Aim: The objectives of the study were to determine the number of newborns admitted into the SNCU with dehydration fever, to ascertain about other associated comorbid conditions, and to know the outcome of these newborns following treatment. Material & methods: It was an observational descriptive study where neonates were admitted in NICU with dehydration fever over period of 1 year and hospital-based convenience sample were taken. This observational descriptive study was undertaken at Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India. The study was conducted among 100 neonates admitted with dehydration fever. All babies born during the study period who were admitted in NICU with hyper-natremic dehydration were included in the study. Results: In the study among subjects presenting with hypernatremic dehydration, 26% of mothers were in the age group <20 years, 50% in the age group 21 to 25 years, 24% were in the age group 26 to 30 years. Mean mother age was 23.7±3.07 years and median age was 25 years. 85% were Primigravida and 15% were Multigravida. 10% had gestational HTN, 6% had preeclampsia, 12% had PROM, 8% had vaginitis. 26% had lactation failure, 74% had no lactation failure. 25% were on supplementary formula feeds. 34% presented with fever, 20% had decreased urine output, 20% had fever + decreased urine output and 26% had jaundice. Association between symptoms at presentation and neonatal factors neonates presenting on day 2, majority had jaundice, on day 3, majority presented with fever, on day 4, majority presented with decreased urine output and jaundice and on day 5, majority presented with decreased urine output. In the study, majority presented with Jaundice, decreased urine output and fever +decreased urine output respectively and fever. Conclusion: Dehydration fever occurs most commonly on day 3 or after, effective measures should be initiated for early diagnosis and prevention of complications like effective breast-feeding counselling, proper techniques, good latching and supplementation of artificial feeds if required and monitoring of daily weight and daily urine output.

Aim: The aim of this study was to find the outcome of repair and resection of the occipital encephalocele. Material & methods: A retrospective study of 50 exclusively occipital encephalocele patients was conducted in between the duration of 2 years at the Department of Neurosurgery and Paediatric Surgery, IGIMS, Patna, Bihar, India The medical records of all operated cases of occipital encephalocele were reviewed, and relevant data such as age, sex, location of encephalocele, the size of the lesion, operative method, seizure, and hydrocephalus along with postoperative complications were recorded for analysis. Results: Of 50 patients, 17 were males and 33 females. The average age of the patients at the time of presentation was 2.4 months, ranging (4 days to 1.33 years). Most of the patients 56% belonged to 3 months age followed by 28% in 3-6 months age group. All patients presented with swelling on the head just after birth. A visible mass was situated in either the occipital (supratorcular or infratorcular). Any overlying skin varied from a thick and wrinkled to a thin or shiny covering. 16 patients (32%) presented with enlarged head circumference with associated hydrocephalus and 3 patients (6%) diagnosed with Dandy–Walker cyst. 3 (6%) patients were suspected developmental delay and mental disorders. 30 (15%) patients also had seizure. 8 (16%) patients admitted with the complication of sac rupture with cerebrospinal fluid (CSF) leakage, 2 (4%) patients having rupture of sac after the admission and 2 (4%) patients admitted with the complaint of haemorrhage from the thin and shiny covering skin of the sac. Postoperatively, only 4 (2%) patients had CSF leakage from the repaired wound. 3 (6%) patients developed Hydrocephalus after the repair of protrude sac. Conclusion: Encephalocele is commonly seen in the practice of neurosurgery in the world. Modern neuroimaging, neurosurgical techniques, and neonatal neurological intensive care have greatly improved morbidity and mortality in the care of encephalocele.

Aim: The aim of the present study was to identify the ability of pre-operative Ultrasonography in predicting difficult Laparoscopic Cholecystectomy. Methods: This cross-sectional observational study was done in the Department of General Surgery, Patna Medical College and Hospital, Bihar, India  for the duration of 2 years. 100 Patients diagnosed with gallbladder stones were included in this study. The study was approved by the institutional ethical approval committee. Verbal consent was obtained from each patient after full illustration of the aim and procedures related to the current study. Results: The age range of those patients was form 14 to 85 years and the mean was 42.28± 15.50 years. With respect to gender, there was 20 male patients accounting for (20%) and 80 female patients accounting for (80%); therefore, the male to female ratio was 1:4.26. Mean body mass index (BMI) was 26.24 ± 7.73 kg/m². Pre-operative USG findings such as gall bladder wall thickness >4 mm, gall bladder size ≥5cm, impacted gall stones, CBD diameter ≥6mm, size of the calculus ≥1cm, and presence of pericholecystic fluid collection were significantly associated with difficult laparoscopic cholecystectomy. There was statistically significant difference between pre-operative USG score and difficult or non-difficult laparoscopic cholecystectomy. Higher the preoperative USG score, higher were the percentage of difficult laparoscopic cholecystectomy. Conclusion: This study has shown that pre-operative USG findings such as gall bladder wall thickness >4 mm, gall bladder size ≥5cm, impacted gall stones, CBD diameter ≥6mm, size of the calculus ≥1cm, and presence of pericholecystic fluid collection were significantly associated with difficult laparoscopic cholecystectomy. Gall bladder wall thickness >4 mm was the most accurate predictor for a difficult laparoscopic cholecystectomy followed by pericholecystic fluid collection and impacted gall stones.

