glass slide with a drop of blood, air dried and stained with Leishman stain. Smears were thoroughly examined under oil immersion for the presence of malaria parasite. Of 1835 samples, 600 samples were randomly selected and Rapid Diagnostic test was performed using Antigen based Pf (HRP-II) and PV (pLDH) specific kit. Procedure was performed as per manufacturer’s instructions. Results: Of the 600 Peripheral smears studied, 175 showed positive for malarial parasite. Plasmodium Vivax (Pv) was diagnosed in 173 Cases, Plasmodium Falciparum (Pf) was identified in one case and one smear showed mixed infection with both Plasmodium Vivax and Plasmodium Falciparum. Rapid Diagnostic test showed 189 positive cases, of which 178 were plasmodium Vivax, four cases were Plasmodium Falciparum and seven cases showed mixed infection with Falciparum and Vivax. Sensitivity, specificity, Positive Predictive Value and Negative Predictive value were 100%, 96.7%, 92.5% and 100% respectively. Conclusions: Peripheral smears are considered to be gold standard for diagnosis of malaria. RDTs can be more sensitive and specific than peripheral smears. Newer Pf /Pv specific antigen card can distinguish mixed and PF infections. However further studies are required to assess cost effectiveness and efficiency of different RDTs.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess functional outcome of fractures of lower end radius treated with surgical management with locked compression plate (LCP) followed by early mobilization of wrist joint. Material & Methods: This study is a prospective, time bound, hospital based study that was conducted in the Department Orthopaedics, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India between the duration of six months. The study included a total of 50 cases of distal end radius fractures that were operated with open reduction and internal fixation with volar Locking Compression Plate (volar LCP). The fractures were classified according to Frykmann classification and were followed up at regular intervals. Functional outcome was assessed using the Gartland and Werley demerit scoring at each follow up visit. Results: In the study, 26% were in 20 – 30 Years, 22% were in 31-40 years, 32% were in 41 – 50 Years and 20% were > 50 Years. Mean age of subjects was 40.5 ± 14.26 years. 46% were Female and 54% were male. 52% had injury in left and 48% had in right. In the study, mode of Injury in 32% was FOOH, 68 % was RTA. In the Study, Frykman/AO type I/A2 was 12%, II/A3 was 10%, III/B3 was 20%, IV/B2 was 10%, V/B3 was 16%, VI/C2 was 10% and VII/C2 was 22%. In the study, 52% got surgery done in 1 day, 32% in 2 days, 12% in 3days and 4% in 4days. In the Study, 84% had follow-up after 6 months, 12% after 9months and 4% after 12 months. In the study, Mean Palmar flexion (PF) was 71.67 ± 9.81, Dorsiflexion (DF) was 76.4 ± 10.02, Radial deviation (RD) was 14 ± 3.40, ulnar deviation (UD) was 22.6 ± 5.55, Supination was 81.49 ± 8.52, Pronation was 72.48±10.06 and G&W Score was 4.96 ± 3.14. In the Study, 4% had Arthritis and 4% had EPL Tendon rupture. Conclusion: Based on the findings of this study it may be concluded that, locking plate fixation for distal radius fractures provided favourable outcome in patients requiring operative intervention with early mobilization of wrist joint.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the patient related barriers affecting effective treatment of asthma. Methods: The study was a retrospective study for a period of one year by the Department of Pharmacology, ANMMCH, Gaya, Bihar, India from March 2019 to February 2020. 100 patients were included in the study. Results: The average age of the Patients was 38.52±23.77 Yrs. (Range- 6-83), majority of the patients were Male -55% and Females were 45%. 13% patients said that they were bored to take medication. 9% patients said they do not remember to take medication. 22% patients did not use inhaled corticosteroid as they were feeling better. 36% patients did not feel the need to take ICS. 18% patients said that it was wastage of money to use ICS. 2% patients had concern about side effects. Conclusion: It can be concluded from our study that the most common barrier found were bored to take medication, do not remember to take medication, feeling better, no need to take it, wastage of money concern about side effects.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the prognostic implications of admission hyperglycemia in non-diabetic acute myocardial infarction patients. Methods: The study was conducted in the Department of Medicine, Government medical College and Hospital, Madhepura, Bihar, India  on 100 non diabetic STEMI patients admitted from May 2022 to June 2023. There were 50 patients in group I and 50 patients in group II. Results: There were total 73 males and 27 females in the study. Group I had 15 females and 35 males. Group II had 12 females and 38 males. There was no significant difference between the number of males and females in two groups (p= 0.723). The mean age of patients in Group I and Group II were 60.42 ± 12.28 and 65.15 ± 13.37 respectively. There was no significant difference in patients’ mean age in between the groups (p= 0.550). There were total 22 smokers in the study of which 10 were in group I and 12 in group II. There was no significant difference in number of smokers in between the two groups (p= 0.282). There were total of 29 patients with history of alcohol consumption in the study. There was no significant difference in number of patients with history of alcohol consumption between the two groups. The history of hypertension was present in 31 patients out of which 13 patients were in Group I and 28 patients in Group II. There was no statistically significant difference in number of hypertensives between the two groups. Conclusion: Therefore, hyperglycemia has different effects on the prognosis of patients with diabetes or undiagnosed diabetes. Hyperglycemia is more predictive of adverse events in patients with undiagnosed diabetes compared to those with diagnosed diabetes. Although the pathophysiological mechanism underlying this phenomenon is unknown, there are several explanations. Some undiagnosed diabetic patients, especially those with severe hyperglycemia, may be at high risk because they have never been treated for diabetes.

DOI: 10.5281/zenodo.

Aim: The aim of this retrospective study was to determine the functional and radiological outcomes of the treatment of periprosthetic femoral fractures following hip hemiarthroplasty. Materials and Methods: This retrospective study was conducted on a series of 22 patients with periprosthetic femoral fractures after hip hemiarthroplasty. PFF was classified according to the Vancouver Classification system. The characteristics of patients, fractures and treatment outcomes in terms of complications, mortality and functionality were analysed. Radiological results were evaluated using the Beals and Tower’s criteria and Harris Hip Score (HHS) was used to evaluate the functional outcome. Results: The mean age was 74.2 years. Thirteen (59.1%) fractures occured in women while 9 (40.9%) in men, and the left hip was the most commonly involved (63.6%). As for comorbidities, 8 patients (36.4%) had a American Society of Anesthesiologists (ASA) score of 1-2 and 14 (63.6%) had ASA score of 3-4. The great majority of fractures were caused by slip down (81.8%), followed by spontaneous fractures (13.7%) and road traffic accident (4.5%). According to the Vancouver classification, there were 5 (22.8%) type A, 10 (45.4%) type B1, 2 (9.1%) type B2, 1 (4.5%) type B3 and 4 (18.2%) type C fractures. HHS showed good to excellent result in 31.9 % patient and fair to poor result in 68.1 % patients at final assessment. Conclusion: Periprosthetic femoral fractures after hemiarthroplasty are more common in women, and usually occur in patients with significant morbidity. The Vancouver classification is widely used to deal with these fractures and it has been emphasised that a proper assessment is important to avoid incorrect methods of treatment.

