International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

p-ISSN: 2961-6042

Peer Review Journal

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1. Retrospective Observational Assessment of the Grades of TB in Invasive Breast Carcinoma and Correlate it with Known Clinicopathological Parameters to Determine its Usefulness as a Prognostic Factor
Fauzia Perveen, C.P. Jaiswal
Aim: The aim of the present study was to assess the grade of TB in Invasive Breast Carcinoma and correlate it with known clinicopathological parameters to determine its usefulness as a prognostic factor. Methods: This was a retrospective observational study carried out in Department of pathology at Nalanda Medical College and Hospital, Patna, Bihar, India with the available histopathological data of 50 cases of modified radical mastectomy for the period of one and a half year. Results: Out of the 50 cases, most of the cases belonged to age groups 40-49 years and 50-59 years (30% each), followed by 22% cases of age group 60-69 years, 12% cases of age group 30-39 years and 6% cases of age group 20-29 years. Of these 50 cases, 35 cases (70%) were of invasive ductal carcinoma, 7 cases (14%) were of No specific type, and 2 cases each of lobular Ca, Mucinous Ca, Metaplastic Ca (4% each), 1 case of Ca with medullary features and Ca with neuroendocrine features (2% each). Maximum cases are of age group >45 years (76%), newly diagnosed (60%), lymph node negative (46%), Tumour size T2 (52%) and TNM stage III (46%). High tumour budding was seen in patients above the age of >45 years (66.66%) compared to age <45 years (42.10%). High tumour budding was seen in patients who had a newly diagnosed malignancy (53.34%) compared to those who were post chemotherapy (45%). 71.42% cases of Invasive carcinoma- NST showed high tumour budding while 28.58% cases showed low tumour budding. 48.58% cases of Invasive ductal carcinoma showed high tumour budding while 51.42% cases showed low tumour budding. 2 cases (100%) each of Lobular, Metaplastic and Medullary carcinoma showed Low tumour budding while 2 cases (100%) of Mucinous and and one case (100%) neuroendocrine carcinoma showed High tumour budding. Conclusion: As higher grade tumour budding was associated with positive lymphnode status, higher tumour stage and presence of lymphovascular invasion, it can be considered as an indicator of poor prognosis in cases of breast carcinoma especially in resource poor institutes which are not equipped with sophisticated IHC and Molecular markers.

2. A Multi-Centric Observational Assessment of the Health Facilities for Airborne Infection Control Practices and Adherence to the National Airborne Infection Control Guidelines
Binish Inam
Aim: The objective of the current study was to assess the health facilities for airborne infection control practices and adherence to the National airborne infection control guidelines. Methods: A cross‑sectional study was conducted department of community medicine, Anugrah Narayan Magadh medical College and Hospital, Gaya, Bihar, India. 60 health‑care facilities ‑ 30 each from Government and Private were selected from five randomly selected districts in the state of Bihar.  A checklist was developed based on the NAIC guidelines, which dealt with three main domains of infection control‑administrative control, environmental control, and personal respiratory protection measures. Results: Most of the facilities had infection control committees 42 (70%). Annual infection control trainings were held for staff in 23 (38.33%) facilities, but 24 (40%) of facilities were not familiar with NAIC guidelines. Counseling on cough etiquette/hygiene practices in registration/ waiting areas was practiced in 6 (10%) institutions. Cross ventilation was present in OPDs in 33 (55%) institutions. Fast‑tracking of respiratory symptomatic in OPD was practiced in 11 (18.33%) institutions. Segregation of respiratory symptomatic was practiced in 11 (18.33%) of the facilities. The provision of providing masks to respiratory symptomatic was present in 15 (25%) of institutions. Sputum was disposed of properly in 52 (86.66%) institutions. N95 masks were available in high‑risk settings in 8 (13.33%) health facilities. Conclusion: There exist deficiencies in adherence to all components of NAIC guidelines including administrative, environmental, and use of personal protective equipment in both government and private hospitals in the state.

3. Single-Center Retrospective Assessment of Clinical Profile of Patients with Sudden Onset Sensorineural Hearing Loss
Raj Kumar Pathak, Shambhu Saran
Aim: The aim of the present study was to study clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital. Methods: The Present study was single-center, retrospective study, conducted in Department of ENT, at Darbhanga Medical College and Hospital Laheriasarai, Darbhanga, Bihar, India. We studied total 100 case records. Case records of patients with sudden onset sensorineural hearing loss examined from January 2018 to December 2018. Results: All patients were compared according to recovery status. Recovery was noticed in 40 patients (40%) while no or less than 50 % recovery was noticed in 60 patients (60%). Majority of patients were from 41-60 years age group (43%) followed by from 21-40 years age group (30%). In patients with recovery, mean age was 41.87 ± 9.34 years as compared to patients without recovery as 50.51 ± 10.78 years and difference was statistically significant (p<0.05). Gender was comparable among total patients as well as patients with or without recovery and difference was statistically not significant (p>0.05). Hypertension (35%), diabetes (20%), dyslipidemia (20%) and thyroid disorder (8%) were common comorbidities noted among patients. Vertigo was significant in patients without recovery (62.50%) as compared to patients with recovery (37.50%) and difference was statistically significant (p<0.05). Tinnitus was comparable in patients with recovery (40%) as well as patients without recovery (60%) and difference was statistically not significant (p>0.05). Degree of hearing loss was mild (8%), moderate (10%), moderately severe (20%), severe (25%) and profound (37%). Incidence of patients without recovery was increased with increase in severity of hearing loss and difference was statistically significant (p<0.05). Conclusion: In patients with sudden onset sensorineural hearing loss age less than 40 years, no comorbidities, lesser degree of hearing loss, early (<14 days) initiation of treatment are factors associated with recovery.

