International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

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Peer Review Journal

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1. Assessment of the Types and Risk Factors of Urinary Incontinence among Postmenopausal Women Attending the Obstetrics and Gynecology Outpatient Department
Binish Inam
Aim: The aim of the present study was to assess the type of urinary incontinence in postmenopausal women visiting obstetrics and gynecology (OBG) outpatient in a tertiary health care sector and to determine the risk factors of urinary incontinence. Methods: A hospital‑based cross‑sectional study was carried out in the OBG Department of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. Postmenopausal women of age 45–90 years, who came to the OBG department, were studied. 500 patients were interviewed in the 12 months of duration. Results: In the present study, 80% were vaginal delivery followed by LSCS. In 90% cases, delivery was assisted by Obstetrician. 70% were tea drinker and 96% patients were taking diuretics. The total prevalence of urinary incontinence in our study was 25%. Stress incontinence accounted for 15%, followed by mixed urinary incontinence, contributing 8% and finally, urge urinary incontinence ‑ 2%. In this study, prevalence of urinary incontinence was more or less similar in women aged 75 and above (27%), women between 45 and 59 years (26.8%) and 60 and 74 years (25%). Of 15 variables studied, only 4 were found to be significant using bivariable analysis. These variables were chronic cough (P = 0.005), recurrent urinary tract infections (UTI) (P < 0.001), duration of labor (P = 0.025), and the type of delivery (0.032). Multivariable analysis was done using binary logistic regression ‑ stepwise backward elimination method. All the variables having P value 0.2 or less were put in the model which included age, occupation, parity, menopausal age, duration of labor, type of delivery, diabetes mellitus, chronic cough, recurrent UTI, and physical activity. Chronic cough, recurrent UTI, and duration of labor were found to be independent risk factors. Conclusion: Stress incontinence was found to be the major type of urinary incontinence in the postmenopausal women. Those having history of chronic cough, prolonged duration of labor, and recurrent UTI should be screened regularly for urinary incontinence.

2. A Hospital Based Observational Assessment to Determine the Rate and Reasons for Blood and Blood Components Wastage in the Blood Bank
Fauzia Perveen, C.P. Jaiswal
Aim: The aim of the study was to determine the rate and reasons for blood and blood components wastage in the blood bank of a tertiary care hospital. Methods: This was a retrospective study involving the analyses of discarded blood and blood components data in Nalanda Medical College and Hospital, Patna, Bihar India for the period of two years which measured the outcome‑based quality of discarded blood and its components. Results: A total of 10,000 units of blood were collected. Among the total donors, 9890 (98.9%) were males and 110 (1.1%) were females. 8000 (80%) were voluntary donations, and 2000 (20%) were from replacement donations. A total of 34850 blood components were prepared from 10,000 whole blood donations during this study period. Of which 6404 (18.37%) components were discarded. Among the total discarded components, platelet concentrates (PCs) were discarded 83.24% (5331/6404), of which 95.39% (5142/5390) was due to expiry, 1.3% (70/5331) due to packed red cells contamination, and 2.7% (182/5331) due to seropositivity. Conclusion: Implementation of proper blood transfusion policy, donor screening, and training of technical staff will help to reduce the discard rate and solve the shortage of these precious elements.

3. Determination of Vancomycin, Linezolid and Daptomycin Resistance among Eenterococcus Isolates from a Tertiary Care Hospital
Simmi Kumari, Manish Kumar, Shilpi Singh
Aim: The aim of the present study was to measure the prevalence of vancomycin, linezolid and daptomycin resistance in Enterococcus clinical isolates from patients in a tertiary hospital. Methods: This study was a retrospective study conducted by Department of Microbiology, AIIMS, Patna, Bihar, India. Total of 500 consecutive, non-repetitive clinical isolates of Enterococcus species from different clinical samples were included in the study. The study period was two years. Results: A total of 500 Enterococcus were isolated during the study period. Of these, there were 350 (70%) isolates were of Enterococcus faecalis and 150 (30%) of Enterococcus faecium. No other Enterococcus species were isolated. Clinical samples included urine, blood, pus, sputum and other samples like body fluids etc. Out of these 500 isolates, the most common sample was urine (440 (88%)), followed by blood (36 (7.20%)), pus (12 (2.4%)), and sputum (8 (1.6%)). Among isolates of Enterococcus– 22, 43 and 435 were intermediate, resistant and sensitive to vancomycin respectively. Linezolid intermediate and resistant was identified in 2 and 4 isolates of Enterococcus faecium only. MIC to vancomycin ranged between 0.25-256 µg/ml, MIC of linezolid ranged between 0.25- 16µg/ml and MIC for daptomycin was less than 1 µg/ml for all the isolates. Conclusion: Our study, demonstrated relatively low prevalence of vancomycin and linezolid resistance, but emergence of combined newer drug resistance in Enterococcus species is cause of concern and reiterates the importance of importance of judicious use of antibiotics.

4. A Hospital Based Analytical Assessment of Sexual Dysfunction in Male Patients with Alcohol Dependence Syndrome
Takum Mokholee, Amardeep Kumar, Kumar Satyadarshee, Karnik Kishore
Aim: The aim was to estimate the prevalence and correlates of sexual dysfunction in alcohol-dependent patients and to explore the association between sexual dysfunction and various alcohol-related variables. Methods: The case-control study was conducted in the inpatient of the department of psychiatry in Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar India for one year. The study sample consisted of two groups, recruited through convenience sampling: 100 in-patients with an ICD-10 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) diagnosis of alcohol dependence and 50 controls enrolled from medical wards admitted for management of transient febrile illness. Results: Men with alcohol dependence were different from controls with regard to socio-demographic data of age, domicile, religion, and family type. They were older than controls. The majority of the controls were from rural, joint, Islamic families compared to cases. There were no differences between them in education, occupation, and socio-economic status (SES). 75% of the patients in the case group initiated drinking alcohol before 25 years of age, with 31% of them started before 18 years of age. However, only 6% developed dependence before 25 years of age. The quantity of alcohol consumed per day was 14.9 (± 7.33) standard drinks (6-48 drinks per day). The prominent SD among men with alcohol dependence was low desire followed by premature ejaculation. Low sexual desire was reported by 14% and premature ejaculation by 11%. Every aspect of sexual functioning was disturbed in men with alcohol dependence. 12% reported more than one sexual dysfunction. Premature ejaculation was a prominent type of dysfunction among controls. Conclusion: The study highlights the global nature of sexual dysfunction in men with alcohol dependence. It emphasizes the need for clinicians to routinely assess the sexual problems in their alcohol drinking patients, especially those with liver disease.