Aim: The purpose of this study was to evaluate urine cytology, detect bladder lesions with two different methods (i.e., direct smears and LBC), and determine the sensitivity and specificity of these methods. Methods: This Observational study was conducted for a period of 1 year at Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. A total of 200 samples were taken from patients with suspected bladder cancer and processed for direct smear and LBC. In both methods, findings were reported according to the Paris System. Then, patients underwent cystoscopy and biopsy. Next, the accuracy of cytology methods was evaluated according to biopsy reports. The sensitivity and specificity of these methods were also calculated. Results: NUAM in LBC and DSC were 80% and 79% respectively. In this study, the largest difference was reported in patients with a diagnosis of AUC in the LBC method. In these 16 cases, 16 cases were reported as negative in DSC. Kappa statistics revealed a significant agreement between LBC and DSC in negative biopsy cases (P<0.000), Kappa value=0.650. In the frequency of biopsy findings, 80% were negative. For DSC methods, credit indices included sensitivity (61.9%), specificity (98%), positive predictive value (89.1%), and negative predictive value (91.5%). For LBC methods, credit indices included sensitivity (84.6%), specificity (99%), positive predictive value (94%), and negative predictive value (96%). Conclusion: This study showed that LBC has higher sensitivity and specificity than the direct smear.

Aim: The objective of the present study was to assess association between socio-demographic, behavioural and clinical risk factors and diabetic foot and response of patients to various treatment modalities. Methods: A prospective study was conducted in the General Surgery Department of Bhagwan Mahavir institute of medical science, Pawapuri, Nalanda, Bihar, India for 7 months. 50 patients were included in the study. All patients who presented to surgical outpatient department or were admitted to the surgical wards with signs and symptoms of diabetic foot during the 7 months period were included. Results: Out of 50 patients in our study, 20 (40%) were in the age group of 51-60 years followed by 13 (26%) in the age group 61-70 years. There was a male preponderance in our study with 36 (72%) patients out of 50. Majority of the study subjects were literate with overall literacy rate being 60%. 96% study subjects belonged to low class. Among the 50 patients, 13 (26%) were unmarried showing lack of support and care and rest (74%) were married. Labourers accounted for 34% of study participants, farmers constituted 30%, businessmen 18% and others 18% of study subjects. Most of the participants had type II diabetes for >10 years. 80% of study participants had family history of diabetes. 92% of study participants were overweight (BMI 25-29.9) and remaining 8% were obese (BMI ≥30). Hypertension was present in 72% of study participants, ischemic heart disease in 60% and hypercholesterolemia in 70%. Conclusion: Diabetic foot is a common complication of long-standing diabetes. Several socio-demographic factors like advancing age, low socio-economic status, lack of family support, occupations involving risk of trauma to foot contribute to the risk of developing diabetic foot in diabetics. Hence it is essential to educate all the diabetic patients at risk about good glycemic control, risk factors, proper foot care, periodic foot examination and neurological examination of lower limbs, prompt treatment of foot lesions and regular follow-up.

Aim: The aim of this study was to determine the diagnostic utility of C- reactive protein (CRP) in combination with hematological parameters of CBC as early diagnostic marker in detection infections in children. Methods: The present study was a hospital based cross-sectional study which was carried out among the Children who presented to the Paediatric OPD or Inpatients attending Skmch, Muzaffarpur, Bihar, India. All the Children who presented to paediatric OPD or admitted to Paediatric ward with history suggestive of Infection were included in the study. The study included 500 children attending pediatric OPD / Inpatients. Results: The study included 500 children attending pediatric OPD / Inpatients whose age ranged from birth to 17 years. Majority of the children 390 (78%) belonged to Under 5 age group. Out of 500, 275 (55%) were boys and 225 (45%) were girls. All the children underwent Widal test and 100 out of 500 were positive for it. The mean difference of all the components of Complete Blood Count was compared between Widal positive and negative children. It was observed that, there was mean difference observed between the groups of Widal positive children and Widal negative children for all the components of the Complete Blood Count and it was statistically significant for Packed Cell Volume, Eosinophil Count and Platelet Count. All the children blood sample was subjected to CRP testing and 180 out of 500 were positive for it. The mean difference of all the components of Complete Blood Count was compared between CRP positive and negative children. Conclusion: In conclusion, the findings of the present study confirm that the serum levels of CRP in combination with WBC counts and other hematological parameters are better indicators of infection in the early diagnosis of sepsis in childhood than isolated use of CBC and it also aids in the evaluation of the response of the disease to the antibiotic therapy.