4. A Hospital-Based Assessment of the Prevalence and Factors Associated with Diabetic Retinopathy among Type 2 Diabetic Patients
Rakhi Kumari, Sanjay Kumar, Amit Kumar, Hemkant Jha
Aim: We conducted a study among outpatients of a tertiary diabetes care centre and screened for DR, non-adherence to drug therapy and other clinical characteristics. Methods: A cross-sectional, observational study was conducted at Darbhanga Medical College and Hospital, Darbhanga, Bihar, India and however, due to time constraints, we managed 500 patients. Study participants were selected using a systematic random sampling technique based on daily attendance in the hospital. Results: A total of 500 participants with a complete retina evaluation were included in this study. Among them, 275 were female (55%) and 225 were male (45%). The mean age of the participants was 52.4±11.2 years. The mean duration of diabetes was 9.7±7.0 years. More than half of the study subjects were housewives (51%). 18% of the participants came from the high-income class and 30% had a lower middle income. 18% of the study subjects were obese, 48% were overweight and 2% were underweight. Based on FPG, 280 (70%) of the participants had uncontrolled diabetes. Conclusion: Undiagnosed diabetic retinopathy is still common among patients even at tertiary care centers. It is associated with longer disease duration, poor metabolic control and self-reported non-adherence to therapy. Regular screening for diabetic retinopathy should be implemented in resource-limited settings and further efforts should be made to improve the patients’ drug adherence and metabolic control.

5. A Hospital Based Prospective Observational Assessment of Peripheral Inserted Venous Catheter Related Local Complications
Wahhaj, Anil Kumar, V.S. Prasad
Aim: To find the most adequate and safe intravenous peripheral device, our study attempted to estimate the incidence of local complications associated with peripheral catheters. Methodology: This observational study was conducted among indoor patients of Upgraded Department of General Surgery, D.M.C.H, Darbhanga, Bihar admitted during the period of December 2017 to November 2018. Patients of age 5 years and above admitted in surgery department who required intravenous fluid therapy and who were willing to give consent for the study. After the admission into general surgery wards, peripheral intravenous cannula inserted peripherally whichever site better accessible under all aseptic precautions. Cannula site was examined daily for local complications and if any signs of local complications (pain, redness, swelling, thrombophlebitis, and extravasation) was observed, the cannula site was either changed or patient was shifted to oral drugs if not contraindicated and recorded on the evaluation sheet. The clinical and observational data were compiled and analyzed and following observations were obtained. Results: Total 500 study cases, out of which 293 male and 207 female candidates were observed. Complications observed in 34.13% of male patient i.e. 100 male patient, and 65.7% of female patient i.e. 136 females. In our study, complications like swelling and infiltration were observed in 13.26% cases with 18 gauze cannulas, while 12.31% cases with 20 gauze cannulas whereas 15.49% cases observed with 22 gauze cannulas. 36% of cases undergone 3 times cannulation on same vein whereas 34.07% of cases with 2-time cannulation attempt. In our study, 24% of cases undergone 3 times cannulation on same vein whereas 14.81% of cases with 2-time cannulation attempt. Conclusion: A high incidence of complications associated with use of a complete safety catheter was seen. Phlebitis was the predominant complication and duration of catheter permanence was over 72 hours. This long period was considered a risk factor for this complication.

6. Assessment of Surgical Evaluation of Bimalleolar Ankle Fracture
Abhishek Kumar, Ramashish Yadav, Rahul Ranjan
Aim: This study aimed to evaluate the outcomes of surgical treatment for bimalleolar ankle fractures. Methods: A retrospective study was conducted, including all patients with bimalleolar ankle fractures who underwent surgical management at Department of Orthopaedics Darbhanga Medical College and Hospital, Darbhanga, Bihar, India, for the duration of 1year. The inclusion criteria were patients aged 18 years or older, with bimalleolar ankle fractures confirmed by radiographic imaging, and who underwent surgical treatment. The exclusion criteria were patients with open fractures, previous ankle surgery, and comorbidities that could affect the outcome. The statistical analysis was performed using SPSS software version 25. Results: A total of 75 patients were included in the study, with a mean age of 38 years. The most common mechanism of injury was a fall from a height, accounting for 57% of cases. The mean follow-up time was 12 months. The surgical management included open reduction and internal fixation with screws or plates. The mean time to weight-bearing was 8 weeks, and the mean time to return to work was 14 weeks. The overall complication rate was 13%, including infection and implant failure. The mean American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 82.2. Conclusion: Surgical management of bimalleolar ankle fractures can provide good functional outcomes, with a low rate of complications. The most common mechanism of injury was a fall from a height, and the mean time to weight-bearing and return to work was 8 and 14 weeks, respectively.

