Aim: The aim of the present study was to compare the attenuation of sympathetic response to laryngoscopy and endotracheal intubation while using lidocaine in its aerosolized form and intra-venous form and establish a safer and better route of administration of the drug. Methods: The present study was conducted at Department of Anesthesiology for one year. we included 120 ASA I & II patients of both the genders who were posted for elective surgeries under general anaesthesia. Patients in all the three groups were equally distributed in variables of age (20-65 years), ASA grades and obvious difficult airway. Results: In all the 3 groups post endotracheal intubation demonstrated an increase in heart rate, systolic BP, Diastolic BP and mean arterial BP. However, the minimum change in hemodynamic and thus most effective way of attenuating the sympathetic response to laryngoscopy and intubation was seen in the subgroup where lidocaine was administered intravenously. Conclusion: In the present study we concluded that the use of lignocaine when used in combination with opioid for laryngoscopy and endotracheal intubations reduces the increase in heart rate and blood Pressure. However, the attenuation of exaggerated sympathetic response was much more in the subset of patients where intravenous lidocaine was used.

Aim:  The aim of the present study was to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding Material & Methods: 100 patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy. Results: Majority of the patients were more than 51 years of age group. Gender distribution of patients as per the result revealed that 75% patients are males and 25% are females, the gender distribution is statistically significant in males (p<0.05). In our study we have 35 patients with anterior epistaxis, which accounts for 35%, 15 patients with posterior epistaxis, which accounts for 15%, and 50 patients with anterior and posterior epistaxis which accounts for 50%. After careful examination of patients the different endoscopic diagnosis was detected in the study showed the bleeding point in the crevices of the lateral nasal wall (BPCLW), posterior deviation of septum with spur (PDWS), enlarged congested significant adenoid (ECSA) and septal spur with ulcer (SSWU) were statistically significant (p<0.05) and strongly associated with age and sex distribution of patients. Endoscopic management of aspects of epistaxis, as per the descriptive statistical analysis endoscopic selective nasal packing (ESNP), endoscopic nasal cautery or bipolar diathermy (ENCD), endoscopic polypectomy (EP), endoscopic mass excision (EME) were highly associated with age and sex matched frequency of the patient and showed statistically significant with different management aspects (p<0.05). Conclusion: Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.

Aim: The objective of this study was to assess the occurrence, distribution and histo-morphological aspect of various salivary gland lesions. Material & Methods: This was an observational, single institutional study and materials required for the study were collected from the Department of Pathology, The surgically resected salivary gland specimens between the period of one year. The study procedure was in accordance with the principles of the Declaration of Helsinki. A total of 50 specimens of salivary gland lesions were analyzed, this study included both the non-neoplastic and neoplastic lesions of the salivary gland. Results: According to that the commonest tumor was pleomorphic adenoma which accounted for 66% (33) of all cases followed by mucoepidermoid carcinoma, accounting for 14% (7) of all cases. And the least common tumors were cavernous haemangioma (2%), adeno cystic carcinoma (4%) and SCC (2%). In present study the distribution of all cases according to age shows that 40 – 49 years of age was the commonest age group with 30% (15) of total cases were from this group followed by 30 – 39 years of age [28% (14)]. The Warthin tumors were commonly seen in 60 – 69 years of age. Also the frequency of malignant tumors was high after 40 years of age. Gender wise incidence of salivary gland tumors in males was 48% and in female was 52%. Among benign tumours, female preponderance was seen in pleomorphic adenoma. Among malignant tumours mucoepidermoid carcinoma showed a female preponderance. Parotid was commonest salivary gland involved with 74% of all tumors, followed by submandibular with 24% and minor salivary glands with 1 (2%) of salivary gland tumors. Conclusion: This study observed that parotid is most common site for the SGT. And pleomorphic adenoma and the Warthin tumors are the common benign tumors involve parotid gland the most. Among malignant tumors mucoepidermoid carcinoma are the commonest with female preponderance. While other carcinoma like adenoid cystic carcinoma and SCC are also common.

Aim: The present study was undertaken in patients undergoing elective laparoscopic surgeries under general anaesthesia with an objective to evaluate the efficiency of transdermal diclofenac patch with transdermal ketoprofen patch. Methods: The present study was undertaken at Department of Anesthesiology for one year. Total 100 patients were included in the study after explaining purpose and procedure of study and written informed consent of the patients. All patients were divided equally in two groups, 50 patients in each group. Results: There was no statistically significant difference between the two groups of patients in terms of age, weight and male/female ratio (P> 0.05). The difference of mean Pulse rate per minute status and systolic and diastolic blood pressure (mmHg) of patients in Group D and Group K was statistically insignificant (p>0.05). The difference was statistically significant at 2 hr, 4 hr, 6 hr, 8 hr, and 12 hr post-operatively. The complications occurrence in both group were insignificant. Conclusion: We concluded that Transdermal Ketoprofen patch is effective and safe pain relievers in management of acute postoperative pain with early onset of pain relief, longer duration of analgesia, better in reducing the severity of pain in post-operative period, lesser adverse effects in laparoscopic abdominal surgeries under general anaesthesia.

Aim: The aim of the present study was to evaluate the effectiveness of lumbar cerebrospinal fluid drainage (LCSFD) for prevention of cerebral vasospasm and its sequelae. Methods: This was a prospective, randomized control trial conducted at Department of Neurosurgery for 12 months . Patients of aneurysmal SAH (Hunt and Hess Grade II–IV) and 50 patients met the inclusion criteria and were randomly allocated to one of the two groups – thirty patients in Group I and thirty patients in Group II. Results: There were 25 patients in each group. Both groups were matched with respect to age, sex, GCS on admission, and SAH grade at admission. Clinical evidence of vasospasm and rising TCD velocities suggestive of vasospasm developed in 28% (7/25) patients in LCSFD group compared to 64% (16/25) patients in non-LCSFD group and this difference was found statistically significant (P = 0.01). Although more number of patients in Group II developed hemiparesis was more due to vasospasm compared to Group I, this difference was not found to be statistically significant. The patient outcome as quantified by GOS at the time of discharge was better in LCSFD group (median GOS = 4) as compared to non-LCSFD group (median GOS = 3) and this difference was found to be statistically significant (P = 0.01). Median GOS at 1- and 3-month follow-up was 5 in Group I compared to 4 in Group II and this difference was statistically significant (P = 0.04). Conclusion: This study has demonstrated the efficacy of LCSFD to significantly reduce clinical vasospasm and vasospasm‑related cerebral infarction in patients with aneurysmal SAH, thereby contributing to a better outcome. Lumbar CSF drainage is believed to decrease cerebral vasospasm by promoting circulation of CSF and clearance of blood from the subarachnoid spaces.