5. A Hospital Based Prospective Comparative Assessment of Anti-Hemorrhagic Effect of Uterotonics and Tranexamic Acid (TXA) for Postpartum Hemorrhage
Aim: The aim of the present study was to compare anti-hemorrhagic effect of uterotonics and Tranexamic acid (TXA) for postpartum hemorrhage. Methods: The prospective observational study was conducted at Department of Obstetrics and Gynecology, Patna medical College and Hospital, Patna, Bihar, India for nine months. 200 pregnant women who were booked in this hospital and delivered vaginally and clinically diagnosed with postpartum hemorrhage were taken for the study. 100 patients received standard protocol with placebo and 100 received standard protocol with Tranexamic acid 1 gm IV. Results: Majority of the patients belonged to age group 19-24 years 60% in group A and 56% in group B respectively followed by 26-30 years, i.e., 25% in group A and 24% in group B. According to parity, 60% belonged to multipara in group A and 65% in group B. 91% and 90% patients delivered full term normal delivery in group A and group B respectively. Two groups are comparable with respect to delivery. P value is significant (p< 0.0001). There was significant difference in FTND and VBAC. Mean blood loss in the control group was 750 ml +/- 100ml while that in study group was 650ml +/- 100ml. the difference between the two groups was significantly high and hence it was statistically significant (p< 0.0001). Conclusion: Tranexamic acid significantly reduces bleeding in post-partum haemorrhage. TXA is not a new drug and is generally well tolerated without any thrombogenic side effects. This data strongly supports the need for double blind study to investigate the potential effects of Tranexamic acid to reduce incidence of PPH and related maternal morbidity and mortality.

6. Assessment of Spectrum of Surgical Site Infections: A Prospective Observational Study
Manish Kumar, Simmi Kumari, Shilpi Singh
Aim: The present study was aimed to determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram at tertiary care hospital. Methods: This prospective study was done in the Department of Microbiology, Narayan Medical College and Hospital, Sasaram, Rohtas, Bihar, India The study period of the study was one year. The patient details were recorded including type of surgery, type of wound infection, wound class including clean, clean contaminated and contaminated wound and total days of stay in the hospital. Results: The patients included 10 males 5 females; the age of the patients were in a range of 17 years to 70 years. 5 patients were in age group 17-34, 5 patients in age group of 35-51, and 5 patients in an age group of 52-70 years with mean age of 43.7 years. The duration of the surgery lasting less than 2 hours has been noticed in 12 cases and in remaining three cases the duration of surgery was more than 2 hours. Few cases are with the comorbidities such as 3 hypertension cases, 1 case of chronic kidney disease, 1 case of coronary artery disease and 1 case has been admitted with road traffic accident. A total of 9 cases (60%) of SSI were culture positive out of 15 cases. The organisms   isolated   were   Staphylococcus species which includes 3 MSSA (Methicillin sensitive Staphylococcus aureus), 1 MRSA (methicillin resistant Staphylococcus aureus) and 1 Staphylococcus hemolyticus, two Enterococcus species which includes one Enterococcus durans and another Enterococcus faecalis. Among gram negative bacteria that were isolated which are specific to SSI included Pseudomonas aeroginosa and the other showed growth of Acinetobacter baumannii. Conclusion: Management of SSIs remains a significant concern for surgeons and physicians in a health care facility, which carries a load with high morbidity and mortality. Due to the proper hospital infection control management we report the occurrence of low SSI in our hospital with the absence of multidrug resistance. We emphasized on the importance of hospital infection control monitoring with proper precautions during surgeries to reduce the load of SSI and better outcome of the treatment.

7. An Analytical Comparative Assessment of Two Different Techniques of Heparin Dressing in Lower Limb Diabetic Ulcers
Md. Wahhaj, Anil Kumar, V.S. Prasad
Aim: To study the effectiveness of topical heparin over conventional dressings for lower limb diabetic foot ulcers. Methodology: A cross-sectional comparative study was done among patients diagnosed with diabetic foot ulcers admitted in the surgical ward of D M.C.H, Darbhanga, Bihar. The study was conducted over a period of  March 2018 to February 2019. A total of around 356 cases visited the surgical OPD with complaints of diabetic foot ulcer of which 124 patients required admission. 34 patients were excluded from the study as they were presenting with sepsis or peripheral vascular disease or didn’t consent for the study. Thus, A Total of 90 patients were included in the study and were divided in to two study groups. For Group 1, only conventional dressing was done and for Group 2, topical heparin solution was applied. For both the groups, glycemic control and antibiotics were added accordingly and monitored. All data were collected according to the guidelines of the Institutional ethical committee. The data was entered in MS Excel and the frequencies were analyzed. Results: Majority (77.8%) of the study participants were male. Of the 45 participants who received conventional treatment, 38 (84.4%) and 7 (15.6%) were male and female respectively, while the gender distribution among the group receiving heparin was 35 (77.8%) and 10 (22.2%) of male and female respectively. The mean hospital stay was higher in conventional group (15.8 days) compared to Heparin group (12.3 days). Of the total study participants, majority (72.2%) received empirical sensitive antibiotics while only 27.8% had the drug revised by culture and sensitivity, of which majority 17 (68%) belonged to the conventional group of treatment. The mean of Bates-Jensen wound healing score was higher in heparin group (28.2) at 0 weeks compared to conventional group (26.6). The score gradually decreased over the period of three weeks. Conclusion: From this study, examination of ulcers have shown significant reduction in the ulcer surface area with appearance of healthy granulation tissue, decreased length of hospital stay in patients treated with topical heparin solution as compared to conventional dressing.