7. A Hospital Based Observational Assessment of Prevalence and Symptoms in Patients with Eosinophilia Using Peripheral Smear Method
Vindeshwar Mahto
Aim: The present study aimed to evaluate the prevalence and symptoms in patients with eosinophilia.
Methods: The study was done in Department of Pathology, Madhubani Medical College & Hospital, Madhubani and Tertiary care hospital Madhubani, Bihar, India. It was done for one year. The study included total of 100 patients based on the inclusion and exclusion criteria. All the patients were explained study protocol and informed consent was obtained. Results: The study included 100 patients. 25 patients were in the age group of 41-50 years. 22 patients were between 51-60 years. 3 patients in each had age between 1-10 and 2 patients in 81-90 years. Male (n=60) were more compared to females (n=40) in this study. A total of 21 symptoms observed in the study population. Fever was the most common (n=20) symptom compared to others. 14 patients showed cough and 12 had breathlessness. 10 had chest pain and 10 had skin lesions. Least number of patients showed hemoptysis, hydrocele, headache, bleeding pepr rectum and history of snake bite. 60 patients in mild, 30 in moderate and 10 in severe eosinophilia categories were observed in this study. Conclusion: The study showed middle age with male sex is more prone to eosinophilia. Fever and cough are the most common symptoms.

8. A Hospital-Based Assessment of the Beneficial Impact of Probiotics Oral Supplementation on Patients Affected by Chalazion
Amit Rajan, Arun Kumar Sinha
Aim: The aim of the present study was to define the possible beneficial impact of probiotics oral supplementation on patients affected by chalazion. Methods: The study was conducted in the Department of ophthalmology, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for the period of one year. Total 24 enrolled patients underwent a complete ophthalmologic examination, including the assessment of size, duration and location of the chalazion before the recruitment. Results: The trial was accomplished by all the participants. The mean age was matched in the two considered groups (P=0.74). Both groups had comparable baseline characteristics in terms of location, size and duration of the chalazion, with the exception of the sex; in fact, there was a higher prevalence in the female. The medical treatment with or without probiotics supplementation was effective only on the small size chalazia.  Medium and large size chalazia did not respond to medical treatment with or without probiotics supplementation over the follow-up period (3mo). Conclusion: The considerable difference in time taken for complete resolution of small chalazia between the two groups in favor of the experimental one confirms the presence of a gut-eye axis.

9. A Hospital Based Observational Assessment of the Psychological Distress and Caregiver Burden among Care Givers of Schizophrenia Patients
Kumar Satyadarshee, Takum Mokholee, Amardeep Kumar, Karnik Kishore
Aim: The study was conducted with the aim of assessing the psychological distress and caregiver burden among care givers of schizophrenia patients.
Methods: The current study was a cross-sectional study conducted in the Department of Psychiatry, Jannayak Karpoori Thakur Medical College & Hospital, Madhepura, Bihar, India for one year.  A total of 50 subjects were included in the analysis. Primary Caregivers of psychiatric outpatients in Jannayak Karpoori Thakur Medical College & Hospital, Madhepura, Bihar, India with a diagnosis of Schizophrenia with duration of illness >2yrs classified under F20 according to ICD-10 and aged more than 18 years were included in the study. Results: The mean duration of caregiving of study population was 7 ± 5.87 years with the range of 2 to 30 years. The mean total caregiving time per day of study population was 7.63 ± 2.37 with the range of 3 to 12 hours/days. The majority of patients were female (70%). The majority of the patients had low educational level with 12% of them being illiterate and 36% of the patients were unemployed. The mean PANSS score of the study population was 57.30 ± 12.74 with the range 36 to 82. The mean caregiver burden schedule score of the study population was 44.60 ± 18.44 with the range of 20 to 80. The odds of psychological distress were 1.073 times increase with each year increase age which was statistically significant (P value 0.044). The odds of psychological distress were 1.392 times increasing with each one hour increase in total caregiving giving time which was statistically significant (P value 0.039). The odds of psychological distress in caregivers were 1.087 times more in patients who had negative symptoms compare to those with positive symptoms. The association was statistically significant (P value 0.045). Conclusion: Caregivers of schizophrenic patients suffered from significant burden. It thus becomes important to plan interventions that would reduce their burden of care and thus improving their psychological well-being.

10. Hospital Based Prospective Comparison of CRP against Blood Culture in Diagnosis of Neonatal Sepsis
Manish Kumar, Simmi Kumari, Shilpi Singh
Aim: The Aim of the study was to compare CRP against blood culture in diagnosis of neonatal Sepsis. Methods: The present study was conducted in the Department of Microbiology, Narayan Medical College and Hospital, Sasaram, Rohtas, Bihar, India, India for 10 months. 100 neonates suspected of septicaemia were included in the study, information on demographic data, blood culture and the level of CRP was extracted. Results: Of the 100 neonates studied, 60 were blood culture positive while 40 were CRP positive. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CRP were 84%, 40%, 44%, 82% and 65% respectively. Conclusion: The specificity and sensitivity of CRP against blood culture strengthen the use of this acute phase protein in the diagnosis of neonatal sepsis and would help the clinicians to fix the period of antibiotic treatment and medical management to reduce the liver damage due to antibiotic exposure, development of bacterial resistance and neonatal mortality.