DOI: 10.5281/zenodo.

Aim: The aim of the present study wads to assess the prevalence of hypocalcaemia in neonates with unconjugated hyperbilirubinemia receiving phototherapy and to observe association of hypocalcaemia with duration of phototherapy. Material & Methods: A retrospective study conducted over a period of 18 months among 200 neonates (both term and preterm) in the Department of Paediatrics, JLNMCH, Bhagalpur, Bihar, India. Results: The mean age of preterm and term neonates was 118.12±42.78 and 122.28±41.19. There were more males as compared to females in preterm and term neonates. Mean birth weight of preterm and term in this study were 2723.17±246.44 grams and 3132.78±370.90 grams respectively. 10 term neonates experienced hypocalcaemia at 12 hours after starting of phototherapy. Similarly, 20 term neonates had hypocalcaemia 48 hours after starting of phototherapy. None of the preterm neonates enrolled in the study experienced hypocalcaemia after starting of phototherapy. It was observed that occurrence of hypocalcaemia was not significantly associated with the duration of phototherapy. On comparing the 0 hours calcium level with subsequent hours, the mean difference in total serum calcium levels in both term, and preterm babies were found to be statistically significant and the difference was seen to be more significant in term babies. Correlation analysis of a duration of phototherapy with hypocalcaemia showed a negative but insignificant correlation with a coefficient (r of −0.045 and a p=0.95). Conclusion: A reduction in the serum calcium with increased duration of phototherapy, however, it does not fall to the level where treatment is required. Hence it is not recommended to monitor serum calcium levels in neonates receiving phototherapy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare complications and mortality in AMI patients with diabetes and without diabetes. Material & Methods: A comparative study  carried out at Department of General Medicine, ESICMCH, Bihta, Bihar, India during the duration of 5 months. Study population was adult patients admitted with Acute myocardial Infarction. 50 diabetic AMI and 50 non-diabetic AMI were studied in the study for post AMI complication and mortality. Results: Group-1 has 50 cases (35 men, 15 females) while group-2 has 50 (40 males, 10 females). Most diabetics and nondiabetics were 45–54 years old. Men and women with diabetes had mean random blood sugar levels of 236.6±94.82 and 246.64±84.26, respectively. Stable angina was more common in non-diabetics (64%), unstable angina and MI in diabetics (26% and 18%). A substantial correlation exists between AMI types in diabetic and non-diabetic patients (P<0.001). Overall, 40 (80%) diabetics developed problems. 30 (60%), non-diabetics, had problems. Pump failure and sinus tachycardia were the most prevalent diabetes complications. Non-diabetics had sinus tachycardia most often, followed by bradycardia. A substantial link exists between diabetes and complications (p<0.05). Conclusion: The research found that diabetics had greater post-MI problems and mortality than non-diabetics.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the validity of sacral rhomboid diameter and maternal height (Ht) to predict contracted pelvis antenatally and to compare its individual efficacy with the combination models in antenatal prediction of the contracted pelvis. Methods: This was a hospital-based prospective study carried out in the and Department of Anatomy, ANMMC, Gaya and  included 200 Primigravidas at 37-40 weeks gestational age, aged 18-40 yrs with an uncomplicated pregnancy and singleton vertex presentation confirmed coming to the Antenatal clinic were randomly recruited in our study for the period of 12 months. Among 200 women, 140 of them delivered through spontaneous vaginal delivery, 12 women gave birth by caesarean section and 8 gave birth by assisted vaginal delivery (both formed the Contracted Pelvis group) while 40 women were excluded on follow-up. Results: Mean Maternal height (1.443m) was significantly lower in group 2 (p=0.000). Mean VD was less in group 2 and was statistically significant (p=0.000). Mean TD was less in group 2 and was statistically significant (p=0.000). Thus, the maternal anthropometric parameters i.e., Height, Weight, and Michaelis sacral rhomboid diameters (i.e., TD and VD) are valid in the independent prediction of Contracted pelvis antenatally (p< 0.05). When combination models were produced, HT+TD was the best predictor model at 10th percentile cut-off values with the highest PPV and Accuracy (76.74% and 92.32%) respectively. Conclusion: Smaller dimensions of the sacral rhomboid along with the maternal height are independent predictors of contracted pelvis. Transverse diameter of Michaelis (TD) along with maternal height at cut-off values enhanced the predictability of contracted pelvis and can be used as a promising and easily measurable screening parameter to detect the women at risk of Contracted pelvis antenatally.

DOI: 10.5281/zenodo.