Aim: The aim of the present study was to investigate the diagnostic value of MCA/UA pulsatility index ratio for the prediction of adverse perinatal outcome in patients with high-risk pregnancy. Methods: The study group consisted of 200 women admitted to Department of Obstetrics & Gynaecology. All patients had undergone serial color Doppler ultrasound. The Umbilical Artery color Doppler waveforms were obtained from a free-floating portion of the umbilical cord during minimal fetal activity and the absence of fetal breathing. All measurements were performed in the semi-recumbent positions with the head and chest slightly elevated. Results: 55% had vaginal delivery and remaining 45% had Caesarean delivery in the present study. 32% had pregnancy induced hypertension followed by PIH+IUGR (25%). Our results suggested that the MCA/UA PI Doppler ratio of less than 1 was a good predictive tool for neonatal outcome in preeclamptic and hypertensive pregnant women and could be used to identify fetuses at risk of morbidity and mortality. Fetuses with abnormal Doppler MCA/UA PI ratio in our study had a significantly lower birth weight, lower gestational age at delivery, l significantly higher incidence of perinatal deaths, higher incidence of admission to NICU and longer duration of treatment there, lower Apgar score at 5-minute. Conclusion: Doppler study is a noninvasive method for assessing the hemodynamic function of the fetus and mother. There is a direct correlation between high-risk pregnancy with abnormal Doppler findings in the umbilical, middle cerebral artery, and CPR compared to non-high-risk pregnancies.

Aim: The aim of the present study was to estimate thyroid function tests i.e. TSH, fT3 and fT4 levels in women with mild Preeclampsia and severe Preeclampsia. Methods: It was a cross sectional study carried out at Department of Biochemistry, Total 150 pregnant women between 18 to 35 years visiting the gynecology and obstetrics OPD were included under study. Results: The mean values of maternal age in all three are not statistically significant. Mean values Group I: 24.76 + 2.58, Group II: 23.27 + 2.88, Group III: 22.44+ 2.38). Mean gestational age at the time of serum sampling in normal pregnant women was 35.15 + 1.45 and it decreases in mild (34.36 + 2.58) and severe PE (32.12+ 1.69) having highly significant P value. While SBP and DBP increases with severity of PE as compared to normal pregnant women having highly significant P value (<0.0001). Urine protein was nil in group I and it increases with severity of PE. Proteinuria and blood pressure are used as parameters for severity of PE. The mean value of birth weight is normal in healthy pregnant women 2.76 + 0.14 but it decreases in mild PE (2.55 + 0.05) to more decrease in severe PE (2.36 + 0.04) having highly significant p value <0.0001. In our study, the mean level of TSH within normal level in normal pregnant women was 2.36 + 0.52 while in mild PE was 3.97+ 0.63 and in severe PE was 5.75 + 1.00with highly significant P value<0.0001. Conclusion: Evaluating thyroid screening during pregnancy might be of help in preventing the occurrence of low birth weight and instituting timely intervention and appropriate measures in terms of possible thyroid hormone administration in preterm infants in future.

Aim: The aim of the present study was to evaluate the patterns of dyslipidaemia in newly diagnosed type 2 diabetes mellitus (T2DM) patients and to understand the initial management options utilised by the treating physician. Material & Methods: This retrospective observational study observed patterns of dyslipidemia and management strategy in newly diagnosed Patients of type 2 diabetes mellitus-2 (REMAP-2) study was conducted at department of General Medicine  in between the duration of 1 year. Clinicians at the respective center captured the data in REMAP-2 study data capture form. Dyslipidemia was considered as: total cholesterol >200 mg/dl, low density lipoprotein cholesterol (LDL-C) >100 mg/dl, high density lipoprotein cholesterol (HDL-C) <40 mg/dl, or triglyceride >150 mg/dl. Results: The patients had a mean age of 54.6±10.32 years, and majority of the patients were males (65%) while females constituted 35% of the study population. More than half of the patients were either overweight (40%, n=4000) or obese (18.6%, n=1860). The triglyceride levels were found to be high (>150 mg/dl) in 85% (n=8190) of patients. Approximately one fourth (26.90%) of newly diagnosed T2DM patients were found to be smokers in this study. Around 52.30 percentages patients had positive family history of diabetes. Most of the patients were not very physically active or lightly active. In the context of dietary pattern, majority (60%) of the patients were non- vegetarian. Hypertension (71.10%) was the most common comorbidity followed by coronary artery disease (23.50%) in patients of newly diagnosed T2DM with dyslipidemia. Statin therapy was used in 94.80% (n=9480) patients, of which atorvastatin was the most (77.74%) preferred statin therapy. Conclusion: This study on newly diagnosed T2DM patients with dyslipidemia found that majority of the patients had hypertriglyceridemia, family history of diabetes and was physically inactive. More than half of T2DM patients were either overweight or obese. More than 2/3rd of the patients had mixed dyslipidemia. Statins were prescribed to the majority of these patients and atorvastatin was the most commonly prescribed statin in Indian T2DM. patients with dyslipidemia.

Aim: The aim of the present study was to find out the incidence of maternal complications, perinatal mortality and morbidity in postdated pregnancies. Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology for 12 months. Total 200 patients in the antenatal ward and labour room were selected for the study and they were divided into two groups, Control group with Gestational age 37-40 weeks and Study group with Gestational age >40 weeks. Results: Majority of the patients belonged to 25-30 years age group. Maximum number of patients belonged to the age group of 25-30 years both in cases (50%) and control group (50%). The maximum number of patients in the study group (82%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. 65% of the patients in study group were primigravida and in the control group and 55% were primigravida. The percentage of LSCS was 30% which was higher than in the control group where it was 15%. Incidence of instrumental delivery was also higher in the study group as compared to control group (10% as compared to 5%). Among the indications for LSCS, the most common indication among the study group was acute foetal distress which includes meconium-stained liquor (10%) followed by cephalopelvic disproportion (9%). In the control group, most common indication was non progress of labour (4%) followed by acute foetal distress (01%) and non-reactive CTG (1%). Conclusion: Postdated pregnancy remains a clinical dilemma for an obstetrician. The choice is between watchful expectancy for labour to start or induction in postdated patients. According to our study, postdated pregnancies are related with higher rate of LSCS and instrumental deliveries.

