International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

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Peer Review Journal

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1. Descriptive Cross-Sectional Assessment of Sleep Duration and Associated Factors among Adolescent School Children
Binish Inam
Aim: The aim of the present study was to assess sleep duration and associated factors among adolescent school children. Methods: This cross‑sectional study was conducted in Gaya district of Bihar with the duration of one year. Data were obtained from 500 adolescents by a team consisting of doctors including a pediatrician, medico social workers, and nurses. Results: The mean age was 15.09 ± 1.33 years. Nearly 30% of students were from government school, 36% from aided school, and 34% from private school. There was a significant difference in the sociodemographic pattern across the schools such as family income (χ2 test = 198.9, P < 0.0001), maternal education (F = 105.6, P < 0.0001), paternal education (F = 146.1, P < 0.0001), and results (F = 27.6, P < 0.0001) (higher values in private school compared to government school). The mean duration of sleep as reported was 7.2 ± 1.2 h. The duration was significantly different in different type of schools (government ‑ 7.29 ± 1.3 h, aided ‑ 7.38 ± 1.2 h, private ‑ 6.56 ± 1.1 h, F = 8.13, P < 0.0001). Nearly 72% of students were having inadequate sleep in private school. The most common (mode) bedtime, both weekdays as well as weekends, was 10 pm. However, the most common (mode) wake‑up time was 6 am during weekdays and 7 am during weekends. The duration was also significantly different during weekdays (7.4 ± 1.2 h) and weekends (9.03 ± 1.4 h) with longer duration during weekends (paired t‑test t = −25.41, P < 0.0001). Conclusion: Inadequate sleep duration and difference in sleep schedule during weekends were observed among adolescents, especially among private school students. Primary prevention approach aimed at spreading adequate awareness regarding the importance of sleep among students, parents, and teachers should be practiced.

2. A Prospective Observational Study to Assess the Prevalence and Associated Factors of Anemia in Pregnant Women
Fauzia Perveen, C.P. Jaiswal
Aim: This study was aimed to determine the prevalence and associated factors of anemia in pregnant women in Bihar. Material & Methods: A prospective observational study was conducted in Department of pathology, Nalanda Medical College and Hospital, Patna, Bihar, India for one year. A sample size of 223 pregnant women was estimated based on the prevalence of anemia of 59% among pregnant women (National Family Health Survey [NFHS]‑3 survey) with 95% confidence level and with an absolute precision of 5%, including a dropout rate of 20%. Results: A total of 223 pregnant women were involved in the study. Most of the pregnant women were within the age group of 18-25 years with mean age of 22.94 years (±2.39year). Among all study participants, 35(15.9%) were illiterate. Prevalence and severity of anemia: Two hundred twenty-three pregnant women, 39.94 (95% CI: 34.7% – 45.2%), were anemic. The mean Hb concentration was 11.55 ± 2.97 g/dl with a range of 5.4 to 18.7g/dl. Among anemic pregnant women, 84(37.50%) had mild anemia, 139(62.50%) had moderate anemia, and 14(9.66%) had severe anemia. From a total of anemic pregnant women, 139(62.5%), 56(25%) and 28(12.5%) had normocytic normochromic, microcytic hypochromic and macrocytic anemia, respectively. Among 223 study participants, 18 (8.07%) were anemic (Hgb: < 11 g/dl). The general distribution of anemia was 15 (62.5%) microcytic hypochromic, 6 (25.0%) normo- cytic hypochromic and 3 (12.5%) macrocytic hypochromic based on the morphology of red blood cells. Entamoeba histolytica 18 (8.07%), Giardia lamblia and both Entamoeba histolytica/dispar and Giardia lamblia 12 (5.3%) were among intestinal parasites detected from stool of the pregnant women. The majority of anemic cases 66.66% (12/28) showed mild type of anemia. Conclusion: This study revealed that the prevalence of anemia among pregnant women was relatively low. Rural residence, history of abortion, current blood loss and third trimester gestational age was statistical significant associated factors with anemia in this study.

3. A Hospital-Based Assessment of the Relationship between Stigma and Sociodemographic Variable with Presentation of Depression
Amardeep Kumar, Kumar Satyadarshee, Takum Mokholee, Karnik Kishore
Aim: The aim of the present study was to identify interrelation between chief presenting complains of depressive disorder with level of stigma associated, with reference to patient’s socio economic and demographic back ground. Methods: This was a cross-sectional study conducted at the out-patient department (OPD) of Department of Psychiatry, Patna Medical College & Hospital, Patna, Bihar for one year. Fifty (50) cases of Major Depressive Disorder were taken using convenience sampling method. Results: Study population consists of 14 (28%) male and 36 (72%) females. Mean age were 36.15 ± 9.71. Among them 40 (80%) were married, 6 (12%) unmarried and 4 (8%) widows. Majority of them were Hindu 38 (76%) and 12 (24%) Muslim by religion. Regarding educational status, 9 (18%) were illiterate, 4 (08%) can read and write only, 9 (18%) upto primary levels, 12 (24%) completed secondary level, 06(12%) upto higher secondary level and 10 (20%) completed graduation. 10 (20.0%) complaint sadness, 24 (48%) pain and other somatic problems, 10 (20%) tension as most troubling and 6 (12%) complaint other problems. Mean HDRS and stigma score were 20.20±3.82 and 16.10±4.68 respectively, 32(53.3%) having stigma score 16 or above and 23 (46%) having less than 16. Relation between age and total stigma score is insignificant (r=0.14, p=0.285) where as there is a positive correlation exists between HDRS score and total stigma score (r=0.490) which is strongly significant at p<0.001 level. Conclusion: Majority of patients with major depression reported somatic complaints as most troubling which may hinder early recognition. As stigma is positively related with depression severity it may acts as barrier to help seeking. Socio-demographic variables are unrelated with presentation of depression.

4. Assessment of the Distribution of Various Uterine Pathology in Hysterectomy Specimens among Women with AUB: A Cross Sectional Study
Kumari Divyamala, Ranu Singh Kushwaha, Ankita Ranjan
Aim: The purpose of this study was to find out the distribution of various uterine pathology in hysterectomy specimens among women with AUB. Methods: A prospective study was conducted in the department of Obstetrics and Gynecology at Nalanda medical College and Hospital, Patna, Bihar, India over a period of one year. 100 AUB cases were included in the study. All cases of AUB who underwent hysterectomy were included in the study. Results: 45 % cases belong to 5th decade 41-50 years followed by 35% cases belong to the 4th decade 31-40  years. Maximum number of cases 52% was second para. HMB was seen in 48% cases followed by dysmenorrhoea in 16% and irregular bleeding in 12% cases. In the study clinically, 46% were diagnosed to have fibroid, 24% had Adenomyosis. In the study, 44% had Proliferative, 28% had Secretory, 12% had endometrial hyperplasia and 9% had Endometrial carcinoma. In the study 40% had Leiomyoma, 20% had Adenomyosis, 12% had Endometrial hyperplasia. Conclusion: This study confirms that benign diseases are more common than their malignant counterparts and the most common pathology identified is leiomyoma. The present study confirms a good correlation between clinical indications and histopathology especially in benign conditions.

5. A Hospital Based Retrospective Observational Analysis of Mesh Related Infections
Wahhaj, Anil Kumar, V.S. Prasad
Aim: To analysis of mesh related infections in a tertiary care center. Methodology: A retrospective observational study was conducted in the department of Surgery, D.M.C.H, Darbhanga, Bihar from January 2020 to December 2020 . and 60 patients were included in the study. All cases that underwent ventral and groin hernia surgeries and reported with mesh infections in the Department of General Surgery were included in the study. All cases of mesh infection during the study period (n=60) were analyzed. Demographics like age, sex and factors associated with mesh infection like BMI, comorbidities, time of presentation, tobacco consumption, ASA grade, type of hernia, type of hernia repair done were taken from medical records of the patients and their association with mesh infections were analyzed. Results: Among 60 patients, 46 (76.7%) were males and 14 (23.3%) female patients. Majority of the patients were in the age group 40-50 (38.3%) followed by 50- 60 age group (30%). 33.3% cases were repaired with open repair and rest of the patients (66.7%) were repaired with lap repair. 85% patients had BMI more than 30 Kg/m2. In 40% patients, co-morbidities were present. Out of those patients, 33.33% had COPD only followed by 29.17% having COPD and type 2 DM. 20.83% had type 2 DM only and 16.67% had COPD and HTN. Polypropylene mesh was used in 80% patients, and the composite mesh was used in 20% patients who underwent IPOM. Conclusion: Most of the patients took more than 5 months to report infection. Comorbidities were present in 40% patients and risk for complications after hernia repair is increased among patients with comorbid conditions. So, the proper selection of the patient, ensuring good control of comorbid medical conditions will prevent mesh infections.