Aim: To investigate autonomic function in individuals newly diagnosed with rheumatoid arthritis by using heart rate variability as a diagnostic tool. Materials and Methods: This study was done in the Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for one year. This study was designed to investigate autonomic function in newly diagnosed rheumatoid arthritis (RA) individuals using heart rate variability (HRV) as a tool. The study employed a cross-sectional design and included 50 patients newly diagnosed with rheumatoid arthritis. The inclusion criteria were as follows: patients newly diagnosed with rheumatoid arthritis as per the 2010 ACR/EULAR classification criteria, aged between 18 and 65 years, and with no prior treatment for RA. Exclusion criteria included a history of cardiovascular disease, current or past use of medications affecting the autonomic nervous system, other autoimmune or inflammatory diseases, diabetes mellitus, pregnancy, and smoking or alcohol use. Results:  The correlation between HRV parameters and the DAS28 score, which measures RA disease activity. A significant negative correlation was observed between SDNN and DAS28 (r = -0.45, p = 0.01), indicating that higher disease activity is associated with lower heart rate variability. Similarly, RMSSD showed a significant negative correlation with DAS28 (r = -0.38, p = 0.02), further supporting the link between increased disease activity and reduced parasympathetic function. The low frequency (LF) component also negatively correlated with DAS28 (r = -0.32, p = 0.04), suggesting that as RA disease activity increases, sympathetic modulation decreases. The high frequency (HF) component had a negative correlation with DAS28 (r = -0.28, p = 0.05), though this was on the threshold of statistical significance. Conversely, the LF/HF ratio had a positive correlation with DAS28 (r = 0.30, p = 0.03), indicating that higher disease activity may shift the balance towards sympathetic dominance, albeit with reduced overall autonomic activity. Conclusion: In conclusion, the study’s results highlight the significant relationship between reduced HRV and increased RA disease activity, suggesting autonomic dysfunction in newly diagnosed RA patients. These findings underscore the importance of monitoring autonomic function in RA patients as part of their comprehensive clinical assessment and support the potential use of HRV as a non-invasive marker for evaluating disease severity and guiding therapeutic interventions.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to examine the relationship between BMI, gender, and anxiety levels. Methods: A cross-sectional study was carried out Department of Medicine, JLNMCH, Bhagalpur, Bihar, India for one  year. In this study, 200 non-smoking, healthy medical students were included. Results: Our study found significant differences in BMI and anxiety scores between male and female participants. Men had an average BMI of 22.62 with a standard deviation of 3.16, while women had a lower average BMI of 20.02 with a standard deviation of 2.96, which was statistically significant (P-value < 0.0001). In terms of anxiety, men had an average score of 11.65±4.16, whereas women had a higher average score of 15.83±7.26. This difference was also statistically significant (P- value = 0.0007). The study investigated the correlation between BMI and anxiety scores. For male participants, the correlation coefficient (r) was -0.156 with a P-value of 0.314, indicating no significant relationship. Similarly, for female participants, the correlation coefficient was -0.108 with a P-value of 0.424, also showing no significant relationship. However, when considering the overall sample of 200 participants, the correlation coefficient was -0.236 with a P-value of 0.018. This result indicates a statistically significant negative correlation between BMI and anxiety scores across the entire sample. Conclusion: MBBS students exhibit a range of anxiety levels, ranging from low to severe. To alleviate this worry, it is advisable to implement various measures such as counseling and stress management approaches right from the beginning of the curriculum.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the efficacy of endoscopic stapedotomy in comparison to traditional microscopic stapedotomy. Methods: This prospective randomized  study applied on 40 patients (40 ears) presented to Department of ENT, Government Medical College and Hospital, Bettiah, Bihar, India for one year and diagnosed clinically and audiologically as stapedial otosclerosis. These patients divided randomly into two groups, 20 patients (20 ears) operated using the traditional microscopic stapedotomy procedure and 20 patients (20 ears) underwent endoscopic stapedotomy procedure. Results: The right ears of 7 (35%) of group A and 12 (60%) of group B were stapled. The left ears of 13 patients (65%) of group A and 8 patients (40%) of group B were operated on. No difference was statistically significant. Group A had a much shorter operational time than group B. All patients in both groups had their mean preoperative air-bone gap (ABG) measured at 500, 1000, 2000, and 4000 Hz. It was 30–58dB. The mean ABG in group A was 40 ± 7.5, with a median of 39.5, whereas group B had a mean of 38 ± 7.6. The difference is not statistically significant. At 4 months postoperatively, both groups’ patients’ mean ABG at 500, 1000, 2000, and 4000 Hz was assessed. From 3 to 45 dB. Group A had a mean postoperative ABG of 7.75 ± 11.5, whereas group B had 10.5 ± 10.2. Bony curettage and CTN modification differed significantly. Conclusion: Postoperative hearing is better than preoperarive one in both groups. Postoperative complications such as CTN injury and taste disturbance were less in endoscopic than microscopic stapedotomy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the plasma lipid profile parameters and their internal ratios to assess their relationship to cardiovascular risk in psoriasis patients.
Methods: The psoriasis patients attending Department of Skin & V. D, Nalanda Medical College & Hospital, Patna, Bihar, India were selected from January 2021 to December 2021. The study included a total number of 200 subjects including 100 normal control and 100 psoriasis patients. Results: Plasma levels of Total Cholesterol (TC), Triacylglycerols (TAG), VLDLC, LDLC, and HDLC in normal controls and psoriasis sufferers. The table shows that psoriasis patients had higher TC, TAG, VLDLC, and LDLC levels than normal controls, but lower HDLC levels. Compared to Group-1 and Group-2, Group-3 had considerably higher lipid profile measures except HDLC. Psoriasis patients have higher ratios of TC/HDLC, TC/LDLC, TAG/HDLC, and TAG/LDLC than normal controls, but lower ratios of TC/TAG, TC/VLDLC, HDLC/LDLC, HDLC/VLDLC, and LDLC/VLDLC. Conclusion: The current research indicated that psoriasis patients are sensitive group for the dyslipidemia produced cardiovascular issues and the ratio TAG/HDLC is fairly promising predictor of the cardiovascular complications in psoriasis. Further the findings reveal that the ratio TAG/HDLC is an excellent diagnostic of psoriasis disease severity.

DOI: 10.5281/zenodo.

Aim: To investigate the link between maternal haemoglobin levels and the birth weight of newborns. Material and Methods: A retrospective study was conducted in the Department of Pediatrics, MGM Medical College, Jamshedpur, Jharkhand, India for one year. A total sample of 95 pregnant women was included from data obtained from medical records of pregnant women. The inclusion criteria were pregnant women aged 20–35 years old whereas the exclusion criteria was pregnant women with high parity (more than 4 previous live births), history of abortion, multiple gestation, premature birth, a baby with congenital abnormalities, history of chronic diseases (hypertension, diabetes, asthma, heart disease, tuberculosis, and renal failure) and bleeding during pregnancy (placental abruption and placenta previa). Results: Of 95 pregnant women included, 44.2% had ever given birth for once (1 parity). The majority were graduated from senior high school (45.3%), and housewife (61.1%). The proportion of maternal anemia and low birth weight were 30.5% and 15.8%, respectively. The mean of maternal hemoglobin level was 11.6±1.2gr/dl and birth weight was 2927±398gram. The linear test was used after normality test. It showed   p-value=0.783 (p>0.05), this result indicates that there was a linear relationship between maternal hemoglobin level and infant birth weight, as shown in Figure 1. Furthermore, the Pearson correlation test was used to see how close the relationship between the two variables. Pearson correlation test showed that the value of the Pearson correlation coefficient (r) was -0.093, indicating a very weak correlation with a negative correlation and value of p=0.369 (p>0.05), showing no significant relationship between maternal hemoglobin level and infant birth weight. Conclusion: To conclude, our study shows that there is no correlation between hemoglobin levels of pregnant women with birth weight. Other factors for low maternal hemoglobin need to be further explored.

DOI: 10.5281/zenodo.