Aim:  The aim of the present study was to assess the relative occurrence of various pathological conditions presenting as thyroid swelling and the clinicopathological examination of swelling. Material & methods: A prospective hospital-based study carried out on 1200 cases of thyroid swelling attending the Department of ENT, Bihar, India having adequate diagnostic and treatment facilities during the period of one year Results: In this study of 200 subjects, maximum patients were in the age group of 31 to 40 years (32%), followed by 41 to 50 years (25%). The youngest patient in our study was 12 years while oldest was 72 years. Mean age of presentation was 40.82 years. 80 (80%) subjects were females while 20 (20%) subjects were male. All cases presented with swelling in front of neck (100%). Associated complaints were 6 (6%) subjects of bulky thyroid swelling complained of difficulty in swallowing, 6 (3%) subjects complained pain in neck, 2 (1%) subject presented with cervical lymphadenopathy and 2 (1%) subjects with hoarseness of voice. Most of the thyroid swellings were firm in consistency 92 (46%) followed by nodular 40 (20%), cystic consistency in 24 (12%) cases and soft consistency in 20 (10%) cases. Hard swellings accounted for 24 (12%) cases, most of which turned out to be malignant. On USG, Colloid nodule was found in 31 (31%) cases, followed by Multinodular goitre which was 27 (27%) cases, neoplastic etiology found in 23 (23%) cases, solitary thyroid nodule found in 12 (12%) cases and colloid cyst in 07 (7%) cases. FNAC findings were colloid goitre (61%), nodular goitre (19%), follicular neoplasm (10%), papillary carcinoma (9%) and medullary carcinoma (01%). Conclusion: FNAC is an easy, rapid, reliable, cost-effective, minimally invasive and readily repeatable technique for diagnosis of thyroid swellings. The common false negative diagnosis is seen in follicular pattern cases, cystic papillary thyroid carcinoma (PTC) and papillary microcarcinoma.

Aim: The aim of the present study was to assess the management with interlocked nail in treatment of acute fracture shaft humerus and to compare its effectiveness with well-established method of plate fixation. Methods: The present study of management of acute humeral shaft fractures by antegrade interlocking nail fixation and dynamic compression plating was undertaken at Department of Orthopedics for the period of 3 years. The average follow-up period was one year (range 10–24 months). 50 patients were included in the study. Results: There was preponderance of male over female (35 Vs. 15) with majority population in 31-40 years age group. The youngest patient was of 24 years and oldest was of 68 years male. Mean age was 36.64 years. In our study, majority of cases were of road traffic accident (84%) followed by history of fall from height (12%) and only two cases of assault. Middle third shaft fractures were more common (52%) followed by lower and upper third (26% and 22%) respectively. Transverse fractures were maximum in number (46%) followed by oblique (30%). There were 6 spiral and 6 comminuted fractures. There were 38 (76%) close fractures and 12 (24%) open fractures.  There were 15 cases (30%) of preoperative radial nerve palsy. Out of 15 cases, 14 had recovered completely. There was no iatrogenic nerve palsy seen in our study. Out of 10 cases explored nerve was found to be intact in 9 cases and contused in one case. Most of cases (9) of radial nerve palsy were associated with fracture of middle third shaft humerus. Majority of cases of fracture shaft humerus were associated with head injury followed by lower extremity fracture and ipsilateral forearm bone fracture. Conclusion: For patients requiring surgical treatment of humeral shaft fractures, both dynamic compression plating and interlock nailing provide predictable methods for achieving fracture stabilization and ultimate healing. Plating requires extensive dissection, more blood loss and duration of surgery as compared to nailing. Antegrade interlock nailing performed properly is safe, effective and quick method.

Aim: The aim of present study was to design, develop and substantiate a modern contemporary biomarker for neuronal instability in epileptic (epilepsy) subjects (patients). Methods: The present study was conducted in the Department of Neurology. The initial study was done on 100 subjects through the application of neuronal-unpredictability and/or variability of the marked epileptic seizure onset zone (e-So Z) as a metric to envisage and foresee the epileptic operational (surgical) outcome. Results: We sought to test these theories by comparing high-frequency oscillation rates and networks in surgical responders and non-responders, with no appreciable change in seizure frequency or severity, within a retrospective cohort of the patients implanted with stereo-EEG electrodes. We recorded inter-ictal activity during non-rapid eye movement sleep and semi-automatically detected and quantified high-frequency oscillations. Each electrode contact was localized in normalized coordinates. We found that the accuracy of seizure onset zone electrode contact classification using high-frequency oscillation rates was not significantly different in surgical responders and non-responders, suggesting that in non-responders the epileptogenic zone partially encompassed the seizure onset zone(s). Conclusion: In this study we attempted to develop a biomarker for the epileptic seizure onset zones. Within the eSoZ, the seizure is captured and then resection can be done accordingly. The source is highly influential on others yet extremely not affected by others. Therefore, the source and sinks within the epileptic seizure patients are the e-patients brains networks. So, think that brain is a complex yet nebulous neural-net-work, in which the nodes are connections, and the weights are the network branch edges (between node to node connection) that are dynamic. Thus, the source in the e-brain‘s neural-nets are within the sink only.

Aim: The aim of the present study was to identify the risk factors for pneumonia and severe pneumonia in children. Material & Methods: A case-control study including 200 children with ARI at Department of Pediatrics was conducted for the duration of 12 months. The source population of the study were all 2–59 months old children visiting pediatric OPD for different reasons during the study period. Results: 200 children with ARI were enrolled. According to the WHO criteria, 30 (15%) and 170 (85%) of the enrolled children had pneumonia and no pneumonia, respectively. On univariate analysis, younger age, male gender and low weight for height, were significant risk factors for pneumonia. On multivariate analysis, one-unit increase in age in months (OR = 0.97; 95% CI: 0.97-0.98) and weight for height z-score (OR = 0.76; 95% CI: 0.72-0.79) had a protective effect. Conclusion: Young age and under nutrition (low weight for height/length) in children are significant independent risk factors for pneumonia.

Aim: The aim of the present study was to assess the factors associated with the Gall stones at tertiary health care center in Bihar region. Methods: The present study was a hospital based, prospective, observational study, conducted in Department of General Surgery. Study duration was of 12 months. During study period, 200 cases were studied with confirmed diagnosis of gallstones. Results: During study period, 200 cases were studied with confirmed diagnosis of gallstones. Majority of patients were from age group 51-60 years (32%) followed by age group 41-50 years (24%). Females (63%) outnumbered males (37%). Diabetes mellitus (36%), gastro-esophageal reflux disease (34%), hypertension (26%), ischemic heart disease (20%) and renal calculus (10%) were common comorbidities noted among patients with gall stone disease. Common clinical symptoms noted among patients with gall stone disease were right hypochondrial pain (75%), nausea (50%), epigastric pain (46%), vomiting (34%) and jaundice (10%). USG findings in majority of patients multiple stones (45%), other findings were two to three stones (20%), biliary sludge (19%), single stone (12%), choledocholithiasis (3%) and carcinoma gall bladder (1%). Sedentary lifestyle (68%), female gender (63%), obesity (BMI > 25 kg/m2) (58%), age > 50 years (40%), family history (38%) was common risk factors noted in patients with gall stone disease. Less common risk factors were parity ≥ 3 (30%), h/o rapid weight loss due to fasting, illness (28%), alcohol drinking (22%), smoking (20%) and drugs like ceftriaxone, octreotide and thiazide diuretics (5%). Conclusion: Gallstone disease is one of the most common disorders among patients presenting to emergency rooms with abdominal discomfort. Sedentary lifestyle, female gender, obesity (BMI > 25 kg/m2), age > 50 years, family history was common risk factors noted in patients with gall stone disease.