11. A Hospital Based Study to Determine the Bacterial Profile of Pneumonia Cases and its Antibiogram
Simmi Kumari, Manish Kumar, Shilpi Singh
Aim: This study aimed to determine the bacterial profile of pneumonia cases and its antibiogram. Methods: The present study was conducted at Department of microbiology, AIIMS, Patna, Bihar, India for a period of 12 months and 100 patients meeting all the inclusion criteria enrolled for the study. Institutional ethical committee clearance was obtained and written consent taken from the parent/ guardian in case of a minor before the beginning of the study. Results: Out of the total 100 patients meeting all the inclusion criteria enrolled for the study, 70(70%) were male and 30(30%) were female. All age groups were considered for the study but most of them 30 (30%) were between 60-69 years. Out of 75 samples which yielded causative agents, 60 yielded single isolate and 15 yielded double isolates. Amongst the bacteria isolated 9 (12%) were Gram positive and 66 (88%) were Gram negative. Staphylococcus aureus (4, 44.4%), Coagulase negative Staphylococcus (4, 44.4%) and Pneumococci (1, 11.2%) were the common Gram-positive bacteria isolated. Among the Gram-negative bacteria, the commonest organism isolated was Klebsiella species (27, 40.90%) followed by Pseudomonas species (20, 30.30%), Acinetobacter (9, 13.63%), E. coli (9, 13.63%) and Providencia spp (1, 1.51%). Among the Enterobacteriaceae, Extended Spectrum Beta-Lactamase (ESBL) production was noted in 7 of the 46 organisms, the most common being Klebsiella spp (3) followed by E. coli (2). Conclusion: Incidence of pneumonia has increased due to lack of early diagnosis and multidrug resistance. The incidence of Gram-negative bacteria as an etiological factor has also increased tremendously.

12. Comparing Efficacy of a Single and Triple Injection Techniques in Ultrasound-Guided Costoclavicular Block for Forearm and Hand Surgery: A Single-Blind Randomized Clinical Study
Shashank Dhiraj, Kritika Singh
Aim: This study aimed to compare triple injections (TI) in each of the three cords in the costoclavicular (CC) space would result in a greater spread in the four major terminal nerves of the brachial plexus compared to a single injection (SI) in the CC space without increasing the local anesthetic (LA) volume.  Methods: Fifty patients with ASA physical status 1, 2, and 3 who underwent upper extremity surgery randomly received either a single injection (SI group, n = 25) or a triple injection (TI group, n = 25) using the CC approach. 20 ml of 0.5% ropivacaine was used for BPB in each group. Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at 5-minute intervals for 30 minutes immediately after LA administration. Results: The rate of blockage of all four nerves was significantly higher in the TI group than in the SI group after the 30-minute block, except for the patients with the radial nerve block at 15 minutes, those with the musculocutaneous nerve block at 20 minutes, and those with the median nerve at 25 and 30 minutes. The performance time was similar in the two groups (3.0 ± 0.9 minutes in the SI group vs. 3.2 ± 1.2 minutes in the TI group, respectively; P=.54).  Conclusion: Our study found that ultrasound-guided costoclavicular brachial plexus block is a quick and effective method for providing sensory-motor blockade, and TI of CC approach increased the consistency of US-guided infraclavicular BPB without increasing the procedure time or LA volume.

13. A Hospital-Based Study to Assess the Symptomatology and Course of COVID-19 Infection among Vaccinated and Unvaccinated Pregnant Women
Kumari Divyamala, Ankita Ranjan, Ranu Singh Kushwaha
Aim: The aim of the present study was to assess the symptomatology and course of COVID-19 infection among vaccinated and unvaccinated pregnant women in Bihar region. Methods:  The present study was conducted at Nalanda medical College and Hospital, Patna, Bihar, India for the period of one year. During the inclusion period, there were 150 pregnant women with PCR-confirmed SARS-CoV-2 infection, of whom 100 were vaccinated and 50 were not. Results: No significant differences were observed between the vaccinated and unvaccinated pregnant women in age (median, 31.0 vs 31.0 years, P=0.730), body mass index (median, 26.7 vs 27.3 kg/m2, P=0.284), rate of obesity (16.9% vs 21.2%, P=0.606) or pregnancy trimester at diagnosis (P=0.254). Few vaccinated women had significant medical comorbidities, including asthma (7%), pregestational diabetes (2%), hypothyroidism (7%), malignancy (1%) and immunosuppression (1%). There was a statistically non-significant trend for fewer unvaccinated compared with vaccinated pregnant women to have comorbidities. Conclusion: In this retrospective cohort study of pregnant women, vaccination compared with no vaccination was associated with a significantly lower risk of SARS-CoV-2 infection. Interpretation of study findings is limited by the observational design.

