Aim: The present study was undertaken to assess the diagnostic role of CSF C-reactive protein quantitatively in acute meningitis and differentiating pyogenic meningitis from non-pyogenic meningitis. Methods: The present study was conducted in the Department of Pathology, Anugrah Narayan Magadh Medical College and Hospital (ANMMCH) Gaya, Bihar, India for one year and patients with suspected cases of meningitis with clinical signs and symptoms of acute meningitis, aged 1 month to 18 years were included. Results: In most of the cases 58 (61.05%) of the study population were in the age group of 1 month to 5 years. The age distribution among Pyogenic meningitis (50) shows the maximum of 17 cases (34%) in the age group 1 month to 1 year followed by 13 (26%) in the age of >1 year to 5 years. Sex distribution of study population where male patients were 55 (57.90%) and female 40 (42.10%). Clinical findings of acute meningitis in the study population where all of the study population (95) were suffering from fever (95%), Headache were present in Pyogenic meningitis 15 (30%) and Non-Pyogenic meningitis 6 (24%) respectively. In 49 cases (98%) of Pyogenic meningitis had elevated CSF-CRP level >1.1μg/ml and 1 case (2%) were in the range of 0.05-0.10 μg/ml. In the case of non-Pyogenic meningitis 24 (96%) were found to have in the range of 0.05-0.10 μg/ml. CSF CRP value of >0.1 μg/ml has a good sensitivity (98.22%), specificity (96.24%), good positive predictive value (98.12%), and good negative predictive value (96.14%) and good Diagnostic Accuracy (97.43%) for Pyogenic meningitis. Conclusion: In conclusion we found that CSF-CRP level is significantly higher in pyogenic meningitis compared to non-pyogenic meningitis patients. It is a good indicator to diagnose pyogenic meningitis. It can be used to differentiate pyogenic from non-pyogenic meningitis also.

Aim: The aim of the present study was to analyze the clinical outcome of effect of chewing gum mainly to avoid post-operative paralytic ileus in post-operative patients of abdominal surgeries. Methods: The study was conducted in Department of General Surgery, Narayan Medical College and Hospital, Sasaram, Bihar, India for the period of one year. Total 100 patients were enrolled, 50 were cases gum chewing and 50 were controls. This was an interventional (Experimental) prospective study. The intervention was very simple, it was allowing the cases to chew chewing gums after surgery. Results: Mean duration of hospitalization (days) was 12.8, 12.48 in cases and control groups respectively. Flatus (mean duration of first flatus passed) in hours was 50.9, 67.3 in cases and control groups respectively. Motion (mean duration of first bowel passed) in hours was 93.7, 128.2 in cases and control groups respectively. Bowel sound (mean duration first sound heard) in hours was 21.5, 35.3 in cases of routine surgery, emergency surgeries respectively. Flatus (mean duration of first flatus passed) in hours 47.3, 66.4 in cases of routine surgery, emergency surgeries respectively. Motion (mean duration of first bowel passed) hours 91.6, 119 in cases of routine surgery, emergency surgeries respectively. Bowel sound (mean duration first sound heard) in hours is 37.6, 38.2 in cases of gastric and small bowel surgeries respectively. Flatus (mean duration of first flatus passed) in hours 68.4, 72.8 in cases of gastric and small bowel surgeries respectively. Motion (mean duration of first bowel passed) in hours 123.7, 124.6 in cases of gastric and small bowel surgeries respectively. Bowel sound (mean duration first sound heard) in hours was 23.4, 35.5 in cases of traumatic surgery, pathological surgeries respectively. Flatus (mean duration of first flatus passed) in hours 53.5, 68.2 in cases of traumatic surgery, pathological surgeries respectively. Motion (mean duration of first bowel passed) in hours 100.8, 113.7 in cases of traumatic surgery, pathological surgeries respectively. Conclusion: It was observed that chewing gum has significant effect over bowel motility as bowel sounds appeared significantly earlier in cases than control and time for first flatus passed and first bowel passed were also noted significantly earlier in cases than controls. Hospital stay of cases were found significantly lesser than control hence simple intervention like chewing can decrease the burden of disease of paralytic ileus from community.

Aim: The Purpose of this study was to evaluate biomechanical factors working around hip which leads to implant failure. Material & Methods: This was a prospective cum retrospective study. All 50 cases below 75 years of age with proximal femoral fracture [fracture Inter-trochanteric & Sub-trochanteric included] fixed with PFN irrespective of the centre where surgery was performed attending routine out-door of Department of Orthopaedics for one year  with implant failure were registered for the study. Results: In our study we registered total of 50 cases with mean age of registered cases was 65.45 + 9.31 years. 36 patients (72%) were male and 14 (28%) were females. Out of 50 cases registered, pattern of implant failure in our study were 15 cases (30%) had implant failure pattern of Z- effect , 12 cases (24%) had implant failure pattern of reverse Z-effect; 5 (10%) had breakage of nails; 2 cases (4%) had both screw breakage with varus collapse; 8 (16%) had single upper proximal screw breakage; & 8 cases (16%) were associated with spiral fracture femur just distal to the tip of PFN. Conclusion: Proper implant selection is critical and should be done on an individualized patient and fracture pattern basis. Poor surgical technique, implant-related issues, delayed fracture union, and poor patient compliance and health status alone or in combination can lead to breakage of the implants requiring challenging treatment options. Prevention of such catastrophic complications is crucial for the patient’s health and quality of life. Biomechanical study of the broken implant may provide useful information regarding failure causes and guide future treatment. Surgeons and mechanics should work hand in hand for implants evolution in order to optimize patient treatment.

Aim: The aim of the present study was to assess the knowledge about lactational amenorrhea method (LAM) of women and determine the proportion of women use LAM was also investigated the factors determining practice of LAM. Methods: The present study was conducted at Department of Obstetrics and Gynecology for one year and the knowledge and practice of lactational amenorrhea as a form of contraception among women visiting primary healthcare facilities were investigated in a cross-sectional study. 200 women of reproductive age completed a structured questionnaire. The participants were chosen using a simple random sample. Sample size was estimated to determine a prevalence of LAM usage and knowledge among lactating women. Results: A total of 200 lactating women in reproductive age (15-49) were included in the study, the mean age was 28.34+6.4 years, 53% of them were in the age group (20-29) and 55% were from rural areas. Most of the lactating women were housewife (77%) and only (23%) were working. From the total number of studied women, 48% had attended at basic education. Concerning family size, among the studied women, 26 women with a family size 3-4 members use LAM. 30 women with a family size 5 members use LAM. 25 women with a family size of 6 members use LAM. 20 of women with a family size of 7 or more members use LAM. (p- value < 0.0001). 65% of women included in the study have used LAM, 64% have used correct LAM, 90% of lactating women know about LAM and 35% have failure of usage LAM and get pregnant. And 40% of studied women had breast feeding barriers. The mean of duration of breast feeding is 11.12 months ± 7.33 and the mean of duration of amenorrhea is 6 months ± 4.11 and the mean of exclusive BF duration 4.63±2.34. Conclusion: The large majority of the participants in this study stated that breastfeeding can be used as a technique of family planning until menstruation returns. Only about two third of the women in the study said they had ever used LAM. Women from rural areas, not working, and educated with lower socioeconomic were more likely to practice LAM.

Aim: The purpose of this study was to study and compare the effectiveness and the disadvantages of intramedullary devices, i.e. short vs long PFN in the management of unstable IT fractures. Methods: The present study was conducted at Department of Orthopaedics for 12 months and with trochanteric fractures was operated at our hospital. Out of the 200 patients, Group A patients were operated with short Pfn and Group B were operated with long pfn.  Results: The mean age of patients in both groups was 63.47±8.42 years and 65.45 ± 8.32 years respectively and did not differ significantly (p =0.619). Further, the subjects of two groups were also gender matched as the number of females and males 62% and 38% in group A and 59% and 41% in group B respectively. The mean operative time was significantly lower in group B as compared to group A (36.34 ± 6.04 minutes vs. 44.26 ± 8.20 minutes, (p <0.001). Mean blood loss was also significantly lower in group B as compared to group A (58.72±15.75 ml vs. 78.72±16.34 ml, (p<0.001). The mean number of images taken per-op was significantly lower in group B as compared to group A (19.51±3.16 vs 28.52±4.76 (p <0.001). The loss of reduction including shortening (>1 cm) (p =0.678) and varus malalignment (p =0.590) were similar between the two groups though they were relatively lower in group as compared to group A. Conclusion: Use of Long PFN has advantages over short PFN in terms of the less postoperative complications like peri implant fracture and anterior thigh pain & better functional outcome. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning and accurate instrumentation.

Aim: The aim of the present study was to assess the role of lung ultrasound: a complementary imaging tool for chest x-ray in the evaluation of dyspnea. Material & Methods: A cross-sectional study, conducted over a duration of 1 year in the Department of Radiodiagnosis. The study population comprised 50 patients of either sex, presenting with a complaint of dyspnea. All patients with a clinical history suggestive of acute coronary syndrome as a cause of dyspnea, patients on invasive ventilatory support, or with suspected/known metabolic causes of dyspnea were excluded from the study. Results: The most common non-translobar consolidation was seen in 83.33% of cases identified by “Fractal sign/shred sign.” Translobar consolidation was identified by the “Lung sign.” Six patients with “Unilateral lung rockets” were also diagnosed with pneumonia. Out of 50 cases included in our study, 45 cases showed concordant diagnosis on ultrasound and chest X-ray (90%). Chest X-ray was found to have a sensitivity, specificity, positive predictive value, and negative predictive value of 100%. Conclusion: A high concordance was noted between ultrasound and chest X-ray for diagnosis of all pathologies studied (p < 0.01), the highest noted in pneumonia/pleural effusion and diffuse interstitial syndrome (κ ¼ 0.9). Hence, ultrasound may be considered a complimentary imaging modality for Chest-X-ray in the evaluation of dyspnoea.

Introduction: Infections caused by MRSA are worldwide, detecting the mecA gene or its product by PCR is recognized as a gold standard for detection of MRSA.  In resource limited clinical settings phenotypic method which is simple, rapid, accurate and cost effective is required. Cefoxitin disc diffusion is considered as surrogate marker for mecA gene, and could be considered as gold standard for MR isolates. MRSA infection is of concern because it is resistant to a number of widely used antibiotics. Treatment options for MRSA are limited and less effective, than options available for susceptible S. aureus infections leading to increased morbidity and mortality in hospitalized patients. To control MRSA in hospitals, correct antibiotic treatment in infected patients is required and  prevent their spread. Object: This study is conducted to know the resistance pattern of various antibiotics in Methicillin-resistant Staphylococcus aureus(MRSA). Type of study: Cross-sectional prospective analytical study. Study time: November 2012 to April 2014. Sample size: Total of 174 S. aureus isolated from non-repetitive clinical samples from IPD and OPD of tertiary care hospital in Bhopal. Result: 174 Staphylococcus aureus strains isolated from the non-repetitive clinical samples were processed for MRSA identification. Out of 174 S. aureus isolates 69(39.65%) were found to be MRSA by cefoxitin disc diffusion test and rest 105 strains were MSSA. Among MRSA  more than 70% resistance is for Ampicillin and Erythromycin and low resistance was for Netilmycin 27.53%, Doxycycline 24.63% and 5.79% for Linezolid and no resistance for Teicoplanin and Vancomycin. Discussion: Multidrug resistance among S. aureus is a potential threat for the health care settings. Prolonged hospitalization and antibiotic therapy especially with β-lactam antibiotics predispose patients to the acquisition of MDR. To control and  prevent the spread of MRSA in hospitals, correct antibiotic treatment in infected patients is required and ad mistered.

Aim: This study aimed to evaluate the demographic and clinical characteristics of non proteinuric kidney disease in type 2 diabetic patients in Bihar region. Material & methods: This study was a single-center, prospective cohort study conducted in the Department of Nephrology for the period of 2 years. Written and informed consent were taken from all participants. In this single-center, prospective observational study, 500 consecutive type 2 diabetic patients with either overt proteinuria (>500 mg/day) and/or renal dysfunction (eGFR <60 ml/min/1.73 m2) were recruited. Results: Both the groups were similar in terms of gender, duration of diabetes, comorbidities, body mass index (BMI), blood pressure control, and glycemic control. The nonproteinuric group was older, had lesser prevalence of diabetic retinopathy (P < 0.001), higher hemoglobin levels and higher cholesterol levels. We studied the predictors of progression of renal dysfunction, but no variable was found to be significantly associated with renal dysfunction. We applied logistic regression analysis to find predictors of nonproteinuric kidney disease and found that the absence of retinopathy and presence of higher hemoglobin predicted non proteinuric phenotype. Conclusion: Most patients with diabetic kidney disease (DKD) have proteinuria, but approximately 20% have chronic kidney disease (CKD) without proteinuria. Simultaneous assessment of both albuminuria and eGFR is required in all diabetic patients. Studies are required to understand the utility of newer markers either alone or in combination with proteinuria to define nonproteinuric DKD.