8. A Hospital-Based Assessment of the Effectiveness and Feasibility of Conventional Smear Preparation in Cervical Cancer Screening
Ranjeet Kumar, Anand Prakash Anand
Aim: To assess the effectiveness and feasibility of conventional smear preparation in cervical cancer screening. Methodology: For eight months, a retrospective record review was performed for a total of 500 women. Pap cervical smear sample was collected by trained personnel for performing conventional smear preparation direct to slide method. Samples were processed and stained within 24 hours of receiving and the slides were reported by the pathologist following the latest Bethesda system of reporting (TBS 2014). Data on age, marital status of the patient, reproductive history and their current gynaecological symptoms (if any), date of Pap smear performed and the result were retrieved from the pre-filled proforma. After screening, all screened women collected their reports and were directed to the Department of Obstetrics and Gynaecology to ensure that those with abnormal cytology were subjected to further necessary evaluations and treated appropriately. Results: It was observed that among women with abnormal cytology (18.4%), majority of the cytology presented as ASC-US with 46.74% (43/92), LSIL 7.61% (7/92), ASC-H 22.83% (21/92), 19.56% (18/92) were High grade squamous intraepithelial lesion (HSIL), while 2.17% (2/92) were Squamous cell carcinoma and adenocarcinoma stood at 1.09% (1/92). The chief complaints among women with abnormal cytology were pain in the lower abdomen (33.7%) and white discharge (28.26%). Among women with abnormal cytology, the mean age was 40 years. Conclusion: From this study, it can be concluded that conventional smear preparation can be a better preparation in cervical cancer screening. Furthermore studies are required.

9. An Observational Assessment of the Drug Utilization Pattern and Cost Effectiveness of Anti-Diabetic Drugs among Diabetic Patients in a Tertiary Care Teaching Hospital of Bihar
Kumar Mayank, Subhash Chandra Yadav, Dinesh Sah
Aim: The aim of the study was to evaluate the utilization pattern of anti-diabetic drugs among diabetic outpatients in a tertiary care teaching hospital. Material & Methods: The present study was taken in the Department of Pharmacology, SKMCH, Muzaffarpur, Bihar, India for three months. The patients were taken from the department of medicine. A total of 200 patients were included in the study. Data were collected by direct patient interview and from case records and discharge certificates. Informed consent was obtained from all patients included in the study. Results: A total of 200 diabetic patients were evaluated during the study period. In the present study, neither male nor female preponderance was seen (males 51%; females 49%). Majority of our patients were in the age group of 51-60 years (40%). The mean age of the patients in the present study was 57.6 years (age range: 18-79 years). Our study found that 68% of patients studied received metformin alone and/or in combination followed by sulfonylureas (50%). 17 ADRs were reported during the study. Hypoglycemia was the most common ADR observed in eight patients (moderate intensity in seven patients and mild in one patient). Seven hypoglycemic episodes were probably related to the study medication. Conclusion: Metformin was the most commonly used drug. The prescribing trend also appears to be moving towards combination therapy particularly two drug therapies.

10. Optimizing Transdermal Patches of HMG-CoA Reductase Inhibitors: Evaluating Parameters with Bioadhesive Polymers as Excipients
Prasad Tandale, Vijay Naresh
Drug variations, gastrointestinal discomfort, hydrolysis and degradation in acidic environments, and first-pass hepatic metabolism are only some of the problems that may be avoided with transdermal drug administration as opposed to oral drug delivery. In the present research work different type of transdermal drug delivery system (TDDS) are mentioned here. There are many evaluation parameters discussed below which are utilized in the evaluation of TDDS like thickness of film, average weight and weight variation, tensile strength, hardness, percentage moisture content, moisture uptake percentage, determination of drug contents, invitro release test of medicaments, skin irritation test and stability studies. After successfully performing all the evaluation parameters the results obtained were satisfactory and were in limit.

11. A Retrospective Assessment of Spectrum of HRCT Findings in COVID19 Infected Patients and Severity of the Disease Based on HRCT Findings to Establish the Role of HRCT Chest as an Investigative Modality of Choice for Prognosis of COVID19 Infected Patients
Ram Kumar Gupta, Ashutosh Jha, Nain Kumar Ram, Vijay Kumar
Aim: The aim of our study was to evaluate the spectrum of HRCT findings in COVID‑19 infected patients, to assess the severity of the disease based on HRCT findings and to establish the role of HRCT chest as an investigative modality of choice for prognosis of COVID‑19 infected patients. Methods: The Retrospective Study was conducted in the department of Radio-diagnosis, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for one year and 200 patients were included in the study. Results: The study included 130 males (65%) and 70 females (35%). Most of the patients belonged to age groups 31-40 and 21-30. Many travelers whose nasopharyngeal swabs were tested positive for COVID infection were asymptomatic (140 cases, 70%), 60 patients (30%) had mild symptoms. Out of 100 cases of abnormal HRCTs, 90 of them (90%) had bilateral lung involvement, while 7 (7%) had only right lung involvement and 3 (3%) had only left lung involvement. Sore throat followed by generalized malaise, fever and cough were the common presenting symptoms. In our study 26 patients (13%) had abnormal chest X ray and HRCT’s while only 64 patients (32%) had abnormal HRCT but normal chest X rays. Ground glass opacities (GGO’s) were the most common finding seen in almost all patients who showed some finding on HRCT. 90 out of 100 (90%) patients who showed findings on HRCT had ground glass opacities. Conclusion: Typical peripheral sub pleural distributions of GGO’s with bilateral asymmetrical lung involvement are characteristic features of COVID19 pneumonia. Chest HRCT can be a very useful and standard imaging method to assess the severity and progression of the disease and thereby optimizing the management of patients. With increasing case load all over the world HRCT can be used as a one stop radiological investigation for the diagnosis and prognosis of corona virus disease.