Aim: The aim of the present study was to determine the usefulness of CSF lactate as a diagnostic marker to differentiate pyogenic meningitis from non-pyogenic meningitis. Methods: A hospital based one-year prospective study was conducted in the Department of General Medicine (Emergency) for one year. Total of 50 cases of meningitis which were diagnosed upon clinical evaluation were included in the study. Results: Meningitis was common in the age group 51-60 (26%). Male patients (60%) were more than female patients (40%). Most number of cases was pyogenic meningitis (58%) while 42% were of non-pyogenic meningitis. Statistically CSF lactate levels were significantly increased in pyogenic meningitis cases when compared to CSF lactate levels in non-pyogenic meningitis patients. Fever was the most common symptom (92%) followed by vomiting (74%), headache (72%) and altered sensorium in 62% of cases. Brudzinski’s sign was observed in 70% of cases and neck stiffness in 64%, kernig’s sign in 58% and nerve palsies in 18% of cases. The mean total cell count was highest in cases of pyogenic meningitis with a mean of 842.88 and SD of 115.25 than viral and tubercular meningitis. However no statistical significance was associated with total count and types of meningitis. (‘p’ value -0.082) A clear neutrophil predominance was observed in all cases of pyogenic meningitis with a mean value of 78.22 and SD of 22.16 than among the cases of viral and tubercular meningitis. Lymphocytic predominance was observed in tubercular meningitis with mean of 75.5 and SD of 24.12 than viral and pyogenic meningitis. Both PMN and lymphocyte count had a clear statistical significance with ‘p’ value <0.001 in this study. Conclusion: This present study concluded that CSF lactate could be a reliable and valid marker in early differentiation of pyogenic from cases of non-pyogenic meningitis. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis.

Aim: The aim of the present study was to assess the efficacy of nutraceuticals in the management of osteoarthritis. Methods: The present study was conducted in the Department of Orthopaedics for one year .100 patients were included in the study and the patients were thoroughly informed about the study protocol and those who were interested in participating signed informed consent. 100 patients were randomised to receive the allocated intervention, either Undenatured Collagen Type II (NUC) (N = 50) or chondroitin sulfate (CS) (N = 50). Results: The two study groups were similar in terms of demographics and clinical characteristics. There were more females in both the groups as compared to male. In the study, there were more married patients as compared to unmarried. There were no significant differences in composite WOMAC and its sub-scales between the two groups at baseline. At follow-up, scores of pain decreased significantly in both groups but patients in the NUC group had significantly lower levels of pain at follow-up as compared to patients in the CS group. Stiffness and physical function were not significantly changed, but score in the composite dimension was decreased significantly only in the NUC group. Subjects in the NUC group reported a significant decrease in pain while pain remained stable for patients in the CS group. In addition, at follow up, patients in the NUC group reported significantly lower levels of pain as compared to those in the CS group. Conclusion: The nutrition can improve the symptoms of declared OA. However, the role of nutrition in slowing down progression of the disease remains to be seen. The preliminary results of this study support the hypothesis that treatment with the newly introduced multi-compound supplement was effective, as reflected by the self-reported feeling of pain.

Aim:  The aim of the study was to assess the incidence and association of serum magnesium levels, serum uric acid levels and microalbuminuria in patients with type 2 DM. Methods: The present study was a hospital based, cross-sectional study, conducted for a period of six months carried out on 100 patients diagnosed with type 2 diabetes mellitus and admitted to Department of General Medicine. The study was done in the department of General Medicine  .who satisfied the inclusion criteria, after taking an informed written consent from all the subjects. Results: In our study, 41% of the population belonged to 51-60 years of age group followed by 21% in 31-40 age group. There were 82 males and 18 females in the study.  Serum magnesium levels were on the lower side in 90% of the population and only 10% had levels within the normal range in our study. Serum uric acid levels were elevated in 68% of the study population whereas 32% were within the normal range or low. Out of 100, 82 were having Microalbuminuria and 14 were having macroalbuminuria. In our study, there was a strong positive correlation between, hypomagnesemia and microalbuminuria, with highly significant p value of 0.000. Out 82 study population with microalbuminuria, 75 patients had elevated serum Mg levels. In our study, there was a positive correlation between, high uric acid levels and microalbuminuria with a highly significant value of 0.000. Out of 82 study population with microalbuminuria, 56 had elevated serum uric acid levels. Conclusion: There was a significant microalbuminuria in patients with type 2 DM, with reduced serum Mg levels and elevated serum uric acid levels as compared with patients who had serum Mg and uric acid levels within the normal range.

Aim: The aim of the present study was to assess stress and psychiatric morbidity among a group of pregnant versus non-pregnant women in the reproductive age group using validated research tools. Methods: This was a comparative cross-sectional study among 500 pregnant and 200 non-pregnant at department of psychiatry using an interviewer-administered questionnaire. The study was conducted among women aged 18 to 45 years. Results: A total of 700 women of which 500 (71.43%) were pregnant and 200 (28.57%) were non-pregnant participated in the study. Their mean age was 30.1 ± 5.4 and 29.6 ± 8.4 years respectively. A significantly higher proportion 400 (80%) of the pregnant women compared with 104 (52%) were in the 25–39 age category (p < 0.001). A higher proportion of the pregnant women were married 475 (95%) compared with the non-pregnant women 120 (60%) which was statistically significant (p < 0.001). Among pregnant women, sociodemographic factors significantly associated with psychiatric morbidity. The highest proportion of psychiatric morbidity was found in women attending tertiary facilities, followed by secondary facilities and the least was in women from primary care facilities. In non-pregnant women, correlates of psychiatric morbidity were mainly family characteristics. Conclusion: The study concluded both working and non-working antenatal mothers were at more risk of developing stress. All antenatal mothers participated in this study had mild stress and there was significant difference between working and non-working antenatal mothers stress score. Psychiatric morbidity is high among women of reproductive age group with higher rates among pregnant women.