Background: A variety of viruses, bacteria, fungi, parasites, spirochetes, chemicals, and poisons can produce acute encephalitis syndrome, a set of clinical neurologic manifestations. Acute encephalitis syndrome due to an unknown agent is defined by AES guidelines as a suspected case in which no diagnostic testing is done, or testing is done but no aetiological agent is found, or in which the test results are unclear. Children’s acute encephalitis syndrome is caused by a confluence of multiple variables. The study’s objective is to assess the environmental and social elements, which are crucial to AES. Materials and Methods: The research was prospective, hospital-based, and non-interventional in nature. The study was carried out from October 2020 to September 2022 at the P.M.C.H. Paediatric Department in Patna, Bihar. Children and infants hospitalised at PMCH, Patna were part of the study. AES standards were followed in defining all cases, and 148 babies and children were chosen for inclusion. For statistical analysis, the Chi-square test, percentage, and proportion were used. Results: Out of the 148 babies and kids who were chosen, 130 (87.8%) had the greatest AES in a rural location. The monsoon season had the highest incidence of AES, 72 (48.6%), with a seasonal incidence spanning from March to July. The age range between 1 and 5 years old has the highest frequency of AES. There was a statistically significant correlation between the age of the children and AES. Males were more likely than females to have AES. The inhabitants in kachcha (mud) houses had the highest AES. AES was highest in children of labourers/farmers, at 134 (90.5%). AES was highest, with a mother’s illiteracy rate of 133 (89.9%). The highest incidence of AES was found in Hinduism. 134 (90.5%) of the AES cases involved malnourished or undernourished children. Conclusion: The primary determining risk factors for AES were sociocultural and environmental variables. The most prevalent risk factor among them was malnutrition or under nutrition, which was followed by maternal illiteracy, employment (labour and farming), Hindu religion, age between 1 and 5 years, seasonal variation (March to July, mostly in June), a lower standard of living, a higher prevalence of male children, and the use of formula feeding. Increased prevalence of these contributory factors serves as a reminder to the government and other healthcare professionals to step up their monitoring of AES-related morbidity and mortality and to develop preventative, control, and reduction efforts.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the Functional outcome of Intramedullary Interlocking Nail and Minimally Invasive Plate Osteosynthesis for distal tibial extra articular fractures. Methods: The present study was conducted in the Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences and Hospital, Budge Budge, Kolkata, West Bengal, India for one  year and 200 patients with confirmed Extra articular distal tibial fractures without any intraarticular extention were included in the study. Results: Patients varied in age from 19 to 75, with a mean of 43.7 years and SD of 16.5 years. The majority of patients were 36–45 years old and 62% male. 49% transverse, 43% oblique fractures. Nailing was 60% and plating 40%. The average period for complete weight bearing was 10.06 ± 1.45 weeks, statistically significant (P < 0.0001). The average union time was 17.23 ± 2.48 weeks (range 15-24 weeks), indicating substantial results (P < 0.0001). 55% showed very much improvement followed by 20% much improved according to Olerud and Molander Ankle score. Conclusion: Both ILN and MIPO are reliable fixing procedures that retain most osseous vascularity and fracture haematoma for biological healing. Both reduce soft tissue dissection and invasiveness.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the serum Ferritin level in Dengue patients and correlation of same, with severity and complications. Methods: The study was conducted in the  Department of Internal Medicine, Tertiary Care Centre, India and newly diagnosed or suspected 100 adults and children were included. Results: Out of the investigated patients (55%) patients were males and the rest (45%) were females. The minimum age of the population was 10 years and the maximum age was 81 years. Incidentally both of the extreme ages were from the female group. Age group 20-29 years forms 30% of the total population. 10-19 years group comprises 25% and 30-39 years forms 20%. Almost three fourth (75%) of the patients were aged less than 40 years.  History of fever was present in all cases. The average day of fever in which patients got admitted was 4.6±1.8 days and the average day of illness in which the fever subsided was 5.08±1.62 days. Hypertension was the most common co-morbidity found in patient population (25 patients) and diabetes was the second found in 15 patients. Other co morbidities include hypothyroidism, HIV reactivity, COPD. Out of 50 patients, 25 patients were categorized as non-severe. Among the rest 14 were non severe dengue with warning signs and the other 11 were severe dengue. The level of serum ferritin is different in all three groups that reach the level of significance statistically. The value was significantly high in severe dengue and in Non severe dengue with warning signs than non severe dengue. More importantly the higher value significantly demarcates severe dengue from non severe dengue with warning signs. Conclusion: Dengue virus infection can present in any form and with any symptom related to any system in our body. This concept would definitely be helpful in making suspicion as early diagnosis and management with hydration would be necessary to prevent any complication. The fever in dengue usually persists for 5-6 days but may persist for 8 days. This needs a good judgment before going to an alternate diagnosis. Serum ferritin is a fairly good marker to prognosticate the severity. The values at the time of admission are significantly different in all the three groups of severity.

DOI: 10.5281/zenodo.

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 12 months at Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, 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 100 patients in the study. Results: The study included 200 patients with mean age 42.8 ± 12.8 years (range 18–79) and mean stone size 30.5 ± 9.7 mm (range 20–70). Mean operative time was 62.8 ± 30.4 min (range 25–180). The average number of tracts per renal unit was 1.26. Mean hospital stay was 2.9 ± 0.9 days. The overall intraoperative and 30‑day postoperative complication rate was 7%, with the majority being Clavien classification Grades I and II. 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. Grade III complications were observed in only 1% as one patient required renal angioembolization for severe hematuria 7 days following the procedure. On multivariate analysis, independent risk factor for significant residual stones was the presence of the stones in multiple sites inside the PCS (relative risk: 13.44, 95% confidence interval: 1.78–101.43, P = 0.012). 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.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine TLC and CRP efficacy in diagnosis of acute appendicitis. Methods: The study was conducted in Department of Surgery at Lord Buddha Koshi Medical College and Hospital. The data was studied for the period of 1 year. A total number of 200 cases were taken diagnosed as acute appendicitis. Results:  62 (31%) were female and 138 (68%) were male. Patient’s age group ranged from 14 years to 59 years. Maximum group of patients belonged to 21-30 years (68 patients i.e., 34%). Group A had inflamed appendix (75%) and the negative appendectomy rate in this study was 25% in Group B. Distribution of cases by histopathology correlation in sex Group A 100 males and 46 females had inflamed appendix. Group B 38 males and 16 females had normal appendix. Among 150 Inflamed appendix cases, CRP was found to be raised in 120 cases and normal in 30 cases. Among 50 normal appendix cases, CRP was found to be raised in 14 cases and normal in 36 cases. Among 150 inflamed appendix cases, TLC was found to be raised in 118 cases and normal in 32 cases. Among 50 normal appendix cases, CRP was found to be raised in 20 cases and normal in 30 cases. Conclusion:  TLC and CRP are useful in diagnosis of acute appendicitis. Appendicitis is common in adult and children. In the present study association of CRP and acute appendicitis has shown to be significant, but it cannot replace surgeon’s clinical acumen.

DOI: 10.5281/zenodo.

Aim: The aim of study to know the pattern of injury in terms of severity and outcome in patients with head injuries admitted in trauma unit of a tertiary care Centre in Bihar region. Methods: This study included 200 patients admitted Department of General Surgery, SKMCH, Muzaffarpur, Bihar, India. Thereafter a complete history of all patients of head injury sustained due to RTA or fall was taken after taking written & informed consent. Those with poly trauma and others not attending the OPD for check-ups timely were eliminated from study. After admission in head injury unit, physical examination was performed in all subjects. Results: It was observed that incidence of head injury was more in males than the females. Out of 200 cases, 175 (87.5%) victims were males and 25 (12.5%) cases were females. Out of 200 cases, maximum incidence of head injury was found in the age group of 21-30 years comprising 50 (25%) cases, followed by 31-40 years 46 (23%) and 41-50 years 40 (20%). The age group 51-60 yrs comprised of 34 (17%) cases. The other affected groups were 61-70 years and 71-80 years group comprising of 12 (6%) cases and 8 (4%) cases respectively. It was observed that road traffic accident was the commonest cause of head injury seen in 144 (72%) cases. This was followed by fall from height 32 (16%) cases and assault 20 (10%) cases. The other causes like fall of tree or wall over-head were seen in 2% cases. It was seen that most of the cases 122 (61%) died within 24 hours of admission to the hospital. 28 (14%) cases survived for 1-2 days. 20 (10%) of cases survived for 2-3 days. 20 (10%) cases survived for 3-7 days and about 10 (5%) of cases survived for more than 7 days. Thus the most fatal period was first 24 hours. Out of 200 cases, 15 cases expired. Conclusion: The study showed that most head injury victims brought to a tertiary care hospital, were due to road traffic accidents and males are more prone to get Head injury. So it warrants the urgency to establish good pre-hospital care and provision of efficient and prompt trauma services at Road side to prevent mortality aroused from RTA. RTA remains the most common cause for Head injury and demands good neurosurgical care for such patients.