12. A Hospital Based Cross-Sectional Assessment of the Correlation of Anemia with Left Ventricular Hypertrophy in CKD Patients
Pushp Raj Kumar
Aim: The aim and objective of this study were to calculate left ventricular mass index in patients of chronic kidney disease stage III-V having hemoglobin level <11 g/dl and to demonstrate development of left ventricular hypertrophy early in chronic kidney disease patients with mild to moderate anemia. Methods: This study was done Department of General medicine, AIIMS Patna, Bihar, India  over one year on 200 patients of CKD (stage III to V), aged 15-80 years, who had elevated serum creatinine and reduced glomerular filtration rate, haemoglobin <11 gm/dl with ultrasonographic evidence of renal parenchymal disease grade >2. The patients were assessed based on clinical history and a number of laboratory parameters including blood urea, serum creatinine, calcium, inorganic phosphorus, serum electrolytes, i PTH level, Hb, Hct, glomerular filtration rate and left ventricular mass index. Results: Majority of study population i.e. 65% was male, 35% was female. Most of the male patient i.e. 73.01% of the study population are having abnormal left ventricular mass index (135 g/m2 is taken as normal value for male patients). Majority of female patients i.e., 92% have abnormal left ventricular mass index. There was strong correlation between Anemia and left ventricular mass index in both male and female patients. 36 out of 46 patients who were diabetic are having abnormal LVMI, whereas 130 out of 154 who were non diabetic were having abnormal LVMI, so there is no correlation between DM and LVMI. Conclusion: Anemia was widely prevalent in our CKD patients. Severity of anemia is correlated to left ventricular hypertrophy in these patients. Hence correction of anemia early in these groups of patients can halt or prevent cardiovascular morbidity and mortality.

13. A Hospital Based Clinical Study to Evaluate the Functional Outcome of Dual Plate Osteosynthesis in Type V & VI Proximal Tibial Fracture
Kumar Mayank, Ranjan Kumar Prakash, Dilip Kumar Singh
Aim: We studied the results of dual locking plate and buttress plating in management of proximal Tibial Schatzker V and VI tibial plateau fracture by using minimally invasive surgical technique. Methods: The present study was conducted at department of Orthopaedics Jawahar Lal Nehru medical College & Hospital, Bhagalpur, Bihar, India for 10 months and total 50 patients with all Bicondylar Tibial plateau fractures (Schatzker type V, VI) admitted and treated with minimally invasive dual locking and buttress proximal Tibial plate having following mention inclusion and exclusion criteria were included in study. Results: Age range of patients included was 18 years to 60 years, with mean age 38.45±15.16 years. 40 patients were male, while 10 were females. 12 patients had left side injury and 38 patients had right side injury. 43 patients had type V fracture and rest of the patients had type VI fracture. Out of 50 patients, 36 achieved excellent knee score (80-100), 20 achieved good (70-79), 4 achieved fair (60-69) and no patient had poor (<60) knee score. Mean range of knee flexion was 110 degrees. Complications included 5 superficial infection which were treated by IV antibiotics and surgical wound management. Malreduction or malalignment was not measured on the first postoperative radiographs. Conclusion: The results of the study concluded that by using minimal invasive technique of bi condylar fracture fixation are excellent without any major complication.

14. An Observational Assessment of the Serum Sodium Levels in Children Presented with Lower Respiratory Tract Infections (LRTI)
Ashwani Kumar Mishra, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal, Gopal Shankar Sahni
Aim: The aim of this study was to find out the association among hyponatremia and LRTI in tertiary care center. Methods: This was an observational, prospective and hospital-based study conducted in  department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for the period of 12 months. The sample size was calculated to be a minimum of 70 subjects. All patients admitted in to the PICU and pediatric ward were included in the present study. Written and informed consent was secured from the parents participating in the study. Results: The sample population consisted of children ≥ 2months -12 months (40, 57.14 percent), 1-5 years (20, 28.58%) and > 5-12 years (10, 14.28 percent). There were 42 (60%) male children and 28 (40%) female children in the present study population. Hyponatremia was found to be more among 1 year-5 years age group compared to ≥ 2months-12 months and > 5-12 years age groups. In the current study no significant difference in the allotment of hyponatremia in infancy period, 1-5 years and > 5-12 years was observed. In the present study mean haemoglobin value found to be lesser among subjects with hyponatremia however the variance was statistically insignificant (p=0.280). Mean TLC count found to be significantly more among subjects with hyponatremia compared to subjects without hyponatremia (p=0.036). Mean Neutrophils count were more among subjects with hyponatremia and mean Lymphocyte count was lesser among subjects with hyponatremia though the difference was statistically insignificant. Conclusion: Hyponatremia is a significantly common association among hospitalized children with lower respiratory tract infections and it is mainly due to syndrome of inappropriate antidiuretic hormone secretion (SIADH).

15. A Hospital Based Observational Research to Evaluate Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease
Nain Kumar Ram, Vijay Kumar, Ashutosh Jha, Ram Kumar Gupta
Aim: The aim of this study was to evaluate diagnostic value of connective tissue disease related CT signs in usual interstitial pneumonia pattern of interstitial lung disease. Methods: The present study was conducted at Department of Radio-diagnosis, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India and retrospective search was done among all CT thorax studies done for nine months for cases which fulfilled UIP pattern as per ATS/ERS/JRS/ALAT guidelines. 100 patients were included in the study. Results: A total of 100 patients were included in the study, 50 (50%) had CTD. Majority of the study subjects were females (53.2%). The mean age for the cohort was 55.85 ±15 years. Comparison of demographic characteristics and CT sign distribution between CTD-related UIP and non-CTD related UIP.  There was significant difference in gender distribution, females being more common in CTD-related UIP. Patients with CTD-related UIP were significantly younger than those without CTD in our study. Rheumatoid  arthritis  (RA) (60%) was the most common subtype of CTD. Conclusion: The presence of SE, AUL, and EHC signs in cases with UIP pattern are specific imaging markers to diagnose underlying CTD; however, due to its low sensitivity, the absence of these signs cannot exclude the same. Because of its excellent interobserver agreement, these signs are reliable in the evaluation of CTD-related ILD.