Aim: The aim of the present study was to evaluate to study the diagnostic accuracy of diaphragmatic rapid shallow breathing index (D-RSBI) as a predictor of weaning outcomes in comparison to rapid shallow breathing index. Methods: The current study was a prospective observational study carried out for a period of 12 months, on consecutively admitted critically ill patients in the ICU at Institute of Medical Sciences, Banaras Hindu University in Varanasi, Uttar Pradesh, India . 60 patients were included in the study. Results: There were 60% male in the study with at least one medical comorbid illness present majority being diabetes mellitus (40%). The primary indication for ventilation in 36 patients (60%) was a hypercapnic respiratory failure arising in an acute exacerbation of chronic obstructive pulmonary disease, followed by acute respiratory distress syndrome (ARDS) in 12 patients; four hypoxemic respiratory failures due to multilobar pneumonia; three pulmonary edema due to cardiac origin; two massive hemoptysis; two depressed sensorium, and one pulmonary edema due to fluid overload secondary to renal insufficiency. The baseline clinical characteristics of age, APACHE II, and SAPS II score on the day of ICU admission, the total number of days of ICU stay, and the total duration of mechanical ventilation before the first SBT were not significantly different in the two outcomes groups. The MIP, RSBI, DD, DTF, and D-RSBI were compared in the outcome groups, and the difference between the groups was statistically significant. At a cut-off of 1.740 breath/minute/millimetre, D-RSBI had a sensitivity, specificity, PPV, and NPV of 100%, 90.2%, 100%, and 68.20%, respectively. Conclusion: Diaphragmatic rapid shallow breathing index is a novel, ultrasonography-based, noninvasive, and simple bedside predictive tool for weaning guiding intensivists during weaning from mechanical ventilation.

Aim: The aim of the present study was to assess lipid profile in patients of cerebrovascular stroke and controls. Methods: The present study was carried out in the Department of Biochemistry. Informed consent was taken from patient / relative and control subjects. The study was conducted for the period of one year. Study Groups: 50 Patients (age 30-90 years) of cerebrovascular stroke referred by  hospitals  were selected. Results: The mean age of cases and controls were 56.54 ± 12.48 and 48.32 ± 7.83 years respectively Maximum number of cases was in the age group of 51-60 years (34%). On comparing mean cholesterol, TG, HDL, LDL and VLDL between cases and controls, the p value was < 0.01 in all above test parameters which was found to be statistically significant. On comparing, levels of total cholesterol, HDL cholesterol and LDL cholesterol between ischemic and hemorrhagic stroke, p value was statistically significant while difference between triglyceride level and VLDL was not significant. On comparing, the difference between mean MDA values of ischemic stroke and controls was found to be statistically significant (p<0.01). On comparison by student t test, the difference between mean SOD values of ischemic stroke and controls was found to be statistically significant (p<0.01). Also on comparison between hemorrhagic stroke and control the difference in mean MDA and SOD values was found to be statistically significant (p<0.01). Conclusion: The difference in lipid profile between ischemic and hemorrhagic stroke should be taken into consideration while starting statin therapy as primary preventive measure to reduce incidence of first stroke in high risk patients, as well as during secondary prevention in case of ischemic strokes.

Aim: The aim of the present study was to evaluate the abnormalities in hematological parameters among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients in a tertiary care hospital. Material & Methods: This was a cross-sectional study carried out in Department of Pathology,  The study period was of 12 months. Includes all patients confirmed with COVID-19 infection. A confirmed 100 case of COVID-19 was defined by a positive result on the reverse transcriptase polymerase chain reaction (RT-PCR) assay of a specimen collected on a nasopharyngeal swab. Informed consent was obtained from all patients during blood sample collection. Results: In the present study, a total of 100 patients confirmed with COVID-19 infection were included, out of which 60 (60%) were males and 40 (40%) were females. The majority of the patients (77%) were more than 40 years of age. In this study, all the patients including both males and females were categorized into three groups based on hemoglobin levels. Out of the 100 patients, 49 cases (49%) had adequate hemoglobin levels of above 12g/dl, around 43 cases (43%) had a mild reduction in the hemoglobin value, and only 8 cases (8%) had moderate anemia with hemoglobin levels less than 10g/dl. In this study, 68 cases (68%) had a WBC count in the normal range while 22 cases (22%) had leukopenia, and 10 cases (10%) had leucocytosis. Conclusion: The common hematological abnormalities in patients with COVID-19 infection were elevated NLR, lymphopenia, thrombocytopenia, and elevated D-dimer levels. Some of the hematological parameters including elevated NLR, thrombocytopenia, and lymphopenia have been found to correlate with the clinical severity of the SARS-COV-2 infection in many patients and are useful in monitoring the patients during the course of the disease.

Aim: The aim of the present study was to analyze various clinical presentation, underlying immunocompromised condition, complication of invasive fungal sinusitis. Material & Methods: Total 50 cases of both types of invasive fungal sinusitis were included in this study.  The demographic profile, clinical presentation, underlying immunocompromised status, complication, mortality and management of all these 50 patients were analyzed. Results: In this study of 50 cases of invasive fungal rhinosinusitis with a male preponderance 68% (n=34). In this study, patients having Diabetes Mellitus were more susceptible to both acute and chronic variant of invasive fungal sinusitis. In Some patients multiple underlying immunocompromised conditions were observed. The patients presented with symptoms of nasal obstruction (n=32) 64%, purulent rhinorrhea (n=23) 46%, headache (n=28) 56%, facial pain (n=11) 22%, and facial swelling (n=21) 42%, epistaxis (n=27) 54%, fever (n=16) 32%, decreased vision (n=4) 8%, diplopia (n=1) 2%. The rhinology findings like mucosal necrosis, black crust or debris, and pus in middle meatus and septum involvement were shown. Orbital cellulitis was the most common complication of invasive fungal rhino sinusitis. 5 patients had intracranial extension. Out of 50 patients 3 patients expired due to complication of fungal invasive fungal rhino sinusitis. Conclusion: Invasive fungal sinusitis was most commonly observed in 3rdand4thdecade of life with male predominance. Prolonged uncontrolled diabetic mellitus was the most common underlying immunocompromised status.  Mucor was the most common isolated fungal species. Preseptal cellulitis was the most common complication.

Aim: The objectives of the study were to audit and implement the use of prophylactic antibiotics in women undergoing elective caesarean section. Methods: This comparative, prospective, hospital-based study was conducted in the department of  Obstetrics and Gynaecology for the period of 12 months. Results: Mean age was 25.5±3.6 years in group A & 24.6±3.4 years in group B. BMI at the time of admission was 26.4±6.4 kg/m² & 27.3± 5.5 kg/m² in group A & B respectively. Mean duration of surgery was 42.8±7.3 min in group A & 46.4±5.5 in group B. Average blood loss in both groups was comparable. Mean days of hospitalization was 4.8±3.7 days & 5.7±2.9 days in group A & B respectively. History of previous laparotomy like LSCS, ectopic surgery, etc. was present in 75 & 68 patients from group A & B respectively. Most common indication for elective LSCS was previous LSCS followed (42 % and 40%) by primi with CPD (24% v/s 20%). Conclusion: This study showed single dose antibiotic prophylaxis is as effective as conventional multi dose antibiotic therapy. It is cost effective, antibiotic resistance of microorganisms can be prevented, reduces patient side effects, nursing staff work.

Aim: The aim of the present study was to determine the efficacy of copper T (Cu T) 380 A as a contraceptive method and to determine the indications of discontinuation of Cu T 380 A. Methods: The retrospective analysis on copper T removals done at Department of obstetrics and Gynecology for the period of 12 months. A total number of 100 cases were observed and included in this study. Results: Among 100 cases, Intracesarian insertions were done in 95 (95%) cases, Interval insertions were done in 5 (5%) cases. Majority of these cases belonged to the age group of 20 – 30 years (85 cases (85%) and 15 (15%) cases belong to >30 years of age group. 55 (55%) cases belong to para 1, 40 (40%) cases belong to para 2, 5 (5%) cases belong to para 3. Most of the cases reported after 2-5 years of usage for removal 72 (72%), 20 (20%) cases reported after 1-2 years, 8 (8%) cases reported after 5 years. Major indication for removal was desire for pregnancy in 80 cases (80%). In 17 (17%) cases CuT was removed for sterilization, 1 (1%) case for failure of contraception, 1 (1%) case for abnormal uterine bleeding and dysmenorrhea, 1 (1%) case for uterine perforation. The difficulties faced during removal were non visible strings and missing CuT. Among the removals, as majority of them were inserted during intracesarian period, they were likely to be high up in the uterine fundus with coiled strings and may present with non-visible strings. Conclusion: Cu T 380 A is a safe, long-lasting, convenient contraceptive method with very few side effects. The technique of insertion and ease of removal at convenient time makes it an effective and useful contraceptive method. Intracesarean insertion of Cu T can be done easily after counselling the patients.

Aim: The aim of the present study was to study the efficacy of amantadine in improving cognitive dysfunction in patients with severe traumatic brain injury. Methods: We conducted a single institution‑based observational study at Department of Neurosurgery. We obtained informed consent from the legal representative or next of kin/relative for each patient to be enrolled and have their data published. 70 patients were included in the study. The patients who survived severe TBI were observed for 2 months with Full Outline of Unresponsiveness (FOUR) score. Results: The cognitive function improved progressively during the 4‑week treatment interval as shown by significant improvement on FOUR score, DRS, and GOS. The adverse effects included spasticity, agitation, vomiting, rash, restlessness, diarrhoea, elevated liver function tests, generalised tonic-clonic seizures (GTCS), constipation, focal convulsions, and nausea. Conclusion: Administration of amantadine is safe and associated with rapid cognitive improvement in patients with static or declining cognitive function occurring after severe TBI, which is the foundation for functional independence.

Aim: The aim of the present study was to find the prevalence and risk factors associated with sensorineural hearing loss in patients with systemic hypertension. Material & Methods: A cross-sectional study conducted during the period of 18 months aimed at finding out the prevalence of sensorineural hearing loss and the risk factors related to hearing impairment among systemic hypertensives in Department of ENT. 100 patients attending the outpatient Department of ENT, meeting the inclusion and exclusion criteria were recruited for the study. Results: Maximum participants were in the 56-60 age group (47%). Female participants predominated in our study (66%). When right ear and left ear were studied separately, 35 patients (35%) had sensorineural hearing loss in the right ear, whereas 33 patients (33%) had sensorineural hearing loss in left ear. When hearing thresholds at individual frequencies were noted, in the right ear 42 patients (42%) had hearing loss at 250 Hz, 34 patients (34%) had hearing loss at 500 Hz. Similarly, in the left ear, 37 patients (37%) had hearing loss at 250 Hz, 33 patients (33%) had hearing loss at 500 Hz. The patients in 55-60 age group had a higher incidence of hearing loss when compared to the remaining study population. In our study we found that increasing age is a risk factor for sensorineural hearing loss in hypertensives. We studied whether duration of hypertension has any bearing on the development of sensorineural hearing loss and found out that patients with more than 10 years duration of hypertension had the highest prevalence of sensorineural hearing loss. Conclusion: Sensorineural hearing loss has a high prevalence among patients with systemic hypertension. Hence, a pure tone audiometry should be done routinely in all hypertensives, particularly in elderly patients with long standing systemic hypertension. Periodic audiological assessment should be incorporated in them to start rehabilitation as early as possible. Early diagnosis of systemic hypertension in the community and initiation of treatment can help to further hinder the progression of microvascular disease that leads to target organ damage.