Aim: The aim of the present study was to assess the clinical profiles of patients with astigmatism who were scheduled for cataract surgery at our tertiary hospital and to report the prevalence of corneal astigmatism. Methods: The present study, a cross-sectional investigation, was carried out in the department of Ophthalmology, The study was carried out for the period of two years. In total 1000 patients with 1000 eligible eyes were scheduled for cataract surgery during the study period. The patients who have been scheduled for cataract surgery were included. Results: Males made up the majority (56%) of the population and a mean age of 64.6 ± 12.8. The majority of cataracts (46%) and nuclear sclerosis (37%) were of the mixed type. Other less frequent kinds included cortical cataract (2.70%), mature cataract (5.6%), posterior sub capsular opacification (8.5%), and developing cataract (0.2%). K1 and K2 had mean keratometry values of 41.19 and 42.48 D, respectively, with a range of 31 to 52 D. The range of corneal astigmatism was 0-5.34 D, with a mean of 0.48 ± 0.42 D. The range of the cylinder was 0-2.25 D, and the mean sphere was 1.28 ± 1.42 D. The mean cylinder was 0.20 ± 0.30 D. In the current investigation, astigmatism was absent in 8.5% of patients, but oblique astigmatism was present in 14.5%. With the rule astigmatism was present in the majority of instances (43%), followed by against the rule astigmatism (34%). Conclusion: For the best visual outcomes and patient satisfaction following cataract surgery, a preoperative assessment of corneal astigmatism is crucial. Astigmatism worsens with age, and a sizable portion of patients have preoperative corneal astigmatism of 1D or higher, which might impair the quality of vision after cataract surgery.

Aim: The aim of this study was to study clinical predictors of hypoxemia in patients of acute lower respiratory infections in children. Material & Methods: The observational prospective study was conducted in the  Pediatric Ward and Pediatric Intensive Care Unit. This was a hospital-based study completed for 1 year. The sample size taken for this study was 200. All children admitted with acute lower respiratory tract infections between the age group of 2 months to 5 years of age and diagnosed with pneumonia or bronchiolitis were included in the study. Results: A total of 200 cases were enrolled in the study, out of which 144 were male and 56 were female.  Out of the 200 cases enrolled, 98 were below the age of 12 months and 102 were above 12 months of age. The mean age was 15.5 months. The most common and significant symptoms were rapid breathing and difficulty breathing. The least common symptom was noisy breathing and pain in the abdomen. 72 cases out of the total 200 were diagnosed to have bronchiolitis, whereas 128 cases had pneumonia. Tachypnea (87%), pallor (85%) and nasal flaring (82%), crepitations (added sounds), and subcostal retractions had better sensitivity for detecting hypoxemia. However, these signs had low specificity for hypoxemia. Head nodding (94%), intercostal retractions (84%), and cyanosis (87%) were highly specific for predicting hypoxemia. Males 138 out of 144 were significantly more hypoxemic than females 52 out of 56. Most cases have moderate hypoxemia which includes 80%. Conclusion: It was observed that a combination of clinical signs and symptoms can be used to predict hypoxemia when facilities of pulse oximetry and arterial blood gas analysis are not available, especially in low-resource settings.

Aim: The aim of the present study was to assess systolic blood pressure, diastolic blood pressure, mean arterial pressure. pulse pressure, chronic kidney disease. Methods: The present study was conducted in the Department of Physiology for nine months and involved 100 subjects both from urban and rural areas. The subjects were selected in the age group of 20 to 60 years  this was done. Results: The systolic blood pressure of both rural and urban population was compared using F test and a p value of 0.48 was obtained. The diastolic blood pressure of both rural and urban population was compared and analyzed by using F test and we got a p value of 0.0028. The pulse pressure of both rural and urban population was compared by F test which shows a p value of 0.039. The mean arterial pressure of both rural and urban population was compared by using F test where we got a p value of 0.0007. Conclusion: Obese and overweight population is significantly more in the urban area compared to the rural area. The urban population have a significantly higher S.B.P., D.B.P, M.A.P and P.P than the rural population. There is increased incidence of hypertension in the urban males and females compared to rural males and females. This clearly indicates that the urban populations are at increased risk of cardiovascular disease.

Aim: The Purpose of this study was to evaluate biomechanical factors working around hip which leads to implant failure. Material & Methods: This was a retrospective study. All 40 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 Orthopedics for one year with implant failure were registered for the study. Results: In our study we registered total of 30 cases with mean age of registered cases was 62.88 + 8.52 years. 30 patients (75%) were male and 10 (25%) were females. Out of 40 cases registered, pattern of implant failure in our study were 10 cases (25%) had implant failure pattern of Z- effect , 9 cases (22.5%) had implant failure pattern of reverse Z-effect; 7 (17.5%) had breakage of nails; 6 cases (15%) had both screw breakage with varus collapse; 4 (10%) had single upper proximal screw breakage; & 4 cases (10%) were associated with spiral fracture femur just distal to the tip of PFN. Conclusion: Various complicated forces are there that acts on hip joint in different direction. Each force has its own direction. These biomechanical forces are due to body-weight while standing and walking. To minimize damage to joint & implant these forces vectors has to be compensated by forces generated in opposite direction either by body itself or biomechanical properties of implant either due to its specific design or due to properties of material which is used.

Aim:  The aim of the present study was to compare skin closure using sutures versus staplers in elective orthopaedic surgery cases that are followed for 4 weeks for postoperative surgical site infection. Material & Methods: The Present study was prospective observational study, carried out in the Department of Orthopaedics for the duration of the study 24 months. A total of 100 patients were included in the study. Results: There was no significant difference in mean ages, gender, BMI, co-morbidities and smoking status (p value >0.05). The present study shows a statistically significant higher incidence of wound infection among stapler group as compared to conventional sutures in terms of type of incision and type of wound closure. Among the Suture group, 14 out of the 50 had wound infection whereas in stapler group 36 out of the 50 had wound infection and this difference was found to be statistically significant. Mean operating time did not differ among the two groups of staple and sutures while closure time was significantly higher in suture group. Prolonged wound discharged was observed more with staples while the problem was lesser in suture group. This difference was also statistically significant with p value <0.05. More pain was felt by the patients in staple group reported as number of patients with VAS score of 3 or higher. No significant difference was observed between infection rate and wound dehiscence in the current study. Conclusion: By this study it can be concluded that sutures can be used for wound closure instead of staplers in elective orthopaedic surgical procedures as the rate of surgical site infections (SSIs) were less in patients whose wound closure were done using sutures.

Aim:  The aim of the present study was to find out various clinical manifestations and laboratory diagnosis of Rickettsial disease in pediatric age group. Material & Methods: A prospective observational study was conducted at Department of Pediatrics for the duration of 24 months, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. A total of 50 cases who were admitted with complaints of fever and presence of one or more of the following clinical features: Rash, edema, eschar, hepatosplenomegaly, lymphadenopathy, History of contact with pets and history of tick bite. Results: Most common age group observed was 1-5 years accounting to 34%. The youngest affected patient was 2-month-old. Males (64%) were most commonly affected group in our study. 80% of the patients hailed from rural background. Fever was the most common symptom present in all the cases enrolled in the study followed by rash in 29 (58%) cases. Eschar though a characteristic feature of rickettsial infection was found in only 5 (10%) of the cases. Clinical examination revealed hepatomegaly in 45 (90%) cases, followed by lymphadenopathy in 15 (30%) cases and splenomegaly in 12 (24%) of cases. Investigations done in our study subjects showed that out of the 50 cases, 47 (94%) had thrombocytopenia. Hypoalbuminemia was seen 46 (92%) cases and hyponatremia was seen in 43 (86%). Anemia was seen in 27 (54%) of the cases. There was no statistical significant correlation between Rickettsial score and Weil-Felix test according to our study. Complications were seen in 28 (56%) of the cases, of which meningoencephalitis was the most common seen in 8 (16%) of the cases, followed by pneumonia and hepatitis in 4 (8%) cases each. 1(2%) patient required hemodialysis. Conclusion: A proper history and careful physical examination help in the diagnosis of Rickettsial disease. Laboratory tests can be carried out to support the diagnosis. Weil-Felix test can be carried out for early detection of suspicious case in resource limited set up.

