Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. In the setting of severe sepsis and septic shock, myocardial depression is common. According to a few studies, troponins also correlate strongly with myocardial dysfunction. Non-invasiveness and instantaneous diagnostic capability are prominent features of the use of Echocardiography in critical care. Sepsis and septic shock represent complex situations where early hemodynamic assessment and support are among the keys to therapeutic success. Materials and Methods: The present observational cross sectional study is carried out in Department of General Medicine, Agartala Government Medical College (AGMC & GBPH), Agartala, Tripura for a period of two years from December 2020 to December 2022 among patients diagnosed with sepsis in Medical Intensive Care Unit. CPKMB and Troponin-I determination along with echocardiography was done in all patients diagnosed with sepsis in Medical Intensive Care Unit. Results: In our study, 68(77.3%) patients were Troponin I positive. 70 (79.5%) patients were CPK MB positive. Left ventricular Systolic dysfunction (LVSD) was found in 55(62.5%) patients whereas Left ventricular diastolic dysfunction (LVDD) was present in 44(50%) patients. In our study 37(42.1%) patients had Right ventricular dysfunction. Conclusion: We conclude that Sepsis Related Myocardial Dysfunction (SRMD) is very much common. Early assessment of SRMD can be done by doing cardiac biomarkers (Troponin I & CPKMB). Cardiac biomarkers can guide us towards underlying cardiac dysfunction. Early echocardiographic assessment can guide us towards proper management of sepsis patients.

DOI: 10.5281/zenodo.

Introduction: This study examines the prevalence, risk factors, clinical presentation, and management outcomes of retinal vascular occlusion (RVO) at a tertiary eye care center in Western India. Materials & Methods: We included 122 patients with RVO presenting at tertiary care center in western India. We collected demographic data, vision, presenting clinical features including complications. We did OCT scan whenever applicable. We managed the patients with help of intravitreal injection anti- VEGF, vitrectomy, sectoral / pan retinal photocoagulation and supportive management as per required. Both quantitative and qualitative variables were studied using SPSS version 2.0 and data was imported into Excel. Results: The mean age was 55±10 years, with a majority (54.34%) being female. Branch retinal vein occlusion (BRVO) (48%) was the most common type, followed by central retinal vein occlusion (CRVO) (31%) and hemi retinal vein occlusion (HCRVO) (12%). Hypertension (68 patients), diabetes (49), and hyperlipidemia (40) were frequent risk factors. Clinical presentations predominantly involved diminished vision (89.85%), with macular edema being the most common complication (66.66%). Treatment included anti-VEGF injections (73.91%) and laser photocoagulation (81.15%). Conclusion: This study highlights the high prevalence of RVO in older adults, especially females, with hypertension and diabetes playing significant roles. Management with anti-VEGF and laser therapy is effective, consistent with international standards. Further population-based studies are warranted for better understanding and prevention of RVO.

DOI: 10.5281/zenodo.

Introduction: In a typical term pregnancy with isolated oligohydramnios, to investigate the outcomes for the mother and the foetus adequate quantities of amniotic fluid are essential for the growing foetus because they provide nutrition, protect the developing embryo from injury, and promote the baby’s growth and mobility in the womb. Quantification of amniotic fluid content is an essential feature of prepartum foetal surveillance. Amniotic fluid is the end product of complex and dynamic physiological processes in the foetus and placenta. Material and Methods: This was a one-year prospective research that took place in the obstetrics and gynaecology department of MKCG MCH, Berhampur between January and December of 2015. In all, 100 patients with gestational ages more than 37 weeks who were matched for age and parity were examined; 50 of the research group’s participants had AFIs of less than 5, and the control group’s participants had AFIs of greater than 5.A comparison was made between the two groups regarding the manner of delivery and the perinatal outcome. For statistical analysis, the chi square test was employed. Results: In 39 patients (78%) in the study group and 46 patients (92%) in the control group, the non-stress test (NST) was reassuring (p value <0.05) and was determined to be statistically significant. In the research group, 16 out of 50 patients (32%) delivered their babies vaginally normally, 9 patients (18%) used an instrument, and 25 patients (50%) had a caesarean section. In the control group, on the other hand, 34 out of 50 patients (68%) delivered their babies vaginally normally, 2 patients (4%) used an instrument, and 14 patients (28%) had a caesarean section (p value <0.05). A statistically significant difference was detected. Nine (18%) of the study group’s patients had an Apgar score of less than seven, compared to six (12%) of the control group (p value >0.05). The distinction wasn’t statistically noteworthy. Ten babies (20%) in the control group and 22 babies (44%) in the experimental group were born weighing less than 2.5 kg (p value <0.05). There was a statistically significant difference. Neonatal intensive care unit (NICU) admissions occurred in 6 newborns (12%) in the study group compared to 4 babies (8%) in the control group (p value >0.05). There was no statistically significant difference. At the time of discharge, every baby was stable. Neither the trial group nor the control group had any infants that required ventilatory assistance or neonatal fatalities. Conclusion: A poor perinatal outcome is not linked to isolated oligohydramnios in the absence of any aggravating factors, yet the babies may be born with a lower birth weight. Due to widespread use of ultrasonography, oligohydramnias are being discovered more frequently these days. Isolated oligohydramniosis without aggravating circumstances is not associated with a bad perinatal outcome, notwithstanding the possibility that the children would be delivered with a lower birth weight.

DOI: 10.5281/zenodo.

Introduction: Dyslipidaemia is due to altered lipid metabolism, often characterised by elevation of LDL & depletion of HDL concentration. Paraoxonase 1 (PON1) is an enzyme associated with HDLc and its atheroprotective and antioxidant role. Atherogenic index (AIP) is a predictor of atherosclerosis which is dependent on both serum triglyceride and HDLc concentration. This study was done to find out the association between atherogenic index and paraoxonase 1 activity in dyslipidemic individuals. Methodology: 63 dyslipidemic patients (diagnosed by lipid profile parameters attending OPD were compared with 63 normolipidemic individuals. Serum paraoxonase1 activity of both dyslipidemic & no dyslipidemic individuals were measured using paranitrophenylacetate substrate. Serum atherogenic index along with other cardiac indices (cardiac risk ratio I and II and atherogenic coefficient) were calculated from lipid profile parameters. Results: Significantly increased parameters of lipid profile including total cholesterol, Triglyceride and LDLc and significantly decreased HDLc and PON1 activity has been found among the dyslipidemics in comparison to normolipidemics (p<0.001). AIP and other cardiac indices are also significantly increased in dyslipidemic group (p<0.001). Statistically significant negative correlation has been found between PON1 & AIP (r= – 0.425 and p<0.001). Conclusion: Low levels of PON1 is associated with high AIP and hence there a higher risk of cardiovascular disease in dyslipidemics.

DOI: 10.5281/zenodo.

Background: The most common medical emergencies, acute upper gastrointestinal bleed have a significant mortality. This study aims to study patients’ endoscopic profile and clinical outcome, presenting with upper gastrointestinal bleeding in this region.  Methods: This study was conducted on 100 patients admitted with upper GI bleeding. These patients underwent endoscopy of the upper gastrointestinal track after the initial examination. The status of patients in the study group was recorded at discharge.  Results: The mean age of patients was 48.98 ±14.50 years with male to female proportion of 2.57:1. The foremost common causes of upper GI bleed were related to portal hypertension (Oesophageal and gastric varices) and were seen in 48% of patients. In 45% of the patients, non-portal hypertensive lesions causing UGI bleed (peptic and other injuries) were seen whereas endoscopy was normal in 7% patients. We found no relationship of mortality and with components like age, history of alcohol and NSAIDs use, peptic ulcer, infection and presence of cirrhosis. Conclusion: Portal Hypertension is the foremost common cause of upper gastrointestinal bleeding in this region. Peptic ulcer and erosive gastro-duodenitis are other leading causes. With effective and prompt management and timely endoscopic intervention mortality can be reduced as in our study it was 4%. However, there is no correlation between age, alcohol and NSAIDs use, peptic ulcer, infection and presence of cirrhosis with death.

DOI: 10.5281/zenodo.