Aim: The aim of the present study was to assess the outcome of acute ischemic stroke patients treated with tenecteplase. Material & Methods: A prospective observational study of acute ischemic stroke patients treated with tenecteplase. On admission, clinical characteristics, temporal, epidemiological, imaging parameters, outcome measures including baseline National Institutes of Health Stroke Scale( NIHSS) score, NIHSS at 1 hour, 24 hours, at discharge, and modified Rankin Scale Scores (mRS) at 0, 1 and 3 months were recorded in a structured proforma. Twenty patients were included in the study. Results: During the study, a total of 20 patients underwent intravenous(IV) thrombolysis with tenecteplase. Mean age was 60.32 years with 70% of the study subjects being males. Hypertension was the commonest risk factor present in 60% of the cases, followed by dyslipidemia in 50%. Most of the patients had large artery stroke subtype, with the infarct region belonging to the territory of middle cerebral artery in all the 20 cases. The mean time from onset of symptoms to arrival at the medical emergency was 115 (±12.48) minutes (min) while mean “door to needle” time was 56 (±18.22) min. The study subjects had a mean NIHSS score of 12 (±3.14) and a median mRS score of 5 (range: 3–5) at the baseline. The primary clinical efficacy outcome was an improvement in NIHSS score of 4 or more points at 24 h. Mean NIHSS scores at 2 h and 24 h were 11.49 (±5.15) and 9.31 (±5.25), respectively. We used “one-way repeated measures analysis of variance” test and observed a significant difference between the NIHSS scores at baseline and 24 h (P = 0.012). Conclusion: Tenecteplase was found to be the safer, faster and cost- effective thrombolytic agent in acute ischemic stroke and is as much suited for the rural setting, as for the urban ones. More studies on this novel thrombolytic agent will throw light on its superiority even in the rural settings thus preventing the stroke epidemics, enhanced by its customized usage especially in this era of endovascular care.

Aim: The aim of the present study was to examine the role of RDW and neutrophil to lymphocyte ratio (NLR) in predicting the prognosis of patients with traumatic brain injury. Methods: The target population in the present prospective study was patients with traumatic brain injury referred to the Department of Anesthesiology, Institute of Medical Sciences Banaras Hindu University, UP, India for 6 months. Using the random sampling method, a total number of 100 participants enrolled in the study. Results: The mean age of the study population was 62.18 (± 15.05) years. The mean NLR (p = 0.05), neutrophil count (p=0.04), platelet count (p = 0.05), and NIHSS (p<0.01) had a significant difference. Hypertension and hyperlipidemia were the most and the least common underlying diseases among the participants, respectively. The mean of the variables by patients’ outcome (death or recovery) was assessed and compared with a T-test between the two groups to investigate the effect of the variables on the mortality of patients. Higher NIHSS scores were statistically significant with death within three months (p < 0.01), while the higher neutrophil count was associated with higher survival (p= 0.02). The receiver operating characteristic (ROC) curve was utilized to compare the predictions of deaths by variables, including RBC, NIHSS, NLR, and RDW at the end of the 3-month follow-up. We found that the NIHSS (area under curve (AUC): 0.905). Conclusion: Red cell distribution width is a predictor of mortality in patients with TBI. NLR  is  a  reflection of  the degree of  the inflammatory response  (neutrophils)  and  immune status  (lymphocytes),  which shows an increase in the  recruitment of inflammatory cells and  the release of inflammatory cytokines when  NLR  level increases. According to the results of the present study, it was suggested to increase the sample size in future studies to increase the accuracy of the results, control and delete other probable variables affecting RDW in the sample, including the information about the region and volume of hemorrhage and evaluate the relationship between study variables and the prognosis of patients in different age groups.

Aim: The aim of the present study was to evaluate the prediction of early neonatal hyperbilirubinemia using 24-hour serum bilirubin level. Methods: The present study was a prospective study and was carried out at the NICU of Department of Pediatrics. The study was carried out for one year. We enrolled 100 infants. All healthy term neonates were to be assayed for TSB levels at 24 hours (Between 24+6hours) and again at 5 days. Results: There were 55 (55%) male neonates. 70 (70%) were delivered by normal vaginal delivery (NVD) and 30 (30%) delivered by LSCS. ABO incompatibility was present in 25% neonates. A TSB of <6mg/dl at 24 +6hours was present in 65 infants (65%). Out of these only 5 infants developed hyperbilirubinemia subsequently. In the rest 35 (35%) cases the TSB at 24+6 hours was >6 mg/dl. Out of this group 10 cases ultimately went on to develop a positive study outcome. All the neonates were classified into four groups depending on the 24 hour serum bilirubin levels <3mg/dl (group-1), 3-4.9mg/dl (group-2), 5-6.9mg/dl (group-3), and >7mg/dl (group-4). Majority 52 of newborns had mean 24hr bilirubin level between 3-4.9mg/dl. 25 (25%) newborns had 24 hours blood bilirubin level between <3mg/dl. 43 newborns had 24 hours blood bilirubin level between 5-6.9 mg/d. 14 neonates had 24 hours bilirubin levels >7mg/dl. The range of bilirubin value within 24 hours was 2.1 to 8.1mg/dl. There was statistically highly significant (p<0.001) association between requirement of phototherapy and higher 24hours serum bilirubin levels. Newborn babies with 24 hours serum bilirubin level of >4.75 mg/dl had a significant risk of developing neonatal hyperbilirubinemia. Conclusion: A bilirubin level over 4.75mg/dl during a 24-hour period may serve as a dependable indicator for the presence of newborn hyperbilirubinemia in healthy term infants.

Aim: The aim of the present study was to estimate the proportion of children with asthma who have food related respiratory symptoms and to correlate it with (a) skin prick test (SPT) results and (b) level of asthma control. Material & Methods: This cross-sectional study involved children with asthma, aged ≥6 years attending the Department of Pediatrics for one year. Basic demography and clinical details were recorded. In subjects with a history of food allergy, skin prick test (SPT) was done using Allergo SPT according to guidelines recommended by British Society of Allergy and Clinical Immunology (BSACI). Asthma control was assessed using asthma control test (ACT) and childhood ACT questionnaire. Results: 68% were male and 32% were females in cases and 70% were male and 30% were females in controls. Majority of the patients in both groups belonged to 6-10 years of age group. Cases had asthma develop at 10.8 compared with 28.8 months for the controls (P < .001). In the univariate analysis, only sensitization to dog or foods was significantly associated with life-threatening asthma. Food allergy was found to be a significant risk factor for life-threatening asthma; 52% of cases had food allergy compared with only 10% of the controls (P = .006). Food allergy was found to be a significant risk factor for life-threatening asthma; 52% of cases had food allergy compared with only 10% of the controls (P = .006). Conclusion: Our findings have important implications for children with coexistent asthma and food allergies. Food allergy is seen in the first few years of life and is potentially a useful marker that would allow increased supervision of this group of high-risk children with asthma to reduce subsequent asthma morbidity and mortality.

Aim: The aim of the present study was to compare enzymatic debridement for ulcer healing by secondary intention by papain debridement versus using povidone iodine solution. Methods: The Present study was single-center, prospective, comparative study, conducted in Department of General Surgery. Study duration was 11 months. 200 patients randomly divided into two groups each after matching for confounding factors Group 1 – 100 patients treated with papain-urea Group 2 – 100 patients treated with Povidone iodine. Results: The overall mean age of patients in both groups was 48.22±12.68 in Group A and Group B 47.33±13.37. The maximum number of patients was in the age group of 56-64 years in both Group A and Group B (36 and 44 patients respectively). In Group A, there are 70 male and 30 female patients. In Group B there are 66 male, 34 female patients. The total number of diabetics in the study included 200 patients (12%) in group A, while 18% in group B. The total number of hypertensives in the study included 8% in group A and 6% in group B while patients having both DM and HTN 8% in group A, 6% in group B.  The most common site affected among group A subjects was left foot (24%) followed by right foot (20%), the least site affected was right thigh (2%) and right hand (2%). The most common site affected among the group B subjects was left leg (22%) and right foot (22%) followed by left foot (20%) The least site affected was left hand, right and left forearm (2%). The commonest organism on Culture sensitivity taken on day 1 for all patients was Staphylococcus aureus – 24 patients, Enterococci – 12 patients, no growth in 7 patients. Conclusion: There was shorter duration of hospital stay, earlier wound disinfection and a greater number of patients who underwent earlier skin grafting in papain urea group. The results were statistically significant and in favour of papain urea. Thus we concluded that use of papain urea is highly recommended as compared to povidone iodine in management of non-healing ulcers.

Aim: The aim of the present study was to compare different doses of magnesium sulphate on hemodynamic changes in patients undergoing laparoscopic surgery. Methods: The study was conducted at Indira Gandhi Institute of Medical Sciences, Patna, India for the period of one year after obtaining ethical clearance from the Institutional Ethics Committee, IGIMS, Patna, India. Total 78 patients were randomly divided into 3 groups. Written informed consent was obtained from all the patients before enrolling them for the study. Results: There was no significant association between gender and group (p=0.524). There was insignificant association between ASA grade and group (p=0.502). There were insignificant changes in the heart rate among all three groups at all time intervals (p value>0.05). There were no significant differences in SBP among the three groups till 5 minutes after pneumoperitoneum, but after that time SBP and DBP was significantly less in group MB compared to group MA and group C till extubation. VAS at 5 minutes and at 20 minutes post extubation was significantly less in group MB compared to group MA and also with group C (p value< 0.05). Fentanyl requirement was less in group MB (only 3 patients among 26 patients) than in group MA (11 patients among 26 patients) and group C (20 patients among total 26 patients). This difference was statistically significant. (p value < 0.05). Extubation time was less in group MB (with a mean of 7.73) compared to group MA (Mean 8.31) and group C (mean 8.88) but the difference in extubation time between the three groups was insignificant (p value> 0.05). Conclusion: The present study concluded that magnesium sulphate attenuates the increase in blood pressure during pneumoperitoneum thus provides intra operative hemodynamic stability during laparoscopic surgery. Our study demonstrated that intravenous magnesium sulphate in a dose of 50mg/kg body weight given before creation of pneumoperitoneum attenuates the hemodynamic alteration during laparoscopic surgery and also reduces the post -operative pain. There were no complications noted during our study.

Introduction: Proximal femoral fractures are a significant contributor to morbidity and mortality in the elderly population. Despite the substantial burden of osteoporosis, the majority of existing literature originates from Western countries. Therefore, we conducted this study to identify risk factors for early mortality in hip fractures within Indian population. Materials and Methods: A total of 227 patients were included. The primary outcome assessed was mortality in elderly patients undergoing operative treatment, and secondary outcome measures examined predictors of mortality within this age group, specifically age, gender, Charlson Comorbidity Index, Injury Severity Score, preoperative ASA grading, duration between injury and surgery, and the length of hospital stay. We performed regression modelling to evaluate the impact of various variables on the time of mortality. Results: The average age of the patients was 70.25 years. The mean Charlson Comorbidity Score was 1.75. The average time from injury to the operation was 34.75 hours, and the mean length of hospital stay was 5 days. Mortality one year after surgery stood at 18.50%. Univariate and multivariate regression analyses revealed that variables significantly associated with mortality included Age, Charlson Index, Charlson Index Category, time between Injury and operation (in hours), Length of hospital stay, and preoperative ASA grade. Conclusion: Our findings underscore the importance of implementing a dedicated hip fracture protocol in resource-poor settings. Early and aggressive management to optimize patients for surgery and expedite surgical intervention lead to a swift return to pre-fracture health status and a reduction in early mortality.

Aim: The aim of this study was to identify the fungal isolates as well as their antifungal susceptibility in patients from undergoing chemo-radiotherapy. Material & Methods: A prospective study was conducted on 100 randomly selected patients of Head and Neck cancer undergoing treatment at Department of Microbiology and Department of Radiotherapy at Patna Medical College and Hospital, Patna for the duration of 1 year. Results: Majority of the study population belonged to age group of 51-60 years (33%) followed by 61-70 years (21%). The mean age was found to be 54.2 years. There were no cases belonging to age group of less than 20 years. Carcinoma of the oral cavity was the most common tumour present among the members of the study group, with Ca Tongue constituting (28%) and Ca Buccal mucosa (26%) followed by Carcinoma supraglottis (20%). The samples collected are urine, blood and throat swab during 0, 2 and 6 weeks of radiotherapy. 90.5% of the isolates were isolated from throat swab and 9.4% isolates from Urine. There were no isolates in blood samples. The increased incidence of fungal infections in both throat swab and urine at 6th week of radiotherapy compared to before radiotherapy was found to be statistically significant with p value of <0.001 (throat swab) and 0.04 (urine). A wide spectrum of clinical presentation was present in the culture positive cases such as Presence of white patch (52.8%), Redness in oral cavity (20.8%), Dry mouth (11.3%), asymptomatic (9.4%) and Dysphagia (5.7%). Conclusion: Oral candidiasis is a common fungal infection in patients with cancer on treatment with chemotherapy and/or radiotherapy. Candida albicans and non-Candida albicans differ significantly in their antifungal susceptibility pattern. Non-Candida albicans like Candida krusei are inherently resistant to azoles. Hence, species level identification with in vitro antifungal susceptibility pattern is essential to choose the appropriate antifungal drug and to predict the outcome of therapy.