Aim: The aim of the present study was to compare the functional outcome of dynamic hip screw and proximal femoral nailing in the treatment of intertrochanteric fractures. Methods: The present study was conducted in the Department of Orthopaedics for the period of one year and all patients with type I, type II or type III intertrochanteric fractures undergoing PFNA2 or DHS fixation. A total of 100 patients were taken and patients were divided to two groups of 50 each for DHS and PFNA2. Results: There was no significant difference in gender distribution, mode of injury and Boyd and Griffin classification distribution between the two groups. The mean six weeks score in Group DHS was 33.47 ± 3.20 and in Group PFN was 34.36 ± 2.7. There was not much significant difference in the mean six weeks comparison between the two groups. The mean 12 weeks score in Group DHS was 53.67 ± 2.68 and in Group PFN was 63.19 ± 5.95. There was a significant difference in the mean 12 weeks comparison between the two groups. The mean 24 weeks score in Group DHS was 82.5 ± 7.63 and in Group PFN was 88.22 ± 6.54. There was a significant difference in the mean 24 weeks comparison between the two groups.  In Group DHS, results were excellent in 34%, good in 42%, fair in 18% and poor in 6%. In Group PFN, results were excellent in 56%, good in 34% and fair in 10%. There was not much significant difference in results distribution between the two groups. Conclusion: From the study based on the functional outcome derived from Harris Hip Score, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS fixation. This was concluded based on the final outcome, range of movements, and HHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group.

Aim: The aim of the present study was to determine the relation between HbA1C, Lipid profile and CRP in individuals with type 2 diabetes mellitus. Material & Methods: This was a hospital-based prospective study comprised of 100 patients with type 2 diabetes mellitus reporting to department of General Medicine for the duration of 12 months. Results: In this study of 100 patients, 70 patients were males, and 20 were females with mean CRP levels of 1.18±1.22 and 1.14±0.98, respectively. There was no significant difference between male and female patients (p>0.05). There was no significance between different age groups in this study (p>0.05). There was no significant correlation between CRP and BMI in this study. FBS and HbA1C were directly correlated. PPBS showed a direct correlation with both HbA1C and CRP in this study. There was a significant positive correlation between CRP and total cholesterol (p<0.05). There was no significant correlation between CRP and LDL cholesterol (p>0.05). There was a negative correlation between HDL cholesterol and CRP. There was significant positive correlation between CRP and triglyceride levels (p<0.05). Conclusion: In this study of 100 patients with T2DM, it was found that CRP is significantly correlated with HbA1C level.  A positive correlation was found between serum CRP and HbA1C in the initial group and in the follow-up patients, showing that CRP levels lowers with better glycemic control and correlates with dyslipidaemia profile.

Aim: The aim of the present study was to evaluate the blood urea & serum creatinine with HbA1C in Diabetes mellitus patients. Methods: The present study was conducted in the Department of Biochemistry. Our study comprises of 100 subjects with age limit between 35-65 years. Our study group compared with normal healthy age matched controls. These are healthy and not having the history of diabetes. Patients with normal blood glucose and normal renal functions tests are taken as controls. Results: Out of 100 cases, we had 25 samples with increased Urea, 35 samples with more creatinine and 40 samples increased with both urea and creatinine when compared with controls. In our study group, males having more creatinine value compared to females due to presence of more muscle mass. Increased blood urea and serum creatinine values are observed in diabetic patients when compared with controls. There was no increase in blood urea and serum creatinine in controls. Mean fasting, and post prandial blood sugar was found to be higher in diabetics subjects when compared to non-diabetic. HbA1C also found to be higher in diabetics. Blood sugar and serum creatinine increases in cases compared with the controls. Both blood urea and serum creatinine shows statistically significant value (p <0.001). Conclusion: Our study showed that blood urea and serum creatinine can be used as biomarkers in the early detection of diabetic nephropathy. These parameters help in reducing the severity of renal failure.

Aim: The aim of the present study was to investigate the prognostic factors of empyema in children with parapneumonic pleural effusion. Methods: This retrospective observational study was conducted at Department of pediatrics for one year. The principles of data confidentiality based on the Helsinki statement were observed. The medical records of all the patients under 14 years who were hospitalized with a diagnosis of bacterial pneumonia, pleural effusion, and empyema were examined. Results: Empyema associated with parapneumonic pleural effusion was detected in 50 patients (33.34%) of 150 hospitalized children. 66 (44%), and 84 (56%) of these patients were boys and girls, respectively. Mean and standard deviation age of study participants were 37.9 ±17.9 months with the range of 1 to 16 months. Comparison of paraclinical laboratory parameters measured in the studied children showed that there was a significant statistical relationship between occurrence of empyema and some paraclinical measures such as leukocytosis (WBC> 15000 μl), neutrophilia > 12000 μl, Thrombocythemia (platelet=450000 μl), hypoalbuminemia (Alb <3 g/dL), high ESR and positive blood culture. The results of multivariate logistic regression modelling showed that the history of ibuprofen consumption increased the chance of empyema in children with parapneumonic pleural effusion by about 7 times (OR = 7.18; 95% CI: 1.36 to 37.83; P = 0.02). Also, having the symptoms of tachycardia (OR = 17.18; 95% CI: 1.64 to 178.82; P = 0.01), and leukocytosis (OR = 5.64; 95% CI: 2.12 to 15.25; P= 0.003) increases the empyema incidence. Conclusion: Based on the findings of this study, a history of ibuprofen use, tachypnea, and leukocytosis are predictive factors for empyema in children with pleural effusion from community-acquired pneumonia (CAP). It is, therefore, helpful to design a scoring system to predict the incidence of empyema in patients with parapneumonic pleural effusion.