6. An Analytical Comparative Evaluation of Vertical Mattress Suture and Subcuticular Suture Skin Closure Techniques in Inguinal Hernia Repair Cases
Wahhaj, Anil Kumar, V.S. Prasad
Aim: To compare subcuticular and vertical mattress suture techniques in inguinal hernia repair. Methodology: Current study is a prospective study conducted at Upgraded Department of General Surgery, D.M.C.H, Darbhanga, Bihar from January 2019 to December 2019 . Patients with inguinal hernia repair were taken as study population. After inguinal hernia repair, the outer wound was sutured with two types of materials in two different groups. The first 30 participants received subcuticular suture technique and another 30 participants received the traditional vertical mattress suture technique. Postoperative pain was evaluated by using the Visual Analog scale which was calibrated from 0-10. The pain score was observed during the day of surgery, the first postoperative day, third post-operative day and seventh postoperative day on suture removal. Complications were observed until suture removal. Results: The majority of participants were in the age group of 51- 60 years in both groups. The common comorbid condition in both groups was Type II DM. The duration taken for closure of the wound by subcuticular suture (405.76±37.74 seconds) was higher compared with vertical mattress (168.56±38.43 seconds) and this result was significant. The post-operative pain score was almost the same in both groups and it shows non-significant values. There was no difference in cosmesis score in vertical mattress (1.81±0.49) and subcuticular suture (1.92±0.84) on seventh post-operative day by using Modified Hollander score. On the fourth week of post-operative day, the cosmesis score was significantly better in subcuticular stitches (71.23±2.95) compared with vertical mattress stitches (69.73±2.44). Conclusion: In the present study, there was no significant difference in post-operative pain and time taken for closure was less with vertical mattress. Hence, we conclude that there is no superiority of subcuticular suturing over vertical mattress suturing in case of inguinal hernia repair surgeries.

7. A Case Control Assessment of the Association between Kharra Chewing and Periodontal Health Status in Oral Submucous Fibrosis Patients: A Comparative Study
Neha Nupur, Rachna Raj
Aim: To determine the effect of kharra chewing on periodontal tissues of patients with OSMF in Bihar region. Methodology: 90 patients (aged 21–60 years) visiting the Department of Dentistry, Private Dental clinic, Patna, Bihar, India.  during the duration of three months, were included in this study. The three groups with 30 patients each are classified as follows: Group I (n = 30) included patients with a healthy periodontium, Group II (n = 30) included patients with chronic periodontitis without OSMF, and Group III (n = 30) included patients with chronic periodontitis and OSMF. Periodontal indices such as gingival index (GI) and plaque index (PI), PPD, and CAL were measured with a graduated periodontal probe for each tooth on all the six sites. On the basis of the region of quid placement, regional PPD and regional CAL (Clinical Attachment Loss) scores were also calculated. OSMF was diagnosed on inspectory and palpatory findings adhering to the clinical classification by to the clinical classification. Differences in the clinical parameters among the three groups were analyzed using one-way analysis of variance. Results: All the 90 patients were of age 21-60 years with mean age of 38.5 + 13.9 years. Mean age in group I, II and III was 41.5+15.7, 39.6+11.8, and 40.2+13.9 years. In group I, 50% were males and 50% were females. In group II, 46.7% were males and 53.3% were females. In group III, 53.3% were males and 46.7% were females. GI for Groups I, II, and III was 0.6+0.5, 1.8+0.7, 1.0+0.7, and PI was 0.7+0.4, 1.4+0.6, and 2.2+0.5, respectively. In Group III, PPD (overall) was 3.9+0.8 mm and CAL (overall) was 4.6+0.8 mm. Group I showed a lower PPD as compared to group II and III. The frequency of kharra chewing in Group II and Group III was 6.32+3.14 times per day and 6.60+2.4 times per day, respectively. The duration of kharra consumption was 4.15+3.05 (3.6-8.4) years and 6.98+3.45 (4.2-8.3) years for Group II and Group III, respectively. CAL regional was also seen higher as compared to CAL overall in group II and group III. Conclusion: From this study in can be concluded that periodontal parameters were more destructive in patients with chronic periodontitis with OSMF as compared to chronic periodontitis without OSMF. Similarly, clinical attachment level in the region of kharra placement was deep as compared to overall clinical attachment level.

8. To Determine the Effect of Ageing on Cortical Thickness Index (CTI) and Canal Flare Index (CFI) of Long Bones in Indian Population at a Tertiary Healthcare: A Comparative Study in Two Age Groups I.E. 19-40 Years and 41-Above Using AP Radiograph of Hip
Padma V Badhe, Khushboo Tekriwal, Anjali Anant Bohir, Swapnil Moharkar, Moinuddin Sultan, Sanika Patil
Aim: the aim of the study was to measure cortical thickness index (CTI) and canal flare index (CFI) on an anteroposterior radiograph of femur in normal Indian population of age group 19-40 years and effect of ageing on these parameters. Methods: A cross-sectional hospital-based study included 684 patients conducted at department of Radiology, in a tertiary healthcare centre under BMC from 1st December 2021-30th November 2022. Results: In the present study, out of 342 participants in group I, maximum 203 (86.5%) were referred due to pain and out of 342 in group II, maximum 154 (45.0%) were referred due to pain. This difference was found to be statistically significant. In the present study, out of 342 participants in group I, 4 (1.2%) were diabetic and out of 342 in group II, 33 (9.6%) were diabetic. In the present study, out of 342 participants in group I, no one hypertensive and out of 342 in group II, 30 (8.8%) were hypertensive. This difference of diabetes, history of addiction and hypertension were found to be statistically significant. In our study, mean CTI in 18-40 years age was found to be 0.53±0.07 (95% CI-0.52-0.53) and mean CTI in >40 years age was found to be 0.50±0.12 (95% CI-0.48-0.51). In our study, mean CFI in 18-40 years age was found to be 4.3±0.71 (95% CI-4.2-4.37) and mean CFI in >40 years age was found to be 3.8±0.92 (95% CI-3.7-3.9). This difference was found to be statistically significant. Conclusion: We found a significant statistical difference in the values of CTI among males and females of the same age group. We also found statistically significant effects of ageing in the values of CTI among both sexes.  We also found statistically significant difference in the values of CFI among each sex of same and different age groups.

9. A Morphometric Analysis of Adult Human Cadaveric Heart Assessment for Anatomical Variations of Papillary Muscles
Sudha Kumari, B C Dutta, Sayantan Das, Anupam Khalkho
Aim: To analyze the papillary muscles of the heart with respect to the variations in their number, length, shape, position and pattern in both ventricles. Material & Methods: The study was conducted using 50 well preserved adult cadaveric human hearts obtained from the department of Anatomy, MGM Medical College, Kishanganj, Bihar, India. The values of the length of papillary muscles and thickness of both ventricles of cadaveric heart specimens were presented as Mean± SD and p value was calculated using student t-test. Different variables of the papillary muscles were compared between two ventricles and p value was calculated by performing a chi-square test. P-value < 0.05 was considered as statistically significant. Results: In our study we observed 33.3% conical apex, 4.3% broad apex and 53.4% pyramidal apex in right ventricles whereas 21.3% conical apex, 26.7% broad apex, 21.3% pyramidal apex in left ventricles. Length of papillary muscles in the right ventricle were 1.28±0.46, 1.39±0.50, 0.90±0.56 in anterior, posterior and septal segments. Whereas, it was 2.15±0.46 in the anterior segment and 1.78±0.48 in the posterior segment of the left ventricle. Conclusion: The papillary muscles have complex and variable anatomy. Knowledge of this variation to the cardiac surgeons during reparative surgical procedures conducted for mitral/ tricuspid valve replacement is of utmost importance to prevent untoward events.