The study focuses on the formulation and evaluation of oral dissolving films (ODFs) of lornoxicam, aiming to improve patient compliance and achieve rapid onset of action. Lornoxicam, a non-steroidal anti-inflammatory drug (NSAID), is effective in pain management but suffers from low bioavailability and gastric irritation when administered orally in conventional forms. To address these challenges, ODFs were developed using the solvent casting method with hydroxypropyl methylcellulose (HPMC) as the film-forming polymer. The films were evaluated for various physicochemical parameters including thickness, tensile strength, disintegration time, and drug content uniformity. Additionally, in vitro dissolution studies were conducted to assess the release profile of lornoxicam from the films. The optimized formulation demonstrated desirable mechanical properties, rapid disintegration (within 60 seconds), and enhanced dissolution rate compared to conventional oral tablets. The weight of films range from 18.45-22.99 mg. The thickness of films were range from 0.046- 0.055 mm.The pH of films range from 6.55-7.95.The folding endurance of films range from 216-267.The disintegration time range from 10-42 seconds. Tensile strength of given formulation is 4.124 to 7.885gm/mm2. The drug content of films was found to be between 94.20-96.80%.These findings suggest that ODFs of lornoxicam are a promising alternative for improving patient adherence and therapeutic efficacy in pain management. Further in vivo studies are recommended to validate these results and explore the potential clinical benefits of this novel drug delivery system.

DOI: 10.5281/zenodo.

The study was a phase III, prospective, randomized, double blind, comparative, parallel group clinical study. The study screened 213 male and female patients diagnosed with type 2 diabetes mellitus inadequately controlled on Metformin monotherapy, out of which 192 patients were randomized Thus, 96 patients were randomized in test product i.e., Vildagliptin SR 100 mg Tablets out of which 94 patients completed the study and 96 patients were randomized in reference product i.e. Teneligliptin 20 mg Tablets out of which 93 patients completed the study.
The glycosylated hemoglobin was decreased in both the treatment groups. The difference in the mean change in glycosylated hemoglobin (HbA1c) at the end of 16 weeks in the two groups was -0.03 with lower limit of 95% CI being -0.18. Thus, the results of the study show that Vildagliptin SR 100 mg Tablets is non-inferior to Teneligliptin 20 mg Tablets. All the treatments were well tolerated.
A total of 28 AEs were reported in 28 patients. 13 AEs were reported in Vildagliptin SR 100 mg Tablets arm and 15 AEs were reported in Teneligliptin 20 mg Tablets arm. 01 AE from Vildagliptin SR 100 mg Tablets arm and 01 AE Teneligliptin 20 mg Tablets arm were moderate in nature; all the other AEs were mild in nature. No SAE was reported during the study.

DOI: 10.5281/zenodo.

Introduction: The effectiveness of supraclavicular brachial plexus block is usually evaluated by assessment of sensory and motor function. Perfusion index (PI) estimates the pulsatility of blood in the extremities and inversely related to the vascular tone. In this study we assessed changes in perfusion index following ultrasound guided brachial plexus block to predict success in this regional anaesthesia technique. Material and Methods: A prospective observational study was conducted after obtaining institutional ethics committee clearance and written and informed consent from each patient. 60 adult patients undergoing upper limb surgery under ultrasound guided brachial plexus block were included and Perfusion index in the blocked and unblocked limb were measured using Masimo SET pulse oximeter. Results: Perfusion index in the blocked limb was higher than the unblocked limb at all intervals. Delta Pi calculated as the difference between Pi at 10 mins and baseline was 1.3+/-0.6 in the blocked limb. Conclusion: The PI is characterized by being simple, rapid, and user friendly compared with other objective methods for evaluation of block success.

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 prospective observational study conducted at pediatric department. 100 children who were diagnosed with nephrotic syndrome at JLNMCH 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.

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 Medicine, Nalanda medical College and Hospital, Patna, Bihar, India. 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.

Meditation produces various effects on human physiology, which are mediated via autonomic nervous system. Meditation is a simple and scientific technique to elicit physical and mental relaxation response, to change one’s attitude and transform life-style. Regular practice of it brings transformation in overall wellbeing of person. The cardiovascular morbidity is increasing in India in recent years. 40 healthy volunteers above the age of 30 years and below 65 years performing meditation regularly were included in the study. The same subjects were chosen as both study and control group in order to minimize the confounding factors. Before recording the parameters, the subject was asked to relax physically and mentally for 30 minutes. The blood pressure was recorded with the sphygmomanometer in supine position in the right upper limb by auscultatory method. Similarly, three readings were taken at an interval of 15 minutes each and average of the three values calculated .Heart rate was counted for one minute. The subjects were trained under the guidance of a certified yoga teacher. They carried out meditation for 6 months for 1 hour daily between 6 am and 7 am. The cardiovascular status of each subject, after 6 months of meditation practice was assessed clinically in terms of blood pressure and heart rate recordings. Statistical analysis was done by t test. The results of this study demonstrated a reduction in Heart rate, systolic blood pressure, diastolic blood pressure indicating parasympathetic nervous system dominance during & immediately after meditation.

DOI: 10.5281/zenodo.

Aim: The aim is to study the outcome of Contralateral PMMC flaps for Supramajor  Head and Neck Onco-reconstruction,  following oncological excision of huge T4 Tumors. Study: Hospitals in India get many advanced T4 Head & Neck malignancy. They are operated by Oncosurgeons as a palliative Oncosurgery. It creates huge three dimensional defects, its reconstruction is challenging for the Plastic surgeons. We are presenting case series of 25 patients, where Contralateral Pmmc played part in reconstruction of defects.  In major T4 Head and Neck post oncological resection where many times we have to use Bilateralpectoralis major Myo cutaneous flap to cover the resultant defect. Sometimes along with microsurgery contra lateral PMMC could be used for one flap, when more than one flaps are needed.  Pectoralis major flap is a workhorse flap, with lesser learning curve. So, the complications are less and healing is also faster. It is single stage surgery so Radiotherapy could be started as early. Method: It is a retrospective study of twenty-five patients, operated by the chief surgeon in the last ten years. Here Contralateral PMMC was used after major excision of major Head and Neck T4 malignancy. In 11 patients contralateral PMMC was used as a part of oral cavity reconstruction.  In four patients for laryngopharynx reconstruction. In five patients it was used to cover the defects in flap failure.  In another five patients it was used for recurrence. In bilateral PMMC one is used to cover the inner lining while outer is covered by another PMMC flap. Sometimes contra lateral PMMC is used along with other pedicled or free flap. Contra lateral PMMC is a pedicled flap, taken from opposite chest. Time taken to elevate and inset is lesser than Microvascular Reconstruction and it could be done where microsurgical expertise is lacking. It is a single stage surgery so radiation/ Physiotherapy could be started early. Conclusion: Contralateral PMMC flap is an answer to cover the defect following supra major excision of T4 Oral Malignancy, It could be used when there is flap failure or in recurrence. It could be used alone or along with some pedicled or free flaps. It is a pedicled flap, taken from opposite chest,  time taken is lesser than Microvascular Reconstruction and it could be done where microsurgical expertise is lacking. It is single-stage surgery so radiation/ Physiotherapy could be started early.

DOI: 10.5281/zenodo.

Background: Diabetic individuals have several complications, such as diabetic retinopathy and nephropathy as well as an increased mortality risk and impairment in health-related quality of life. Despite some authors have suggested that pulmonary function reduction might be a chronic complication of Diabetes mellitus (DM), there are doubts whether the pulmonary function decrease is really caused by DM itself or if it represents a deleterious impact of ageing process. With the looming expansion of the elderly population of the US, a thorough understanding of “normal” aging-related changes on the respiratory system is paramount. The respiratory system undergoes various anatomical, physiological changes with age. The present study has focused on the impact of age on respiratory system in type -2 diabetics as well as on pulmonary function tests like FVC, FEV1 and FEV1/FVC ratio.

DOI: 10.5281/zenodo.

This research examines the link between smartphone usage, academic stress, and lifestyle in young adults. The data was gathered from surveys given to youngsters to assess their smartphone habits, academic stress levels, and lifestyle. The findings show significant connections between smartphone usages, academic stress, and lifestyle emphasizing the importance of implementing strategies to encourage healthier technology practices and enhances sleep quality among youngsters.

DOI: 10.5281/zenodo.