16. A Retrospective Observational Radiographic Assessment of the Efficacy of Laparoscopic Treatment in the Management of Intra-Abdominal Ruptured Liver Abscess
Vijay Kumar, Ram Kumar Gupta, Ashutosh Jha, Nain Kumar Ram
Aim: The aim of the study was to assess the efficacy of laparoscopic treatment in the management of intra-abdominal ruptured liver abscess. Methods: This was а retrospective observational study of Department of Radio Diagnosis, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for one year, patients with intra-abdominal ruptured liver abscess. 50 patients were included in the study. All diagnosed cases of ruptured liver abscess based on radiology and laparoscopic investigation were included in the study. Details of demographics, clinical features, computed tomography were recorded. Results: The study group consisted of 50 patients with а median age of 54.6±15.5 years (range, 24-85 years). There were more men than women in the study. Diabetes mellitus was the most common underlying medical condition (30%), followed by bacterial pneumoniаe (20%), hypertension (8%), bile duct stones (4%). Most of the patients were suffering from abdominal pain (94%), malaise and anorexia (94%), fever (80%), peritonitis (76%). The mean time interval between the onset of fever and CT was 8.4 days (range, 1-30 days). The mean size of the liver abscess was 8.2 cm (range, 4.0-14 cm). А single abscess was found in 18 patients, and multiple abscesses were seen in 32 patients. Unilobаr involvement was seen in 46 patients. The abscesses were completely liquefied in 40 patients and gas in the abscess cavity in 10 patients. Free intraperitoneal fluid was seen in all patients. The right lobe affected more commonly than left lobe. Conclusion: А ruptured hepatic abscess is more life-threatening than an unruptured one. А rapid and accurate diagnosis and prompt surgical intervention are essential. Most of the cases had an acute presentation and the right lobe is commonly affected. Abdominal pain was the most common symptom. Computed tomography is an ideal tool for diagnosing hepatic abscesses and its complications.

17. A Hospital-Based Study to Analyze the Patterns of Radiological Findings on Chest Radiograph (CXR) for Suspected and Confirmed COVID19 Patients on Initial Presentation to the Emergency Medical Services (EMS)
Ashutosh Jha, Nain Kumar Ram, Vijay Kumar, Ram Kumar Gupta
Aim: The purpose of this study was to analyze the patterns of radiological findings on chest radiograph (CXR) for suspected and confirmed COVID‑19 patients on initial presentation to the emergency medical services (EMS) on admission and to assess the progression and resolution. Methods: The present study was conducted at department of Radio-diagnosis, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for one year and 500 cases of covid-19 were included in the study. Results: 500 RT‑PCR confirmed COVID‑19 patients were included in our study who had initial CXR. 350 (70%) of our patients with positive initial RT‑PCR showed abnormal baseline CXR. The abnormal findings were described as haziness akin to ground glass opacities (GGO) on CT, peripheral opacities, patchy parenchymal opacities and consolidation. Peripheral opacities and lower zone distribution were the commonest pattern of CXR abnormalities with bilateral involvement. The severity of findings on serial CXR and radiographic regression was studied along with follow‑up to assess response to treatment. Forty‑six patients showed features of acute lung injury (ALI). Complications and new CXR findings were reported for patients who were given ventilator support. Conclusion: CXR is a valuable baseline radiological investigation on hospital admission in symptomatic patients with suspected or confirmed Covid‑19 presenting to the EMS as it helps to monitor the progress and regression of the disease in conjunction with clinical findings.

18. A Hospital Based Assessment of Maternal Nutritional Awareness and Iron Deficiency Anemia in Children Aged 6 Months–2 Years: A Questionnaire Study
Upendra Prasad Sahu, Sunanda Jha, Bhardwaj Narayan Chaudhary, Pawan Kumar
Aim: This study aimed to analyze the risk factors and vital role of mothers in prevention of nutritional anemia in the early childhood. Methods: This study was carried out at department of Pediatrics, RIMS-Ranchi India for the period of one year. Children aged 6 months–2 years admitted at the hospital during the study period were included. Any child with chronic disorders such as hemoglobinopathies, hemolytic anemia, and treated for anemia and those on any immuno suppressants such as steroids and biologics were excluded as an indirect measure to eliminate anemia of chronic disease. Results: Of the 500 children, 270 (54%) were anemic. Moderate anemia was found in 120 (24%) and only 10 (2%) had severe anemia. Mean age of anemic children was 13.23±5.15 months. Mean maternal age was 26.49±3.46 years, ranging between 19 and 36 years. Majority (78%) of the mothers were aware that neural development of child could be affected by anemia. Despite WHO’s efforts to enforce exclusive breastfeeding until 6 months of age, 18% of mothers preferred to initiate complementary feeds at 4 months of age. Maternal knowledge regarding cow’s milk was poor as 84% had a faulty belief that it increases iron absorption, whereas 16% were unaware of the relationship between cow’s milk and anemia. Around 80% and 70% mothers recognized green leaves and jaggery to be enriched with iron. On an attempt to establish a correlation between maternal education status and anemic children, we found that mothers with better literacy rates had significant awareness regarding anemia and nutrition. Conclusion: Recognizing the causative factors plays an essential role in preventing iron deficiency anemia (IDA). Exclusive breastfeeding must be promoted, along with avoiding excessive cow’s milk intake. Intervening at the right period with age-appropriate foods becomes a necessity. Maternal illiteracy has a positive correlation with anemia in infants. Improving maternal awareness by the physicians will pave the road toward a nation free from anemia.

19. Assessment of the Effect of Ingestion of Clear Water and Glucose Water Over 10 Hours NPO in Elective Laparoscopic Cholecystetctomy Surgery: Analytical Comparative Study
Soumya Singh, Amit Kumar Singh, Uma Shanker Singh
Aim: The aim of this study was to compare the effect of ingestion of clear water and glucose water over 10 hours NPO in elective laparoscopic cholecystetctomy surgery. Material & Methods: An analytical comparative study was conducted in Department of Anesthesiology, AIIMS, Patna, Bihar, India for eight months. The study included ASA I-II patients undergoing laparoscopic cholecystectomy surgery. Patients undergoing general anaesthesia were included in the study. A total of 60 patients were included and 20 patients each were randomly assigned to one of the 3 groups. Results: There was no significant difference between the groups with regard to weight, age and sex. Patients who had 200 ml of clear water in Group B had lesser variation in serum K+ level [3.80±0.56; p=0.040] and serum lactate level [1.80±0.80; p=0.001] than that of Group A [4.16±0.54; 2.70±0.70], which was statistically significant. Patients who had 200 ml of glucose water in Group C had lesser variation in serum K+ level [3.60 ±0.30; p=0.01], serum lactate level [1.10±0.40; p<0.001], RBS level [125.75±8.72; p<0.001] and no episode of hypoglycaemia noticed as compared to Group A [4.12 ±0.40; 2.70±0.55; 109.41±21.42], which was statistically significant. Patients in Group C had lesser variation in serum lactate level [1.10 ±0.22; p=0.002], RBS level [142.62 ±8.60; p<0.001] and no episode of hypoglycaemia recorded as compared to Group B [1.75 ±0.80; 112.40 ±12.48 ] which was statistically significant. Conclusion: We concluded that it is safe to conduct general anaesthesia in patients who have ingested 150 ml of water 2 h prior to surgery. Prolonged withholding of oral fluid does not decrease gastric fluid volume and pH.