14. Observational Research to Find the Rate of Caesarean Deliveries and Various Indications of the Procedure
Aim: The aim of the present study was to find the rate of caesarean deliveries and various indications of the procedure. Methods: The Department of Obstetrics and Gynecology of Patna medical College and Hospital, Patna, Bihar, India conducted this retrospective study on women who underwent LSCS over a period of 11 Months.  Out of the 935 deliveries, 500 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 53.47% 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. 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. Out of the 500 LSCS performed, 45% were emergency cases and 55% were elective. LSCS was mostly done for ‘previous LSCS’ indication (210 cases, 42%), followed by failure of induction of labor (120 cases, 24%). Fetal distress was an indication in 40 cases (8%), Breech presentation in 30 cases (6%), PPROM in 25 (5%), CPD in 20 (4%). Other indications such as preeclampsia, placenta previa, unfavorable cervix, multiple gestation, abruptio placenta, LSCS on demand etc., was less than 3%. 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.

15. A Hospital-Based Assessment of Various Etiological Factors of Intestinal Obstruction in Patients Presenting with Intestinal Obstruction
MD. Wahhaj, Anil Kumar, V.S. Prasad
Aim: To evaluate the various etiological factors of intestinal obstruction in patients presenting with intestinal obstruction in our tertiary care center. Methodology: The study cross sectional study was conducted in department of surgery, D M.C.H, Darbhanga, Bihar. from July 2019 to June 2020 . Total 100 patients age above 15 years were studied. The diagnosis of intestinal obstruction was made on the basis of detailed history especially regarding cardinal features of intestinal obstruction like, abdominal distension, pain, vomiting, and absolute constipation, clinical findings, x-ray abdomen and ultra sound of the abdomen. Other investigations for fitness for anesthesia, to exclude a dynamic cause and for the management of intestinal obstruction were carried out, i.e., complete blood picture, electrolytes, urea, creatinine, X ray chest and ECG. A close observation of all bedside parameters (like pulse rate, BP, RR, urine output, abdominal girth, bowel sounds and tenderness and guarding) were done. Operative information of every case was recorded on proforma. Frequency and pattern of different causes of intestinal obstruction were recorded and analyzed. Histopathological examination of the specimen of resection/ biopsy was undertaken whenever necessary. The postoperative period had been monitored carefully and all the parameters were recorded hourly or fourth hourly basis depending on the patient’s general condition and toxemia. Postoperatively Nasogastric tube aspiration, intravenous fluids and antibiotics were administered. Any complications were noted and treated accordingly. All the patients were called for regular follow up depending on their cause of intestinal obstruction and surgery performed. Results: 62% patients were male and 38% were female. All the patients were categorized in different age group, 18% patients belong to 15-25 years age group, 33% patients were in 26- 40 years, 28% patients were in 41-55 years, 11% patients were in 56-70 years and remaining 10% were having age above 71 years. Abdominal pain was present in 96% patients, vomiting in 77% patients, tenderness in 91% patients, absolute constipation in 85% patients, abdominal distension in 90% patients, rebound tenderness in 48% patients, significant finding on per rectal examination in 8% patients, absent/ decreased bowel sound in 31% patients, increased bowel sound in 64% patients and palpable mass and swelling was present in 21% patients. Out of 100 patients, 77% patients were having intestinal obstruction due to mechanical causes like Adhesions were present in 18% patients, Hernias in 23% patients, Malignancy in 7% patients, intestinal volvulus in 4% patients, diverticulum in 1% patients, strictures in 4% patients, intestinal tuberculosis in 16% patients, fecal impaction in 2% patients and superior mesenteric artery syndrome in 2% patients. Remaining 23% patients were having non-mechanical (adynamic) intestinal obstruction. Out of these 23% patients 15% patients developed paralytic ileus due to gastrointestinal tract perforations (ileum, duodenal, appendix etc.), 2% patients were having gangrenous ileum, 1% patient were having pelvic abscess and 5% patients were having intestinal obstruction due to unknown paralytic ileus cause. The outcome observed in patients were as, 84% patients improved, 9% patients developed morbid condition, 3% lost to follow up and 4% patient died. Conclusion: Our study presented that the most common etiological reason for small intestinal obstruction is hernia and adhesions, respectively. The treatment of abdominal tuberculosis is mainly conservative (non-operatively) with anti-tuberculous therapy, and surgical treatment is reserved for complications. To find the exact and earlier diagnosis and treatment of small bowel obstruction, randomized studies may be more informative and useful.

16. A Hospital Based Comparative Assessment of the Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) and with Histopathological Correlation in Patients with Detectable Breast Lesions
Anand Prakash Anand, Ranjeet Kumar
Aim: To compare the diagnostic accuracy of fine needle aspiration cytology (FNAC) and with histopathological correlation in patients with detectable breast lesions. Methodology: The study was conducted in the Department of Pathology, ANMMCH, Gaya, Bihar for six months. During this period, 100 fine needle aspiration were performed for various breast lumps. The FNAC was carried out using 23 Gauge needle and 10 ml disposable syringe for aspirating the material from the breast lump. The cytological smears were fixed in 95% alcohol and stained with Haematoxylin and Papanicolaous stains. The surgical specimens for histopathological examination were fixed in 10% formal saline. Several sections were taken from appropriate sites for processing and paraffin embedding. The section from each block were cut in 04 micron thickness and stained with Haematoxylin and Eosin. The slides were seen under the microscope and graded accordingly. Results: Out of the 100 FNACs, cytological diagnosis was correlated with histopathological diagnosis in 100 patients. Sex distribution included 97% females and 3% males. The age of patients ranged from 10-70 yrs. In FNAC, 95% cases were labelled as benign and 5% cases were malignant. The correlation between FNAC and histopathological examination for the sensitivity, specificity and positive predictive value were calculated. The false positives were zero and 3% were false negative cases in the study. The cytohistological correlation of 100 patients, out of which 8% patients had the final diagnosis of malignancy and 92% patients had benign conditions. In the present study, the sensitivity of FNAC was 50%, specificity 100% and the positive predictive value of 100%, negative predictive value 97% and the overall accuracy of the study was 96.1%. Conclusion: In patients with a palpable breast lump fine needle aspiration cytology can help to rule out a malignant lesion. This can hence afford as a cost –effective method in diagnosing breast lesions. Also due to its good tolerability and high diagnostic accuracy the patient need not be subjected to further evaluation which helps in the psychological well-being of the patient.