Background: The aim of this study is to explore the clinical outcomes of locking compression plates (LCPs) Philos in elderly patients with 2-4 parts proximal humerus fracture (PHF). Material and Methods: This is a Prospective, observational and descriptive study conducted from Department of Orthopaedics, Shri Atal Bihari Vajpayee Medical College and Research institute, Bengaluru.  Sampling methods: After confirmation of the proximal humerus fracture, patients were taken for study, if they fit into the above said criteria. Patients had undergone open reduction internal fixation with philos locking plating under GA for the sustained fracture. Post-operative physiotherapy followed according to protocol, to evaluate the functional outcome. Fractures were classified using  Neer’s classification. Results: In the present study, the most common mechanism of injury was found to be road traffic accidents with a total of 25 (62.5%) patients and rest 15 (37.5%) were injured due to accidental fall on the ground. In the present study, the right side proximal humerus fracture occurred in 22 (55%) patients and left side proximal humerus fracture occurred in 18 (45%) patients respectively. All fractures were classified according to Neer’s classification system. 17 (42.5%) patients were two-part, 13 (32.5%) were three-part and 10 (25%) were four-part. The Constant -Murley score achieved at the end of study period (6 months) was 66.32 ± 6.47. Conclusions: The proximal humerus locking plate seems to be an adequate device for the fixation of displaced two-part, three part and four-part proximal humerus fractures. Due to stable fixation, early functional aftercare is possible and allows the patient to regain good shoulder function and resume normal activities much earlier.

DOI: 10.5281/zenodo.

Supracondylar fractures of the humerus the most common type of elbow fracture in children. Severely displaced supracondylar fractures of the distal humerus in children are a challenging problem. Many treatment methods have been described for the treatment of displaced supracondylar fracture of the humerus, however it has not been reached a consensus for the choice of treatment. The purpose of this study is to clinically asses the outcome of surgically managed supracondylar fracture of humerus using K wire fixation. Materials and Method: 30 Children of supracondylar fracture of humerus treated in the Department of Orthopaedics, Shri Atal Bihari Vajpayee Medical College and Research institute, Bengaluru. Out of a total of 30 cases 24 were treated with closed reduction and internal fixation by k wire and 6 were treated with open reduction and internal fixation with k wire. The average age was 7.1 years. We evaluated the results using FLYNN’S criteria. Result: According to the results of the study, we obtained 21 excellent, 4 good, 4 fair and 1 poor result. Conclusion: The data in the current study shows that surgically managed displaced supracondylar fracture of humerus in children using K wire fixation gives excellent outcomes both radiologically and functionally thus can be deemed as treatment of choice for the same.

DOI: 10.5281/zenodo.

Introduction: The posterior cruciate ligament (PCL) in total knee arthroplasty (TKA), so-called cruciate-retaining (CR), or to substitute for it, so-called posterior stabilized (PS), continues to engage orthopaedists. The many reasons for retaining the posterior cruciate ligament (PCL) during total knee replacement (TKR) include improved stability, reduced shear stresses at the fixation interface, improved proprioception, and more efficient gait patterns during level walking and stair climbing; Material and Method: This is prospective study at Department of Orthopaedics, Shri Atal Bihari Vajpayee Medical College and Research institute, Bengaluru. Results: There were many prospective studies with the evidence level 1–2 to compare the CR and PS TKAs using contemporary prostheses.  Most studies reported no difference in clinical scores, ROM, midterm survival rate, and quadriceps muscle recovery; two studies reported only the better ROM in PS TKAs. In our preliminary prospective study using the recently introduced prosthesis of Persona, all the clinical results did not differ at 1 year postoperatively. Conclusion: CT TKA may not be feasible in certain conditions; PCL insufficiency, severe deformity, and the history of previous traumas or operations should be carefully examined for appropriate selection of the prosthesis type. The surgeon should have a clear idea on the technical differences between CR and PS TKAs. The extent of distal femoral resection, selection of femoral component size, and adjustment of tibial slope are particularly crucial for successful TKA.

DOI: 10.5281/zenodo.

Background: Extrahepatic biliary obstruction (EHBO) is a common entity encountered in clinical practice. EHBO is a result of obstruction to bile flow anywhere from liver to duodenum. Material and Methods: We retrospectively analyzed clinical, laboratory and endoscopic data of all the patients with features of EHBO who had undergone ERCP over a period of 1 year. Results: 206 EHBO patients underwent ERCP. Mean age was 51.5 years. Majority were females (55.8%). However pancreatic head carcinoma (66.7%) and cholangiocarcinoma (100%) preferentially affected males. Benign causes were more common 65.5%. Choledocholithiasis was the most prevalent (56.8%) followed by benign biliary stricture (8.8%). Amongst malignant aetiologies gall bladder carcinoma (15.5%) was most common. Most of the patients presented with pain abdomen (58.2%). Mean bilirubin, raised alkaline phosphatase and renal dysfunction were more common in malignant cases though not statistically significant. However, anaemia (p=0.037) and deranged coagulation profile (p=0.041) was statistically significantly higher among malignant cases. Thrombocytopenia was statistically significantly higher among benign cases (p=0.044). Amongst choledocholithiasis 86.3% individuals had complete biliary clearance, while 8.5% underwent lithotripsy. Bismuth type 1, 2 & 3 benign biliary strictures were found in 72.2%, 16.6%, and 11.2%, respectively. In 83.3% of such patients biliary stenting was successful. Those with malignant strictures, 67.3% had block below hilum, 27.6% had hilar block, 5.1% had complex anatomy of block. Adequate endoscopic biliary drainage was achieved in 86.2%, while 13.7 % required percutaneous transhepatic biliary drainage after the failed ERCP. Self-expanding metallic stent was inserted in 11 patients. Overall, periampullary diverticula and needle knife were present in 5 and 18 cases respectively. Conclusions: Contrary to previous Indian studies, benign causes were more common causes of EHBO undergoing ERCP than malignancy. Common benign and malignant aetiologies were choledocholithiasis and gall bladder carcinoma respectively.

DOI: 10.5281/zenodo.

Introduction: Apolipoprotein E gene polymorphism is associated with chance of occurrence and the outcome of cerebrovascular accident. Different alleles of APO E gene show different outcomes in the stroke patients. This study was done to compare the genetic polymorphism of APOE in stroke patients with healthy population and also to find out any difference in genetic polymorphism in different types of strokes. Materials and Methods: Total 300 stroke patients were compared with equal number of controls from the Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata. DNA extraction and gene amplification were done from the samples collected from all the study subjects and the different alleles were finally identified by the method of restriction fragment gene polymorphism. Result: The homozygous E3 genotype was the most common (85.5%) followed by E3/E4 (14.5%) in our study group. The APOE4 allele showed a 1.14-fold odd for developing ischemic stroke whereas the E3 allele is showed protection with odds ratio 0.53. The E3 allele showed protection from developing hemorrhagic stroke with odds ratio 0.366. and higher frequency of E4 allele with odds 1.08. Conclusion: there is significant association of APOE gene polymorphism in ischemic as well as haemorrhagic stroke patients of ethnic Bengali population and the E3 allele had been the protective factor from developing the stroke.

DOI: 10.5281/zenodo.

Introduction: The Prevalence of Type 2 Diabetes mellitus in India is 8.7%. It is crucial for individuals with Diabetes to engage in self-care practices, which include monitoring blood glucose levels regularly, adhering to medication and diet plans, engaging in regular exercise, and getting periodic foot examinations. Numerous studies have demonstrated that maintaining healthy self-care practices can significantly lower blood glucose levels and improve the overall quality of life for people with Diabetes. Objective: To assess self-care practices and factors influencing the self-care practices among Type 2 Diabetes Mellitus patients attending Makkalai Thedi Maruthuvam Clinic. Methodology: A Hospital Based Cross-Sectional Study was conducted among 150 patients attending Makkalai Thedi Maruthuvam Clinic in a Tertiary Care Hospital in Chengalpattu during December 2023. 18 years and above Type 2 Diabetes patients who were willing to participate were included. A Semi-structured Questionnaire was administered to the patients to assess socio-demographic details, clinical profile, and the Selfcare practice (SCP) was assessed using revised version of the Summary Diabetes Self-Care Activities questionnaire (SDSCA). Data was collected and entered in Microsoft Excel and analysed using SPSS version 25. Results: The majority of the patients were female (63.9%), literate (59.4%), unemployed (69.7%), belonged to the nuclear family (82.6%) and were from middle socioeconomic status (83.2%). 75.5% of patients followed good dietary practice, had good compliance to drugs (98.7%) and checked blood glucose every 3 months (87.1%), while 2/3^rd of the patients had poor foot care practices and less physical activity. The younger age group had good Self-care practices and this was found to be statistically significant(p-value – 0.05). There was a significant association found between Poor dietary practice with alcohol consumption (p-value – 0.001) and tobacco usage ((p-value – 0.001). Conclusion: This study concludes that Dietary changes, compliance to medications and blood glucose monitoring are much better than physical activity and foot-care practices. Focused education programs and monitoring during follow-up visits will improve self-care in the less adhered domains.