DOI: 10.5281/zenodo.

Aim: A retrospective observational study on mycotic keratitis. Materials and Methods: This study was conducted in the department of Ophthalmology, AIIMS, Patna, Bihar, India from July 2022 to June 2023. The outpatient department saw a total of 800 patients, of whom 90 cases (11.25%) of microbial keratitis and 8 cases (8.8%) of keratomycosis were observed. Upper eyelids were everted to exclude foreign body. Size and depth of the lesions were measured and examined for satellite lesions. Prerequisites were: to numb the cornea, topical 0.5% proparacaine eye drop , sterile universal speculum is used to split and fix the lids and to get a clear view of an ulcerated cornea it also guards against contamination from the conjunctiva and lid edge, to remove the ulcer, a disposable no. 15 bard parker scalpel blade was employed, glass slides measuring 10cm X 4cm X 0.2cm, gram’s staining products, 10% KOH -related preparatory materials, sterile culture swipes for specimen collection. On Blood sugar and chocolate agar for Aerobic organism, Thiogloycolate broth for Anaerobic organisms, and on Saboraud’S agar for fungi. Results: In the current study, agricultural labourers have the highest incidence of fungal ulcers (6), i.e. 80%, others (20%, or 2 cases) (Rickshaw drivers, students, and business people). The current investigation revealed that Fluconazole is effective against Candida Albicans and Natamycin 5% eye drops are effective against Aspergillus species. All of the straightforward fungal corneal ulcers, or those lacking hypopyon, responded well to natamycin eye drops. Conclusion: The main cause of a fungus-induced corneal ulcer is trauma. More filamentous fungus than yeast are found. All filamentous fungus were dominated by Aspergillus species. Ulcers with a mix of bacteria and fungi were also found. People with impaired immune systems and diabetes were most affected. Natamycin was the better option for the treatment of fungal keratitis. Filamentous fungi (Aspergillus species, fusarium, and curvularia) responded effectively to Natamycin 5% eyedrops. Cases that received good responses revealed corneal opacity.

DOI: 10.5281/zenodo.

Aim: To determine the impact of laparoscopic surgery on liver function. Material and Methods: This Prospective study was conducted in the Department of General Surgery, Jawaharlal Nehru medical college and Hospital, Bhagalpur, Bihar, India for one year. This prospective study was done to evaluate the effect of laparoscopic surgeries on hepatic function. The patient population included in the study were selected by purposive sampling method from those who underwent laparoscopic surgeries. All the patients studied were selected using Purposive sampling method for laparoscopic surgeries after routine history taking, physical examination and investigations to exclude pre-existing liver diseases. Various laparoscopic procedures were performed on 103 patients and they constituted the study population. Results: In this study preoperative mean AST was 34.83±24.80 U/L which increased to 53.8±28.96 U/l on 1st post- operative day and again reduced near to pre- operative value of 37.06±22.08 U/l on 3rd post-operative day. There was significant increase in mean AST values between Pre-operative and 1st Post- operative day (p<0.001) . In this study preoperative mean ALT was 35.93±26.51 U/l which increased to 54.58±29.28 U/l on 1st post- operative day and again reduced near to pre- operative value of 37.06±22.08 U/l on 3rd post-operative day. There was significant increase in mean ALT values between Pre-operative and 1st post-operative day (p<0.001). In this study preoperative mean ALP was 98.42±51.64 U/l which increased to 122.96±46.67 U/l on 1st post- operative day. There was significant increase in mean ALP values between Pre-operative and 1st Post- Operative day (p<0.001). In this study the pre-operative mean serum total bilirubin (STB) was 0.62±0.31 mg/dl, which raised to 0.82±0.36 mg/dl on 1st post-operative day and again reduced to 0.63±0.27 mg/dl on 3rd post-operative day. There was significant increase in mean STB between pre-operative and 1st post-operative day (p value <0.001). Conclusion: We conclude that, all laparoscopic procedures cause a transient elevation of serum bilirubin and liver enzymes, elevation in the liver enzymes correlated directly with the duration of pneumoperitoneum, elevation in the serum bilirubin but doesn’t correlates with the duration of pneumoperitoneum, these elevation does not have clinical significance in patients with normal hepatic function.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the changes in spirometric parameters of the patients following laparoscopic cholecystectomy as compared to preoperative values. Methods: The study was carried out in Department of General Surgery, ANMMCH Gaya, Bihar, India over a period of 2 years. It was a prospective observational comparative study and included 100 patients admitted in the Department of General Surgery, ANMMCH Gaya, Bihar, India for undergoing laparoscopic cholecystectomy. Results: In patients who underwent laparoscopic cholecystectomy, the BMI of<18.5 in 4%, 18.5-24.9 in 40%, 25-29.9 in 38%, 30-34.9 in 14%, 35 in 4% was observed. 4 (4%) had a restrictive pattern of lung function and 8 (8%) had an obstructive pattern of lung function. On the second post-operative day of laparoscopic cholecystectomy, 32 patients (32%) had normal lung function, 56 (56%) had the restrictive pattern and 10 (10%) had an obstructive pattern of lung function on spirometry. On the seventh postoperative day of laparoscopic cholecystectomy, 76 patients (76%) had normal lung function, 18 (18%) had restrictive pattern while 6 (6%) had an obstructive pattern. On the second postoperative day, the majority of the patients had a restrictive pattern of lung function with a p-value of (0.005) which was statistically significant. We observed that on the seventh postoperative day, only 6 (6%) had an obstructive pattern of lung functions. On the seventh postoperative day, 76% had normal lung function, 18% had a restrictive pattern, while 6% had an obstructive pattern. Conclusion: Our results for pulmonary function tests after laparoscopic cholecystectomy show a restrictive pattern of pulmonary dysfunction, which was statistically significant. Laparoscopic cholecystectomy may reduce the degree of diaphragmatic dysfunction and the incidence of pulmonary complications. Residual Pneumo- peritoneum has no influence on pulmonary function after diagnostic laparoscopy. This restrictive pattern of pulmonary dysfunction is predominant on the second postoperative day and usually returns to normal in the majority of the patients by the seventh postoperative day.

DOI: 10.5281/zenodo.