Aim: The aim of the present study was to assess the role of different modalities in making diagnosis the etiologies of obstructive jaundice. Methods: The present study was conducted in the surgical wards of Department of Surgical Gastroenterology, IGIMS, Patna, Bihar, India. The time period of the study was from April 2022 to March 2023. The total number of patients was 56. The subject selection was random and only Adult cases were selected for the study. No special consideration of sex of the subjects was considered. Other causes of Jaundice were excluded and only those which can be corrected by surgical intervention were included. Results: Most of the patients were in mean age of 21- 30 whereas for malignant disease patients were in mean age of 51- 60 (46.66%). The youngest patient was 18 years female presenting with CBD stone whereas the oldest patients was male patient of carcinoma head of pancreas aged 78 years. 65.38% were females in the group. In the present study, Male: Female Ratio was 1:5:1 in malignant cause of jaundice. The clinical examination of patients of Jaundice was based on detailed analysis of Symptoms and sizes of patients, accounting for prevalence of symptoms signs with study on prevalence of uncommon symptoms (as pain radiating to back).  U.S.G. detects (caused level of obstruction) in 14/26 = 53.8% of cases of obstructive Jaundice and 9/15 = 60% of cases of CBD stones. 2 patients with CBD stone (as found later on exploration) has a clinical diagnosis of peri ampullary neoplasm/ malignant Jaundice in whom CT scan was done; The Findings of CT in 2 such patients. “Classical Target Sign”: ½ Echogenic Debris in Lower 1/3 CBD 2/2 CBD Dilatation 2/2. Thus CECT has a detection rate of CBD stone as 100% (2/2). Conclusion: The result of this study suggested that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice. Primary closure of the common bile duct is safe and cost effective alternative to routine T-tube drainage after open Choledocholithotomy and associated with low complication rates.

Aim: The aim of the present study was to compare oxiport laryngoscope blade and miller laryngoscope blade for neonatal and infant intubations. Material & Methods: This controlled interventional study conducted in the Department of Anesthesiology for one year in which 150 neonates/infants in groups of 75 each posted for surgery in paediatric operation theatre over a period of 6 months were included in the study. Results: Out of the 150 patients 75 patients in Miller group and 75 patients in Oxiport group were included. Both groups were comparable with respect to age, sex, weight, mean time to intubation and anaesthesiologist performing the laryngoscopy. The incidence of mild desaturation (SpO2 up to 90%) was 86.66% in Miller group and 93.34% in Oxiport group. The incidence of moderate desaturation (SpO2 between 85% and 92.5%) was 4% in Miller group and 6.66% in Oxiport group. Incidence of severe desaturation (SpO2 <85%) was 9.34% in Miller group and 0 in Oxiport group. Conclusion: Apneic laryngeal oxygen insufflation with Oxiport laryngoscope blade decreases the incidence and rate of desaturation with a better hemodynamic stability as compared to Miller blade while intubating neonates and infants.

Aim:  The aim of the present study was to determine the correlation of MPV with fasting blood glucose, glycosylated hemoglobin (HbA1c), body-mass index, and duration of diabetes in the diabetic patients. Material & Methods: This was a cross-sectional study carried out in Department of Pathology,  including 100 patients who were already diagnosed to have Type 2 DM and 100 nondiabetic subjects without known coronary artery disease in between the duration of 12 months. Results: There were more male as compared to females in both groups. MPV was significantly raised in the diabetic population in comparison to controls. Similarly, we also observed significantly higher MPV among diabetics with vascular complications in comparison to those without vascular complications. Among diabetics with microvascular complications, MPV showed a significant association with Diabetic Nephropathy and Diabetic retinopathy. Similarly, among those with macrovascular complications, MPV showed a significant association with Peripheral Artery Disease. MPV showed significant positive correlation with HbA1C, fasting blood sugar, and duration of diabetes in our study. All three correlations are reflected by their positive “r” values. Conclusion: Results showed significantly higher MPV in diabetic patients than in the nondiabetic subjects. This indicates that elevated MPV could be either the cause for or due to the effect of the vascular complications. Hence, platelets may play a role and MPV can be used as a simple parameter to assess the vascular events in diabetes.

Aim: The aim of the present study was to evaluate the role of colour flow duplex ultrasound in clinically suspected patients of chronic venous insufficiency of the lower limbs. Methods: The prospective study was done at department of Radiodiagnosis for the period of six months. Total 100 cases are included in study with all clinically suspected cases of venous disease of the lower limb, referred to the department of radiodiagnosis were evaluated. All patients underwent detailed colour duplex ultrasound of the lower limb venous system. Results: The age group was wide varying from 19-80 yrs. Most common age group was 41-50 yrs (25 cases) accounting for 25% of the cases with the mean age of 46.62. 80% were male in the study. The most common side of lower to be involved was left (46 cases, 46%) as compared to right (34 cases, 34%) or bilateral (20 cases, 20%). The most common pathology in patients with chronic venous insufficiency was varicose veins (85 cases, 85%) with the remaining 7 cases suffering from deep vein thrombosis (18%). The most common site of reflex was perforator (incompetence) with 60 cases (60%) followed by mixed incompetence (both junctional and perforator) (32 cases, 32%) sapheno-femoral incompetence (3%). Most of the patients had multiple-level perforator incompetence, but the most common level was below knee medial mid 1/3rd (72 cases, 72%) and below knee medial lower 1, 3rd (68 cases, 68%). the least incompetent perforator was anterior (3 cases, 3%). All the 15 patients with deep vein thrombosis showed involvement of the proximal segment veins. Conclusion: The study concluded that colour flow duplex sonography provides a good knowledge of the anatomy and the pathophysiology of CVI in each patient, describes the pattern of incompetence at the superficial and deep venous junction the distribution of the incompetent perforation and the prevalence of deep venous reflex, also helps in ruling out DVT.

Aim:  The aim of the present study was to find out the usefulness of absolute eosinophil count as a biomarker for sepsis and septic Shock In ICU. Material & Methods: A prospective cohort study was conducted in the ICU of Subjects were recruited consecutively. 50 subjects were included in the study. The recruitment criteria were patients age ≥18 years admitted to the ICU. Results: 74% were males and 26% were females. 78% had infection on admission. 48% had sepsis on admission. These findings contrasted when compared with the CRP levels, which did not differ significantly among the study groups. Conclusion: In conclusion, the present study found an association between eosinopenia with the diagnosis of sepsis. However, considering the low sensitivity and specificity, our study did not recommend the use of absolute eosinophil count as single diagnostic tool.

Aim: The aim of the present study was to compare the functional outcome of dynamic hip screw and proximal femoral nailing in the treatment of intertrochanteric fractures. Methods: The present study was conducted in the Department of Orthopaedics, for the period of 24 months and all patients with type I, type II or type III intertrochanteric fractures undergoing PFNA2 or DHS fixation. A total of 200 patients were taken and patients were divided to two groups of 100 each for DHS and PFNA2. Results: There was no significant difference in gender distribution, mode of injury and Boyd and Griffin classification distribution between the two groups. The mean six weeks score in Group DHS was 33.47 ± 3.20 and in Group PFN was 34.36 ± 2.7. There was not much significant difference in the mean six weeks comparison between the two groups. The mean 12 weeks score in Group DHS was 53.67 ± 2.68 and in Group PFN was 63.19 ± 5.95. There was a significant difference in the mean 12 weeks comparison between the two groups. The mean 24 weeks score in Group DHS was 82.5 ± 7.63 and in Group PFN was 88.22 ± 6.54. There was a significant difference in the mean 24 weeks comparison between the two groups.  In Group DHS, results were excellent in 34%, good in 42%, fair in 18% and poor in 6%. In Group PFN, results were excellent in 56%, good in 34% and fair in 10%. There was not much significant difference in results distribution between the two groups. Conclusion: From the study based on the functional outcome derived from Harris Hip Score, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS fixation. This was concluded based on the final outcome, range of movements, and HHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group.