DOI: 10.5281/zenodo.

Introduction: Improper solid waste disposal is identified as a major public health threat throughout the world. The key to control the hazards and diseases caused by improper waste disposal rests not only on the efforts taken by the health officials and local body administrators, but also on the community’s knowledge, Attitude and Practice regarding safe waste disposal methods. Objective: To assess the knowledge, Attitude and Practice of solid waste disposal practices among the households in an urban area of Chengalpattu municipality in southern India and also to determine the factors influencing the solid waste disposal practices among the study population. Methodology: A community based cross-sectional study was done among 150 households selected through multistage random sampling from Chengalpattu Municipality of Tamil Nadu in Southern India, from July to August 2023.Participants who were 18-60 years and willing to participate were included. Semi structured questionnaire was used to collect data regarding the socio demographic details & knowledge, Awareness and Practice of the participants. Data was entered in Microsoft Excel and analysed using SPSS version 25. Results: In this study, mean age of participants was observed to be 45.91 (±S.D. 8.63). 85.3% of the participants had adequate knowledge, 48% had positive attitude and 36% had good practice. Statistically significant association was found between Age(p=0.035), Education (p=0.047) and knowledge regarding solid waste disposal. Statistically significant association was found between gender(p=0.009), education(p=0.051), type of house (0.001) and practice regarding waste disposal. Conclusion: The study found adequate knowledge in majority of the participants, however the attitude level and practice regarding proper waste disposal could be improved. Measures to encourage people towards adopting a committed attitude and good practice, regarding proper solid waste disposal can help achieve the goal of ‘Clean India’.

DOI: 10.5281/zenodo.

Background: Lung cancer is the leading cause of cancer related deaths worldwide and accounts for 28% of all cancer mortality. Several histopathological types of lung cancer exist, among them the majority are non-small cell carcinomas (NSCLCs) including adenocarcinoma (ADC) and squamous cell carcinoma (SqCC). In light of discovery of molecular alterations associated with lung ADCs and advent of targeted therapies, further subtyping of NSCLCs has profound therapeutic implications. Materials and Methods: A total number of 90 consecutive cases of NSCLCs diagnosed on core‑needle biopsies (CNBs) and endobronchial biopsies (EBBs) of the lung sent for histopathological evaluation were included in the study. The demographic data, clinical details, radiological features, and laboratory investigations were retrieved. The Small cell lung carcinomas (SCLC), carcinoids, lymphomas, mesenchymal neoplasms, metastatic carcinomas, and mesotheliomas were not included in the study. Result: Out of 90 cases 60 were ADC and 30 were SqCC. Most of the patients were in the age group of 61-70 years, 10 were between 71-80 years, 10 were between 51-60years and 10 were between 40-50 years. In this study the sensitivity and the specificity of p63 were 100% and 80% respectively, and sensitivity and specificity of p40 were 100% and 98.3% respectively. Positive predictive value was higher for the p40 compared to p63. To summarize, sensitivity of p63 and p40 was found to be the same, but the specificity and positive predictive value were higher for p40 for diagnosis of SqCC. One case of ADC showed positivity for p40 which may be due to adeno-squamous carcinoma misdiagnosed as ADC on cytology. Conclusion: P63 has a better sensitivity, and P40 has a better specificity for SqCC. A positive staining pattern with both markers was also found in certain non-SqCC cases.

DOI: 10.5281/zenodo.

Aim: To compare the effectiveness of dry needling and steroid injection in treating plantar fasciitis. Material and Methods: This study was conducted in the Department of PMR, ANMMCH, Gaya Bihar. 83 patients were enrolled. Eligible patients were individuals > 18 years old, with a history of plantar heel pain of at least for three months and who were diagnosed for plantar fasciitis according to the guidelines of Orthopaedic Section of the American Physical Therapy Association. Results: Three and six weeks and one year after treatment, mean VAS scores were significantly different between groups: 0.32 ± 0.71 steroid group and 3.47 ± 1.32 dry-needling group (P<0.001); 0.21 ± 0.67 steroid group and 2.66 ± 1.33 dry-needling group (P<0.001); 2.09 ± 1.58 steroid group and 0.69 ± 0.93 dry- needling group, (P = 0.004), respectively. There were no significant differences between groups at the other time points. Steroid injection quickly reduced pain, but after six weeks of treatment, pain increased; in the dry-needling group, pain reduced slowly, but after six weeks of treatment, pain continued to decline. And at the end of the study, average pain in the steroid group was greater than in the dry-needling group. Conclusions: This study suggested that dry needling was superior to steroid injection in patients with plantar fasciitis at the end of one year of follow-up. Pain reduced gradually in dry-needled patients, and endpoint VAS scores were lower than in the steroid group, although rapid and short-term effects of steroid injection was also found.

DOI: 10.5281/zenodo.

The COVID-19 pandemic necessitated the development of efficient diagnostic tools to quickly identify infected individuals and mitigate the spread of the virus. This study evaluates the success rate of rapid tests for the detection of COVID-19 antigens using immune-based diagnostic devices. Rapid antigen tests offer the advantages of speed and ease of use, making them a vital component in large-scale screening efforts. The research involved a comprehensive analysis of various rapid antigen test devices, assessing their sensitivity, specificity, and overall accuracy compared to the gold standard RT-PCR tests. Results indicated that while rapid antigen tests generally provide quicker results, their sensitivity varies significantly, impacting their reliability in different settings. Despite these limitations, the study highlights the importance of rapid antigen tests in complementing other diagnostic methods, particularly in resource-limited environments and for mass screening purposes. The findings underscore the need for continuous improvement and validation of these tests to ensure they meet the necessary accuracy standards for effective pandemic management.

DOI: 10.5281/zenodo.

Background: Fungal infections are prevalent and pose significant health risks, necessitating effective and targeted treatment options. Ketoconazole, a broad-spectrum antifungal agent, is commonly used in the treatment of various fungal infections. However, traditional formulations may have limitations in terms of drug release and patient compliance. Hydrogel-based drug delivery systems offer a promising alternative, providing controlled release, improved drug stability, and enhanced patient compliance. Objective: This study aims to develop and evaluate a hydrogel-based topical drug delivery system for ketoconazole to improve its therapeutic efficacy in treating fungal infections. Methods: Ketoconazole-loaded hydrogels were formulated using a combination of biocompatible polymers. Various formulations were prepared and characterized for their physicochemical properties, including pH, viscosity, and drug content. The in vitro release profile of ketoconazole from the hydrogels was evaluated using a Franz diffusion cell apparatus. Ex vivo skin permeation studies were conducted using excised human skin to assess the penetration capability of the hydrogel formulation. Additionally, antifungal activity was tested against common fungal strains to determine the therapeutic potential of the developed hydrogel. Results: The prepared hydrogels exhibited satisfactory physicochemical properties with an optimal pH and viscosity suitable for topical application. In vitro release studies demonstrated a sustained release profile of ketoconazole over 24 hours. Ex vivo skin permeation studies indicated significant penetration of the drug through the skin layers, suggesting effective delivery to the target site. Antifungal activity tests confirmed the efficacy of the ketoconazole-loaded hydrogel against various fungal strains, with results comparable to conventional formulations. Conclusion: The developed hydrogel-based topical drug delivery system for ketoconazole shows promising potential in enhancing the treatment of fungal infections. The sustained release, improved skin penetration, and effective antifungal activity indicate that this formulation could provide a better therapeutic outcome and increased patient compliance. Further in vivo studies and clinical evaluations are warranted to confirm these findings and explore the full potential of this novel drug delivery system.

DOI: 10.5281/zenodo.