20. A Hospital Based Prospective Estimation of Prevalence of Dengue Viral Infection among Clinically Suspected Patients
Abishek Anand, Sunil Kumar
Aim: The purpose of the present study is to estimate prevalence of dengue viral infection among suspected patients attending a tertiary care centre. Methods: The present study is a retrospective study to observe prevalence of dengue infection, conducted at the Department of General medicine, BMIMS, Pawapuri, Nalanda, Bihar, India. Patients clinically suspected of having dengue infection and advised for dengue investigation for establishing the diagnosis were enrolled in the study, irrespective of their age or sex, over one-year period. Total 200 samples were tested for dengue seropositivity. Results: Out of 200 dengue patients 120 (60%) were male patients and 80 (40%) were female patients. Out of 200 dengue patients, 140 (70%) patients were from urban area and 60 (30%) from rural area. In our study dengue infection was observed more (30%) in the age group 20 to 30 years followed by 10 to 20 years (24%) and 30 to 40 years (20%). All dengue positive patients in our study had fever of 2 to 7 days. The most common presenting symptoms of dengue were fever with body ache (45%), headache (36%), nausea (34%) and vomiting (22%). Out of 200 dengue cases fever with rash was observed in 14 cases (7%). Conclusion: For estimation of true burden of dengue in India and its geographical mapping to control further disease transmission; laboratory-based active surveillance systems are required along with passive surveillance and control programs.

21. Prospective Comparative Assessment of the Effect of Different Doses of Dexmedetomidine on Hemodynamic Parameters and Depth of Anaesthesia
Vinit Kumar, Pawan Kumar, Santosh Kumar, C D Ram
Aim: The aim of the present study was to evaluate and compare the effect of different doses of Dexmedetomidine on hemodynamic parameters and depth of anaesthesia. Methods: The present study was conducted in Department of Anaesthesiology, SNMMCH, Dhanbad, Jharkhand, India for 10 months and after approval by institutional ethics committee this study was carried out on 150 patients in the age group of 20 to 60 years. Patients were ASA I-II, scheduled for open cholecystectomy. Results: The enrolled patients fulfilling all the inclusion and exclusion criteria were divided into three groups with 50 patients in each group. Group A (n=50) 0.5µg /kg of Dexmedetomidine in NS (Total volume 10 ml). Group B (n=50) 0.75µg/kg of Dexmedetomidine in NS (Total volume 10 ml) Group C (n=50) 1 µg/kg of Dexmedetomidine in NS (Total volume 10 ml). There were more females than male in all the three groups. Mean Age in group A, B and C were 42.18±11.19, 41.69± 11.20 and 43.67± 9.25 respectively. All the three groups were comparable with respect to age of the patients (p>0.05). The groups were also comparable in terms of Sex, BMI and ASA grade (p>0.05). The groups were comparable in terms of duration of surgery and interval between start of Dexmedetomidine infusion and Extubation (p>0.05). In group C 25 patients had no coughing at the time of Extubation as compared to 24 patients in group B and 12 in group A. Both in group B & group C 20 patients had smooth Extubation with minimal coughing whereas 18 patients in group A had smooth Extubation with minimal coughing. The difference in quality of Extubation is significant between group A & group B and between group A & group C whereas it was comparable between group B & group C. Conclusion: The attenuation of Extubation response was almost similar with Dexmedetomidine in dose of 0.75μg/kg and 1μg /kg. However with increase in dose from 0.75μg/kg to1μg /kg there was significant increase in the side effects in the form of bradycardia (p<0.05). Also the quality of Extubation was much better with Dexmedetomidine in dose of 0.75μg/kg and 1μg /kg as compared to Dexmedetomidine in dose of 0.5μg/kg (p<0.05). So we concluded that 0.75μg/kg is the single best dose of Dexmedetomidine for attenuation of Extubation response.

22. Assessment of Thyroid Status of the Patient with Abnormal Uterine Bleeding: An Observational Study
Renu Prabha, Madhu Sinha
Aim: The present study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. Methods: The present study was conducted in the department of obstetrics and gynecology, outpatient department, DMCH, Laheriasarai, Darbhanga, Bihar, India from September 2021 to September 2022. The total number of cases studied as AUB was 500.The study population was, those women who presented to OPD with complaints of abnormal uterine bleeding (AUB). The study was done for the period of 12 months. Results: In the present study, majority of the patients 50% were in the >40 years age group followed by 30% in the 31-40 age group. AUB was more common amongst multiparous women contributing to 58%. The most common menstrual disorder pattern seen in AUB was menorrhagia which was 52%. Next commonest was polymenorrhea at 22%. The thyroid status was studied in all AUB cases and the percentage of thyroid abnormality was found in 50 cases (10%), including hypothyroidism and hyperthyroidism. Euthyroid, hypothyroid and hyperthyroid were 90%, 8% and 2% respectively. More number of hypothyroid cases were in >40 years age group and a smaller number of cases in <20 years age group. There was high association observed between age groups and thyroid type and it is found statistically significant (p<0.001). There was high association observed between types of menstrual disturbances and thyroid type and it was found statistically significant (p<0.001). Conclusion: We found most of the women with abnormal uterine bleeding were euthyroid. In our study among hypothyroid patients most common complaint of abnormal uterine bleeding was menorrhagia, followed by polymenorrhoea, oligomenorrhoea and Hypomenorrhea.