10. A Hospital Based Observational Assessment of the Platelet Count in the Pregnant Women
Ranjeet Kumar, Anand Prakash Anand
Aim: To assess the Platelet Count in the Pregnant Women visiting the hospital. Methodology: The present study was planned in Department of Pathology, Anugrah Narayan Magadh Medical College and Hospital (ANMMCH), Gaya, Bihar for a period of 9 months. In the present study, 120 pregnant females’ samples received for the platelet estimation were enrolled in the present study out of which 60 (50%) had thrombocytopenia and 60 (50%) were without thrombocytopenia. The records of pregnant women with proved platelet abnormalities and normal pregnancy at 2nd/3rd trimester. Relevant data were obtained from case files like socio-demographic characteristics of mothers, obstetric history, signs and symptoms in mother at presentation, laboratory data, and maternal and perinatal outcomes. Those cases with pre-existing hypertension, having associated co morbid diseases such as diabetes mellitus, auto immune disorders, ITP, neoplastic diseases, heart diseases and cases on anticoagulants were excluded from the study. All the patients were informed consents. The aim and the objective of the present study were conveyed to them. Results: The commonest age group in cases as well as controls was 21-25 years (38.3% and 41.7% respectively) followed by less than 20 years of age group (28.3% and 26.7% respectively). Most of the cases belonged to the mild preeclampsia (50%) group followed by cases with severe preeclampsia (25%). The incidence of eclampsia was found 8%. Conclusion: From this study, it can be concluded that clinically platelet indices can be a useful screening test for early identification of preeclampsia and eclampsia. Also platelet indices can assess the prognosis of this disease in pregnant women and can be used as an effective prognostic marker because it correlates with severity of the disease.

11. Comparative Study of Complications and Continuity Rate in IUD Placed Right After Childbirth and the Delayed Insertion
Sudha Malini Parvathareddy, Jahnavi Ethakota
Objective: To compare the continuity and complications arising from intrauterine device (IUD) insertion immediately after childbirth with delayed insertion at postpartum visit. Methods: The patients age, parity, socioeconomic status, breast feeding were matched in 200 patients who have delivered vaginally in a tertiary care centre and 100 each were allotted to the two subgroups and they were followed for an year for complications and continuity rate. Results: The study found a five times increased risk of expulsion, six time increased risk of threads coming out, abnormal bleeding patterns three times more in IUD inserted immediately after childbirth when compared to delayed insertion. There were no cases of perforation or unwanted pregnancies in both the groups.

12. Interconnection between the Timing of Physical Activity and Control of Diabetes in Type 2 DM Patients
Elavarasi Sivakumar, V. Saranya, Porchelvan Swaminathan
Aim: To associate the timing of Physical activity and control of Diabetes in Type 2 DM patients. Objective: To study the timing of Physical activity in Type 2 Diabetes mellitus patients. Background & Introduction: Type -2 Diabetes mellitus, is one of the common chronic diseases, where there is a disturbance in using the excess glucose getting entering into the blood. Thereby high glucose levels in the blood lead to disorders of the nervous, circulatory, and immune systems. Physical activity promotes positive self-image and good well-being. World health organization defines physical activity as any body movement in which the skeletal muscle is taking part that requires a lot of energy. Regular physical activity helps to decrease the morbidity from many non – communicable diseases. Knowledge about regular physical activity, type of physical activity and the timings to be followed to perform the activities among diabetes patients results in control of their glycemic status. Methods and Methodology: 500 known cases of Type 2 Diabetes patients were enrolled in the study. Reports necessary for glycaemic status are collected. Physical activity or exercise history obtained from the patients. Results: The person who did regular physical activity had better control of diabetes than those who did not do regular physical activity. Conclusion: Globally it is very important to promote the importance of physical activity which can act as a single component that can reduce the risk of developing early complications and also act as a vital component for the prevention as well as management of type 2 diabetes. It must also be recognized that regular physical activity in improving the abnormalities in the metabolism of type 2 diabetes is probably the highest. This study helps to be aware of the morbidity associated with their lifestyle habits. Further, it also helps in changing their lifestyle from a sedentary lifestyle which will help in reducing the higher glycemic status and comorbidities.

13. Studies on Feruloyl Esterase Enzyme from Pleurotus Ostreatus Hp-1: Production, Statistical Optimization, Purification and Biochemical Characterization
Meghna N. Diarsa, Akshaya Gupte
An extracellular feruloyl esterase (FAE) was produced from Pleurotus ostreatus HP-1 through solid state fermentation using banana pseudostem. Statistical optimization increased the enzyme production by 1.22 fold on the 9th of fermentation with an activity of 3651U/gm. The FAE enzyme was purified using size exclusion chromatography and confirmed using native and SDS-PAGE in which enzyme showed the monomeric protein with an estimated molecular mass of 28 KDa.  The maximum catalytic activity was obtained at pH-6 at 30°C. FAE exhibited pH stability in the range of 5-7 with temperature tolerance up to 40°C. Enzyme also showed the tolerance in presence of various metal ions in which Co+2, Mn+2, and Ni+2 influenced its activity by 1.01, 1.34 and 1.47 times at 10 mM concentration. The enzyme also exhibited higher activity in presence of non-polar organic solvents i.e., benzene, hexane and chloroform with increment of 105.49%, 72.37% and 67.28%, respectively while polar solvents reduced (methanol, ethanol) the enzyme activity by 90%.

14. A Cross-Sectional Observational Assessment of Erectile Dysfunction in Patients of Type 2 Diabetes Mellitus and its Association with Cardiovascular Risk
Pushp Raj Kumar
Aim: The present study was planned to access CAD risk in T2 DM patients with erectile dysfunction. Methods: In this cross-sectional observational study 200 diabetic patients (who visited to hospital attending medicine OPD) recruited which was diagnosed according to ADA revised criteria. This study was conducted for the period of two years in department of General medicine AIIMS Patna, Bihar, India. Results: Out of 200 diabetic patient ED was present in 68 (34%) and ED was absent in 132 (66%). maximum frequency of moderate ED 44.11% was found then severe ED 32.35%, mild to moderate ED-14.70% and mild ED-8.82%. The age showed insignificant (p>0.05) relation with ED. Prevalence of ED was 34% in diabetic population. %. Duration of the diabetes, FBS and PPBS showed a significant correlation (p<0.05) with ED. Age, HbA1C, ASCVD risk showed insignificant (p>0.05) relation with ED. ASCVD risk showed insignificant (p>0.05) relation with ED. Maximum patients aged 46-55 years in moderate ED, severe ED found maximum in 35-45 years age group. BMI showed insignificant (p>0.05) relation with ED. Conclusion: Poor glycemic control is a risk factor for ED. Fasting blood sugar and postprandial blood sugar showed significant (p<0.05) relation with ED. HbA1c show an insignificant correlation (p>0.05) with ED. Duration of diabetes have been associated with an increased risk of ED.

15. A Hospital Based Comparative Clinical Assessment of Intravenous Magnesium Sulphate and Lignocaine in Attenuation of Pressor Response to Laryngoscopy and Endotracheal Intubation
Anant Prakash, Rahul Kumar, Krishna Kumar
Aim: This study was undertaken with the objective of comparing the effectiveness of magnesium sulphate and lignocaine for attenuation of pressor response during laryngoscopy and intubation at dosages of 30 mg/kg and 1.5 mg/kg respectively. Methods: This study was undertaken in Department of Anesthesiology, Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar and the duration of study was 1 years. Institutional Ethical committee clearance was obtained for the study. Informed written consent was obtained from all patients. 100 ASA 1 patients in age group of 18-40 years of either gender scheduled for elective surgeries under general anaesthesia with endotracheal intubation. Results: There was no statistically significant difference between the groups with regard to demographic parameters. There was no significant change in HR, immediately after intubation, in both MgSO4 and lignocaine groups. In lignocaine group, at intubation, there was a rise in SBP from baseline which was not significant. Rise in DBP was seen at intubation with greater rise in group M but it was neither clinically nor statistically significant. There was an increase in MAP immediately after intubation, which wasn’t significant. Conclusion: MgSO4 30 mg/kg given intravenously as infusion over 10 minutes prior to induction and lignocaine 1.5 mg/kg given 90 seconds before intubation were comparable in attenuating pressor response to laryngoscopy and intubation with no clinically significant prolongation in time taken to extubate in MgSO4 group.