Aim:  Aim of the present study was to compare the effect of injection Rocuronium with priming dose and injection Rocuronium without priming dose on intubating conditions and onset time of intubation. Methods: The present study was single-center, prospective, randomized study, conducted in Department of Anaesthesiology, Jagannath Gupta institute of Medical Sciences, Kolkata, West Bengal, India. Study duration was of 2 years. 50 patients were included in the study. Results: We compared mean age, weight, gender and ASA grade between group C and group P and difference was statistically not significant (p value >0.05). We compared preoperative baseline mean HR, mean HR at induction, mean HR at intubation, 1 minute after intubation and  5 minute after intubation between group C and group P, the difference between two groups was statistically insignificant. We compared baseline mean MAP {full form} preoperatively, at induction, at intubation, mean HR  1 minute after intubation and mean HR  5 minute after intubation between group C and group P, the difference between two groups was statistically insignificant. We compared mean SPO2 preoperatively baseline, at induction, at intubation, mean HR at 1 minute after intubation and mean HR 5 minute after intubation between group C and group P, the difference between two groups was statistically insignificant. In group C mean Onset Time of Intubation was 93.36 ± 6.24 seconds, while in group P it was 57.00 ± 6.74 seconds, so the difference between the groups on the basis of OTI was statistically highly significant. Conclusion: Rocuronium with priming would be an excellent alternative to succinylcholine, whenever fast induction will be needed. Intubating conditions were good to excellent and comparable in both rocuronium with priming and without priming dose. NMT {full form} monitoring is a useful tool for indicating the clinically acceptable paralysis.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the levels of bone minerals, calcium and phosphorus in hypothyroidism and its relation with thyroid hormone levels. Methods: The cross-sectional and observational study was done at department of Biochemistry, NMCH, Jamuhar, Sasaram, Bihar over a period of 12 months (August 2022 to July 2023). Results: There was a significant increase of TSH, in cases with p value < 0.001. Significant decrease in T4 was noted (p <0.05) in cases. Among the minerals, there was a significant increase in phosphorous and magnesium serum levels and a significant decrease in that of calcium levels. In our study analysis when TSH levels were compared with serum calcium and phosphorus among the hypothyroid patients, it showed a statistically significant negative correlation between TSH and serum calcium. However there was no significant correlation of TSH with serum phosphorous and magnesium. Conclusion: The study concluded that in hypothyroid patients, the serum calcium level was decreased and serum phosphorus level was increased when compared to euthyroid control subjects. Also there was a strong negative correlation between serum TSH and serum calcium levels were observed among hypothyroid individuals. It is therefore recommended for the regular evaluation of these minerals in hypothyroid patients which would improve their bone health and quality of life.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the level of serum ferritin in type 2 diabetes patients with good and poor glycemic control and also assessed the correlation between serum free iron concentrations with glycemic control. Methods: The study was conducted in the Department of General Medicine, JLN Medical College and Hospital, Bhagalpur, Bihar, India for the period of two years. Study population was patients of type 2 diabetes mellitus visiting outpatient department of our hospital. This study comprises 200 patients with type 2 diabetes mellitus (treated with hypoglycemic drugs), as cases and 200 patients, age and sex matched apparently healthy adults as a control group. Results: Age and sex difference between two groups was statistically non-significant. On comparison of serum ferritin levels between cases and controls it was found that the mean serum ferritin of diabetic population was 139.85 ± 62.98 ng/mL and that of control group was 61.97 ± 26.64 ng/mL (p value< 0.05). Serum ferritin of case group is therefore significantly higher than the control group. Similarly, BMI, fasting blood glucose (mg/dl) and glycated haemoglobin (HbA1C) values were significantly higher in diabetic group as compared to control group. We compared serum ferritin values with HbA1C values in diabetic patients. Increase in serum ferritin levels was noted with increasing values of HbA1C. Correlation between serum ferritin and HbA1c was also assessed. The correlation between glycated haemoglobin and serum ferritin was done by Pearson correlation test and it showed a significantly positive correlation (r=0.512) with serum ferritin. Conclusion: The present study concluded that positive correlation between serum ferritin levels and increased HbA1c reflecting poor glycemic control. This highlights the need for strict glycemic control in these subjects. Further studies are needed to verify the importance of screening of hyperferritinemia in type 2 diabetic patients and to define cut-off level of serum ferritin for possible early detection and subsequent prevention or delaying of impaired glucose tolerance and diabetes in those participants.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyze the complications after Cranioplasty (CP) and to identify risk factors that may be associated with the failure of the procedure. Methods: The present study was conducted in the Department of Neurosurgery, I.G.I.M.S.,Patna from March 2019 to March 2024 in which 200 patients were included in the study. It included patients undergoing CP for a defect arising out of previous Decompressive Craniectomy (DC) or inability to replace the bone flap (without surgical site infection, size > 5 cm, Glasgow Coma Scale > 13). Patients under this study underwent CT imaging before and after the procedures. The CP technique largely depended on the patients, based on the cost of implant or prosthesis and availability. Results: Complications were seen in 44 out of 200 patients. Out of 200 patients, 176 were male and 26 were female. Single comorbidity was seen in 41 patients and multiple comorbidities in 35. Traumatic brain injury (TBI) was the most common indication for craniectomy in 176 patients, while intraoperative was 6 patients. At the time of CP, 128 patients had GCS of 15 and 72 patients had deficits and/or GCS < 15. Mean blood loss during surgery was 176 mL which was 208.82 mL for autologous CP. The occurrence of pyrexia >101°F in the postoperative period was associated with a higher rate of complication. Conclusion: Complications related to CP are common, as noted in our study, and few factors may increase the risk. Positive relation was observed between complication and CP done using chemically cured PMMA and ETO sterilized bone flap. Patients in younger age group, those with fever >101°F in the postoperative period, and subgaleal collection were found significantly associated with complications.

DOI: 10.5281/zenodo.

Background: The significance of amniotic fluid volume as a fetal status indicator is a relatively recent discovery. At any given stage of pregnancy, between 3% and 8% of expectant mothers have low amniotic fluid. The goal of the current study was to investigate the perinatal outcome of pregnancies that at 30 weeks or later had oligohydramniosis (AFI≤5cm). Methods: This study consists of 50 cases of antenatal patients with oligohydramnios (AFI≤5) at or beyond 30 weeks of gestation compared with age and gestation matched 50 normal liquor (AFI≥5 and ≤25). The outcome measures recorded were live birth, still birth, early neonatal death, MSAF, birth asphyxia and neonatal jaundice. Results: In the present study, AFI was significantly decreased in cases (3.74±1.2) compared (12.54±2.5) with controls. The incidence of live birth with normal AFI group was 94% and with oligohydramnios group was 84%. The incidence of still birth and early neonatal deaths in oligohydramnios group was 12% and 4% respectively, whereas in control group he incidence of still birth and early neonatal deaths was 4% and 2% respectively. The incidence of MSAF, birth asphyxia and neonatal jaundice was 13.6%, 4.5% and 4.5%, whereas in control group it was 4.2%, 2.1% and 2.1%. Conclusions: Pregnancies with Oligohydramnios (AFI≤5) is associated with increased risk of still birth, early neonatal death, MSAF, birth asphyxia and neonatal jaundice. Routine induction of labor for Oligohydramnios is not recommended. It is preferable to allow patients to go into spontaneous labor with continuous FHR monitoring. Antepartum diagnosis of Oligohydramnios warrants close fetal surveillance.

DOI: 10.5281/zenodo.

Aim: The present study was conducted to study the presence of bacteremia, markers of sepsis and Inflammation in renal failure patients on hemodialysis. Material & Methods: The present study was conducted in the Department of Internal Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India and total of 200 patients of both sexes who were diagnosed as case of renal failure which include both acute kidney injury (AKI) and CKD on basis of clinical history, examination, biochemical markers and were advised for hemodialysis were included in the study. Results: In our study among 200 patients of renal failure on hemodialysis the mean age in our study was 45.65±15.35 years with 140 male patients. Out of 200 patients 50 (25%) had positive blood and catheter tip culture and 150 (75%) of patients had negative blood and catheter tip culture. Out of 200 patients with sepsis 36 (18%) were in the age group between 15–25 years, 36 (18%) were in the age group between 26–35 years, 32 (16%) were in the age group 36–45 years and 96 (48%) were above 45 years of age. All 200 (100%) patients had episode of fever with chills and rigor, 96 (48%) patients had redness and pain at hemodialysis catheter site, 64 patients (32%) were confused, disoriented or comatose and 40 (20%) patients had hypotension. Among 200 patients of renal failure with sepsis, none had TLC less than 4.8/cumm (leucopenia), 40 (20%) patients had count between 4.8–10.8/cumm and 160 (80%) patients had TLC more than 10.8/cumm. 40 (80%) patients’ blood culture was positive for S. aureus, and E. coli found in blood culture 6 (12%) patients, Acinectobacter in 2 (4%) patient and Candida in 2 (4%) patients. Among 200 patients of renal failure on hemodialysis with sepsis 48 (24%) patients had internal jugular line for hemodialysis,16 (8%) had subclavian line and 136 (68%) had femoral line for hemodialysis. Conclusion: Patients requiring hemodialysis, 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 correlate serum bilirubin level by transcutaneous blood and conventional blood sample. Material & Methods: An observational study was conducted on a total of 200 neonates admitted in NICU of Nalanda medical College and hospital Patna, Bihar, India over a period of 12 months. Study was conducted from April 2023 to March 2024. Patients were included in the study after taking the voluntary informed consent of their parents. Results: In current study, distribution of newborns showed more number of males 132 (66%) and term 120 (60%) newborns. The mean and standard deviation for TSB and TcB at Forehead were 12.38±4.36 and 13.27±4.75, respectively (p<0.5). TSB and TcB at Forehead have a positive connection (r = 0.7456). The mean and standard deviation for TSB and TcB at sternum were 12.48±5.25, 13.17±4.86. The significant p-value was <0.5. TSB and TcB at sternum have a favorable connection (r = 0.7286). Conclusion: The current research found that transcutaneous bilirubin at forehead and sternum correlated well with serum: Neonatal hyperbilirubinemia, serum bilirubin level, transcutaneous blood, conventional blood.