Aim: To compare the effects of injecting ropivacaine 0.75% alone with injecting ropivacaine 0.75% plus dexmedetomidine in lumbar epidural anesthesia for vaginal hysterectomies. Materials and Methods: This study was conducted in the Department of Anesthesia, SKMCH, Muzaffarpur, Bihar, India for 12 months. This is a comparative study undertaken after obtaining permission from ethical committee. Fifty patients, posted for elective vaginal hysterectomies belonging to ASA class I and II were selected for the study. This study group was randomly divided into two with 25 patients in each group. Group R (n=25) 20ml of 0.75% ropivacaine and Group RD (n=25) 20ml of 0.75% ropivacaine + 1µg/kg of dexmedetomidine. Adult female patients aged between 25 to 65 years, Patients of ASA class I and II, Weight between 50-70 kilograms and Height (150-180) cms were included in this study. Results: Average time for sensory onset in group R and group RD was 11.08minutes and 9.92minutes respectively. The difference was highly significant between the groups (p=0.028). Average duration of sensory block was 226.4.0±19.76 minutes in group R and 495.30±15.67 minutes in group RD. There was statistically highly significant difference between the groups (p<0.0001). Average time of onset for motor block in group R and group RD was 32.88 minutes and 19.00 minutes respectively. There was statistically significant difference in both the groups. (p<0.0001). Average duration of motor blockade was 184.00±17.79 minutes in group R and 423.20±27.94 minutes in group RD. There was statistically highly significant difference between the groups. (p< 0.0001). The maximum level of sensory block attained by group R and group RD was T4 in both groups. 18 patients of group RD attained T4 level whereas only 4 patients of group R attained the same level which was highly significant. (P 0.0006). No statistically significant difference was seen in diastolic BP between both the groups (p=0.999) at various intervals. No statistically significant difference was seen in average heart rates in both the groups at various intervals. (p=0.93). Average sedation score at 20 minutes in Group R and Group RD were 2.24 and 3.28 respectively. At 90 minutes the difference increased and average sedation score in Group R and Group RD were 2.56 and 4.16 respectively. Conclusion: Dexmedetomidine given epidurally with ropivacaine produces synergistic effect of profound and prolonged motor blockade and sensory blockade with better sedation and hemodynamic stability. Ropivacaine and dexmedetomidine can be a safe and effective agent for epidural blockade in Vaginal hysterectomies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the performance of maximum sequential organ failure assessment (SOFA) score to predict the outcome of patients admitted to ICU. Methods: This prospective, observational, cohort study was done during one‑year period at critical care unit Institute of medical sciences BH which is 36 bedded critical care centre. The study recruited 100 women aged 18 years or more between 28 weeks of gestation and up to six weeks post‑partum who were referred to ICU from the obstetric unit of our hospital with severe obstetrical or non‑obstetrical complications and who stayed for more than 48 hours in ICU. Results: There was no difference among two groups (survivor group and non‑survivor group) regarding age, gestational age, cause of admission (obstetric or non‑obstetric cause), socio‑economic status, or time of admission (ante‑partum or post‑partum) but relatively more women were anaemic and had received inadequate ante‑natal care in non‑survivor group (P < 0.05). There was no difference among survivors and non‑survivors in relation to duration of ICU stay and interventions required. Mean total maximum SOFA score was higher in non‑survivors than in survivors. All the individual organ/system scores were significantly higher in non‑ survivors than in survivors (P < 0.001) except in coagulation. The patients with failure of one organ (maximum SOFA score 3.18 ± 1.46) had mortality rate of 11.11% while patients with failure of all six organs (maximum SOFA score 20.52 ± 1.86) had a mortality rate of 91.66%. Conclusion: The present study concluded that use of SOFA score had good prognostic power when applied to obstetric patients with severe illness admitted to ICU. The score is easy to calculate and requires easily available laboratory and other variables. Based on this, obstetricians can transfer the women with severe illness at early stage to appropriate referral centre. Being young and otherwise healthy, if these patients receive timely intervention in ICU then they have better chances of survival.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the radiological, clinical and patient-reported outcomes of patients with intraarticular calcaneal fractures treated surgically. Methods: The single-center, prospective, observational research at the Department of Orthopaedic Surgery, JNKTMCH, Madhepura, Bihar, India, examined calcaneal fracture patients. Study lasted 1 years. In this research, 22 patients (25 calcaneal fractures) were operated on and followed for 18 months. Results: The research had a mean age of 46.4 ± 12.48 years. More men than women were diagnosed. These fractures were mostly Sander’s type 2. Unilateral fractures outnumbered bilateral. 36.6% had associated injuries. The average operation time was 5.5 ± 1.3 days, and the average hospital stay was 8.2 ± 3.7 days. In the study, 3 cases had pre-operative Bohler’s angle ≥20° and 22 had <20°. Most post-op patients had excellent AOFAS scores at 18 months. The two groups’ AOFAS scores were not significantly different. Both groups had most patients with Allmacher grades 0 and 1. There was no significant difference between groups. Pre- and post-operative Bohler’s angles were compared 18 months after surgery. In instances with Pre-operative Bohler’s angle ≥20°, Post-operative Bohler’s angle 25–29° was recorded in 2 cases. Pre-operative Bohler’s angle <20° was associated with post-operative angle 25-29° in 19 cases, with a statistically significant difference between two groups. Conclusion: Open reduction and internal fixation are the best treatments for joint depression type and Sanders Type II/III calcaneal fractures, with favorable short-term outcomes.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the orthopaedic management of club foot at Bihar region. Methods: This cross-sectional research was conducted at the Department of Orthopaedics at JNKTMCH, Madhepura, Bihar, India. It focused on infants with idiopathic club foot who were less than one year old and came to the Orthopaedic Department throughout a two-year period. These infants were included in the study. During the two-year period, a total of 200 patients were included in the research after providing written informed permission. All pertinent patient information, including age, sex, and pre-intervention modified Pirani score, was recorded. Results: Among the patients, 43% were in the 0-3 (months) age bracket, 31% were in the 3-6 (years) bracket, 17% were in the 6-9 (years) bracket, and 9% were in the 9-12 (years) bracket. Of the total patients, 64% were female and 36% were male. The post-treatment Pirani score was significantly different from the pre-treatment score in all age groups. For 0-3, it was 5.36 ± 2.16 and 1.56 ± 1.034 (t=8.71,df=70, p<0.01), for 3-6, it was 5.49± 0.80 and 1.57 ± 1.33 (t=11.44,df=54, p<0.001), for 6-9, it was 5.78± 2.12 and 2.16±0.94 (t=9.81df=22, p<0.05); and for 9-12, it was 5.34 ± 1.26 and 1.84 ± 1.32 (t=10.22, df=20, p<0.001). Conclusion: We found that the ponsetti technique was effective in treating idiopathic club foot, as indicated by the Pirani score for club foot evaluation. Almost all patients responded favorably to this therapy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the impact of intravascular contrast agent on apparent diffusion coefficient measurements of ovarian neoplasms using diffusion-weighted imaging. Methods: A Retrospective study was conducted in the Department of Radiology, Mahavir Cancer Sansthan and research Centre, Phulwari sharif Patna, Bihar, India for the period of six months. 50 patients selected based on universal sampling, with Study population being women with newly diagnosed ovarian tumors who underwent CEMRI study to evaluate the nature of tumor and extent. Results: Majority of the patients belonged to >60 years of age and 60% had benign tumors. 20 patients had size 151-200 in mm. In benign ovarian tumors, Pre contrast mean ADC was 1.48± 0.46 and Post contrast mean ADC value was 1.40±0.62 with statistically insignificant P value. In malignant ovarian tumors, Pre contrast mean ADC was 0.91±0.20 and post contrast mean ADC value was 0.94±0.23 with statistically insignificant P value. ADC values of solid and cystic components in both benign and malignant tumors before and after administration of contrast, did not make statistically significant difference. Conclusion: ADC measures using our approach were not significantly changed after contrast administration for ovarian tumors at 1.5T. Our findings support the possibility that DWI optimized may be obtained before or after DCE-MRI without compromising important clinical information.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the outcome of acute ischemic stroke patients treated with tenecteplase. Material & Methods: A prospective observational study on consecutive ischemic stroke patients above 18 years of age coming to Department Of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India and treated with tenecteplase was included in the study. 40 patients were included in the study. Results: In the trial, 40 patients received tenecteplase IV stroke thrombolysis. The research had a mean age of 61.36±12.48 years, with 70% of participants being male. Hypertension predominated at 60%, followed by dyslipidemia at 50%. Most patients had major artery stroke subtype, with all 20 infarct regions in the middle cerebral artery. The mean time from symptom start to medical emergency was 116 (±11.49) minutes, whereas the mean “door to needle” duration was 55 (±17.23) minutes. At baseline, the research individuals had a mean NIHSS score of 11 (±3.16) and a median mRS score of 5 (range: 3–5). Primary clinical effectiveness outcome: NIHSS score improvement of 4 or more points at 24 h. The mean NIHSS scores at 2 and 24 hours were 10.48 (±5.16) and 9.34 (±5.23), respectively. We utilized “one-way repeated measures analysis of variance” to find a significant difference in baseline and 24-h NIHSS scores (P = 0.017). Conclusion: Teneplase is the safest, quicker, and cheaper thrombolytic drug for acute ischemic stroke, and it works in rural and urban settings. More investigations on this innovative thrombolytic drug will show its superiority even in rural settings, reducing stroke epidemics, particularly in this endovascular care era.