16. An Institutionalized Randomized Comparative Assessment of Long Proximal Femoral Nail versus Short Proximal Femoral Nail in Treatment of Unstable Intertrochanteric Fractures
Kumar Mayank, Ranjan Kumar Prakash, Dilip Kumar Singh
Aim: The purpose of this study was to evaluate and compare the effectiveness and the disadvantages of intramedullary devices, i.e. short vs long pfn in the management of unstable IT fractures. Methods: The present study was conducted at department of Orthopaedics Jawahar Lal Nehru Medical College & Hospital, Bhagalpur, Bihar, India for one year and with trochanteric fractures were operated at our tertiary care hospital. Out of the 100 patients, Group A patients were operated with short Pfn and Group B were operated with long pfn. Results: The mean age of patients in both groups was 64.36 ± 8.32 years and 65.36 ± 8.40 years respectively and did not differ significantly (p =0.662). Further, the subjects of two groups were also gender matched as the number of females and males 60% and 20% in group A and 58% and 42% in group B respectively. The mean operative time was significantly lower in group B as compared to group A (35.25 ± 6.03 minutes vs. 43.37 ± 8.12 minutes, (p <0.001). Mean blood loss was also significantly lower in group B as compared to group A (59.81 ± 14.96 ml vs. 77.83 ± 17.33 ml, (p<0.001). The mean number of images taken per-op was significantly lower in group B as compared to group A (18.62 ± 3.17 vs 29.51 ± 4.86 (p <0.001). Conclusion: Use of Long PFN has advantages over short PFN in terms of the less postoperative complications like peri implant fracture and anterior thigh pain & better functional outcome. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning and accurate instrumentation.

17. Clinical Assessment of Hyponatraemic Dehydration in Neonates and Children Aged Till 12 Years: An Observational Study
Ashwani Kumar Mishra, Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal, Gopal Shankar Sahni
Aim: The aim of the present study was to estimate the incidence of hyponatraemic dehydration in neonates and children aged till 12 years. Methods The prospective study was conducted in the Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for the period of one year and Study population consisted from Infants to children aged till 12 years attending the pediatric Department both OPD and IPD care for acute gastroenteritis are enroll in the study who was satisfying the criteria for Moderate to severe dehydration. A total of 100 Children including neonates were enrolled in the study. Results: It was found that 60% of the males were having acute gastroenteritis while it was 40% in female subjects. The data also reveals that higher incidence of acute gastroenteritis was noted between 6 to 24 months of age while the lower incidence was found in the subjects above 36 months of age. Hyponatremia was occurred in 37 subjects with high incidence in lower age group in both the genders. Males were more affected than females. Lowest sodium level was 127 mmol. Among 100 individuals, 28 were severely dehydrated and rest of them was moderately dehydrated (59). The number of episodes of loose stools was correlating with the extent of dehydration. Higher the episodes the severe were the dehydration. Conclusion: The study suggested that routine estimation of serum electrolytes is not necessary however it is necessary whenever electrolyte imbalance is suspected on clinical grounds and in cases which do not respond satisfactorily with routine fluid electrolyte therapy.

18. A Hospital Based Comparative Assessment of Laparoscopic Cholecystectomy with Spillage versus Without Spillage of Gall Bladder Contents
Roshani Prasad, Binod Kumar Jaiswal
Aim: This study was conducted to assess and compare Right shoulder Tip Pain after laparoscopic cholecystectomy with spillage versus without spillage of gall bladder contents patients, diagnosed, admitted and operated. Methods: The present Study conducted at department of General Surgery, JLNMCH, Bhagalpur, Bihar, India and all the patients undergoing laparoscopic cholecystectomy at the dept. of general surgery in JLNMCH, Bhagalpur, Bihar were included. The time period of the study was 12 months. The 100 consecutive patients were selected from indoor patients admitted with cholecystitis with or without gall bladder stone and undergone laparoscopic cholecystectomy during the study period. Results: There was no significant difference in the demographic data between both groups. There was no significant difference in HR mean value between both groups throughout the perioperative period. There was no significant difference in MAP between both groups throughout the perioperative period. The NRS mean value in group 2 was 1.16±0.72, 2.06±1.54,    4.86±2.08,    0.91±1.41,    1.52±1.73,    and 1.78±1.59 at time 0, 2, 6, 12, 18, and 24 h, respectively. There was significant increase in NRS at 6 h postoperatively compared with preoperative mean value (p=0.001). In group 1, NRS mean value was 0.78±0.72, 1.45±1.25,    1.55±1.25,    4.46±2.18,    1.29±1.60,    and 1.50±1.25 at preoperative, 2, 6, 12, 18, and 24 h, respectively. There was significant increase in NRS at 6 h and 12 h compared with preoperative mean value (p=0.001). Conclusion: We showed that mean Right Shoulder Pain was significantly lower in without Spillage group compared to with Spillage group.

19. Diagnostic Role of FNAC on Parotid Gland Swellings in Order to Determine its Usefulness in the Planning of Parotid Gland Surgery: A Observational Study
Prashant Kumar, Gyanendra Kumar, Pradeep Kumar Singh
Aim: The aim of the present investigation was to assess the diagnostic accuracy of FNAC, on parotid gland swellings, in order to determine its usefulness in the planning of parotid gland surgery. Methods: The present study was conducted in the Department of Pathology, Government Medical College, Bettiah, Bihar, India and 100 patients were included in the study for the period of 1 year. All patients underwent FNAC under US guidance following clinical examination. In order to obtain homogeneous and comparable data, only FNAC performed in the Institute were considered. All details regarding demographic and clinical data, including age, sex, previous surgery, timing of symptoms, cytological and histological results, site and volume of the lesions, involvement of histological sample margins and relapses were saved in an electronic database. Results: FNAC samples were obtained in 100 cases. FNAC results were “non-diagnostic” in 22 cases (22%), “inflammatory/ benign lesion” in 70 (70%), “malignant neoplasm” in 8 (8%). In the present study, pleomorphic adenoma was in 45 patients (56.25%) and Warthin’s tumour in 20 (25%). Adenocarcinoma (2.14%) was the most common malignancy, followed by Mucoepidermoid carcinoma (2.5%) and squamous cell carcinoma (2.14%). The most common histopathological diagnosis was “benign lesion”, that occurred in 70 patients (87.5%). FNAC showed a sensitivity of 81% and a specificity of 99%. Accuracy for malignancy was 97%, accuracy for a benign lesion was 83%, overall diagnostic accuracy was 97%. Conclusion: Our study suggests that preoperative FNAC plays a useful role in the accurate diagnosis of parotid tumors. It is a safe and effective diagnostic modality for the treatment of patients with parotid tumors. Fine needle aspiration cytology is a reliable, cost-effective, well tolerated and an easy procedure to perform.

20. A Hospital Based Observational Assessment of Histopathological Changes of Endometrium in Women with Dysfunctional Uterine Bleeding
Ranu Singh Kushwaha, Ankita Ranjan, Kumari Divyamala
Aim: The aim of the present study was to understand the pathogenesis of dysfunctional uterine bleeding by noting different types of Histopathological changes of endometrium by dilatation and curettage. Methods: The study was conducted at Department of Obstetrics and Gynaecology, Nalanda Medical College and Hospital, Patna, Bihar, India for one year. In this study 100 women with complaints of abnormal uterine bleeding were selected from OBG OPD of NMCH. Results: In between the age group of 16-20 years 4 cases were seen, 21-25 years age group 21 cases were seen, 26-30 years age group 20 cases were seen, 31-35 years age group 19 cases were seen, 36-40 years 31 cases were seen, and in between 41-45 years 5 cases were seen. So the maximum incidence as seen in the age group of 36-40 years following 21-25 years age group. Minimum incidence was in the age group 16-20 years. Heavy menstrual bleeding was the most common symptom accounting for 55% of patients followed by postmenopausal bleeding accounting for 18% with the least being menometrorrhagia (3%). Proliferative phase was the most common histological finding accounting for 37% followed by secretory phase accounting for 23 and disordered proliferative endometrium 15% and the least commonly seen were complex hyperplasia with atypia 1%, complex hyperplasia without atypia 1%, endometrial adenocarcinoma 1% & carcinosarcoma 1%. Conclusion: Histopathological pattern of endometrium helps in finding the cause of dysfunctional uterine bleeding. Dilatation and curettage serves diagnostic and therapeutic purposes in DUB.