Aim: The aim of the present study was to describe sexual life in women with spinal cord injury. Material & Methods: A cross sectional study included all women with traumatic spinal cord injury treated at spinal cord centres at hospital. Out of the 300 women, 100 were excluded: 8 due to death, 14 were recovered, 6 with language difficulties, 16 had congenital injuries, 6 due to psychiatric disease, 18 due to other severe illness and 18 because they could not be located. The total eligible sample thus comprised 200 women. Results: Mean age of the women was 44 years and the average time since injury was 12 years. Almost two-thirds were married or in a committed relationship. 56 women were tetraplegics and 96 women had paraplegics. For single women, both SCI and controls, wanting a partner, the most common reason reported for being single was that they had not met the “right” partner. Other reasons reported by the women with SCI were feelings of inadequacy, fewer opportunities to find new contacts, low self-esteem, and feelings of being unattractive, doubts about sexual abilities and fear of bladder and/or bowel leakage. Hugging, kissing and caresses were listed as important by approximately three-quarters of the women with SCI both before and after the injury, and the control women. Almost half of the women with SCI considered it important to be caressed, even on body parts with no sensation, in order to become sexually aroused. Conclusion: For women who are able to overcome the physical restrictions and mental obstacles due to injury, it is possible to regain an active and positive sexual life together with a partner. Sexual information and counselling should be available both during initial rehabilitation and later when the women have returned to their homes.

Aim: The aim of the present study to assess factors associated with the incidence of radiocarpal stiffness following management of distal radius fractures surgically. Material & Methods: This study reviewed a series of patients who suffered from DRFs at Department of Orthopedics. The inclusion criteria were adult patients with closed DRFs confirmed by x-ray test or computed tomography (CT) scan and underwent surgical treatment with volar locking plate fixation. A total of 150 patients who underwent distal radius volar locking plate fixation were included in the current study. Results: Among these patients, 40 (26.66%) were male, and 110 (73.33%) were female. The mean age at the time of surgery was 54.6 ± 10.6 with stiffness and 52.8 ± 9.1 without stiffness. Preoperative swelling was considered to be slight in 57 patients (38%) and was severe in 93 patients (62%).  Extra-articular fractures were seen in 30 patients (20%), and intra-articular fractures were in 120 patients (80%). During surgery, 78 fractures (52%) were fixed with plate only, and the other 72 fractures (48%) were fixed with plate and Kirschner wire. The incidence of RJS, we found that age, preoperative swelling, types of internal fixation, fracture type, post-operative volar tile and improper rehabilitation exercise were potential risk factors, while gender, BMI, history of smoking or alcohol, diabetes mellitus, osteoporosis,  dominant hand, time from injury to operation, ulnar styloid process fracture, post-operative radial inclination, post- operative ulnar variance, assisted cast or splint fixation, postoperative infection, or removal of internal fixation was not. In the further multivariate logistic regression analysis, intra-articular fracture, pre-operative severe swelling, post-operative unsatisfied volar tile and improper rehabilitation exercise were demonstrated to be associated with the incidence of RJS during follow-up. Conclusion: Factors such as intra-articular extension, preoperative severe swelling, use of additional k-wire, unsatisfied volar tilt, improper rehabilitation is associated with a higher incidence of radiocarpal joint stiffness in patients with distal radius fracture. Re-operative risk notification and postoperative precautions are necessary for relevant patients.

Aim: The aim of the present study was to assess knowledge and performance of the parents at the time of fever in children and how they act when encountering children’s fever. Methods: In this cross-sectional descriptive study, the studied population included parents of children less than 10 years admitted to Department of Pediatrics for 12 months. Samples were selected using the convenience sampling method and were enrolled after informed consents were obtained. Sample size was determined as 200 parents of children under 10 years. Results: The total number of mothers included in this study was 200. 144 (72%) of them have more than three children. The majority of mothers have neither job nor sufficient income that suffices the basic needs of life, such as food and clothing. 80 (40%) mothers have good knowledge about preschool childhood fever, and 94 (47%) of them show good management practices toward childhood fever. Approximately half of all mothers responded correctly regarding the definition of fever (48%), best site for measuring the temperature of under 5-year children (51%), and types of antipyretics (55%). Better responses are observed regarding the complications of fever (60%), choosing the proper type of antipyretic (64%), increasing the antipyretic dose is not beneficial in lowering high fever (66%), and dose calculation of antipyretic (61%). Mothers show correct responses regarding diagnosing fever by forehead touch or thermometer (46%), consulting a physician or health care facility once the fever is detected (44%), and the proper site for measuring temperature by thermometer for under-five children (52%). Only 35% of the studied group can correctly calculate the dose of antipyretic. Better responses are observed regarding the proper way to administer the pre-scribed antipyretic doses, using alternative medicine such as lukewarm water compresses, and administration of antibiotics with medical advice. Conclusion: This study indicated more than one-third of mothers had good knowledge about childhood fever, and a quarter of them showed good management practices towards preschool childhood fever. The mothers’ management practices towards fever were significantly related to some factors, which are young age, fewer children, higher educational level, sufficient income, and good knowledge.

Aim: The aim of the present study was to assess the association of anemia and hypoalbuminemia with the mortality of CKD patients undergoing routine hemodialysis. Methods: A retrospective cohort study was conducted in the Department of General Medicine,  for the period of six months. The inclusion criteria were CKD patients aged ≥19-year-old who had undergone routine hemodialysis at our hospital. There were 100 patients enrolled in this study. Results: Out of 100 patients, 55% of patients were male and 45% were female. The majority of patients were adults (65%) and elderly (35%). The etiology of CKD included the following: diabetic nephropathy (43%), hypertensive kidney disease (30%), obstructive nephropathy (16%) and others (11%). Regarding vascular access at dialysis initiation, 81% were induced through subclavian vein catheter, 7% through internal jugular vein catheter, 10% through femoral access, and 2% through arteriovenous fistula. At dialysis initiation, 68% of patients had anemia, and 70% of patients had hypoalbuminemia. The mean hemoglobin level was 9.145±2.24 g/dl, while the mean albumin serum level was of 3.27±0.63 g/dl. During the dialysis treatment, 28 patients (28%) died. The majority of patients had anemia and hypoalbuminemia. The bivariate analysis showed that anemia (p value=0.180), and hypoalbuminemia (p value=0.340) were not statistically significant associated with mortality among patients undergoing routine HD. Conclusion: The mortality rate was higher in patients with anemia and hypoalbuminemia. Although our study concluded anemia and hypoalbuminemia are not statistically associated with mortality outcome of CKD patients, anemia and hypoalbuminemia may still have prognostic importance for CKD patients undergoing routine HD.

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

Aim: The aim of the present study was to assess the usefulness of PEDIS scoring in identifying the severity of diabetic foot ulcer and its management. Methods: This was a hospital based prospective observational study conducted in Department of General Surgery. Patients who came to hospitals with Diabetic foot ulcers below the level of malleolus including both outpatients and inpatients were taken into this study after getting consent. This study was conducted for 1 year. Totally 100 patients were included in the study and followed up for 6 months. Results: Out of 100, 68 (68%) were males and 32 (32%) were females. White blood cell counts were found to be elevated in 34 (34%) patients. The cut-off value for high WBC was considered to be more than 11,000/mm3. Cut-off value taken for high random blood sugar was 140 mg/dl. About 65 (65%) patients were having abnormally elevated random blood sugar. 10 (10%) patients were found to have osteomyelitis and they were tested positive for probe to bone test. Patients with score of less than 7 managed with debridement showed good results at the end. Patients with score more than 4 with high random blood sugar and elevated white cell count being showed delayed healing. Conclusion: In our study, PEDIS score helped us in identifying the severity of the diabetic foot ulcer. Patients with higher score needed amputation. Majority of the patients with low score were managed successfully with debridement alone and the outcome was good.

Aim: The aim of the present study was to evaluate the test characteristics of the urinalysis for diagnosing UTI in young febrile infants. Material & Methods: A prospective study of febrile infants ≤60 days old at Department of Pediatrics. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, by using 2 definitions of UTI: growth of ≥50000 or ≥10000 colony-forming units (CFUs) per mL of a uropathogen. We defined a positive urinalysis by the presence of any leukocyte esterase, nitrite, or pyuria (>5 white blood cells per high-power field). Results: 205 patients were enrolled in this study out of which 5 patients who met exclusion criteria were excluded. Of the 200 patients enrolled in this study and who met the inclusion criteria, 120 (60%) were male and 80 (40%) were female. 96% of febrile patients (n=192) showed no significant growth on urine culture. 4% (n=8) of the febrile patients had positive cultures. Out of 200 children, 20 (10%) children showed significant pyuria (>5 pus cells/HPF) in centrifuged urine sample of which 12 (60%) were males and 8 (40%) were females. Chi-square analysis was done taking urine culture as gold standard for diagnosis of UTI. Analysis was done for significant pyuria (> 5 pus cells/HPF) and the following were calculated with the standard formulas: Sensitivity=100, Specificity=96.4%, Positive predictive vale=65.5%, Negative predictive value=98.2%, Percentage of false positive=2.5%, Percentage of false negative=0%, Accuracy rates=96.4%. Conclusion: The urinalysis is highly sensitive and specific for diagnosing UTIs, especially with ≥50000 CFUs/mL, in febrile infants ≤60 days old, and particularly for UTIs with associated bacteremia.

Aim: The aim of the present study was to assess the lipid profile abnormalities in newly diagnosed type 2 diabetes mellitus. Material & Methods: A cross-sectional study was carried out to determine the triglyceride levels in newly diagnosed type 2 diabetics in the Department of General  Medicine. A total of 200 newly diagnosed type 2 diabetics were enrolled in our study. The Study was carried out during a period of 2 years. Results: Among the total participants, 80 (40%) were males, and 120 (60%) were females. The maximum number of patients belonged to the age group of 40-50 years (52%) and the least number belonged to the age group 20-30 years (2%). Among the participants in the study, 22.5% male and 32.5% female participants had above normal triglyceride levels. The total number of female participants who had abnormal triglycerides was higher than the male participants. The p value was not statistically significant. The Gender distribution showed that 35 male participants and 58 female participants had low HDL. The P value was >0.05 and was not statistically significant. In our study, among the 200 participants, 138 (69%) participants had desirable total Cholesterol levels of <200mg/dl, 52 (26%) had borderline high levels of 200-239mg/dl and 10 (5%) had high total cholesterol levels of ≥240mg/dl. Among the total participants, according to the NCEP-ATP III criteria, 70 (35%) participants had an optimal level of LDL of which 30 participants were males and 40 were females. 68 (34%) had near optimal levels of LDL and 23 participants were males and 45 were females. 35 (17.5%) had borderline high levels of LDL out of which 15 participants were males and 20 were females. 17 (8.5%) had high levels of LDL of which 7 were males and 10 were females. 8 (4%) participants had very high levels of LDL of which 3 was male and 5 was female. Conclusion: Deranged lipid profiles are quite prevalent in type 2 diabetics with females having higher triglyceride levels. Recognition of such elevated triglyceride levels in even newly diagnosed type 2 diabetics will help in  better prevention of associated cardiovascular disease.