23. An Observational Prospective Evaluation Platelet Count and its Indices-Effectiveness in Early Diagnosis of Neonatal Sepsis
Partha Kumar Chaudhuri, Prita Naaz Dubraj, Kiran Shankar Das
Aim: The aim of the study was to evaluate the efficacy of platelet count (Platelets) and its indices in the early diagnosis of sepsis. Methods: This was a prospective study conducted at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India for the period of one year. Sample size of 100 patients was recruited as per hospital neonatal intensive care unit work load during the period of study. The study protocol was presented to Institutional Ethics Committee and all the data were collected after taking the informed consent of parents. Results: The general characteristics of a study group showing 100 patients including 60 males and 40 females. On the basis of NNF guidelines, the patients were divided in three groups – 50% were clinically suspected sepsis (probable sepsis), 35% were with blood culture positive (culture positive sepsis), and remaining 15% in blood culture negative but CRP positive group (culture negative sepsis). The patients were divided into early and late onset. EOS was seen more in males (65%) as compared to females (35%). However, in LOS both male and females were equally affected. Conclusion: Platelets can be considered as an early diagnostic tool for neonatal sepsis as it is cheap, rapid, and easily available and does not require additional equipment.

24. A Prospective Observational Study Evaluating Acute Renal Failure in Pediatric Patients Admitted to our Institute
Nagendra Nath, Bhupendra Narain
Aim: The aim of the present study was to perform a prospective study of acute renal failure in pediatric patients admitted to our institute. Methods: All children with ARF in the age group from 0 to 14 years were included who were admitted to the Upgraded  Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India. We studied 200 children admitted with ARF. All these patients were studied by obtaining a detailed history, a thorough physical examination and necessary investigations. Results: Children less than one year of age were 17%. Children between one and five years comprised 30.5%, while children more than five years of age comprised the maximum 51%. 55% were females and 45% were male in the study. Only 10% of the cases were due to pre-renal cases because most of the pre-renal cases are treated at primary or secondary care centers. In the present study, acute tubular necrosis (40%) remains the major cause of ARF. Post- renal cases were 16%. Out of 200 patients, 140 patients had complete recovery, 16 patients had partial recovery, 7 had not recovered and 37 died. Mortality in the below one year age group was higher. This can be due to underlying septicemia, pre- maturity, feeding problems, associated congenital anomalies, etc. in neonates. Of 37 expired patients, ten patients were late arrivals for dialysis and were with severe pulmonary edema and acidosis, which could not be reverted, and those patients expired. Mortality in the present study was 18.5%. Conclusion: In conclusion, ARF in pediatric nephrology is not uncommon. In our setup, peritoneal dialysis seems to be an effective and safe modality of renal replacement therapy in most of the cases. Delayed referral, malnutrition, infections, age less than one year and multiorgan involvement were all bad prognostic features.

25. Association of Serum Ferritin Levels with Metabolic Syndrome in India
Mohd Abdul Salam Tamboli, Prabhakar D. Deshmukh
Background: Iron can be stored and released by the common intracellular protein ferritin, which also serves as a buffer against iron overload and deficiency. Metabolic syndrome (MetS) characteristics have been linked to elevated serum ferritin concentrations. Serum ferritin concentrations vary widely by sex and ethnicity, and there is inconsistent evidence about the association between serum ferritin concentrations and MetS in Asian men and women. The prevalence of metabolic syndrome (MS), which affects 20–25% of adults worldwide, includes central obesity, hypertriglyceridemia, low HDL cholesterol, hyperglycemia, and hypertension. Insulin resistance, a common feature of metabolic syndrome, has been theorized to be a key factor in the association between MS and inactivity. Aim: The present study was designed to explore the association of serum ferritin levels with metabolic syndrome and insulin resistance. Material And Method: This case-control study was carried out in the Department of General Medicine with 50 instances of young adult metabolic syndrome in Group A and 50 cases of healthy, normal people in Group B. Patients with metabolic syndrome who were seen in the hospital’s outpatient department made up the study population. According to the Adult Treatment Panel III (ATP III) criteria of the National Cholesterol Education Program, a person has a metabolic syndrome if at least three of the following symptoms are present. In agreement with the International Diabetes Federation (IDF), metabolic syndrome is described. Every study subject gave their written consent in accordance with the institutional ethics committee’s rules and regulations.  Patients who agreed to participate in the trial with their guardians’ permission provided signed informed consent. Results: There were 28 males amongst cases 27 males in controls while 22 and 23females amongst the case and control group respectively. the mean age was 33.48 ± 4.66 yrs. in patients with metabolic syndrome and 33.07 ± 4.49 yrs. amongst controls. It was observed that all 50 patients had 3 components, 43 patients had 4 components and 15 patients had all 5 components of metabolic syndrome. In metabolic syndrome group 12 (25.9) cases had History of Diabetes Mellitus, 20 (44.4) cases had History of Hypertension, 8 (18.5) cases History of Dyslipidemia, and 15 (33.3) cases had Family history of Metabolic syndrome while amongst the control group 2 (7.4%) had positive Family history of Metabolic syndrome. It was observed that serum ferritin was significantly increased amongst metabolic syndrome patient as compared to control group. Conclusion: According to the findings, serum ferritin levels were considerably higher in metabolic syndrome sufferers compared to healthy persons in general. Comparing patients with 3, 4, and 5 components of the metabolic syndrome to controls, the association between mean blood ferritin levels increased in a direct proportion to the number of components. A higher BMI is correlated with higher serum ferritin levels. Therefore, serum ferritin can be utilized as a clinical indicator of illness severity and a marker for the metabolic syndrome.

26. Mannheim Peritonitis Index’s Ability to Accurately Predict Individuals with Hollow Viscous Perforation’s Morbidity and Mortality
Anil Kumar  Gupta, Anand Agarwal, Pawan Kumar, Yogesh Agarwal
Background: Hollow viscus perforation peritonitis is one of the most frequent surgical emergencies, with significant rates of death and morbidity. The goal of this study was to evaluate the Mannheim’s peritonitis index’s predictive power for patient mortality. Methods: Hollow viscus perforation peritonitis is one of the most frequent surgical emergencies, with significant rates of death and morbidity. The goal of this study was to evaluate the Mannheim’s peritonitis index’s predictive power for patient mortality. Results: A 100% survival rate was discovered in cases involving the stomach, 96% in cases involving the duodenum, 0% in cases involving the jejunum, 73% in cases involving the ileum, 83% in cases involving the appendix, and 50% in cases involving the colorectal region. The survival rates were influenced by a number of variables, including age, sex, organ failure, and sepsis origin. Conclusions: The Mannheim peritonitis index, which is particularly useful in stratifying the severity of the condition and predicting death in patients with peritonitis, should be considered in the care of all these patients.