Aim: The objective of the present study was to study the primary reasons and pattern of obstetric cases referred to a tertiary care centre and management of its complications. Material & Methods: A Prospective observational study including 100 patients within duration of two years in the Department of Obstetrics and Gynecology of JLNMCH, Bhagalpur, Bihar, India .  Written informed consent was sought from all study participants. We studied 50 patients. Results: Maximum number of cases in the present study was in the age group 20-30 yrs, comprising 76% of total cases. Out of 50 patients, 24 were primigravids (48%). The antecedent causes for admission to ICU are grouped into two – Obstetric and non -obstetric causes. The Obstetric causes accounted for 76% of the admissions in ICU and non-obstetric causes were 24%. Commonest risk factor for ICU admission was hypertensive disorders of pregnancy and obstetric haemorrhage. Other major risk factors were heart disease and sepsis. Major cause of maternal mortality was multi-organ-dysfunction and sepsis secondary to massive obstetric haemorrhage. Majority of them delivered by cesarean section (74%) and the rest were vaginally (24%). The indications of LSCS were Severe Pre-eclampsia, CPD, malposition & eclampsia. Among the total patients, MMR was 12%, 84% improved whereas 4% were discharged against medical advice. The main reasons for mortality were multi-organ-failure, sepsis, congestive cardiac failure and hemorrhagic shock following massive obstetric hemorrhage. Conclusion: The multi-disciplinary team approach in intensive care units, close monitoring, symptomatic treatment, prompt surgical intervention and safe motherhood initiative would reduce the current Maternal Mortality Rate. Development of standard referral protocol, availability of tertiary care, proper training in this regard is much needed.

Aim: The present study evaluates and compare the outcome between laparoscopic inguinal hernia repair and open incisional inguinal hernia repair surgery. Methods: The present study was conducted in the Department of General Surgery, Lord Buddha Koshi medical College and Hospital, Saharsa, Bihar, India for one year A total of 100 patients with uncomplicated inguinal small or medium sized, direct or indirect, unilateral or bilateral hernias undergoing elective inguinal hernia surgery, who are fit for laparoscopy and open surgery were included in the study. The study consisted of 100 patients, of which 50 were in the open surgery group and 50 were in the laparoscopic group. Results: The open surgery group had patients with a mean age of 45.15±14.36 years, with 40 males and 10 females. The laparoscopic group consisted of patients with a mean age of 46.54±16.24years, with 42 males and 8 females. 81 of the cases presented with unilateral hernia, of which 54 showed right laterality and 27 displayed left laterality. In 19 cases, bilateral representation was noted. 27 cases were of direct type, 50 of indirect type, and 23 of direct/indirect type. No statistical correlation was noted with the age, gender, laterality, type and surgical procedure employed. The VAS score values of laproscopic were always lower than that of open group at the same hour and this difference was shown to be statistically significant. Subsequently, the post-operative analgesic requirement was less in the laparoscopic method with only 2 patients requiring analgesic. Seroma was the most commonly noted post-operative complication, especially in laparoscopic cases. Conclusion: Laparoscopic hernia repair is safe and provide less postoperative morbidity in experienced hands compared to open hernia repair.

Aim: This study was done to study the serum sodium levels in chronic liver disease (CLD) patients and establish its association with the severity of disease in such patients. Material & Methods: An observational cross-sectional study with 200 cases of chronic liver disease was done in the Department of General Medicine for 2 years. Results: All patients had abdominal distension. It was observed that patients from group A had jaundice (p<0.05) and altered sensorium (p<0.001) significantly more commonly as compared to those from group B and C. Alcohol consumption was reported by 88.5% of the patients. Serum sodium levels were not significantly associated with alcohol consumption. Among all examination findings, icterus (p<0.05) and clubbing (p<0.01) were found to be significantly more common among patients from group A, as compared to patients from group B or C. Pallor, pedal edema, signs of liver cell failure and organomegaly were not significantly associated with serum sodium levels in our study population. Portal hypertension was observed in 85.5%, hepatic encephalopathy in 23.5%, hepatorenal syndrome in 21.5%, spontaneous bacterial peritonitis in 4.5% and coagulopathy in 18%. Of these, hepatic encephalopathy (p<0.01), hepatorenal syndrome (p<0.01) and coagulopathy (p<0.01) were found to occur significantly more common among patients from group A, as compared to those in patients from group B or C. We observed that mean direct bilirubin, alanine transaminase, aspartate transaminase and alkaline phosphatase were significantly higher among group A patients as compared to those from group B or C respectively. We observed that mean MELD score was significantly higher among group A patients as compared to those with group B and group C. We also observed that mean Child Pugh score was significantly higher among group A patients as compared to those with group B and group C. Conclusion: Patients with lower serum salt levels had a substantially higher MELD score and CPS. Low blood sodium levels were linked to more severe liver disease, greater complications, and increased death. As a result, we urge that serum salt levels be checked on a frequent basis in patients with chronic liver disease.