21. A Hospital Based Analytical Comparative Assessment of Yoga on Sympathetic Nervous System of Human Body
Shanta Kumari, Rajiva Kumar Singh
Aim: The aim of the present study was to evaluate the effects of yoga on sympathetic nervous system in yoga practitioners. Material and Methods: The present prospective case control study was conducted in the Department of Physiology, Patna Medical College, Patna, Bihar, India for the period of one year. The findings were tabulated and subjected to statistical analysis. Case group (N=30): subjects who were performing regular yoga asanas and relaxation techniques for at least 5 years. Control group (N=30): age and gender matched subject who were not performing yoga asanas and relaxation techniques or were not engaged with any other type of physical exercises. Results: Amongst the sympathetic nervous system parameters, statistically significant difference existed between cases and controls for the Resting Heart Rate, Resting Diastolic Blood Pressure, Hand grip systolic blood pressure and Hand grip systolic blood pressure (p<0.05) respectively. Conclusion: The present study concluded that yogic activity significantly alters the sympathetic activity like heart rate and blood pressure. With expanded mindfulness and enthusiasm for wellbeing, one ought to embrace the non-pharmacological strategies like Yoga exercise, reflection and way of life alteration to control the modifiable hazard factors responsible for cardiovascular morbidity and mortality.

22. A Hospital Based Observational Assessment of Cardiac Functions in Patients with Chronic Kidney Disease (CKD)
Pushp Raj Kumar
Aim: The aim of the present study was to assess the cardiac functions in patients with chronic kidney disease (CKD). Methods: An observational study was carried out in 100 patients from department of medicine from AIIMS Patna, Bihar, India for the period of one year after obtaining an approval from institutional ethics committee. Data were collected in the predesigned Patient Profile Form along with complete laboratory reports and all relevant history. All the patients were gone through two-dimensional and M mode echocardiography for determination of their cardiac functions. Results: This study included 100 patients with 60 (60%) male and 40 (40%) female who were diagnosed with chronic kidney disease (stage 1 to 5) or End stage renal disease based on laboratory interpretation of GFR (<90 ml/min/1.73 m2) and serum creatinine (>3 mg/dl). Among that 65 (65%) patients were hypertensive (BP >140/90 mmhg) and 35 (35%) were normotensive. Echocardiography showed that left ventricular hypertrophy (LVH) was present in 75 (75%). Systolic dysfunction as measured by reduced fractional shortening (<25%) and decreased LVEF (<52%) was present in (8) 8% and 18 (12%) respectively. In hypertensive patients with CKD, LVH was present in 40 patients, diastolic dysfunction was present in 45 patients as deliberate by abnormal E/A ratio, systolic dysfunction as considered by reduced LVEF was present in 7 patients and pericardial effusion observed in 17 patients. Conclusion: LV diastolic dysfunction also happens in patients who having the early stage of CKD. Hypertensive patients along with CKD had found higher widespread presence of diastolic and systolic dysfunction as compared to normotensive.

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

24. A Hospital Based Study Assessing Epidural or Intrathecal Morphine for Post-Operative Analgesia Following Laparoscopic Endometriosis Surgery: An Observational Study
Soumya Singh, Amit Kumar Singh, Uma Shanker Singh
Aim: The aim of the present study was to assess epidural or intrathecal morphine for post-operative analgesia following laparoscopic endometriosis surgery. Methods: The present study was conducted at department of Anesthesiology, AIIMS, Patna, Bihar, India for 10 months and 100 patients were included in the study. Results: Majority of the patients (28%) were belonged to overweight (25.00–29.99) category followed by 22% Obesity class III (≥40). 75% cases completed ≤12 years of school and 65% were married. 65% had no analgesia followed by 32% non-opioid analgesia. Mean pain scores were significantly higher at one week (1.62, 𝑃 < 0.0001), four weeks (0.63, 𝑃 = 0.02), and six months (0.27, 𝑃 = 0.04), but not at three months following surgery. During the first two postoperative days, opioid analgesia (98%, 𝑃 = 0.09) and NSAIDS (60%, 𝑃 = 0.7), a significantly higher proportion of patients required Paracetamol (95%, 𝑃 = 0.03). At 3–5 days after surgery. Analgesic use was comparable between groups after 60 days after surgery. Conclusion: The results of this study showed that laparoscopic surgery for endometrial cancer is associated with less need for epidural and postoperative analgesic prescription compared with open surgery, saving on costs of analgesia and highlighting a further significant benefit to patients and the healthcare system of laparoscopic treatment over traditional open abdominal surgery.

25. An Observational Assessment of Bacterio-Etiologic in the Course of Disease and Their Drug Sensitivity Pattern of Sputum in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)
Sunil Kumar, Abishek Anand
Aim: The study was carried out to find out the bacterial etiology in the course of disease and their drug sensitivity pattern. Methods: All hospitalized patients diagnosed with AECOPD admitted in the Department of general medicine, BMIMS, Pawapuri, Nalanda, Bihar, India for the period of one year were evaluated. The individual bacterial isolates and their sensitive pattern to various antibiotics were also recorded in all 100 patients. The study was carried out and COPD was diagnosed according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines. Results: Out of 100 patients, clinically diagnosed as AECOPD, 80% were males and 20% were females.  38% patients were in the age group 56-65 years followed by 66-75 (24%) age group. Out of a total 100 cases, forty-four (44%) were positive for pathogenic bacteria and fifty-six (56%) were non-pathogenic. Out of forty-five pathogenic bacteria, K. pneumoniae was the commonest (35.55%) followed by P. aeruginosa (22.22%), S. aureus (15.55%), S. pneumoniae (11.11%), S. pyogenes (6.66%). Among antibiotics, Amikacin was found highest sensitive followed by Azithromycin (68.68%), Amoxycillin Clavulanic acid (66.66%), Ciprofloxacin (62.22%) and Gentamycin (55.55%). However, Levofloxacin and Co-trimoxazole were found to be highly resistant 68.88% and 62.22% respectively among the drugs used in culture and sensitivity of 45 isolated pathogenic bacteria. Conclusion: Repeated exacerbation and hospital admission leads to a major impact on the quality of life of patients with COPD. Antibiogram helps in screening resistant pathogens and prescribing right treatment protocol.

26. A Questionnaire-Based Assessment of the Use of Cuffed Endotracheal Tubes in Paediatric Anaesthesia amongst Indian Anaesthesiologists
Vinit Kumar, Priyanka Hansda, Pawan Kumar, Mrityuanjay Kumar, C D Ram
Aim: The aim of the present study was to understand the current practices regarding the use of cuffed endotracheal tubes in paediatric anaesthesia amongst Indian anaesthesiologists. Methods: The present study was conducted at department of Anesthesiology, SNMMCH, Dhanbad, Jharkhand, India for one year and we formulated a questionnaire intended to assess the use of cuffed endotracheal tubes in pediatric age-group by pediatric and general anaesthetics in India. The questionnaire was also designed to evaluate practices related to the use of cuffed endotracheal tube in pediatric age group, such as the medium used for inflation of the cuff and whether or not cuff pressure monitoring was done during surgery. Results: In our study, 46% anaesthetists were in the age range of 40 – 60 years, 44% in the range of 25 to 39 years, 8% above 60 years, while the remaining minority in the age group of less than 25 years. In our study, 41% respondents were males, while 59% were females. Only 6% were pediatric anaesthesiologists and 32% has experience more than 20 years. More number of cuffed ETT has been used in the age group of 2 to 8 years children however more number of uncuffed ETT has been used up-to 2 years aged children. 2000 children with cuffed ETT and 550 children with uncuffed ETT belonged to 2-8 years. There were more females who underwent cuffed and uncufed ETT as compared to males. Conclusion: In our study, we concluded that more number of cuffed ETT has been seen to be used by the practitioners who are in the age group of 25 to 40 years. More number of cuffed ETT has been used by female practitioners for pediatric anaesthesia. Strong association has been observed with practitioners with less than 10 years post PG experience preferring cuffed ETT while those with post PG experience of > 20 years preferring uncuffed ETT. We also concluded that majority practitioners prefer uncuffed ETT in neonates and in children between 1 month to 2 years of age while most of them prefer cuffed ETT in children above 2 years of age.