17. Effect of Amlodipine and Cilnidipine on Heart Rate, Blood Pressure, Albuminuria and Lipid Profile in Stage I Hypertension in a Tertiary Care Hospital of Bihar
Kumar Mayank, Subhash Chandra Yadav, Shankar Dayal Singh
Aim: The aim of the study was to compare the clinical effectiveness of Cilnidipine and Amlodipine on blood pressure, heart rate, proteinuria and lipid profile in hypertensive patients. Material & Methods: The present study conducted in the Department of Pharmacology, SKMCH, Muzaffarpur, Bihar, India for 4 months. Total hundred patients were included in the study. One group comprising of 50 patients took 5-10 mg Amlodipine and other group comprising of 50 patients took 10-20 mg Cilnidipine. Results: There were no significant differences in background factors between the Amlodipine and Cilnidipine groups. Daytime, Night time and Morning BP decreased significantly in both groups after treatment. There were no significant differences in the reduction in any of the BP parameters between Amlodipine and Cilnidipine groups. There was significant decrease in day time and night time PR in the Cilnidipine treatment group. The protein/creatinine ratio was significantly lower with Cilnidipine than Amlodipine group. There were no significant differences between the Amlodipine treatment and Cilnidipine treatment in terms of total cholesterol, HDL-c and LDL-c level when the analysis was performed on the entire population, the DM(+) or the DM(-) group. Conclusion: The study indicated that unlike Amlodipine, Cilnidipine which inhibits L-and N-type calcium channels will be useful for patients with hypertension and cardiovascular disease, diabetes mellitus or renal disease and proves to be a better alternative to existing calcium channel blockers.

18. Ketamine Gargle Versus Tramadol Gargle for Attenuation of Post-Operative Sore Throat after Endotracheal Intubation: A Randomized Controlled Study
Vikram Nath, Vinod Kumar Verma, Alok Kumar Bharti
Aim: The aim of the present study was to compare the difference between Ketamine gargle to Tramadol gargle given 5 minutes before induction on attenuating POST for 24 Post-operative hours. Methods: The present study was conducted after obtaining ethical clearance from the Institutional Ethics Committee, Department of Anesthesiology and Critical care medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The duration of the Double blind randomized, controlled study was of 2 years. Results: The present study observed that maximum number of patients were in the Tramadol group (group T) of 20-30 years age group is 15 (30%) and Ketamine group (group K) has 40-50 years age group is 15 (30%). The mean age observed was 40.700±12.813 years in the Tramadol group (Group T) and 43.720±12.641 years in the Ketamine (Group K) group. While taking Gender into consideration, Tramadol group (T group) had 20 male patient (40%) & 30 female patient (60%), Ketamine group (K group) had 17 male patient (34%) & 33 female patients (66%), on comparing no significant difference observed (P -value= 0.534). Conclusion: From the present study we can conclude that preoperative gargling with Tramadol attenuate the incidence and severity of postoperative sore throat more than Ketamine at 4, 8 and 12 hours along with lesser requirement of rescue analgesic than Ketamine that too without much adverse side effects.

19. Preformulation Assessment of Transdermal Patches of HMG-CoA Reductase Inhibitors with Bioadhesive Polymers as Excipient
Prasad Tandale, Vijay Naresh
The pharmaceutical science and medication distribution has developed tremendously over an era. Many advancements are done in the field of drug distribution technique. Transdermal drug delivery systems (TDDS) have many advantages and represent an excellent alternative to oral delivery and hypodermic injections. Patients apply these patches to their skin, and the active ingredients enter the circulation by simple diffusion, making their way to the tissues where they can exert their therapeutic effects. In this study, thin-layer chromatography, Infra-Red spectroscopy were used to conduct pre-formulation tests on drug and polymer compatibility. Transdermal patch preparation methods are discussed here, various methods are utilized such as casting solution preparation and transdermal patch preparation.