Aim: The aim of the present study was to assess compare the pain sensitivity and functional outcome in patients of early osteoarthritis knee when treated with intra-articular steroids versus intra-articular hyaluronic acid. Methods: This study was conducted at Department of Orthopaedic, SNMMCH, Dhanbad, Jharkhand, India to analyze the pain sensitivity and functional outcome in patients of early osteoarthritis knee when treated with intra-articular steroids versus intra-articular hyaluronic acid using VAS and WOMAC scoring system for the period of 2 years. A total of 100 patients were included in the study of which 50 patients were given intra-articular steroid injection and 50 patients were given hyaluronic acid. Results: A major number of patients in steroid Group were in the age group 60 – 65 years i.e. 58%. On the other hand, 50% of patients in H.A. group were in the age group 60 – 65 years. In steroid group, male population accounted for 40% and female was 60%. In HA group, male population accounted for 48% and female was 52%. In steroid Group, 24 patients (48%) that were given treatment were right side as compared to 10 patients (20%) on left side while 16 where bi- lateral (32%). The mean Pre procedure VAS Score in steroid Group was 8.412 which had reduced to 6.8245 by the end of one year. The mean Pre procedure VAS Score in H.A. Group was 8.322 which had reduced to 5.110 by the end of one year. The mean Pre procedure WOMAC Score in steroid Group was 84.5516 which had reduced to 77.7715 by the end of one year. The mean Pre procedure WOMAC Score in H.A. Group was 85.814 which had reduced to 58.8236 by the end of one year. Conclusion:  In conclusion, our study showed that the Pain sensitivity and functional outcome of Intra articular therapy performed via H.A. group are similar till three months in comparison to Steroid group.

Aim: The aim of the present study was to determine the prevalence and predictors of stunting in children with Type-1 diabetes. Methods: This was a single-center, cross-sectional, observational study. Children (1–18 years) with T1D along with their parents who attended the at department of pediatrics for 12 months. during the study period were approached. Parents were provided written informed consent and children gave assent for the study. 250 children were included in the study. Results: Of the 250 children studied, 120 (48%) were boys and 130 (52%) were girls. Mean age of the children in the study group was 11.8±3.8 (1.2–18) years and the average duration of diabetes was 5.0±3.7 years. The children’s mean HbA1c was 10.0±2.4%. We reported 20% prevalence of stunting in our cohort of children with T1D. Stunted children had higher cholesterol, lower hemoglobin, lower midparental height Z-scores, and higher urinary albumin creatinine ratio. Binary logistic regression revealed that pre-existing comorbidities, compromised renal function, longer disease duration, and short mid-parental height were significant predictors of stunting. Conclusion: Our study suggested that a little under one-sixth of children with T1D had short stature. Monitoring growth in these patients, especially in subjects with short parents, prolonged duration of diabetes, existing comorbidities, and deteriorating renal function are critical.

Aim: The aim of the present study was to determine the association and diagnostic effectiveness of abnormal Doppler and abnormal amniotic fluid volume (AFV) in the third trimester of pregnancy with preterm births. Methods: The study population was recruited from at Department of Radiodiagnosis. All trimester-specific ultrasound and Doppler assessments were done. Total 500 women were included in the study. The data were collected prospectively and the study population included pregnant women with single-ton live fetuses. Results: The clinical and demographic details of the 500 women screened in the third trimester. 60% had EFW 10th–50th percentile. And 80% had no FGR. 25% had Preterm births < 37 gestational weeks. 20% had Oligohydramnios and 2% had polyhydramnios. Mean UtA PI > 95th percentile (p =0.03), UA PI > 95th percentile (p =0.03), MCA < 5th percentile (p < 0.001), and   CPR < 5th   percentile (p < 0.001) were associated with the presence of abnormal AFV. 125 (25%) of the 500 women had a preterm birth before 37 gestational weeks. These included 80 (20%) of 400 women with no FGR, 25 (50%) of 50 women with stage  1  FGR,  66.66%  of women with stage  2 (n = 3),   stage   3   (n =3),   or stage   4   (n =2)   FGR,   and   12 (28.58%)   of the   42   women with an   SGA   baby. The AUROC curves and the positive likelihood ratios for abnormal AFV and abnormal fetal Doppler parameters indicated that abnormal fetal Doppler and AFV did not have a good discriminatory ability for preterm births. Neither abnormal AFV nor abnormal fetal Doppler studies were significantly associated with preterm births in a multivariate logistic regression model that adjusted for preterm PE, EFW, type of conception, stages of FGR and SGA, and maternal age. Conclusion: In conclusion, we found that abnormal Doppler studies or abnormal AFV were not associated with preterm birth in the screened population. First-trimester identification of high-risk pregnant women and early initiation of low- dose aspirin can help reduce the pool of women at risk for preterm birth.

Aim: The aim of the present study was to determine the frequency of the causes and outcomes of respiratory distress in neonates hospitalized in the neonatal intensive care unit (NICU). Material & Methods: In this descriptive and cross-sectional study, all the neonates with respiratory distress (RD), who were admitted at NICU Upgraded Department of Pediatrics were included. The study was conducted for the duration of one year. The required demographic information was extracted from patients’ dossiers. The collected data were analyzed using SPSS version 16.0. Results: About 68% of 100 neonates with RD were male. The mean neonatal age and mean birth weight were 5.22±7.18 days and 2743.9±727.9 grams, respectively. The minimum birth weight was 850 grams while the maximum was 4,500 grams. According to the results, intercostal muscle retraction,   tachypnea, grunting, cyanosis, apnea and nasal flaring were the most common symptoms of NRD while RDS and TTN were the most common causes of respiratory distress. Furthermore, about 20% of the neonates died of the disease. The outcomes of NRD had a significant correlation with respiratory failure requiring mechanical ventilation, apnea, multiple and concurrent of respiratory symptoms and mean duration of hospitalization (p˂0.05). Therefore, the variables that significantly correlated with infant mortality entered logistic regression model. Conclusion: It was found that RDS is the most common cause of respiratory distress in the hospitalized neonates. Moreover, infant mortality rate increased due to respiratory failure requiring mechanical ventilation and occurrence of apnea. It was concluded that improving the care of newborns requires mechanical ventilation and prevention of apnea leads to better outcomes and reduced infant mortality rate.

Aim: The aim of the present study was to assess the knowledge of nurses working in an intensive care unit for at least 6 months regarding ventilator-associated complications and its prevention. Methods: The present study was conducted in Department of Trauma and Emergency. All staff nurses working in the ICU were included in the study. 50 staff nurses were included in the study. Results: Age wise distribution of sample reveals that majority 74% within the age group of 22-25 years and 26% were in the age group of 26-30 years. Gender distribution of sample reveals that about 68% were female. While 32% were male. The percentage distribution of patients in educational qualification shows that among 54% were B.B.sc. and 44% were RGNM. The year of work experience was 96% between 1-5 years and 4% between 6-10 years, respectively. Most of the samples 29 (58%) were having average knowledge, 12 (22%) were having poor knowledge and 9 (18%) were having good knowledge regarding VAP. Most of the samples 47 (94%) were having good knowledge, 3 (6%) were having average knowledge regarding VAP. The pretest and post test knowledge score among staff nurses the pretest mean score was 11.519 with SD 2.648 and post-test mean score was 16.634 and SD 2.528 and the mean difference was 6.114 and calculated t value was 17.713 which was statistically significant at level of <0.001. Conclusion: The current study showed that the nurses had satisfactory total knowledge at the pre-program implementation, indicating that the respondents lacked knowledge. However, the score of total knowledge increased immediately after the planned teaching program, indicating that the nurses gained knowledge after the teaching program.

Aim: The aim of the present study was to assess the level of serum magnesium in diagnosed Type II diabetics without microvascular and macrovascular complications and correlate with glycemic status. Methods: A cross-sectional study was conducted in the Department of Biochemistry. The data was collected for finding out correlation between the glycemic index and serum magnesium was analysed and the results were obtained. The estimated sample size was 50. The sampling type was purposive sample. Results: 32 (64%) were in the age group of 41–60 years, 10 (20%) were in age group of 19–40 years, whereas 8 (16%) were between 61 and 80 years. 32 (64%) were male and 18 (36%) were female. Thus, there was male preponderance. 24 (48%) were diabetic since 11–20 years, 15 (30%) were diabetic since 0–10 years, 8 (16%) were diabetic since 21–30 years, while 3 (6%) were diabetic since >30 years. Laboratory reports revealed that there was significant difference in mean total leukocyte count, Serum glutamic pyruvic transaminase (SGPT), serum glutamic‑ oxaloacetic transaminase (SGOT), K+, Randon blood sugar (RBS), and HbA1c between hypomagnesemia patients compared to normomagnesemia patients (P < 0.05) There was no significant difference in other laboratory values between the two groups. The prevalence of hypomagnesemia in patient with HbA1c <7% was 20% as compared to that of normomagnesemia (60%), while the prevalence of hypomagnesemia in patient with HbA1c >7% was 80% as compared to that of normomagnesemia (40%). This difference of S. Mg level in relation to HbA1c was statistically highly significant. Conclusion: The study concluded that that low S. Mg level in type 2 diabetes patients may be associated with higher HbA1c level, higher incidence of retinopathy and nephropathy. Routine monitoring and correcting S. Mg levels in type 2 diabetes patients may help in better control of HbA1c and delaying progression to retinopathy and nephropathy.

Aim: The aim of the present study was to assess endometrial Biopsy Audit and its Clinico-Pathological Correlation in Patients with Abnormal Uterine Bleeding in Bihar region. Methods: The present study was conducted in the Department of Pathology over a period of 12 months. 200 cases were selected in the study. Results: In the study majority 45% were in the age group 41 to 50 years. In the study 5% were Nulliparous and majority were in para 2 (51%). In the study majority of subjects had Heavy menstrual bleeding (48%). In the study clinically, 48% were diagnosed to have fibroid, 25% had Adenomyosis. In the study 45% had Proliferative, 28% had Secretory, 12% had Endometrial hyperplasia and 8% had Endometrial carcinoma. Conclusion: Abnormal uterine bleeding is a common diagnosis and the commonest presentation is menorrhagia. Histopathological examination of the endometrium showed a wide spectrum of pathological changes ranging from normal endometrium to malignancy thus necessitating endometrial sampling as an important diagnostic tool in the management of abnormal uterine bleeding. Accurate analysis of endometrial sampling is the key to effective therapy and optimal outcome.

Aim: The aim of the proposed study was to evaluate virtual reality (VR) as a non-pharmacological intervention tool to reduce pain and separation anxiety in patients of paediatric age group undergoing intravenous cannulation and surgery. Methods: A prospective randomized control study was conducted in Department of Anaesthesiology at ESICMCH, Bihta, Patna after clearance by ethical committee. Patients with ASA physical status I, II posted for elective surgeries were included in the study which was conducted during 1 year period. Sixty patients were randomized into two groups. Results: statistical analysis of the heart rate and oxygen saturation of Children with moderate anxiety and severe anxiety and anxiety with regard to parental separation and about the unfamiliar people and environment done using paired t test. Patients using VR exhibited lower pain and anxiety score during intravenous cannulation and parental separation. Conclusion: This current study found that application of immersive VR had better pain alleviation and parent separation anxiety score when compared with non-VR group patient.

Background: In this study we wanted to evaluate Intravenous Regional Anaesthesia with regard to effectiveness, usefulness, drugs and adjuvants used, types of surgeries done, safety and complications. Methods: This was a record based descriptive study conducted in Government Medical College, Ernakulam, for a period of 6 months among 129 patients, after obtaining IRC and IEC approval. Results: Lignocaine 0.5% along with muscle relaxants and either Dexmedetomidine or Buprenorphine or Fentanyl or Morphine as adjuvants can be used for IVRA with high success rate. Conclusion: IVRA is a safe and effective method for providing anaesthesia for upper limb surgeries of bone and forearm, Metacarpal fractures, Phalanx bone surgeries & Soft tissue surgeries of the hands and wrists. Complications with IVRA are less except for occasional Tourniquet pain, and transient Bradycardia responding to Atropine.

Background: Leprosy is one of the causes of gynaecomastia (enlargement of the breast) and gynaecothelia (enlargement of the nipples); however, little has been published about it, and it is usually an ignored sign. Methods: This was an observational study. Herein, we report three male patients with multibacillary leprosy. Results: Two patients had gynaecomastia and one patient had gynaecothelia not associated with gynaecomastia. None of these patients were aware of it until it was detected by the treating doctor during an examination. Conclusion: Through this study, we are highlighting the fact that gynaecomastia or gynaecothelia may not be a rare phenomenon if it is observed in all cases of leprosy and the possibility of leprosy should be considered in any male patient complaining of isolated hypertrophy of the breast or nipple.