Aim: The aim of the present study was to evaluate screening of cervical carcinoma by PAP smear and Colposcopy. Methods: This study was conducted in Department of Obstetrics and Gynecology. The study constituted 200 women as subjects who attended the Gynecology OPD as well as ones admitted in gynecology ward fulfilling the inclusion and exclusion criteria. Results: Among 200 patients, 18% belongs to age group of 20-30 years, 54% among 31-40 years, 16% among 41-50 years, 12% among 51-60 years age group. The maximum cases belong to 31-40 years age group (55=4%) with mean age 38.04 years. According to Modified Kuppu-swamy classification, 55% of women were of Upper-lower class, 25% were of Lower-middle class and 20% were of Lower class. Significant differences noted between different classifications and age at 1st coitus, therefore, premalignant lesions are commonly associated with 1st coital history at an early age of life. On colposcopy examination, most of the cases show neoplastic proliferation (112 cases, 56%). Among them, most cases were diagnosed as cervical intraepithelial neoplasia-I (CIN-I). 88 cases (44%) were non-neoplastic. Conclusion: The use of colposcopy and pap smear testing has gained widespread acceptance as a screening strategy. Cost-effective non-invasive tests for the early diagnosis of cervical cancer exist and may be efficiently used in rural locations. These interventions have the potential to significantly decrease the rates of both death and morbidity associated with cervical cancer.

Aim: The aim of the present study was to examine effect of play therapy on ADHD children. Methods: Present study was conducted at Indira Gandhi Institute of Medical Sciences (IGIMS) in Department of Paediatrics for a period of one year.  In the present study by using randomized sampling 32 children of fifth and sixth grade (average age of 11 years) were selected based on the inclusion criteria through purposeful sampling. They were randomly divided into experimental and control groups (16 individuals each) and then the experimental group underwent eight, 90- min-sessions of play therapy with the cooperation of the school’s psychological counseling officials. Results: The post-test mean score of ADHD symptoms was lower than that of the pre-test. This variable of behavioral problems has also obtained a lower average in the post-test test in different components (anxiety and depression, aggression, social incompatibility, antisocial behaviors, attention deficit disorder). Based on the obtained results the values of the significance level of the variables are more than 0.05, so it was concluded that the variables are in a normal state for the analysis of covariance. Levin’s test values are insignificant. In other words, the null hypothesis for the equality of the variances of the two groups was confirmed. Conclusion: The findings of the present study indicate that educational Play therapy is efficacious in mitigating behavioral issues and attention deficit and hyperactivity symptoms in children diagnosed with ADHD. This therapeutic approach facilitates their socialization process, enabling them to integrate into society as productive and well-adjusted individuals.

Aim:  The aim of the present study was to quantify protein intake and compare growth parameters at hospital discharge (as measured by discharge weight and head circumference percentiles) in ELBW infants in the first two weeks after birth using two different methods. Material & Methods: The present study was conducted at Department of Pediatrics and all ELBW admissions to the NICU were included except those regaining BW in ≤ 3 days, those who were transferred to another facility, or those who died before reaching discharge. Results: We studied 150 infants with 100 and 50 infants in P1 and P2 periods, respectively. Mean gestational age was lower during Phase 1 (24.86 ±1.34 vs. 25.45 ±1.85 weeks). P value =0.01). However, the birth weights were not different between the two periods. The incidence of SGA at birth was higher during Phase 2. Compared to P1, babies in P2 received 1 g/kg/day more protein till BW was regained. This average daily protein deficit would have resulted in a cumulative protein deficit of 5.1 g/kg if the infant’s current weight was used for protein calculations for the duration of 1 week (P2 phase). There were no significant differences in protein and fluid intakes. However, there was a higher caloric intake in P2 compared to P1. Conclusion: The decision to utilize birth weight as the basis for nutrition calculations in extremely low birth weight (ELBW) infants, rather than their current daily weight until they reach their birth weight, led to notable outcomes. Specifically, this approach resulted in a substantial increase in protein delivery, a significant reduction in the occurrence of failure to thrive, and a decrease in head circumference percentiles at the time of discharge in ELBW infants.