20. Mesh Related Infections: Retrospective Analysis
Hari Shankar Prasad, Kashinath Pandit
Aim: The aim of this study was to analysis of mesh related infections in a tertiary care centre. Methods: A retrospective observational study was conducted in the department of General Surgery, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for one year and 50 patients were included in the study. Results: Mesh infection was more common in males. Among 50 patients, 40 were males and 10 female patients. Majority of the patients were in the age group 40-50 (40%) followed by 50-60 age group 30%. 30% cases were repaired with open repair and rest of the patients was repaired with lap repair. In our study, mesh infection was more common in obese patients with a mean BMI of 32.70+/-1.78kg/m2. (Range 30.40-34.10). 40% patients had co-morbidities. The antibiotic protocol was followed in 48 cases out of 50. Antibiotic has used according to the protocol of our hospital; it was followed in 48 patients in the first surgery i.e., hernia repair surgery. Parenteral cephalosporin was used in 48 patients and amoxicillin-clavulanic acid in 2 patients. Antibiotic has repeated if the procedure was beyond 2 hours. After postoperative day 2, patients were switched over to oral antibiotics for three days. Likewise, during the second admission, i.e., when the patient was admitted with mesh infection, 48 patients were given cephalosporin, and 2 patients were given Piperacillin tazobactam. Conclusion: In our study incidence was more common after laparoscopic surgeries because there was a lapse in the sterilization process of the laparoscopic instruments, which was rectified with timely culture sensitivity tests and stringent sterilization process.

21. A Hospital-Based Assessment of the Predictors of Outcome in Pediatric Septic Shock
Ashwani Kumar Mishra, Gopal Shankar Sahni
Aim: The aim of the present study assessed predictors of poor outcome in septic shock. Methods: The present study was conducted in the department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India . During the study period of 6 months, total 120 cases were admitted. There were 100 cases of shock of different etiologies and of these 57 cases of septic shock were enrolled in the study. Among the enrolled patients 3 did not give consent to participate in the study, 4 patients left against medical advice and 10 patients expired during the course of the illness. 40 of 50 (40/50 = 80%) cases enrolled in the study were discharged after recovery while 10 (10/50 = 20%) expired. Results: On analysis of clinical symptoms as predictors of outcome, fever was the most common symptom present in all the patients. On analysis of the vital parameters, a delayed capillary refill time (>3 seconds) was a statistically significant (p=0.008) predictor of poor outcome with all the 9 patients having failed to survive, having a prolonged CRT on admission. Amongst the laboratory predictors, a low mean pH on admission had a statistically significant (p=0.008) association with a poor outcome. Conclusion: A delayed capillary refill time on admission and a low mean pH were statistically significant predictors of mortality in septic shock, in this study.

22. A Hospital-Based Study Assessing the Association of Serum Magnesium, Serum Uric Acid Levels and Microalbuminuria in Patients with Type 2 Diabetes Mellitus
Pushp Raj Kumar
Aim:  The aim of the study was to assess the incidence and association of serum magnesium levels, serum uric acid levels and microalbuminuria in patients with type 2 DM. Methods: The present study was a hospital based, cross-sectional study, conducted for a period of two years carried out on 200 patients diagnosed with type 2 diabetes mellitus and admitted to AIIMS Patna, Bihar, India. The study was done in the department of general medicine AIIMS Patna, Bihar, India who satisfied the inclusion criteria, after taking an informed written consent from all the subjects. Results: In our study, 40% of the population belonged to 51-60 years of age group followed by 20% in 31-40 age group. There were 160 males and 40 females in the study. Serum magnesium levels were on the lower side in 92% of the population and only 8% had levels within the normal range in our study. Serum uric acid levels were elevated in 65% of the study population whereas 35% were within the normal range or low. Out of 200, 160 were having Microalbuminuria and 30 were having macroalbuminuria. In our study, there was a strong positive correlation between, hypomagnesemia and microalbuminuria, with highly significant p value of 0.000. Out 160 study population with microalbuminuria, 146 patients had elevated serum Mg levels, i.e., 91.25%. In our study, there was a positive correlation between, high uric acid levels and microalbuminuria with a highly significant value of 0.000. Out of 160 study population with microalbuminuria, 102 had elevated serum uric acid levels. Conclusion: There was a significant microalbuminuria in patients with type 2 DM, with reduced serum Mg levels and elevated serum uric acid levels as compared with patients who had serum Mg and uric acid levels within the normal range.

23. A Hospital-Based Retrospective Assessment of the Factors Associated with Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Retrospective Study
Manoj Kumar Jayaswal, OK Maurya
Aim: To determine factors of conversion of laparoscopic to open cholecystectomy in tertiary care center. Material & Methods: This is a retrospective observational study conducted on 120 admitted patients in Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India, during the period June 2017 to June 2020.  The hospital records of all patients exhibited symptomatic gallbladder disease and scheduled for laparoscopic cholecystectomy. Study was conducted after taking ethical clearance. Results: Out of 120 participants, 66 were males and 54 were females. Max no. of patients (N=82) between 30 to 60 years. A total of 11 conversions were obtained. Gender wise distribution showed increased incidence of conversion in male 62% patients compare to female 38% patients. Patients having age group of 30-60 years had more conversion rate 74%. the most common reason for conversion was intraoperative adhesions which was found in 9 patients. CBD injury and bleeding from cystic artery was found in 2 patients each. Conclusion: Laparoscopic cholecystectomy is a safe and minimally invasive technique, with only low conversion rate and the commonest cause of conversion in this study was the presence of dense adhesions at Calot’s triangle.