DOI: 10.5281/zenodo.

Aim: To detect the presence of mycobacterium tuberculosis by sputum examination procedures at a specialized medical center offering advanced treatment. Materials and Methods: The Study was conducted as a prospective epidemiological study. Total of 143 sputum samples obtained from both in-patients and out-patients of Department of Microbiology, Jawaharlal Nehru medical college and Hospital, Bhagalpur, Bihar, India for one year. TB and RD and Orthopedics were subjected to decontamination by both HS-SH method and NALC-NAOH methods. Slides were then examined under oil immersion for acid fast bacilli by conventional Ziehl-Neelsen staining microscopic method. Results : Out of 143 microbiological sputum samples, 104 were found to be positive for acid fast bacilli by both Modified petroff’s method and Hypertonic Saline Sodium Hydroxide method (HS-SH) of concentration and decontamination and 39 samples were negative by both these methods. Sensitivity, Specificity, Positive predictive value and Negative predictive value of the HS- SH method was found to be 100%. Conclusion: In conclusion, the HSSH sputum decontamination method is equally sensitive, specific, cost-effective, feasible and less time consuming procedure compared to the gold standard NALC-NaOH method for decontamination of Mycobacterium tuberculosis from sputum samples and can be routinely used in all peripheral health centres because of the low cost, especially in developing countries.

DOI: 10.5281/zenodo.

Background and Objectives: Congestive heart failure (CHF) is a major public health issue with significant morbidity and mortality worldwide. This study aims to analyze the clinical and etiological profile of patients diagnosed with CHF in a tertiary care hospital, identifying key factors contributing to the disease and its outcomes. Methods: A cross-sectional study was conducted in Department of Medicine, Government Medical College. Bettiah, West Champaran, Bihar, India involving 100 patients diagnosed with CHF. Data on demographics, clinical presentation, underlying etiologies, comorbidities, echocardiographic findings, laboratory parameters, and treatment outcomes were collected and analyzed. The study sought to identify the most common causes of CHF and assess the relationship between these factors and patient outcomes. Results: Ischemic heart disease was the leading cause of CHF (45%), followed by hypertension (30%) and dilated cardiomyopathy (15%). A significant proportion of patients had comorbid conditions, including diabetes mellitus (40%) and chronic kidney disease (25%). Echocardiographic findings revealed that 60% of patients had a reduced ejection fraction (LVEF < 40%), indicative of systolic heart failure. The overall in-hospital mortality rate was 12%, with higher mortality observed in patients with ischemic heart disease and advanced New York Heart Association (NYHA) class. Conclusion: Ischemic heart disease, hypertension, and dilated cardiomyopathy are the predominant causes of  CHF in this population. The presence of comorbidities significantly impacts patient outcomes. Early diagnosis and aggressive management of underlying etiologies and comorbid conditions are essential to improving the prognosis of CHF patients.

DOI: 10.5281/zenodo.

Aim: Clinical investigation of therapeutic approaches for cystic edema of the scrotum. Material and Methods: A retrospective study was conducted in Department of Surgery, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India from June 2019 to May 2020. Patients aged up to 70 years, cystic swellings from testis, and its coverings, epididymis, spermatic cord and from the scrotal skin are included in this study. Acute swellings of the testis, inguinoscrotal swelling, torsion of testis, congenital hydrocele are excluded in this study.  100 patients aged up to 70 years were enrolled in this clinical study with written informed consent. Respiratory and per abdomen examination were done. Blood investigations were done to rule out eosinophilia and microfilaria, lymphocytosis and increased E.S.R. Urine examination was done to rule out associated any urinary tract infection. Scrotal ultrasound was done in all cases. Results: A total of 100 cases were studied during the period of two years in medical college and hospital. Most of the patient presented with swelling as chief complaint 86 cases, 14 cases had pain along with scrotal swelling. Sidewise distribution of cystic swellings of scrotum indicated higher incidence on the right side of the scrotum accounting for 60 of cases. Total of 30 cases were seen on the left side. While bilateral swelling constituted 10 cases of all cases among these 1 case was multiple sebaceous cyst. Primary vaginal hydrocele formed the most common cause of cystic swellings of the scrotum encountered in this study. Next common cause being epididymis cyst which constituted in 16 cases. Other causes were Spermatocele in 6 cases and multiple sebaceous cyst in 2 case. The age distribution of primary vaginal hydrocele varied from the age group of 11-20 years up to 61-70 years. Maximum number of cases of primary vaginal hydrocele was encountered in the age group of 41-50 and 51-60 years- 11 cases each followed by 6 cases in the age group of 61-70 years. A total of 66 patients were discharged between 0- 5 days, earliest was among excision for sebaceous cyst, 32 patients were discharged between 6-10 days and 2 patient was discharged between 11-15 day. Patients who underwent Lord‘s procedure had a record of early discharge than compared to eversion of sac for primary vaginal hydrocoele. Conclusion: A cystic swelling of the scrotum poses a common surgical problem. Primary vaginal hydrocoele was the commonest cystic swellings of scrotum. Most of the cystic swellings were treated surgically with good results. Lord’s procedure was the least to have post-operative complication.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical pattern and course of nephrotic syndrome in children. Material & Methods: The study was conducted on diagnosed nephrotic syndrome patients, in the Department of Pediatrics, Laxmi Chandravanshi Medical College, (LCMCH) Palamu, Jharkhand, India. The study was a retrospective analysis of medical records and prospective follow-up of patients were conducted over period 2 years. Results: Of the 100 patients, 65 were males (65%) and 35 were females (35%). It was found that 88 (88%) children had first episode within 1-5 years of age, 4 (4%) were of 5-11 years and 8 (8%) were above 11 year of age. Majority 62 (62%) of cases had hospital stay of 7-14 days. Infectious complications were reported in majority of the patients 36%. According to diagnostic classification, SSNS was seen in majority of cases. The steroids and diuretics were used as the treatment modality in all the cases (100%) in the study, and 72 (72%) cases required the use of immunomodulators of which levamisole was the most commonly used agent. Mycophenolate mofetil and tacrolimus were used only in those cases that failed therapy with first line (levamisole + cyclophosphamide) immunomodulators. Conclusion: This study concludes that the age of onset of nephrotic syndrome was around 5 years with a male predilection. SSNS was the commonest type with majority of the patients having a hospital stay of 7-14 days. Among the complications, UTI was the most common infectious complication, whereas drug toxicity was the non-infectious complication. Most of the relapses were triggered by respiratory infections, which leads us to conclude that prevention of respiratory infections by observing respiratory etiquette, early and aggressive treatment of infections and respiratory protective vaccines could minimise the occurrence and number of relapses.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare complications and mortality in AMI patients with diabetes and without diabetes Material & Methods: A cross sectional study carried out at Department of Medicine, Laxmi Chandravanshi Medical College, (LCMCH) Palamu, Jharkhand, India during the duration of 24 months. Study population was adult patients admitted with Acute myocardial Infarction. 100 diabetic AMI and 100 non-diabetic AMI were studied in the study for post AMI complication and mortality. Results: Group-1 consists of 100 cases (70 males and 30 females) and group- 2 consists of 100 cases (80 males and 20 females). Most of the patients in both group diabetic and nondiabetic belonged to age group 45 – 54. The mean random blood sugar in diabetes group in male and female were 236.6±94.82 and 246.64±84.26 respectively. Maximum number of cases of Stable angina belonged to Non-Diabetic group (65%) and unstable angina and MI belonged to Diabetic group (27% and 18%) respectively. There was a significant association between types of AMI among the diabetic and the non-diabetic groups (P<0.001). Among the diabetic patients total 80 (80%) patients had complications. In the non diabetic patients complications were observed in 60 (60%). Pump failure was most common complication followed by sinus tachycardia in diabetic patients. Among the non diabetic patients, sinus tachycardia was most commonly observed followed by bradycardia. There was a significant association between diabetes and complications (p<0.05). Conclusion: The present study concluded that Post MI complications and Mortality is significantly more among diabetics compared to among non diabetics.