27. Comparative Evaluation of Operative Site Infection and Consequences in Clean and Clean-Contaminated Elective Hernia Operations with Single and Multi-Dose Antibiotics
Nitish Prabhakar, Ajit Kumar
Aim: The aim of the present study was to assess the impact of single and multiple-dose antibiotics in clean and clean-contaminated elective hernia surgeries concerning surgical site infection and associated complications. Methods: This prospective, longitudinal study was conducted for a period of 12 months at Department of General Surgery, Government Medical College, Bettiah, Bihar, India. 200 suitable patients who were admitted for elective groin surgery were included in this study were randomly assigned into two groups (n=100) single-dose pre-operative (SD) group and multiple-dose (MD) in each group. Results: Data collected from both single antibiotic group I (n=100) and group II multidose group (n=100) who underwent elective hernia surgery. Out of 100 patients of group SD, only 15% of patients developed surgical site infection compared to none in group MD. Statistically, there was no appreciable difference in the incidence of SSI in both SD and MD groups with a p value of 0.310. Main complaints by many patients in the post-operative period were pain and headache managed well with intravenous fluids for spinal headache and analgesics. Seroma was found on the 3rd postoperative day in 5 patients in group I, fluid aspirated, and culture turned out to be negative. Conclusion: This study on antibiotic prophylaxis for hernia repair consisted of two groups with one group received a single-dose antibiotic and the other group a multi-dose antibiotic and its outcome on surgery related infections. It was found that the rate of infections is quite similar in SD and MD antibiotics thereby making single-dose antibiotics prophylaxis as effective as multiple doses of antibiotics prophylaxis.

28. A Hospital Based Descriptive Cross-Sectional Assessment of Refractive Error
Bidisha Rani, Kaushal Kishore Mishra, Arun Kumar Sinha
Aim: The aim of the present study was to determine refractive error study in western region of Bihar region. Methods: This cross-sectional study was conducted at department of Ophthalmology, Bhagwan Mahavir Institute of Medical Sciences for 12 months. Total 540 children of age group 6-16 years of the selected school were screened for visual acuity testing using Snellen’s Chart for distance and Jaeger’s chart for near with the help of experienced optometrist in the respective class. Among 540 children screened at school, 100 were found to have refractive errors. Results: Out of 100 children diagnosed to have refractive errors, myopia was seen in 62 cases (62%), hypermetropia in 15 cases (15%) and astigmatism in 23 cases (23%). Among the cases of refractive errors, 18 cases (18%) were in the age group of 6to ≤9 years, 30 cases (30%) in the age group of >9 to ≤12years and 52 cases (52%) in the age group of >12 to≤ 16 years. Maximum numbers of cases were seen in the age group of >12 to≤ 16 years. By applying Chi-square test we found a significant association between age and refractive errors. Among the total study participants diagnosed to have refractive errors, according to the proposed revision of categories for visual impairment 90% of the cases had mild visual impairment and 10% cases had moderate visual impairment. No cases in the category of severe visual impairment and blindness were observed. Conclusion: Majority of children had visual impairment in the form of simple myopia and low degree astigmatism. Early screening and timely correction of refractive errors plays key role in preventing its consequences.

29. A Prospective Observational Assessment of the Clinico-Etiologic Profile of Visual Impairment
Kaushal Kishore Mishra, Bidisha Rani, Arun Kumar Sinha
Aim: The aim of study was to assess the clinical profile of causes of visual impairment in Bihar Region. Methods: A study was conducted in Department of ophthalmology Bhagwan Mahavir Institute of  Medical Sciences, Pawapuri, Nalanda, Bihar, India for 1 year. The study participants included 100 patients irrespective of their age group, coming in the OPD of the Ophthalmology. Informed consent was obtained and patients were interviewed by the investigators and information was entered, based on a pre-tested pre-designed proforma. Results: The majority of the participants (36%) were middle-aged belonging to the age group of 41-60 years; while the least (3%) were those aged more than 80 years. The participants studied were grouped into; no visual impairment i.e. 70 (70%), visual impairment Grade 1 i.e. 20 (20%), Grade 2 i.e. 5 (5%) or blindness Grade 3 i.e. 3 (3%), Grade 4 i.e. 2 (2%) based on WHO classification of low vision1. In our study, 61% of the study participants i.e. 61 were found to have refractive errors. 6 participants (6%) presented with retinopathy due to diabetes or hypertension. 2 patients i.e. 2% had macular diseases such as age related or hereditary macular degeneration. Conclusion: A high prevalence of refractive errors and cataract was noted, which are both causes of preventable blindness and can only be prevented by creating awareness by means of health education.

30. A Hospital Based Retrospective Assessment of Emergency Presentation and Immediate Outcome of Children with Autoimmune Hemolytic Anemia
Partha Kumar Chaudhuri, Divya Singh, Pawan Kumar , Bhuwan Kumar Singh
Aim: This study aims to analyze the clinical spectrum, severity of anemia, challenges in arranging cross matched blood in the emergency department (ED), and treatment outcomes of children with autoimmune hemolytic anemia (AIHA). Material & Methods: This was a retrospective analysis of data from our digital medical records database. Children, less than 18 years of age diagnosed with AIHA, admitted to the Department of Paediatrics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, in between one year were enrolled in the study. Our study included 30 children aged 1 month–18 years. Results: Females constituted 60% of the study population. The most common clinical feature at diagnosis was fever (70%) followed by pallor (53.34%), fatigue (23.33%), jaundice and skin rash (20% each), bleeding manifestations in 16.66%, and joint pain in 6.66% of children. Positive DAT was 4+ in three children, 3+ in eight children, 2+ positive in seven children, and 1+ positive in 12 children. Mild, severe, and very severe anaemia were observed in 20.7%, 66.66%, and 13.34%, respectively. About 40% (n=12) of cases required intensive care treatment. The reasons for transfer to the intensive care unit were cardiorespiratory failure (10%), severe anemia with congestive cardiac failure (10%), diphtheritic myocarditis with acute kidney injury (3.4%), fulminant hepatic failure (3.34%), severe thrombocytopenia with intracranial hemorrhage (3.34%), respiratory distress (3.34%), and very severe pneumonia (6.66%). AIHA was classified as primary (idiopathic) in 6 cases (20%). AIHA was secondary in 24 cases (80%) such as infection triggered (n=8), systemic lupus erythematosis (n=5), connective tissue disorder (n=4), Evans syndrome (n=3), Wilson disease (n=1), acute leukemia (n=1), neonatal diabetes (n=1), and pure red cell aplasia (n=1). Conclusion: Identifying secondary causes of pediatric AIHA are essential and larger data from multiple centers will contribute toward creating the best clinical approach and emergency management of children with AIHA.

31. A Comparative Assessment of the Effect of Amlodipine, Atenolol, Enalapril and Thiazide on Hemodynamic Parameters and Renal Function Tests in Hypertensive Patients
Ashoka Kumar Chowdhury
Aim: The aim of the present study was to study effect of amlodipine, atenolol, enalapril and chlorothiazide on arterial blood pressure, heart rate and renal function tests. Methods: The study was carried out in the Department of Pharmacology, Sri Krishna Medical College, Muzaffarpur, Bihar, India for 1 year. Total 100 patients with hypertension were included in the study. These patients were assigned to one of the 4 groups randomly. 4 There were 25 patients in each group. Patient prescribed with tablet amlodipine 5mg or 10 mg was be considered as Group I, likewise, prescription of tablet atenolol 25 mg or 50 mg was be considered as group II, prescription of tablet enalapril 2.5 mg or 5 mg was considered as group III and prescription of tablet thiazide diuretics 12.5 mg or 25 mg was be considered as group IV. Results: Mean change in systolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease in blood pressure was seen by Enalapril followed by thiazides, Atenolol & Amlodipine. Mean change in diastolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease in blood pressure was seen by Atenolol followed by amlodipine, enalapril & thiazide. Mean change in systolic blood pressure was analyzed by chi square test. It was statistically significant. Highest decrease in blood pressure was seen by Atenolol followed by enalapril, amlodipine & thiazides. Mean change in blood urea was analyzed by chi square test. It was statistically significant. Highest decrease in blood urea level was seen by Thiazides followed by enalapril, amlodipine & atenolol. Conclusion: Antihypertensives have effect on blood pressure, heart rate, renal functions. Patient’s renal function, heart rate should always be considered while prescribing antihypertensive drugs.