DOI: 10.5281/zenodo.

Necrotizing fasciitis is a rare, progressive, and life-threatening bacterial infection that spreads rapidly along fascial planes and subcutaneous tissues, leading to extensive tissue necrosis and often resulting in death. The rapid spread of necrosis can cause systemic sepsis, toxic shock syndrome, and multi-organ failure. While necrotizing fasciitis of the neck is uncommon, it typically arises from dental or pharyngeal sources. Key factors influencing treatment success include early diagnosis, appropriate antibiotic therapy, and surgical debridement. This article presents a case of necrotizing fasciitis of the neck and discussing the clinical features, pathogenesis, and treatment in relation to existing literature.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to role of locking proximal humerus plating for early mobilization of fractures of proximal humerus in adult at tertiary care center. Methods: The Present study is a retrospective study, conducted in Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences and Hospital, Budge Budge, Kolkata, West Bengal, India. Study duration was of 2 years. In present study, 100 cases satisfying study criteria were studied. Results: Most were male (72%), > 60 years old (50%), RTA-injured (72%), right-sided (60%), and had co-morbidities such hypertension (33%), diabetes (22%), and coronary artery disease (16%). Two-part fractures predominated (48%), followed by part 3 (30%) and part 4 (22%). To determine outcomes, Neer’s rating method was used for pain intensity, function, range of motion, and anatomy. Excellent, acceptable, and poor outcomes were found in 26%, 59%, and 15% of patients. Plate impingement (7%), Varus malunion (6%), and stiffness (6%). Conclusion: Locking compression plates for proximal humerus fractures provide robust fixation, angular stability, and early functional aftercare. It helps patients to mobilise early , restore shoulder function, and resume routine activities faster.

DOI: 10.5281/zenodo.

Aim: A clinical comparison research to evaluate the effectiveness of combining bupivacaine with clonidine against using bupivacaine alone in paravertebral block for uncomplicated breast surgery. Materials and Methods: This study was conducted in the Department of Anesthesia, SKMCH, Muzaffarpur, Bihar, India for one year. Sixty patients posted for simple breast surgery were allocated into two groups-Group BC (receiving 0.5% bupivacaine with clonidine in PVB) and Group B (receiving 0.5% bupivacaine alone in PVB). The onset of sensory block was assessed using Pinprick test. Duration of sensory block measured. Level of postoperative pain was assessed using the Visual Analogue Scale (VAS). A complication of PVB measured. Results: Mean age(yrs) and weight in kg of BC group was 32.9and55.33 and the B group was 32.33and55.87, the difference between two groups statistically not significant (p>0.05). The preoperative baseline PR, MAP, SPO2 among the two groups comparison were statistically not significant (p>0.05). The mean onset of sensory block was 8.937 minutes in group BC and 11.32 minutes in group B. When compared it was statistically high significant(p<0.05). The mean total duration of sensory block was HIGH in group BC when compared with group B. It’s statistically highly significant(p<0.01). The mean duration of analgesia was 1098 minutes in group BC, and 713 minutes in group B when compared, It was statistically highly significant(p<0.05). The mean of the visual analog score was 1hr,2hr,4hr,8hr,12hr,24hr was low in group BC when compared with group B. Its statistically significant (p<0.05), except 1hr VAS, is not statistically significant. Conclusion: Paravertebral block, when used in alone, provides effective surgical anesthesia and superior analgesia in the post operative period. Paravertebral block reduces the incidence of postoperative nausea and vomiting. Paravertebral block provided effective intra operative and postoperative hemodynamic stability.

DOI: 10.5281/zenodo.

Aim: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This was a single-center prospective comparative study conducted in the Department of General Surgery, ANMMCH Gaya, Bihar, India for the duration of 2 years. A total of 80 patients were included in the study, divided into two groups, percutaneous needle aspiration (n=40) and pigtail catheter drainage (n=40). Results: In present study the age group of the patients ranged from the 20-68 years. Highest incidence (57.5%) was found in 30-39 years age group. In this study 70 patients were male and 10 patients were female. 68 patients were from rural and 12 were from urban population and the incidence of alcohol consumption was 70%. It was observed that fever was present in needle aspiration and catheter drainage 96% and 94% respectively. There was 100% anorexia, pain and tenderness in right upper quadrant and hypochondruim in needle aspiration and catheter drainage respectively. It was observed that leukocytosis was 84% and 100% in needle syringe and catheter drainage. There was no significant difference between the duration of hospital stay or the time required for total or near-total resolution of cavity. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyse of post-operative pain management in elective laparotomies in a tertiary care centre in Bihar region. Methods: This study was conducted in the Department of General Surgery, SKMCH, Muzaffarpur, Bihar, India. The present study was conducted for period of 18 months. A sample size of 100 patients fulfilling eligibility criteria was taken for the study. Results: The patients who underwent elective laparotomies were aged between 22 and 74. (34%) 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 24 (24%) patients followed by open cholecystectomy (for carcinoma gall bladder and other indications) which included 8 (8%) patients. Most common was general anaesthesia with transverse plane block which was used in 42 (42%) patients, followed by general anaesthesia with quadratus lumborum block which was used in 18 (18%) patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine in 55 patients followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural in 38 patients. 7 (7%) patients were on transdermal patch on post-operative day 2 and 1 patients were on diclofenac patch and 5 patients were on fentanyl patch. 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.

Aim: The aim of the present study was to assess the maternal and perinatal outcomes among women with pregnancy induced hypertension with normal and high serum LDH levels. Material & Methods: This was a prospective observational study conducted in Department of Obstetrics and Gynaecology, RDJM Medical College & Hospital, Turki, Muzaffarpur, Bihar, India for 10 months. 200 patients were studied in present study. Results: The maximum number of patients of pre-eclampsia were from age group 20-24 years (51%), next being 25-29 years (33%). Maximum number of cases was primigravida (53%), G2 were (31%), G3 were (12%). Maximum number of cases was > 38 weeks of gestation (47%), cases between 36-38 weeks were 27% and between 32-34 weeks and 34-36 were 13% each. In our study with serum LDH <600 with urine albumin 2+ was in 14 patients, 1+ in 30 patients, nil in 20 patients, traces in 10 patients and 3+ in 16 patients. Serum LDH between 600 to 800 with urine albumin 1+ was in 14 patients, 2+ was in 16 patients and nil was in 10 patients. Serum LDH >800 with urine albumin 1+ and 2+ was 18 patients each, with 3+ and nil in 2 patients each. P value is 0.001 which was statistically significant. In our study serum LDH <600 had abruption with PPH, DIC, eclampsia and PPH were noted and p value was 0.72 which was statistically not significant. In our study serum LDH <600 had IUGR in 6 patients, fetal distress in 4 patients, neonatal death in 4 patients. Serum LDH between 600-800 had IUGR and LBW in one patient each. Serum LDH with >800 had IUGR in 4 patients. P value was 0.220 which was statistically not significant. Conclusion: Higher LDH levels are indicative of maternal and fetal complications. higher serum LDH levels more than 500 IU/L to 600 to 800 IU/L have closer association with severe preeclampsia. Pre-eclampsia patients with raised LDH levels should be closely monitored.

DOI: 10.5281/zenodo.