DOI: 10.5281/zenodo.

Background and Aim: Total Knee Arthroplasty (TKA) continues to be a crucial procedure for treating severe gonarthrosis. Thanks to advancements in this procedure, both the surgical techniques and implants have significantly improved, resulting in a higher quality of the surgical procedure and a better quality of life for the patient. This study aimed to determine the optimal timing for performing PR based on the extent of cartilage involvement in the patella, as classified by Outerbridge. Material and Methods: Present Study involves 50 patients with severe primary osteoarthritis of the knee, aged between 45-85 years. The population was divided into two groups based on the assigned Outerbridge class. <Group A consisted of patients with Outerbridge Grades I, II, and III, while Group B included patients with Grade IV. Group A consisted of 40 patients; with 20 having PR and 20 not having PR. Group B consisted of 40 patients, with an equal distribution of 20 patients with PR and 20 patients without PR. A comparison was made between the incidence of the need for revision patellar resurfacing in Groups A and B using Fisher’s exact test. Results: Among the 80 patients who underwent total knee arthroplasty, half of them had their patella re-surfaced while the other halves were managed without patellar re-surfacement. The study results indicate that there is no advantage to resurfacing the patella in patients with patella in Outerbridge class I & II. However, for patients in group III & IV, there was a significant difference observed. Group B had a higher frequency of revision surgery to resurface the patella due to patellar pain compared to Group A. In Group A, there was only one patient who needed a secondary PR, while in Group B, three patients required PR. Conclusion: Patellar resurfacing is something that ought to be taken into serious consideration for patellae that are categorized as Outerbridge Grade III and IV.

DOI: 10.5281/zenodo.

Aim: The aim of present study was to compare dexmedetomidine with tramadol on the treatment of post-spinal anesthesia shivering. Methods: Present study was a retrospective study, conducted in Department of Anesthesiology, Sri Krishna medical college and hospital, Muzaffarpur, Bihar, India from January 2023 to December 2023. Total 50 patients were studied in present study, 25 patients each were divided in group D – intravenous dexmedetomidine 0.5 μg/kg and group T- intravenous tramadol 0.5 mg/kg. Results: General characteristics such as mean age (years), gender (M:F), ASA grading (I/II), duration of surgery and duration of spinal anaesthesia were comparable in both groups and difference was not statistically significant. In present study, patients from general surgery, gynaecological and orthopaedic surgeries were included. The difference between two groups was not statistically significant. Score 3 and 4 patients were treated, patients with score 3 were more than score 4 and difference between two groups was not statistically significant. Onset of shivering after spinal anaesthesia was at 25.4 ± 9.5 min in group D while at 24.7 ± 10.3 min in group T, difference was not statistically significant. We noted delayed cessation of shivering after medication in group T (4.91 ± 0.93 min) than in group M (3.12 ± 0.71 min), difference was statistically significant (p-0.01). We noted 100% response in both groups. No recurrence or side effects were noted. Conclusion: Intravenous dexmedetomidine controls shivering faster than intravenous tramadol and thereby reduces patient discomfort time. Slight sedation with dexmedetomidine proves beneficial. Tramadol had higher incidence of side effects and delayed onset of action. Dexmedetomidine is faster, more effective with lesser side effects when compared to tramadol in control of per operative shivering after giving of spinal anesthesia.

DOI: 10.5281/zenodo.

Background: Intra-uterine growth restriction (IUGR) and Pregnancy-induced hypertension (PIH) are major complications impacting maternal and fetal health. PIH, including preeclampsia and gestational hypertension, and IUGR, often due to placental insufficiency, increase perinatal mortality and morbidity. Doppler ultra-sound is a non-invasive technique that offers valuable insights into fetal and placental blood flow, aiding early diagnosis and management. Aim: The aim of this research is to compare Doppler flow patterns between normal pregnancies and those complicated by IUGR in primigravida women, measuring changes in blood flow that might suggest fetal impairment. Methodology: An observational study was conducted over 12 months with 77 primigravida women aged 18 to 35 years. Initial Doppler assessments were performed between 18 and 22 weeks of gestation, with follow-up studies after 30 weeks. Doppler indices including pulsatility index (PI), systolic/diastolic ratio, and resistance index were analyzed in the uterine, umbilical, and middle cerebral arteries. Results: The wide range of participants were aged 19-24 years. Doppler scans were most frequent around 20 weeks and late in pregnancy. Emergency lower segment cesarean sections (LSCS) were most common in cases with both PIH and IUGR. The uterine artery PI showed the highest sensitivity for detecting both conditions at 18-22 weeks, while the uterine artery S/D ratio and umbilical artery PI were most accurate after 30 weeks. Conclusion: Doppler velocimetry is crucial for managing high-risk pregnancies with PIH and IUGR. Early detection using Doppler indices allows for timely intervention, improving outcomes.

DOI: 10.5281/zenodo.