24. A Prospective Observational Clinical Outcome Assessment of Managing Forearm Fractures Using Titanium Elastic Nailing System (TENS)
Vikarm Singh Raigar, Ramashish Yadav
Aim: The aim of this prospective study was to evaluate the clinical outcome of managing paediatric forearm fractures using Titanium Elastic Nailing System (TENS). Methods: The current study was done at the Department of Orthopaedics at Darbhanga Medical College and Hospital in Darbhanga, Bihar, India, from August 2020 to August 2022. One hundred patients were included in the study if they were between the ages of 6 and 14, had a fracture that was displaced or grossly rotated, and had failed closed manipulation. They also had to be followed up for at least six months. Patients with a single forearm bone fracture, multiple fractures, or a fracture that caused nerve or blood vessel damage were not considered. Results: In this study, there were 20 females and 80 males. 48 of them were between 6 and 10 years old, and the rest were between 11 and 14 years old. In 88 people, the injury was simple or closed. 48 people had a fracture at the middle 1/3rd level. CRIF surgery was done 92% of the time. Based on the criteria set by Price CT et al., 95 patients had good results and 5 patients had excellent results. None of the patients’ results were fair or bad. The result showed that most patients who used TENS got good results from it. Conclusion: The titanium elastic nailing system (TENS) works well and looks good on x-rays. Because it is minimally invasive, keeps the fracture hematoma, doesn’t strip the periosteum, takes less time during surgery and in the hospital, and has a lower chance of refracturing when the implant is taken out, it can be used instead of ORIF with plate osteosynthesis to treat forearm fractures in adults.

25. The Effect of Exclusive Breastfeeding Up to 6 Months in Children in Terms of Mortality Due to Pneumonia: An Observational Study
Ashwani Kumar Mishra, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal, Gopal Shankar Sahni
Aim: The Aim Of The Present Study Was To Observe The Effect Of Exclusive Breastfeeding Up To 6 Months In Children In Terms Of Mortality Due To Pneumonia. Methods: The Study Was Conducted  In Department Of Pediatrics A Sri Krishna Medical College And Hospital, Muzaffarpur, Bihar, India For Eight Months. A Total 200 Children Of Both Sex With WHO Defined Severe And Very Severe Pneumonia Were Enrolled In The Study. The Age Group Was 2 Months To 5 Years. Results: In Our Study 140 Children Were Male (70%), 60 Were Female (30%), 110 Patients Were Below 1 Year Of Age (55%), 50 Were Between 1-2 Years (25%) And 56 Were Between 2-5 Years (20%). Out Of 200 Patients, 98 Were Having Severe Pneumonia (49%) And 102 Were Having Very Severe Pneumonia (51%). Among These 200 Patients, 140 (70%) Received Exclusive Breast Milk Up To 6 Months. Among The Children Who Were Breast Fed Up To 6 Months, 42.85% Were Having Very Severe Pneumonia Which Was Significantly 75% Of The Children Who Were Not Breast Fed Up To 6 Months (P<0.001). So, Children Who Were Not Breast Fed Up To 6 Months Were 4.1 Times More Likely To Be Suffering From Very Severe Pneumonia (Vs Severe Pneumonia) Than Those Who Were Breast Fed Up To 6 Months (P<0.05). 2.85% Of The Children Who Were Breast Fed Up To 6 Months Died Whereas 25% Of Those Who Were Not Breast Fed Up To 6 Months Died (P<0.001). Those Who Were Not Breast Fed Up To 6 Months Were Significantly 83% (OR=0.17) Less Likely To Survive As Compared To Those Who Were Breast Fed Up To 6 Months(P<0.05). 19 (9.5%) Patients Expired In The Present Study. Conclusion: Children Who Do Not Receive Exclusive Breastfeeding Up To 6 Months Are More Prone To Have More Severe Pneumonia And Relatively Higher Chance Of Mortality.

26. Evaluation Anemia Profile in a Tertiary Care Facility: Prospective Cross-Sectional Study
Abishek Anand, Sunil Kumar
Aim: The aim of the present study was to determine the clinical and laboratory profile of anaemia among patients admitted to the tertiary care facility. Methods: This study was a hospital based prospective cross-sectional study undertaken in the Department of Medicine, BMIMS, Pawapuri, Nalanda, Bihar, India. Fifty patients with anaemia were included in the study. Duration of the study was 7 months. Results: Easy fatiguability and generalized weakness were the most common symptoms of anemia in our study. Easy fatiguability and generalised weakness were the most common symptoms of anemia in our study. Fever was seen in 10% of cases and asymptomatic symptoms were noted in 12% patients. On systemic examination anemic murmurs on CVS examination were detected among 12 patients. Basilar crepts not attributable to other diseases were found among 3 patients. Isolated hepatomegaly was found in 8, splenomegaly in 2 and hepatosplenomegaly was found in 3 patients. Conclusion: The most common aetiology of anemia in patients enrolled was iron deficiency, followed by anemia of chronic disease and malignancy, both hematological and non-hematological. The most commonly encountered complaints on presentation in general were subjective non-specific ones such as weakness, fatigue and lassitude whereas in females it was per vaginal bleeding.

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