Background: Malaria diagnosis often relies on peripheral blood smear microscopy or rapid diagnostic tests (MRDTs). While microscopy is considered the gold standard due to its high specificity, MRDTs offer the advantage of rapid results and ease of use. This study compares these diagnostic methods to assess their effectiveness in detecting malaria, with a focus on sensitivity, specificity, and practical implications in field settings. Aim: To assess the differences between rapid diagnostic tests (RDTs) and peripheral smear for malaria diagnosis. Method and Material: Every clinically suspected case of malaria had blood samples that were regularly tested for the presence of the malaria parasite using RDT and peripheral smear analysis. Standard formulas were employed to evaluate the predictive value, specificity, sensitivities, and negative predictive values. Results: The study found that the majority of participants were young males. Rapid diagnostic tests (RDTs) had a true positive rate of 45.2% and detected more positive cases (36.4%) compared to peripheral blood smear microscopy (30.7%). However, MRDTs had higher false positive (13.6%) and false negative rates (3.4%) than microscopy, highlighting the need for combined diagnostic methods. Conclusion: The study found MRDTs slightly more sensitive than peripheral smears in detecting malaria and mixed infections, but with a higher false-positive rate (13%). Despite this, MRDTs’ ease of use and rapid results make them valuable, though combining them with microscopy may offer the most reliable diagnosis.

DOI: 10.5281/zenodo.

Aim: To assess the effects of a single dosage of prophylactic antibiotics compared to many doses in elective hernia repair. Material and Methods: A retrospective study was conducted in Department of Surgery, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India from August 2019 to July 2020. 100 suitable patients who were admitted for elective groin surgery were included in this study were randomly assigned two groups (n=50) single-dose pre-operative (SD) group and multiple- dose (MD) in each group. Master chart for Protocol of the procedure was designed along with Performa, patient identification details, and informed written consent form for all study. Both groups were homogenized in terms of age, type of hernia, and clinical findings. SD group was given amoxycillin-clavulanic acid (2 gm) intravenously at the time of induction of anesthesia. MD group was given amoxycillin-clavulanic acid (2 gm) parentally at the time of induction of anesthesia and following it up with the same antibiotic (1 gm) intravenously twice a day for two days post-operatively. Results: Patients with uncomplicated inguinal hernia and operated as elective cases only included. All data related to wound site infection, number of days in the hospital, expenditure all collected tabled and analyzed. Both groups met all inclusion criteria and homogenized in all the aspects are only included in the study. Data collected from both single antibiotic group I (n=50) and group II multidose group (n=50) who underwent elective hernia surgery. Out of 50 patients of group SD, only 8% of patients developed surgical site infection compared to none in group MD. Statistically, there was no appreciable difference in the incidence of SSI in both SD and MD groups with a p value of 0.291, which is in agreement with earlier studies. Main complaints by many patients in the post-operative period were pain and headache managed well with intravenous fluids for spinal headache and analgesics. Seroma was found in the 3rd postoperative day in 2 patients in group I, fluid aspirated, and culture turned out to be negative. Five of the SD group developed an infection, which subsided with the continuation of antibiotics. Expenditure incurred by the patient only for antibiotic analyzed of antibiotic (amoxicillin and clavulanic acid) and found the average cost of antibiotic per patient in SD group was Rs. 145 while the cost of antibiotic per patient in group II was Rs. 1400. P value is 0.0001 (p value <0.05) found to be significant. Conclusion: Prophylactic use of antibiotics in clean elective cases is still a subject of many controversies. Our study on antibiotic prophylaxis for hernia repair consisted of two groups with one group received a single-dose antibiotic and the other group a multi-dose antibiotic and the outcome on surgery related infections and cost compared. We found that the rate of infections is quite similar in SD and MD antibiotics thereby making single-dose antibiotics prophylaxis as effective as multiple doses of antibiotics prophylaxis.

DOI: 10.5281/zenodo.

Background: Hoarseness of voice is a common symptom that can result from a variety of conditions ranging from benign lesions to serious malignancies. Understanding the clinicopathological profile of patients presenting with hoarseness can aid in early diagnosis and appropriate management. This study investigates the clinicopathological characteristics of adult patients with hoarseness of voice in the Bihar region. Methods: A prospective study was conducted over 18 months at Department of ENT,Nalanda Medical College and Hospital, Patna, Bihar, India , involving 100 adult patients presenting with hoarseness of voice. Detailed clinical evaluations, including laryngoscopic examination and histopathological analysis, were performed. The study analyzed demographic data, etiological factors, and the correlation between clinical findings and histopathological diagnoses. Results: The most common cause of hoarseness was laryngitis, accounting for 40% of cases, followed by vocal cord nodules (25%), and malignancies (20%). Male patients were predominantly affected, with a male-to-female ratio of 2:1. A significant correlation was found between smoking and the presence of laryngeal malignancies (p<0.01). Histopathological analysis confirmed malignancies in 20% of the cases, with squamous cell carcinoma being the most common type. Conclusion: Laryngitis and vocal cord nodules are the leading causes of hoarseness in the Bihar region, but the high prevalence of malignancies underscores the need for thorough evaluation of patients presenting with this symptom. Early laryngoscopic examination and biopsy are crucial for the timely diagnosis and management of potential malignancies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the Angiographic & Clinical profile of patients with ischemic stroke in the younger age group. Methods: This cross-sectional observational study was conducted on 200 patients one standard vessel imaging procedure within 2 weeks of stroke onset at Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for the period of three months. Results: The study included 70% men and 75% over 35. The majority of risk factors were in patients over 35. Based on the clinical presentation patients were categorized as right hemispheric/left hemispheric/ posterior circulation or uncertain area. Most patients showed clinical suspicion of left hemispheric strokes, and 21% showed posterior circulation involvement. Out of 200 patients, 42% (n=84) had normal angiography. Undetermined stroke was the most common cause in normal angiography patients. The second leading cause was cardio embolism. Conclusion: After 35-50 years of age, traditional vascular risk factors move towards the ‘older population’ pattern. Patients under 35 should be carefully screened for unusual stroke causes. Youthful arterial dissections are prevalent and should be evaluated in clinical settings. All patients should have a proper and timely angiographic examination to rule out dissections. This research emphasizes the necessity of risk factor evaluation, control, and thorough etiological evaluation, including angiographic assessment, in diagnosing, managing, and developing secondary prevention initiatives for young stroke patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the serum prostate specific antigen levels in patients with prostate lesions. Methods: This was a retrospective record based study in which we retrieved all the prostatic specimens including Transurethral urethral resection of prostate (TURP) specimens and prostatic core biopsies, received at the Department of Pathology, over period of 12 months. Out of total 70 prostatic specimens received during the study period, total of 50 cases satisfied the inclusion criteria. Results: Mean age at the time of diagnosis was 66.84 years with age ranging from 48-80 years. Most common age group was between 61-70 years accounting for 23 (46%) of all cases. Mean age at the time of diagnosis was 66.84 years with age ranging from 48-80 years. Most common age group was between 61-70 years accounting for 23 (46%) of all cases. Out of total 50 cases, 43 (86%) were benign lesions which included 28 cases BPH alone, 12 cases of BPH with prostatitis while single 2 cases each for BPH with granulomatous prostatitis and basal cell hyperplasia. Mean PSA value for benign lesions was 6.57 ng/ml. There were 6 malignant lesions which included 5 cases of Prostatic adenocarcinomas (PCa) and a single case of metastatic Transitonal cell carcinoma (TCC) of bladder. Mean PSA for PCa cases were 35.05 ng/ml. Single case of high grade prostatic intraepithelial neoplasia (HGPIN) also detected. The distribution of various prostatic lesions along with their PSA values was shown. Maximum prostatic lesions came under 0-4 PSA values. While maximum benign cases presented in seventh decade while maximum PCa cases presented in eighth decade of life in this study. Conclusion: We concluded that the most common prostatic lesions are benign predominantly BPH. PCa are the commonest malignancies. Common age group at the time of presentation of prostatic pathologies was 60-70 years. Elevated levels of PSA >20 ng/ml are commonly observed in PCa.

DOI: 10.5281/zenodo.