32. Study Of Incidence, Etiology, Presentation, Complication and Outcome of Acute Renal Failure ln Children 1-15 Years
Nagendra Nath, Bhupendra Narain
Aim:  The aim of the present study was to determine the incidence of acute renal failure in children. Material and Methods: A Prospective observational study with 78 patients with ARF were included in the Upgraded Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India  in between one year from April ‘2015 to March’ 2016. Systematic record of case history, physical signs of patients with ARF was recorded. Blood, urine, kidney tissue and other necessary tests of patient carried out.  X-Ray, USG, ECG and other investigation reports of patient done during hospital stay. Results: Most common cause of ARF in children in our study was Acute gastroenteritis (18 cases, 23.07 %,) followed by post streptococcal glomerulonephritis (16 cases, 20.51%). six cases were due to pneumonia and four cases each were due to sepsis, Pyogenic meningitis, systemic lupas erythematosus (SLE), pyelonephritis and posterior urethral valve (PUV) each. According to age distribution of cases, 12 cases (15.38%) were admitted in 1 to 2 year age group (age up to 2 year included). Similarly 22 cases (28.20%) were admitted in 2 to 5 years age group (age above 2 year and up to 5 years included) and 44 cases (56.41%) were admitted in 5 to 15 years age group (age above 5 years and up to 15 years ). Conclusion: ARF in children was most commonly found in 5 to 15 years age group (53.84%). DIC and arrhythmia were the two worst complications with high mortality rate. Dialysis remains the most important tool to bridge the time needed for recovery of renal function. The awareness of prevention, early diagnosis and proper management can also change the mortality rate significantly as seen in acute gastroenteritis cases.

33. Effectiveness of Electrocoagulation in Laparoscopic Cholecystectomy for Cystic Artery and Cystic Duct Occlusion with Just One Absorbable Clip
Yogesh Agarwal, Pawan Kumar, Anand Agarwal, Anil Kumar Gupta
Background: The standard method of treating gallbladder problems is laparoscopic cholecystectomy (LC), but there is disagreement over the best way to ligate the cystic duct and artery. The shortcomings of conventional metal clips have sparked interest in absorbable clips. However, difficulties arise when using numerous expensive ultrasonic devices and huge clips. Methods: Patients undergoing LC participated in the trial, which was conducted in Mahatma Gandhi hospital attached to RVRS medical college, Bhilwara. For occlusion, different clips were used. We gathered information on demographics, surgical specifics, and postoperative results. Results: In contrast to Group 2 (56.08 17.04 min, 12.07 0.17 ml, no particular deviation was given), Group 1 had a shorter operating time (40.18 14.19 min), more blood loss (13.06 0.7 ml), and a shorter hospital stay (2 days). In Group 1 (7.01 0.6), Calot’s triangle measures were larger than in Group 2 (3.01 0.52). In-depth investigation is required to adequately evaluate these results. Conclusions: A safer and more efficient alternative is electrocoagulation with a single absorbable clip for cystic duct blockage in LC. It makes the process simpler, cuts down on expenses and operative time, and avoids issues like slippage and migration. The hazards of foreign bodies and imaging artefacts are removed by absorbable clips. In the care of gallbladder disease, this strategy may boost patient outcomes, lower costs, and improve surgical procedures.

34. Evaluation PFT and BMI in Obese V/S Non-Obese Individual in Different Age Groups
Kumari Abha, Chandrakant Prasad, Dinesh Kumar
Aim: The aim of the present study was to evaluate and compare pft and bmi in obese and non-obese individual in different age groups. Methods: The present study was carried out in department of Physiology, Government medical college, Bettiah, Bihar, India for one year. A total of 100 subjects – 50 in each of the two BMI categories, i.e., obese, and normal weight were selected by stratified random sampling technique after applying the inclusion and exclusion criteria. Subjects were categorized into the two groups (obese and normal weight) based on the BMI classification according to the WHO standards. Ethical clearance was obtained from the institutional ethics committee before starting the study. Results: A total of 100 cases (obese = 50, non-obese= 50) were included. Of 50 children with obesity/over‑weight, 38 (76%) were boys. Among non-obese, 28 (56%) were boys. The mean (± SD) age of children with obese was 10.6 (± 2.38) years compared to 10.1 (± 2.38) years among the non-obese. The mean (± SD) weight of the non-obese group was 32.4 (± 6.64) kg, and that of the obese group was 56.5 (± 12.8) kg. The mean height (± SD) of the non-obese and obese group was 139 (± 9) cm and 142 (± 12) cm, respectively. The highest mean FVC was in subjects of the non-obese group and the lowest was found in the obese category. The highest mean values 98.55 were in the obese category followed by the overweight category 96.34 and the least values were in the normal weight category 94.35. The ANOVA analysis between the groups indicated that the values were significantly different between the group and the p values were less than 0.05. The FEV1 (liters) values in the non-obese group, the values were 1.85± 0.35 and in the obese group with lowest values 1.48 ± 0.22.  The lowest mean values were found to be present in the obese group of subjects. The highest mean values were found in non-obese subjects. The ANOVA analysis revealed the p values were >0.05 hence no significant intra or intergroup difference. Conclusion: The study concluded that increasing BMI has a negative effect on pulmonary functions. Therefore, awareness to maintain normal BMI by lifestyle modifications and interventions might help us in moving forward for eradication of obesity and impairment of pulmonary functions.


35. A Hospital Based Analytical Observational Assessment of the Effect of Yoga on Respiratory Endurance Test in Medical Undergraduates
Kumari Abha, Chandrakant Prasad, Dinesh Kumar
Aim: The aim of the present study was to investigate the effect of yoga on respiratory endurance test in medical students. Methods: This study was conducted in the Department of Physiology, Government medical college, Bettiah, Bihar, India. After approval of Ethical Committee, eighty medical students between the age group of 18 to 24 years (20 ± 2 years) of both the sexes were selected. Informed and written consent were taken from all the participants involved in the study. The duration of the study was six months. 100 normal medical students of MBBS were randomly selected and included in our study. Results: The MVV, 40 mm endurance and chest expansion were significantly increased (p<0.005) in the pranayama group (Group-II) and suryanamaskar group (Group-III). But the RR was significantly decreased (p<0.005) in pranayama (Group-II), suryanamaskar (Group-III) and combined group (Group-IV) than control group (Group-I), (p<0.005). Conclusion: The regular practice of pranayama and Suryanamaskar practice induces more beneficial effects than physical exercise which mostly affects skeletal muscles.