Background: There are few quantitative assessments of how anaesthesia management affects perioperative morbidity and mortality. The authors conducted a study to determine risk variables for anaesthetic care about severe morbidity and mortality within 24 hours of surgery. Methods: In a case-control study conducted in 2021–2022, anaesthetized patients were evaluated. Within 24 hours of being put under anaesthesia, some patients in the cases passed away or went into a coma; in contrast, the controls did not experience any of these outcomes. The Anaesthesia and Recovery Form was used to gather data, and confounder-corrected odds ratios were the result. Results: The cohort comprised 869,483 patients; 705 cases and 711 controls were studied. The frequency of 24-hour postoperative death was 8.8 per 10,000 anaesthetics, while the rate of unconsciousness was 0.5. Some significant anaesthetic management factors associated with decreased risk were using a checklist and protocol to check equipment (odds ratio: 0.64), recording equipment checks (odds ratio: 0.61), having a direct anaesthesiologist available (odds ratio: 0.46), having the same anaesthesiologist present during anaesthesia (odds ratio: 0.44); having a full-time working anaesthetic nurse (odds ratio: 0.41); having two people present at emergence (odds ratio: 0.69); and reversing anaesthesia (odds  Postoperative pain medicine also carried a lower risk profile, mainly when administered intramuscularly or epidurally as opposed to intravenously. Conclusions: Preoperative unconsciousness and death are associated, making postoperative mortality a severe problem. Anaesthetic management factors that impact this association include using medications during and after therapy, the type of anaesthetic care given during and after surgery, and the presence of anaesthesiologists throughout the procedure.

Background: This study was conducted to evaluate the benefits of oral glycerol in moderate head injury patients and assess the outcome in terms of GCS (Glasgow Coma Scale). Methods: This was a hospital based prospective, observational study conducted among 200 patients with moderate head injuries at the Department of General Surgery, LTMMC and LTMGH, Sion, Mumbai-400022, over a period of 18 months after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: We compared the GCS score over a follow-up period of 15 days in group A. We observed statistically significant improvement in the GCS scores. (The value of the F-ratio was 316.11148. The p-value was<0.00001. At p < 0.05, the outcome was significant). We compared the GCS score over a follow-up period of 15 days in group B. We observed statistically significant improvement in the GCS scores. (The F-ratio value was 147.45626. The p-value was < 0.00001. At p < 0.05, the result was significant). Conclusion: Mannitol 10% plus 10% glycerol is better than mannitol 20% because it keeps the mannitol dose the same and offers better CNS bioregulation without causing neurodeficiency.

Introduction: The following are risk factors for intrapartum haemorrhage: breech presentation, protracted labour, stationary labour, prolonged rupture of the membrane during term, caesarean section, home birth, and maternal fever. Preterm births, low birth weight, foetal distress, and child resuscitation are foetal risk factors.6.7 However, perinatal variables related to labour and delivery appear to have minimal effect on the prevalence of mental retardation and seizures, according to the British National Child Development Study (BNCDS). The prevalence of true intrapartum asphyxia in babies with CP was about 3–13% 8. “Successful neonatal resuscitation requires adequate preparation, accurate evaluation, and prompt initiation of support,” according to the American Academy of Paediatrics. “An appropriate preparation of an anticipated high risk delivery requires communication between the persons caring for the mother and those responsible for resuscitation of the newly born child.” Material and Method: In instances, a thorough history of the current disease is obtained, a thorough general examination, a thorough systemic examination, and staging is carried out using Levene44 staging for preterm newborns and Sarnat and Sarnat 31 staging for term babies. Complications and results have been examined in light of this information and with the aid of studies. A pre-made case report format (CRF) is used to gather information on the mother and child. Data gathered from case reports was entered into a master chart. Variables within the master chart were then analysed using SPSS software and all calculations were made in accordance with chi-square, anova, and p-value analyses. Result: The incidence of HIE Newborn is more in 18-23 yrs age group i.e. 51.5%. Primigravida has significant association with HIE Newborn constitutes 69.2%. Maternal Anemia has a significant association with HIE Newborn constitutes 56.5%. Prolonged labor and obstructed labor has significant association with HIE Newborn accounts 46.2%. There are more number of HIE Newborn cases in low socioeconomic status (65.8%) Male babies are more prone for HIE Newborns accounts 63.5%.Meconium stained liquor accounts 26.9% with HIE Newborns. Oligohydraminos accounts 19.6% for HIE Newborns. Conclusion: It appears that even with breakthroughs in foetal medicine and technology, birth asphyxia is linked to a considerable risk of morbidity and death in high-early infants. After ten years, there was no change in its mortality, morbidity, and risk factors. Research reveals that the development of HIE was mostly associated with maternal anaemia as a risk factor. Significantly higher severe grades of HIE were linked to prolonged and obstructed labour. Low socioeconomic level and severe HIE newborns are highly related. Primagravidae have a higher frequency of HIE. Most frequently, there are complications including shock and sepsis. A five-minute APGAR score of less than seven indicates a significant incidence of birth asphyxia.

Background: The leading cause of death and disability in children is Traumatic brain injury (TBI). Pediatric TBI is associated with several distinctive characteristics that differ from adults and are attributable to age-related anatomical and physiological differences, pattern of injuries based on the physical ability of the child, and difficulty in neurological evaluation in children. Aim: To study the current trends in the management of paediatric head injuries and to study the outcome with the current management guidelines and followup status of the patients. Materials and Methods: This study was a prospective observational study and all patients diagnosed with head injury in Department of Neurosurgery, Osmania General Hospital, Hyderabad. This study was conducted between November 2014 to February 2017. 205 patients were selected in this study. Results: The commonest age group of paediatric head injuries is 11-14 years with the incidence rate of 39.5% i.e. 81 patients with the mean age group of 7 years. The male to female ratio is 4:3 with a male preponderance. The commonest mode of mechanism of injury is due road traffic accident with an incidence rate of 60% followed by fall. The commonest complaint the patients presented are the loss of consciousness for a period of more than 30 minutes to 24 hours with an incidence rate of 70% followed by altered sensorium with an incidence rate of 62%. Most of the patients admitted are with mild head injury with the incidence rate of 43.4%, followed by moderate and severe head injuries with the incidence rate of 37.5% and 19.02% respectively. The commonest type of injury is EDH with incidence rate of 26.8%.The patients with duration of stay less than 7 days are 180 i.e. 87.8% and the patients with duration of stay more than 7 days are 25 i.e. 12.19 %. Most of the patients admitted are managed conservatively i.e. 170 patients and only 35 patients are operated. The patients admitted in the study underwent various surgical procedures like craniotomy and evacuation of EDH, wound debridment and elevation of depressed fracture segment, endoscopic repair of fistula for traumatic csf rhinnorea, craniotomy and evacuation of SDH and decompressive craniotomy. The patients with good recovery had a incidence rate of 75.1% i.e. 154 patients and 189 cases of GOS >/=5 the patients expired are 11 with a mortality rate of 5.3%. Conclusion: In the present study, a number of interesting recent reports in the field of clinical research in pediatric TBI were studied. We believe that the field is moving forward at an accelerated pace since the publication of the first guidelines document, and that valuable innovations in our understanding of the pathophysiology, diagnosis, and monitoring have been made, along with some progress in defining optimal therapy.

Background: Prolonged QT interval (QT) has been identified as risk factors for sudden cardiac death. This study aimed to explore the correlation between cardiac autonomic neuropathy (CAN) and QT interval in individuals with type 2 diabetes. Methods: A total of 150 diabetic participants were enrolled, comprising 80 with and 70 without CAN. All subjects exhibited sinus cardiac rhythm, and those with conditions or medication usage leading to orthostatic hypotension (OH), cardiac arrhythmia, or QT prolongation were excluded. Following interviews and examinations, standard and continuous electrocardiograms (ECG) were recorded in the supine position during deep breathing and standing. CAN diagnosis relied on Ewing’s tests. QT, corrected QT (QTc), minimum QT (QT min), maximum QT (QT max), and mean±SD of QT (QT mean) were evaluated from standard ECG. Results: Among patients with CAN, 21.5% were symptomatic. The prevalence of abnormal QTc was 11.3%. No significant difference in long QTc was observed between patients with or without CAN. However, the mean±SD of QT max, QT mean, were higher in those with CAN. Conclusion: The prevalence of asymptomatic CAN was higher than that of symptomatic CAN. Patients with CAN exhibited higher QT max, QT mean compared to those without CAN. However, there was no discernible association between CAN and prolonged QTc.

Background and Objectives: While a majority of individuals who engage in smoking exhibit discernible signs of both pulmonary and systemic cellular and/or humoral inflammation, only a limited subset undergoes an intensified response leading to the development of COPD. Numerous investigations have substantiated the existence of systemic inflammation in COPD-afflicted individuals. This study endeavours to examine the levels of oxidative stress, antioxidant status, and TNF-α in patients diagnosed with COPD. Materials and Methods: A cohort of 89 COPD patients, matched by age and sex with an equivalent number of controls, was enrolled in the study. The assessment involved the quantification of malondialdehyde (MDA) levels, TNF-α assay, and total antioxidant levels. Results: The analysis revealed a significantly elevated level of malondialdehyde in all cases, with statistical significance observed in COPD patients. Total antioxidant levels were notably diminished in all COPD patients, exhibiting statistical significance. Similar to MDA, TNF-α levels exhibited a significant increase across all cases. Conclusion: The heightened malondialdehyde and TNF-α levels, coupled with diminished total antioxidant levels, underscore the imperative to delve deeper into the intricate interplay of trace elements and oxidative stress in the pathogenesis and complications of COPD. This necessitates the undertaking of further comprehensive clinical studies.

Aim: The aim of the present study was to compare the effect of warm versus regular room temperature seitz bath. Methods: This was a clinical retrospectively study conducted in the Department of General Surgery for 24 months. Out of 100 patients 55 patients (55%) opted for warm water seitz bath (Group A) and others 45 (45%) (Group B) opted for regular room temperature seitz bath. Results: 55 patients (55%) in the study group opted for warm water seitz bath as compared to 45 patients (45%) of regular water seitz bath from the second day of surgery onwards. The cases who opted for regular water seitz, were in poor socioeconomic background, due to easy and frequent availability of regular water as compared to warm water. All the 16 cases of episiotomy (29.09%) wounds repaired by gynaecologist opted warm water seitz only. The choice of selection of sitz bath basically depends upon patient’s discussion with past treated cases of similar disease, educational background, socioeconomic status in the society and treating surgeon’s advice. Conclusion: The progress of wound healing and postoperative comfort in operated perineal surgical wound does not based on type of seitz bath and the antiseptic solution used for sitz bath. But it is found that the frequency of sitz bath and subsequent improvement in the local hygiene definitely give comfort to the patient and speeds up wound healing.

Aim: The aim of the present study was to assess the epidemiology, clinical features and early outcome in traumatic spine injuries at a tertiary hospital in Bihar region. Material & methods: The present study was single-center, prospective, observational study, conducted in Department of Orthopedics for the period of 2 years. 100 patients were included in the study. Results: Out of 100 patients, most of the patients were in the age group 51-60 (32%) and 41-50 (30%). Mean age was 51.59 years. Majority of the patients were male 70% while 30% patients were female. In present study, majority of traumatic spine injuries were due to road traffic accidents (52%), followed by fall from height (45%) and assault (3%). Majority of spine fractures occurred at cervical (40%) followed by Lumbar (30%) followed by thoracic (20%) vertebral level. Out of 100 patients, 55 patients (55%) had no associated injuries. Common associated injuries were hemoperitoneum (12%), head injury (11%), fracture humerus (9%) and fracture clavicle (6%). Out of 100 patients, 54% patients had no Neurodeficit and 48=6% patients had Neurodeficit. On pre -operative assessment 50% patients had ASIA score of E, 11% had ASIA score of D, 17% had ASIA score of C, 7% had ASIA score of B and 15% had ASIA score of A. Follow up ASIA score after 2 weeks in patients was A in 14% patients, B in 8%, C in 16%, D in 12, E in 50%. Follow up ASIA score after 3 months in patients was A in 8% patients, B in 5%, C in 6%, D in 15%, E in 68%. Follow up ASIA score after 6 months in patients was A in 9% patients, B in 5%, C in 4%, D in 16%, E in 66%. Follow up ASIA score after 9 months in patients was A in 8% patients, B in 6%, C in 4%, D in 20, E in 60%. Follow up ASIA score after 12 months in patients was A in 12%, D in 28, E in 60%. Conclusion: Complication rates were higher in patients treated non-operatively. Leading causes in deaths at cervical level were due to respiratory failure and leading causes of deaths in thoracic and lumbar vertebral level were due to secondary complications of long-standing bed sores.