Background and Objectives: Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD) and a significant contributor to the morbidity and mortality associated with type II diabetes mellitus (DM). This study aims to explore the clinical spectrum of diabetic nephropathy in patients with type II DM, focusing on the prevalence, progression, and associated risk factors contributing to the onset and severity of nephropathy. Methods: This observational study was conducted in Department of Medicine, Government Medical College. Bettiah, West Champaran, Bihar, India for one year,  involving 100 patients with type II DM. Data were collected on demographics, clinical presentation, laboratory findings, and the presence of microalbuminuria or overt proteinuria. The relationship between glycemic control, hypertension, lipid profile, and the progression of diabetic nephropathy was analyzed. Results: The prevalence of diabetic nephropathy was 35%, with microalbuminuria detected in 60% of these cases. Poor glycemic control, longer duration of diabetes, and hypertension were strongly associated with the progression of nephropathy. Patients with diabetic nephropathy had significantly higher serum creatinine levels and lower estimated glomerular filtration rates (eGFR). The presence of retinopathy was also correlated with a higher risk of nephropathy. Conclusion: Diabetic nephropathy is prevalent among patients with type II DM, particularly those with poor glycemic control and hypertension. Early detection and aggressive management of risk factors are essential to slow the progression of nephropathy and prevent ESRD.

DOI: 10.5281/zenodo.

Aim: To investigate the occurrence and frequency of dermatophytes in patients visiting a tertiary care hospital. Material and Methods: This observational prospective study was carried out in the Department of Microbiology, Jawaharlal Nehru medical college and Hospital, Bhagalpur, Bihar, India for one year. Total of 120 patients showing lesions typical of dermatophytes infection based on the clinicians’ preliminary diagnosis from outpatient Department of Dermatology. Result: Samples were collected from patient’s various anatomical sites such as epidermal layers of skin, hair and nail. Among them tinea corporis was predominant in 73/120 (60.83%) patients followed by tinea cruris in 20/120 (16.67%) patients. Tinea unguium was found in 15/120 (12.5%) patients, tinea manuum was observed in 4 (3.3%) patients, tinea pedis was seen in 3 (2.5%) patients and tinea capitis, tinea facei were 2 and tinea barbae were seen in 1(1.67%) and one (0.83%) patient respectively. Conclusion: Dermatophytoses are worldwide distributed with increased incidence especially in tropical countries like India. Several factors such as age, sex, illiteracy, poor hygiene and social economy influence the infection with dermatophytes.

DOI: 10.5281/zenodo.

Background and Objectives: Chronic rhinosinusitis without polyposis (CRSsNP) is a common condition characterized by prolonged inflammation of the sinuses and nasal passages, leading to significant morbidity. The size of nasopharyngeal lymphoid tissue (NALT) and its bacteriological profile may influence the severity and treatment outcomes of CRSsNP. This study aims to investigate the relationship between NALT size, bacteriology, and the efficacy of treatment in adult patients with CRSsNP. Methods: A prospective study was conducted in Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India from Jan 2022 to Dec 2022.  100 adult patients diagnosed with CRSsNP. The size of NALT was assessed using nasoendoscopy, and bacterial cultures were obtained from nasopharyngeal swabs. Patients were treated according to standardized guidelines, and outcomes were measured based on symptom resolution and recurrence rates. Results: Larger NALT size was significantly associated with the presence of pathogenic bacteria, particularly Staphylococcus aureus and Pseudomonas aeruginosa (p < 0.001). Patients with larger NALT had lower rates of symptom resolution and higher recurrence rates after treatment. Multivariate analysis identified NALT size and specific bacterial infections as independent predictors of poor treatment outcomes (adjusted OR: 3.8; 95% CI: 2.2-6.4). Conclusion: The size of nasopharyngeal lymphoid tissue and the presence of specific bacterial pathogens play a crucial role in the treatment outcomes of CRSsNP. Early identification and targeted treatment strategies may improve patient outcomes and reduce recurrence rates.

DOI: 10.5281/zenodo.

Background: The partogram, a pictorial representation of labor progress, has been a cornerstone of obstetric care since its development in the 1950s. Although the World Health Organization (WHO) endorses its use for managing labor and reducing maternal and fetal complications. The partogram is a newer approach designed to streamline labor management while maintaining essential monitoring functions. Aim: This study aims to evaluate the effectiveness of partogram monitoring in improving maternal and fetal outcomes during labor in patients with a history of lower segment Caesarean section (LSCS), and to identify key factors influencing the progress of labor and overall delivery outcomes. Methodology: This prospective study was conducted at the Department of Obstetrics and Gynaecology, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India for one year. A total of 94 women, meeting specific inclusion criteria, were enrolled. The partogram model involved calculating ACTION and ALERT estimated times of delivery (ETD) based on monitoring labor and Friedman’s rule progress accordingly. Interventions included rupturing membranes and applying prostaglandin E2 (PGE2) gel for slow labor. Results: The study population was predominantly young, with 60.64% aged 18-25. Most deliveries (76.60%) occurred between 37.5 and 40 weeks of gestation. The majority of patients (51.06%) underwent repeat LSCS, while 30.85% had normal deliveries. Fetal distress (47.92%) was the primary indication for LSCS. The partogram effectively guided timely interventions, reducing complications and optimizing delivery outcomes. Conclusion: The partogram proved to be an effective tool for managing labor in patients with previous LSCS. It facilitated early detection of Labor deviations, guiding timely interventions and improving maternal and fetal outcomes by reducing complications such as obstructed labor and perinatal mortality.

DOI: 10.5281/zenodo.

Background: Lateral epicondylitis is commonly known as “tennis elbow” and represents 1-3% of the morbidity in the general population; occupational factors contribute to most cases. Treatment can take many forms but very few have evidence to support them as effective treatments. Aim: This study aims to compare injections of corticosteroids and platelet-rich plasma for lateral epicondylitis. Methodology:  A retrospective, randomized study was done on 60 patients. Thirty patients received an injection of corticosteroids and thirty an injection of PRP. Calculations regarding the pain and functional results at baseline, 4th, 8th, and 12th week were done by utilizing the Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results: At the 12th week, the corticosteroid group showed significantly greater pain reduction (VAS: 5.0 ± 1.1) and functional improvement (DASH: 35.3 ± 6.1) compared to the PRP group (VAS: 3.8 ± 1.0; DASH: 25.8 ± 6.3) (p < 0.001). Conclusion: Corticosteroid injections provide more significant short-term pain relief and functional recovery than PRP in treating lateral epicondylitis.

DOI: 10.5281/zenodo.

Background: Tibial spine or anterior cruciate ligament bone avulsion is most commonly caused by low-velocity accidents, motorbikes, or falls from bicycles, especially during sports. Classified by Meyers and McKeever into three types, these avulsions can lead to significant complications if left untreated. Aim: The purpose of this study is to compare the clinical and radiological results of arthroscopic fixation of anterior cruciate ligament bone avulsions with a suture pull-out method to those reported in the existing literature. Methodology: This prospective study was conducted over one year, this research involved 80 patients suffering from type II, III, or IV tibial spine avulsions. Exclusion criteria included type I injuries and other associated conditions. Surgical procedures involved diagnostic arthroscopy also fixation of the avulsed fragment using nonabsorbable sutures tied over a bone bridge or fixation button. Results: The cohort consisted mostly of younger males (76%), with motorbike-related falls (50%) being the predominant cause of injury. The majority of injuries were classified as type III (80%). Post-operative assessments showed significant improvements in mean Lysholm scores: 85.62 at three months, 95.72 at six months, and 96.45 at nine months. Furthermore, 80% of patients reported no post-operative complications. Conclusion: Arthroscopic suture pull-out fixation for tibial spine avulsion fractures, particularly types III and IV, is effective, resulting in improved knee function and a low complication rate. These findings support the technique as a preferred treatment option and highlight the need for further research to explore long-term outcomes across different populations.

DOI: 10.5281/zenodo.

Background: An inguinal hernia may result from tissue pressing through a vulnerable area in the abdominal muscles located around the pelvis. The purpose of open mesh inguinal hernia repair is to reduce the risk of recurrence and reinforce the abdominal wall using a mesh implant. Aim: The aim of this study was to assess the efficacy and adverse effects of open mesh inguinal hernia repair. Methods: A Retrospective Study was conducted at the Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, for one year. A purposive sample strategy was used to enroll 50 individuals who had mesh surgery for inguinal hernia. Results: In this research, inguinal hernia recurrence was seen in 5 cases (10%), with 4 cases (8%), necessitating reoperation. Intraoperatively, 80% (n=80) had no problems, with 10% suffering from spermatic cord and neurovascular structural injuries. More than 10% of individuals experienced problems after surgery, including numbness (28%), hematoma (22%), scrotal enlargement (18%), and seroma (14%). Conclusions: Inguinal hernia repairs with open mesh had comparatively low rates of recurrence and reoperation.  Physicians should be on the lookout for possible postoperative problems

DOI: 10.5281/zenodo.