Aim: The aim of the present study was to assess the nutritional status of school-going adolescent girls in Bihar region. Material & methods: A Community-based cross-sectional study was conducted in Department of Pediatrics for 24 months  with collobration with schools in the urban area of Muzaffarpur region. A total of 500 adolescent girls attending high school and higher secondary school ranging from 15-18 years (IX-XII Standard) in Muzaffarpur were studied. 2 were studied. Results: As per WHO nutritional measurement criteria, children were classified as per their anthropometric criteria as, 32% had moderate stunting and 5% were severely stunted. 2% had severe thinness, 29% were thin and 7% were overweight. The major morbidity among study subjects was, 20% had conjunctival pallor(anaemia), 8% had dental caries, 6% had Vitamin B complex deficiency, 4% had angular stomatitis and 1% had Vitamin A deficiency. Conclusion: The present study recommends that efforts should be made to reduce the prevalence of malnutrition among adolescent girls. For this regular health check-ups should be done at schools with the help of school authorities and hospitals.

Aim: The aim of the present study was to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss. Methods: The present analytical cross-sectional study was conducted in Department of ENT for period of two years. The present study was conducted on 100 type 2 diabetes patients and age and gender matched 100 non- diabetic controls in the age group of <50 years. Results: In the present study, 68% were females and 32% were male. The mean age of patients of diabetic group was 40.20 ±6.36, mean fasting blood sugar was 129.41±26.54, mean PP blood sugar was 170.20±40.25 and mean HbA1c was 7.43±0.49. Mean age of patients of non-diabetic group was 38.52±7.43, mean fasting blood sugar was 107.03±3.16, mean post-prandial blood sugar was 128.52±9.81 and mean HbA1c was 6.006±0.222. The result showed that only 28 patients had normal hearing and 72 patients had SNHL whereas 12 patients in this group had minimal hearing, 19 had mild SNHL, 23 had moderate, 6 had severe SNHL and 12 patients had profound SNHL. 75 patients had DPOAE refer whereas 25 patients had DPOAE pass. Wave V grossly delayed in DM group as compared to non-DM with all frequencies (i.e. 70, 80 and 90) whereas interpeak latencies of wave I-V at 70 db frequency is almost equal in DM and non-DM group but it increase with increase in frequencies (i.e. 80 and 90 db). Conclusion: This study concluded that the diabetics are at definite risk of developing auditory dysfunction, therefore it is recommended that all newly diagnosed diabetic patients should undergo a complete audiological evaluation at the time of diagnosis and a regular half yearly or yearly follow up is warranted for early detection of damage to auditory functions. Although factors other than diabetes contribute to hearing loss, early glycemic control for type 2 diabetic patients may reduce the incidence rate of this disease.

Aim: The aim of the present study was to evaluate the different approaches of treatment modalities for chronic venous ulcers. Material & methods: A cross-sectional study was conducted at the Department of General Surgeryfor the period of one year. 100 patients were studied who were patients attending the outpatient department and casualty during the study period with venous ulcers over the leg. Results: In our study, the age varied from 24 years to 68 years. Out of 100 patients, 18 (18%) patients were from 21-30 years age group, 20 (20%) from 31-40 years, 28 (28%) from 41-50 years, 28 (28%) from 51-60 years and 6 (6%) from 60 and above years of age. The mean age was noted to be 49 years. There were 80 (80%) males and 20 (20%) females. Total 20 (20%) patients had a normal BMI, 45 patients (45%) were overweight and 35 (35%) patients were obese. All 20 females were overweight or obese. Along with ulceration, 42 (42%) patients had pain, 68 (68%) patients had edema and 70 (70%) patients had skin changes. All our patients had underlying venous abnormalities either clinically or radiologically. Of the patients, 42 (42%) patients had venous ulcer in the right leg, 54 (54%) in the left leg. 4 (4%) had bilateral venous ulcers. In our study, 72 (72%) patients had pathology of great saphenous vein, 23 (23%) patients had perforator incompetence, and 5 cases (5%) had involvement of short saphenous vein. In our study, 20 patients (20%) underwent conservative management alone and 80 patients (80%) underwent surgery. Amongst 80 patients who underwent surgery, flush ligation of Sapheno-femoral junction with stripping of GSV up to knee was done in 56 (70%) patients. All of these patients had phlebectomy below the knee also. 6 (7.5%) cases underwent subfascial endoscopic perforator ligation (SEPS). Phlebectomy alone was done in 16 (20%) patients. 6 cases were operated with SSV ligation. Conclusion: Venous ulcers are common ulcers of lower limb causing a progressive disability affecting patient with pain, disability, loss of work, and social isolation. Ulcers need prompt treatment with dressings and surgery.

Aim: The aim of the present study was to assess the demography, disease distribution and co morbid conditions, complications and mortality among elderly patients undergoing operation in general surgical wards. Methods: A prospective observational study was conducted in the Department of General Surgery, over a period of one year. A total of 100 patients were studied. Results: In our study, 90 patients were under group I and 10 in group II. Out of 100 patients, 60% were men and 40% were women. Most common surgical diagnosis in our study population was Hernias with 23 cases (23%) followed by gallstone disease (GSD/cholelithiasis) with 27%. About 16 cases were diagnosed with malignancy accounting to 16%. Diagnoses related to trauma were seen in 18 cases i.e. 18% of the population. After System-wise categorizing the diagnosis, the most common systems involved were hepatobiliary with 30 cases (30%) followed by Hernias 32 cases (32%). Post-operative complications like seroma formation in 12 cases, surgical site infections in 5 cases of study patients were observed. These were managed conservatively. Wound dehiscence was seen in one patient with sheath intact in emergency abdominal surgery. Postoperative fever was observed in one patient which resolved subsequently and hypocalcaemia was identified in patient post thyroidectomy and was managed by oral medicines. By Third week complications were resolved. Conclusion: With increasing age, the risk of co morbidities increases. Early surgical intervention in elderly patients is preferred and must be advisable after optimization of co morbid conditions for good surgical outcomes. Hernias and gallstone disease are the most common elective surgical diseases found in elderly patients. Surgically treatable causes should be corrected early, preferably electively, to avoid intervention in emergency setting, which would increase morbidity and mortality.