Aim: The aim of the present study was to evaluate the association between Mg intake and the risk of reflux disease and that the addition of magnesium supplements should be considered and added to the LPRD treatment protocol for adults in accordance with the dietary reference intake (DRI). Methods: This was a hospital based prospective study done over a period of 2 years in the Department of ENT  in patients presenting with symptoms suggestive of LPR of the age group 18-65 years. A total of 200 patients were included in the study. Results: Out of total 200 cases, 120 (60%) were females and 80 (40%) were males. Out of 120 female patients, 25% (n=30) were below 30 years, 62.50% (n=75) were within 30 to 50 years and 12.50% (n=15) were above 50 years. Out of 80 male patients, 25% (n=20) were below 30 years, 60% (n=48) were within 30 to 50 years and 15% (n=12) were above 50 years. The mean RSI score in each of these age groups for females were 17.4, 18.6 and 16.4 respectively and for males were 12.8, 14.6 and 14.2. Similarly the mean RFS for females were 13.3, 14.4 and 12.6 and for males were 10.2, 13.4 and 12.3 respectively. Foreign body/sticky sensation in throat was the foremost presenting complaint found in 70% of the study population, followed by excessive throat mucus (64%) and constant throat clearing (48%). Hoarseness of voice was seen in 7% of the patients. Dysphagia and dyspnea were the least common symptoms noticed 6% and 3% respectively. Conclusion: Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.

Aim: The aim of the present study was to assess the management modalities of isolated liver injury in blunt abdominal trauma. Methods: A retrospective study of 100 patients of isolated liver injury due to blunt abdominal injury conducted at the Department of  General Surgery for the period of 2 years. Results: In this series, the majority of the patients (45%) belonged to 21-30 years age group, followed by 11-20 (18%) and 31-40 years age group (15%). The majority of patients were male 88% whereas female patients were only 10%. MVA was responsible for 84% of blunt abdominal trauma cases, while fall from height accounted for 16% of cases. Majority of the patients presented with abdominal pain (100%) and abdominal tenderness (100%). There were 12 cases of chest injury. 15 cases of fracture of extremities were managed by the orthopedic surgery department. In present series, most of the liver injuries due to blunt trauma abdomen were minor type (grade I, II and III), they are (92%) of the total blunt liver injuries, major injuries (grade IV, V and VI were seen in (8%) cases of blunt liver trauma. In present series, in the present series, the majority of the blunt liver injuries were grade II (38%), 1 (26%) and III (22%) injuries followed by grade IV (15%) and V injury (2%) have the lowest incidence. In the present study, 95 (95%) patient discharge and 2 (4%) patient expired. Conclusion: Isolated liver injury is common in the blunt abdominal trauma patient. Most of the patients with the liver injury with hemodynamically stable treated conservatively. Only a few of them require surgical management if they are hemodynamically unstable.

Aim: The aim of this study was to compare neonatal morbidity and mortality between late-preterm IUGR and AGA infants of the same gestational age. Methods: The present study was conducted in the Department of Pediatrics for  two years. and we retrospectively analyzed 200 singleton pregnancies, including 100 pregnancies involving infants with a birth weight of or below the 10th percentile (IUGR) delivered between 34 weeks and 36 6/7 weeks of gestation due to maternal and/or fetal indications. The control group consisted of 100 singleton pregnancies with spontaneous preterm delivery at the same gestational age, in which the birth weight ranged from the 11th to 89th percentile (AGA). Results: There was no significant difference in maternal age which ranged from 16 to 45 years (mean±standard deviation: 25.1 ± 5.5 years) (P > .05). Among mothers of the IUGR group, 80 (80%) presented some underlying disease or obstetric complication in addition to IUGR, whereas 20 (20%) did not. Hypertensive syndromes were the most frequent condition and were observed in 49 (49%) women of the IUGR group. Heart disease was observed in 10 (10%) mothers of this group, systemic lupus erythematosus in 9 (9%), and other underlying diseases in 12 (12%) (pulmonary disease, hepatitis, thrombophilia, anemia, etc.). TTN or apnea rates did not differ significantly between IUGR and AGA infants. Late-preterm IUGR infants were found to be at a higher risk for IVH. There were only Grade 1 IVH in this sample. No respiratory distress syndrome, pulmonary hemorrhage or bronchopulmonary dysplasia was observed in either group. The frequency of sepsis or thrombocytopenia did not differ between groups. Hypoglycemia was more frequent in the IUGR group. The presence of hyperbilirubinemia was similar in the two groups (96% in the IUGR group versus 100% in the AGA group) (P = .52, Fisher’s exact test). Conclusion: In conclusion, our study showed that late-preterm IUGR infants present a significantly higher risk of neonatal complications and a significantly longer NCIU and hospital stay when compared to late-preterm AGA infants.

Background: Haemodynamic changes to laryngoscopy and endotracheal intubation during elective surgeries are a major challenge to the Anaesthesiologist. Use of oral premedicants like Clonidine (200μg) and Pregabalin (150mg) can be useful. The primary objective of this study was to compare the effects of oral Clonidine (200μg) and Pregabalin (150mg) on mean arterial pressure (MAP) and heart rate (HR) during laryngoscopy. The secondary objective was to note any changes on sedation and post-operative nausea and vomiting (PONV). Setting: The study conducted in a Tertiary Care Hospital of Kolkata, India. Methods: Sixty adults, aged 18 to 60 years, of ASA physical status I or II, undergoing elective surgeries were randomized into 2 groups. Group C received tablet Clonidine (200μg) while group P received tablet Pregabalin (150mg), 90 minutes before the induction of general anaesthesia. Their MAP, HR were noted at different time
points, and sedation scores and PONV were noted post-operatively. Statistical analysis was done using Wilcoxin test and p value < 0.05 will be considered as significant. Results: There MAP values (during laryngoscopy, intubation, one and five minutes post-intubation) in group C were significantly lower compared to group P (p < 0.05). Similar trend was noted for heart rates (HR). The sedation scores and incidence of post-operative nausea and vomiting were significantly lower in group C compared to group P. Conclusion: Oral Clonidine as compared to Pregabalin provides better control of mean arterial pressure and heart rate during laryngoscopy and intubation with lesser post-operative sedation and nausea/vomiting. Further large scale studies will be needed to corroborate these findings.

Background: Dengue fever caused by dengue virus is an acute viral infection associated with significant morbidity and mortality all over the world. This study is conducted to know the seroprevalance of dengue fever in a tertiary care centre at Kanyakumari district. Aim: To determine the prevalence of Dengue in Kanya kumari district of Tamil Nadu. Methods: A total of 176 clinically suspected dengue cases attending the medical OPD of Sree Mookambika Institute of Medical Sciences from March 2021 to March 2022 were included in the study. The samples were collected after taking informed consent from the patient . The samples were screened for IgM and IgG antibody by Enzyme Linked Immunosorbent Assay. The manufacturer instructions were strictly followed. Results: Out of the 176 samples for dengue only 32 (18%) were positive for IgM only, 15 (8.5%) were positive for IgG only and 7 (3.9%) samples were positive for IgM and IgG Conclusion: A significant rise in the prevalance (18%) of primary dengue viral infection cases were reported in the Kanyakumari district of Tamil Nadu.

Background: A variety of respiratory complications can be encountered in pregnancy. An understanding of the pathophysiology of pregnancy is important in the management of such complications. During healthy pregnancy, pulmonary function, ventilatory pattern and gas exchange are affected through both biochemical and mechanical pathways. [1] The normal lung function of a pregnant women changes in every trimester i.e., the lung volumes undergo major changes. Some women will have pre-existing respiratory conditions such as Asthma, TB, Cystic Fibrosis, COVID 19. The major physiologic changes that occur in pregnancy are the increased minute ventilation, which is caused by increased respiratory center sensitivity and drive; a compensated respiratory alkalosis; and a low expiratory reserve volume. The vital capacity and measures of forced expiration are well preserved. Patients with many lung diseases tolerate pregnancy well, with the exception of those with pulmonary hypertension or chronic respiratory insufficiency. The lung volume of post COVID pregnant women undergoes major changes like, ERV gradually decreases during second half of pregnancy, FRC decreases, Increased inspiratory capacity, Increased oxygen consumption and basal metabolic rate, Dyspnea. Methods: A survey was conducted with a self-prepared questionnaire among the sample size of 102 pregnant women of different trimesters coming to Obstetrics and Gynaecology department of Sree Balaji Medical College and Hospital OPD, Chromepet. The questionnaire included questions about their Covid severity (Hospitalized/ICU admission) and their pre-existing respiratory complications. The descriptive statistical analysis was carried out including frequency and percentage. The results of the study were tabulated. Data entry and analysis: Data entry was done is MS-EXCEL sheet, 2010 Graph was presented in MS EXCEL, 2010 Results: There is a significant relationship between FEV1_FVC values of patient when compared to if the patient is admitted to ICU and if she is Covid positive with P-VALUE<0.05. There is a significant relationship between FEV1 values of the patient when compared to if the patient is admitted to ICU and if she Covid positive with P-VALUE<0.05. The mean age among the study population was 27 years. 8.06% was hospitalized for covid and 2.02% was admitted in ICU during covid. Among them 25.0% of women hospitalized for Covid and 16.7% of women admitted in ICU shows decreased FEV1/FVC and 100.0% of women hospitalized for Covid and 20.2% of women admitted in ICU decreased FEV1 values. Conclusions: The present study revealed that there is a significant change in lung function of 3^rd trimester pregnant women who were previously hospitalized for COVID-19 and There is also a significant relationship between the patients admitted to ICU and their FEV1 and FEV1/FVC values. The results of PFTs must be analysed with caution and considering the respiratory Comorbidities (asthma, cystic fibrosis).

Background: Haemodynamic changes to laryngoscopy and endotracheal intubation during elective surgeries are a major challenge to the Anaesthesiologist. Use of oral premedicants like Clonidine (200µg) and Pregabalin (150mg) can be useful. The primary objective of this study was to compare the effects of oral Clonidine (200µg) and Pregabalin (150mg) on mean arterial pressure (MAP) and heart rate (HR) during laryngoscopy. The secondary objective was to note any changes on sedation and post-operative nausea and vomiting (PONV).Setting: The study conducted in a Tertiary Care Hospital of Kolkata, India.Methods: Sixty adults, aged 18 to 60 years, of ASA physical status I or II, undergoing elective surgeries were randomized into 2 groups. Group C received tablet Clonidine (200µg) while group P received tablet Pregabalin (150mg), 90 minutes before the induction of general anaesthesia. Their MAP, HR were noted at different time points, and sedation scores and PONV were noted post-operatively. Statistical analysis was done using Wilcoxin test and p value < 0.05 will be considered as significant. Results: There MAP values (during laryngoscopy, intubation, one and five minutes post-intubation) in group C were significantly lower compared to group P (p < 0.05). Similar trend was noted for heart rates (HR). The sedation scores and incidence of post-operative nausea and vomiting were significantly lower in group C compared to group P.Conclusion: Oral Clonidine as compared to Pregabalin provides better control of mean arterial pressure and heart rate during laryngoscopy and intubation with lesser post-operative sedation and nausea/vomiting. Further large scale studies will be needed to corroborate these findings.

Background: Dengue fever caused by dengue virus is an acute viral infection associated with significant morbidity and mortality all over the world. This study is conducted to know the seroprevalance   of dengue fever in a tertiary  care centre at Kanyakumari district.Aim: To determine the prevalence of Dengue in  Kanyakumari district of Tamil Nadu.Methods: A total of 176  clinically suspected dengue cases attending the medical OPD of Sree Mookambika Institute of Medical Sciences  from March 2021 to March 2022 were included in the study. The samples were collected after taking informed consent from the patient . The samples were screened for IgM and IgG antibody by Enzyme Linked Immunosorbent Assay. The manufacturer instructions were strictly followed.Results: Out of  the  176 samples for dengue  only 32 (18%) were positive for IgM only, 15 (8.5%) were positive for IgG only and 7 (3.9%) samples were positive for IgM and IgGConclusion: A significant  rise in the prevalance (18%) of primary dengue viral infection cases were reported in the Kanyakumari district of Tamil Nadu.