27. A Hospital-Based Assessment of the Trigger Tool Method for Adverse Drug Reaction Monitoring
Jaya Roy, Rohit Kumar Singh
Aim: The objective of this study is to evaluate the trigger tool method (TTM) in detection, monitoring, and reporting of adverse drug reactions (ADRs) at teaching hospital, Gaya, Bihar, India. Methods: The present study was conducted at a teaching hospital ANMMCH, GAYA, Bihar, India for a period of 12 months. A total of 200 patients who fulfill the selection criteria were enrolled and male were 70% and female 30%. The mean age of patients was 42.08 ± 16.4 years, and the mean length of hospital stay was 5.75 ± 3.12 days. Results: DT (800 times) was the most commonly observed trigger followed by PT (80 times), ST (80 times), and LT (16 times). One or more DT was observed 800 times in 285 patients, of which 40 patients had ADRs. Hence, the PPV of DT was 10.3%. Similarly, PT was observed 100 times in 150 patients and 50 patients had ADRs. While ST was observed 80 times in 70 patients, of which 15 patients had ADRs. The use of thrombophob gel has the highest PPV (100%), followed by rash (84.16%), other complaints not related to disease (48.96%), antihistamines (40.50%), and laxatives (35.5%). Conclusion: Trigger tool approach is highly effective in the identification of ADRs in comparison to traditional approach. This method enables health care professionals including pharmacists for easy identification and reporting of ADRs.

28. The Clinico-Epidemiological Study of Balanoposthitis
Shiva Prasad D., Satish K.S.
Background: In this study we wanted to evaluate the socio-demographic profile of the patients with balanoposthitis. We also wanted to study the factors causing balanoposthitis in the age group of 18-60 years in relation to systemic diseases.  Methods: The present study is an observational prospective study with a sample size of 50. Detailed history, clinical examination (local and systemic), Bedside investigation, KOH, Gram stain and Tzanck smear. Lab investigation which included urine routine, CBC, ESR, RBS, HIV I & II, VDRL, Hepatitis B, Culture and Sensitivity were done. Results: It was observed that maximum number of patients with balanoposthitis were in the 31-40 age group (42%). The next predominant groups affected were 20-30 &41-50 respectively 34% and 16% each. majority of patients with balanoposthitis belonged to middle income group (56%) and only 32%of patients belonged to low-income group followed by 6 patients belonging to high income group (12%). Conclusion: Balanoposthitis is very commonly encountered condition in the STD clinics. Balanoposthitis has many predisposing factors with a multifactorial aetiology. It is most commonly seen in the sexually active age group and in majority of cases exposure to STD plays a major role. The various precipitating factors like smegma, urine, alkaline vaginal discharge, friction of clothing, vaginal pathogens of unhygienic contacts.

29. A Study on Awareness and Practice of Dengue Control Measures Among the Rural Population Residing in Field Practicing Area of Chengalpattu Medical College
Getrude Banumathi P, Sujatha S, Harikrishnan J, Dharmendiran A, Jaiganesh D
Introduction: Dengue is identified as public health problem due to its rapid spread throughout the world. The key to controlling Dengue rests not only on the services offered by health officials but also on community awareness of preventive measures and their behaviour while seeking out health care. Objective: To assess awareness and practice of Dengue control measures among the rural population residing in field practicing area of Chengalpattu Medical College and to explore the factors influencing awareness and practice among the study population. Methodology: A community based cross sectional study was conducted among 165 participants selected by Simple Random Sampling method from Manampathi block during December 2022. 18 years and above who were willing to participate were included. Semi-structured Questionnaire administered to the participants to assess socio-demographic details, awareness and practices. Data was collected and entered in Microsoft Excel and analyzed using SPSS version 25. Results: In this study mean age was 40 years ± 11.276. 61.2% participants had adequate awareness and 35.2% had good practices. A statistically significant association found between age group (<40years, p=0.019), gender (male, p=0.03), educational status(literate, p=0.032) and occupation(working participants, p=0.015) with awareness. Among the participants who had good practices 79.3% had adequate awareness about Dengue (p=0.001). Conclusion: Gaps in awareness and practices found in this study. So regular awareness activities, such as health education campaigns and home visits to inform people about the mode of transmission and preventive measures needed to fill this gaps.

30. Outcome Assessment of Short Segment Added Injury Level Pedicle Screw Fixation and Conventional Short Segment Pedicle Screw Fixation in Thoraco-Lumbar Spine Fractures: A Comparative Study
Arnab Sinha, Santosh Kumar
Aim: The aim of the present study was to evaluate the outcome of short segment added injury level pedicle screw fixation and conventional short segment pedicle screw fixation in thoraco-lumbar spine fractures. Methods: The present study was conducted at department of Orthopaedics, IGIMS, Patna, Bihar, India and 100 patients of thoracolumbar fractures mainly wedge compression & burst fracture without neurological deficits were selected in the study. The study was conducted from July 2016-June 2017. With 50 randomly selected cases in each group and were managed either by using CPSF or short segment injury level pedicle screw fixation (SSIPSF). Results: In our study group of 100 patients (80 males & 20 females), most common mode of injury was fall from height (70%); RTA (20%); other causes (10%). Most common vertebra involved was L1 (50%), followed by T12 (40%), L2 (10%). In our series, Denis classification was used. Most common type was wedge compression fractures (60%) and burst fracture (40%). In SSIPSF the average pre-op Sagittal cobb’s angle was 25.65±4.32°, the immediate post-op 12.38±2.28° & at final follow-up the correction was 11.19±1.18°. In CPSF the average pre-op Sagittal cobb’s angle was 28.02±8.32, the immediate post-op 16.34±6.04& at final follow-up the correction was 14.46±2.58. Fractured vertebral body angle in SSIPSF group the average pre-op fractured vertebral body angle was 15.45±4.52, the immediate post-op 25.75±4.06 & at final follow-up the correction was 23.17±4.08. Conclusion: In Open short segment Injury Level pedicle screw fixation (SSIPSF) inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to no instrument failures, without additional complications had better and more rigid construct than conventional open short segment four pedicle screw fixation(CPSF).

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