Introduction: Neuropathic pain is a complex, heterogeneous disorder which is prevalent world over. It is often poorly understood, under diagnosed and underrated. Though the exact mechanism involving the genesis of neuropathic pain is ill understood, nevertheless nociceptive pain and neuropathic pain often co-exist in spinal disorders. Neuropathic pain in spinal disorders remains the major anatomically plausible reported neuropathic pain. History and physical examination remains the mainstay in diagnosis, but additional questionnaires, imaging has improved the accuracy in diagnosis. Aim: To assess the prevalence of chronic neuropathic pain in lumbar and lumbosacral spinal disorders based on history and clinical examination. Materials and Method: This is a retrospective study comprising of 441 patients with data retrieved from outpatient medical records. It was conducted in Kalinga Institute of Medical Sciences (KIMS) from January 2000 to December 2021. The out patients record of patients aged between 20 years to 60 years with back pain and leg pain of at least 3 months duration were reviewed, and 441 patients fulfilling the inclusion and exclusion criteria, were included in the study. The data were analyzed using Microsoft Excel Software. Result: There were 249 males and 192 females with male and female  ratio being 1.29:1. The average age of the study population was 45.68 years. Two main clinical types such as Lumbar Radiculopathy 77.77% (n=343) and Lumbar Spinal Stenosis(LSS) 22.22% (n=98) were detected. Each type was further sub divided into two sub types. 33.10% (n=146) patients were found to have neurologic deficit of which 76.02% (111) was from lumbar radiculopathy group and 23.97% (35) was from LSS group. 63.49% of patients were categorized under Quebeck Task Force classification of which 28.11% had above knee and below knee pain with neurological deficit.  Conclusion: Neuropathic pain in lumbar and lumbosacral spinal disorder is common. Sciatica was the commonest mode of presentation in chronic neuropathic pain. Lumbar spinal stenosis was seen in older age group of patients as compared to patients with Lumbar radiculopathy. High index of clinical suspicion, detail history and physical examination are mandatory for achieving a proper diagnosis. Additional imaging and pain questionnaire may enhance in the diagnostic accuracy.

Background: Gestational diabetes mellitus and hypothyroidism are common in pregnancy which can affect both maternal and fetal outcome if not controlled. Thyroid disease and diabetes mellitus seems to be connected in pathophysiological aspect. Unrecognised thyroid dysfunction may cause impairment of the glycemic control. Early diagnosis and management are necessary to prevent fetomaternal complications. We aim to evaluate risk of diabetes with hypothyroidism in pregnancy. Aims and Objectives: To find whether hypothyroid antenatal patient are high risk for developing gestational diabetes mellitus. Methods: A prospective observational study was done in a tertiary care hospital in New Delhi, India where in antenatal patients attending OPD were screened for hypothyroidism before 22 weeks of pregnancy. Thyroid function test was performed including T3, T4, TSH and anti-TPO antibody at the first antenatal visit and segregated into 2 groups based on their TSH value that is group A and B, with 210 patients in each group and followed up till 24 weeks of gestation after which oral glucose tolerance test by DIPSI criteria was performed and the diagnosis of gestational diabetes mellites in these patients was made accordingly. Results: Prevalence of GDM was in hypothyroid group was 15.7% compared to 5.7% in euthyroid group. The relative risk for developing GDM was 1.98 (95% CI: 1.20-3.24). The result was statistically significant (p<0.0001). Additionally, the mean T3 and T4 level were significantly lower in GDM patients (1.89±0.81 & 0.54±0.30 respectively) compared to patients without GDM (2.27±0.90 & 0.65±0.27 respectively). Conclusion: It was observed that a significant association exists between hypothyroidism and diabetes melilites in antenatal patients. Furthermore, the study highlights the needs for vigilance in early gestation in obese and older hypothyroid patients for development of gestational diabetes mellitus in pregnancy.

Background: Leprosy continues to be a public health problem despite elimination from India in December 2005 with around 60% cases being reported from India globally. The covid pandemic has additionally disrupted case detection and treatment leading to under-reporting. The current study aims to get insights into the clinical and epidemiological profile of leprosy in post covid era at a tertiary care center. Methods: A retrospective observational study of all patients visiting leprosy clinic of dermatology department of NSCB Medical College, Jabalpur, MP over 1-year period from May 2022 to April 2023. Data regarding clinical and epidemiological characteristics were collected from patients’ records and tabulated and analyzed using appropriate statistical methods. Results: A total of 119 patients visited the leprosy clinic during the study period. Maximum patients belonged to age group 20-40 years (49.6%). There were 81 males and 38 females with male female ratio of 2.1:1. Most common clinical type of leprosy was lepromatous leprosy (LL) (40.3%) followed by borderline tuberculoid (BT) (26.9%). Nerves were involved in all patients with ulnar nerve being the most common (71.4%). Lepra reactions were noted in 13.6%, grade-2 disability 50.4%, deformity -ulcer 37% of cases. PCR test for detecting M. leprae DNA was positive in 91.6% cases. Conclusion: Our findings highlight the need for increasing leprosy case detection and early treatment through community based approaches as there in increased burden of lepromatous cases and disability patients post the covid pandemic phase due to compromised case reporting during lockdown. Also molecular diagnosis like PCR should be widely utilized for leprosy.

A hospital based open label observational study was conducted in the department of Onco anaesthesia and critical care, State cancer institute, GMCH to observe the post-operative analgesia after Cytoreductive Surgeries in patients receiving intrathecal morphine. Ethical clearance was obtained from the institutional ethics committee prior to commencement of the trial. Based on the selection criteria, 40 patients were selected of ASA 2 scheduled for Cytoreductive Surgeries and were divided into 2 groups of 20 patients each. Group ITM received 300 mcg of intrathecal morphine along with standard anaesthetic care while placebo control group received the standard anaesthetic care. Injection Fentanyl 2mcg/kg was used in both the groups at the time of induction and Infusion Paracetamol 1gm was used intraoperatively in both the groups. Inf Paracetamol was also used postoperatively 12 hourly in both the groups. The parameters used in this study were age, weight, heart rate, SBP, DBP, MAP, VAS score for 48 hours. Time of first rescue analgesia. Analgesic consumption in the first 24 hours, analgesic consumption in the next 48 hours and side effects. In our study the demographic profile such as age, weight, ASA physical status were comparable in both groups and were statistically insignificant. In our study the hemodynamic status was assessed in terms of heart rate, systolic blood pressure (SBP), diastolic blood pressure(DBP) and mean arterial pressure (MAP). There was no statistically significant variation in the hemodynamic status in both the groups (p>.05). There was statistically significant difference (p<.05) in favor of ITM with respect to VAS for most part of our study. There was statistically significant difference in the use of rescue analgesic immediately after the postoperative period at 2hours postoperatively. 1 patient in ITM group (Group1) needed first rescue analgesia at 2nd hour whereas 19 patients needed in Placebo group (Group2) which was statistically significant p-value <0.0001. It was observed that total analgesic consumption in  group 1 was 46 and in group 2 was 114 in 48 hours. Total analgesic consumption in first 24 hours in group1 was 30 whereas in group 2 it was 87 which was statistically significant. There was no significant adverse effect in both the groups. Total ICU stay in both the groups were comparable and was not statistically significant

Background and Aim: The survival perspective of extramural neonates significantly relies on the state of neonate at admission. This study was undertaken to analyze clinical, demographic and transport characteristics of external referred neonates. It was also designed to delineate correlation of TOPS score with outcome of referred neonates. Material and Methods: Present Prospective Observational Study conducted at NICU of a Nootan General Hospital affiliated with Nootan Medical College & Research Centre, Visnagar, Gujarat during October 2022 to September 2023. Clinico- demographic characteristics including details of pregnancy, birth history, sex, weight on admission, transport details, clinical status on admission, and indication of admission, course during hospital stay, final diagnosis and final outcome were recorded in a pre-designed proforma. TOPS score was documented as observed on arrival of neonates to NICU. Results: Out of 120 neonates 70 (58.3%) were males and 50 (41.6%) were females. Male: female ratio came to be 1.40:1. 67 out of 120 (55.83%) neonates were in early neonatal period (7 days old) including 15 neonates who were <24 hours old. 53 (44.16%) neonates were >7 days old. The main indications for admission were neonatal jaundice, probable sepsis and respiratory distress syndrome. Hypothermia was present in 37.5% (45/120) of neonates on admission. 12.5% (15/120) had poor perfusion, 11.6% (14/120) were hypoxic and hypoglycemia was detected in 2.5% (3/120) neonates.  Conclusion: In order to reduce neonatal mortality rate in the country, strengthening of neonatal services is an essential step. Establishment and strengthening of SNCUs and Janani shishu suraksha karyakram (JSSK) are important steps taken by the government in this direction.

Background: Gestational diabetes mellitus and hypothyroidism can affect both maternal and fetal outcome if not controlled. Thyroid disease and diabetes mellitus seems to be connected in pathophysiological aspect. Unrecognised thyroid dysfunction may cause impairment of the glycemic control. Early diagnosis and management are necessary to prevent fetomaternal complications. We aim to evaluate risk of gestational diabetes with hypothyroidism. Aims and Objectives: To find whether hypothyroid antenatal patient are high risk for developing gestational diabetes mellitus. Methods: A prospective observational study was done in a tertiary care hospital in New Delhi, India where in antenatal patients attending OPD were screened for hypothyroidism before 22 weeks of pregnancy. Thyroid function test was performed including fT3, fT4, TSH and anti-TPO antibody at the first antenatal visit and segregated into 2 groups based on their TSH value that is group A and B, with 210 patients in each group and followed up till 24 weeks of gestation after which oral glucose tolerance test by DIPSI criteria was performed and the diagnosis of gestational diabetes mellitus in these patients was made accordingly. Results: Prevalence of GDM was in hypothyroid group was 15.7% compared to 5.7% in euthyroid group. The relative risk for developing GDM was 1.98 (95% CI: 1.20-3.24). The result was statistically significant (p<0.0001). Additionally, the mean T3 and T4 level were significantly lower in GDM patients (1.89±0.81 & 0.54±0.30 respectively) compared to patients without GDM (2.27±0.90 & 0.65±0.27 respectively). Conclusion: It was observed that a significant association exists between hypothyroidism and diabetes melilites in antenatal patients. Furthermore, the study highlights the needs for vigilance in early gestation in obese and older hypothyroid patients for development of gestational diabetes mellitus.

A hospital based open label observational study was conducted in the department of Onco anaesthesia and critical care, State cancer institute, GMCH to observe the post-operative analgesia after Cytoreductive Surgeries in patients receiving intrathecal morphine. Ethical clearance was obtained from the institutional ethics committee prior to commencement of the trial. Based on the selection criteria, 40 patients were selected of ASA 2 scheduled for Cytoreductive Surgeries and were divided into 2 groups of 20 patients each. Group ITM received 300 mcg of intrathecal morphine along with standard anaesthetic care while placebo control group received the standard anaesthetic care. Injection Fentanyl 2mcg/kg was used in both the groups at the time of induction and Infusion Paracetamol 1gm was used intraoperatively in both the groups. Inf Paracetamol was also used postoperatively 12 hourly in both the groups. The parameters used in this study were age, weight, heart rate, SBP, DBP, MAP, VAS score for 48 hours. Time of first rescue analgesia. Analgesic consumption in the first 24 hours, analgesic consumption in the next 48 hours and side effects. In our study the demographic profile such as age, weight, ASA physical status were comparable in both groups and were statistically insignificant. In our study the hemodynamic status was assessed in terms of heart rate, systolic blood pressure (SBP), diastolic blood pressure(DBP) and mean arterial pressure (MAP). There was no statistically significant variation in the hemodynamic status in both the groups (p>.05). There was statistically significant difference (p<.05) in favor of ITM with respect to VAS for most part of our study. There was statistically significant difference in the use of rescue analgesic immediately after the postoperative period at 2hours postoperatively. 1 patient in ITM group (Group1) needed first rescue analgesia at 2nd hour whereas 19 patients needed in Placebo group (Group2) which was statistically significant p-value <0.0001. It was observed that total analgesic consumption in  group 1 was 46 and in group 2 was 114 in 48 hours. Total analgesic consumption in first 24 hours in group1 was 30 whereas in group 2 it was 87 which was statistically significant. There was no significant adverse effect in both the groups. Total ICU stay in both the groups were comparable and was not statistically significant