36. Post MI VSR – Clinical Characteristics, Interventions and Patient Outcomes in the Interventional Era
G. Selvarani, G. Nagasundar, K. M. Nisamudeen, S. R. Veeramani, S. Balasubramanian, G. S. Sivakumar, R. R. Saravanan, S. Sathish Kumar, T. R. Hemanath, M. Saravanan
Introduction: VSR is a rare but devastating complication after acute MI. Objective is to study prevalence and clinical characteristics of post MI VSR patients. To find out role of Trans Catheter Device Closure at its impact in outcomes of VSR patients. To devise effective prevention and management strategies in VSR patients and to assess outcomes and long term survival analysis of VSR patients. Materials & Methods: Population of study comprises of adult patients presenting to Department of Cardiology with VSR after acute MI for period from August 2017 to August 2022. Results: Out of 54 cases of post MI VSR, 29 cases were male (53%), 25 were female (46%). The highest incidence occurred involving age group between 51-60 years.46 cases(85.2%) had AWMI and 8 cases (14.8%) had IWMI. Half of them were diabetic (46%), 37 out of them were hypertensive(68%).  High incidence of VSR occurred with cases with median delay between 24-48hours. LV systolic function was between 31-49% among 76% of cases. preserved EF >50% in 24% of cases. RV dysfucntion was present in 16 (29%). Most of the rupture occurred on the second day of acute myocardial infarction (53%).Echo assessment by transthoracic approach using 2D inferred defects between 7mm to 10 mm (average 7.3mm) before device closure along with CAG, LV angiogram was done in stable patients (9.2%). The defect in any angiography varied between 7mm to 18mm (average 13mm). The device sizes used ranges between 18 to 28mm. 18mm size used in 3 cases in our study. 18 cases underwent coronary & LV angiogram. 46 cases had apical posterior (85%). 1 cases had basal position (1.8%), mid septal position in one case and inlet position in one case. 2 male patients had multiple VSRs with both apical and Basal positions. 5 cases underwent  Device closure with Amplatzeroccluder device (ASD Device) with successful deployment after forming AV loop between RFA and RT IJV.  The survival rate is 50% at 30 days. Surgical closure was done for 6 cases. 4 patients died during  Post operative  period and the  mortality rate was 4/6 (66%). In hospital death were 41 cases among 54 cases(75.9%) which  occurred around 2 – 7 days. Conclusion: Post MI VSR is a lethal disorder and carries high mortality. The earlier the repair, the higher the mortality as sutures does not hold in friable tissue. Overall mortality is slightly lower for patients with anterior VSR compared to posterior VSR. Prognosis is favourable if rupture size is small and patient is hemodynamically stable at time of surgical repair.

37. Diagnosis And Management of Arrhythmias In COVID-19 Patients in A Tertiary Care Hospital: Outcomes and Clinical Implications
G. Selvarani, G. Nagasundar, K.M. Nisamudeen, S. Balasubramanian, S.R. Veeramani, M. Natarajan, K. Senthil
Introduction: In COVID-19 pandemic second wave many cardiac patients got admitted due to direct and indirect effects of COVID-19 virus infection. Some cases develop Arrhythmias either Tachy Arrhythmia or Brady Arrhythmia due to varied reasons. It is due to dehydration, volume and pressure alterations in cardiac chambers. Increased sympathetic drive due to reflex mechanisms following hypoxia is one of the main mechanisms. Tachycardia due to anxiety, hemodynamic stress leads to alteration in metabolism of cardiac smooth muscle cells. There is alternation in the electrolyte balance due to severe COVID infection. Severe pulmonary involvement will lead to release of cytokines which stimulate the cardiac conduction pathways. Cellular mechanisms being increased automatically, micro and macro re-entry. In this study, we would like to study the incidence of arrhythmias and its impact on the outcome. Materials And Methods: Single centre observational study conducted in a tertiary care centre from April 2021 to March 2022, All patients who were included under retrospective observational study, were subjected to take ECG and ECHO, CT chest, and CBC, RFT, random blood sugar, ESR, CRP  and other serological markers for inflammation, and other baseline investigations. Clinical history, details regarding COVID-19 illness & its severity were obtained and ECG findings were noted before and after treatment of arrhythmias and other useful parameters like ECHO and details of COVID-19 disease treatment were all entered in a master sheet. Qualitative data obtained were analysed using Chi-Square test. Results: During COVID pandemic 2nd wave, between April 2021 and March 2022, there were 18104 admissions in COVID ward. out of them, 62 cases were admitted with ACS (0.34%), 22 patients had arrhythmias, 16 Cases (73%) with tachyarrythmias,6 cases (27%) had bradyarrythmia,17(77%) were males,5(23%) cases were females.7 cases had atrial fibrillation with rapid ventricular rate, 3 had atrial tachycardia, one case of supraventricular tachycardia, one case of multifocal atrial tachycardia, one case of fascicular Ventricular tachycardia, one case with multifocal ventricular premature beats, one case of WPW syndrome. two patients had bradycardia and, junction rhythm. complete heart block,2nd degree AV block was seen in one case respectively.10 patients had diabetes mellitus,7 had hypertension,5 cases had chronic kidney disease. one patient is a known case of RHD,2 cases had coronary arty disease, one case had mitral valve prolapse. DC cardioversion was given for two cases, a case of SVT, and fascicular VT, Temporary pacemaker insertion done for two cases of complete heart block. Among patients who had arrhythmias 50% had mortality. Conclusion: It is important to recognize that COVID -19 patients those who are critically ill and in ICU care may develop life-threatening arrhythmias that can be detected as early as possible for the appropriate management and optimal outcomes. Underlying viral myocarditis if present should be treated promptly. Primary prevention with careful monitoring of patients, who are at high risk for developing life threatening arrhythmias, plays vital role in COVID-19 patients.

38. Intravital CT and Autopsy Findings in Traumatic Head Injuries: A Comparative Study
Raju Surwase
Background: Any injury to the skull or brain that causes trauma qualifies as a head injury. In the medical literature, the phrases traumatic brain injury and head injury are sometimes used interchangeably. One of the major health issues of the present is traumatic injuries. Approximately 4.5 million people each year globally pass away from trauma in the twenty-first century. CT scans are frequently used to diagnose injuries and provide details on the precise location and degree of organ and tissue damage. Whole-body CT is becoming a common diagnostic tool in cases of severe trauma. The final diagnostic test is an autopsy, which is still regarded as the best diagnostic technique in medicine. Rarely are secondary analyses conducted because they are never as effective as the initial one. The use of post-mortem imaging (CT and MRI) has increased although the number of autopsies has declined recently, mostly due to financial concerns. Aim: The aim of the study was to assess the reliability and accuracy of CT scan results, as well as limits in detecting trauma for forensic purposes. Material and Method: The Department of Forensic Medicine carried out this retrospective-prospective investigation. At the Department of Forensic Medicine, all fatal head injury cases underwent a medico-legal autopsy after a prior CT head scan was performed while the patient was hospitalized. 25 cases totalled in our final dataset, 15 of which were men and 10 of which were women. When antemortem CT scan records were available, all fatal instances of head injuries that were subjected to post-mortem inspection were selected for analysis. Results: The age group with the greatest vulnerability in the current study was those between the ages of 21 and 30 (13 cases), followed by those under 20 (7 cases). The most vulnerable age range was between the ages of 21 and 30 (13 instances), followed by the under-20 age range (7 cases). 19 of the instances included RTA injuries, and the other 3 involved assault and falls, respectively. At autopsies, scalp injuries were found in 22 out of the 25 cases, although CT found them in just 28. Of the 25 cases, skull fractures were found at autopsy in 22 cases, but the CT scan revealed the same thing in 25 cases. Conclusion: It was found that the diagnosis of different types of brain injury lesions may be made using a combination of CT scan and autopsy results, which aids in developing better policies. In forensic medicine, certain injuries that are clinically inconsequential but crucial to understanding the mechanism of harm and mode of death may be present. A CT scan can considerably supplement an autopsy’s results. It is currently still not viable as a substitute for the conventional autopsy, nevertheless. Only in a few number of situations is CT scanning thought to be a viable alternative to an autopsy.

39. A Clinical Observational Assessment of Surgical Management of Acute Intestinal Obstruction
Ajit Kumar, Nitish Prabhakar, Khursheed Alam
Aim: The aim of the present study was to identify and analyse the clinical presentation, management and outcome of patients with acute mechanical, obstruction along with the etiology of obstruction, the incidence and causes of bowel ischaemia, necrosis and perforation. Methods: This was a prospective study conducted among indoor patients of  Department of General Surgery, Government Medical College, Bettiah, Bihar, India for 2 years who were willing to give consent for the study and fall into inclusion criteria. 50 cases of acute intestinal obstruction who required emergency operation at Government Medical College, Bettiah  have been studied. The study was approved by the institutional ethics committee. Results: The maximum incidence in the present study group was 31-40 and 51-60 with each 9 cases out of 50 cases. There were 30 males and 20 females. In the present study, 80% belonged to poor socio-economic and remaining was in the middle socio-economic status. The present study the most common symptoms were pain abdomen (90%) and vomiting (80%), and the most common signs were tachycardia (82%) and visible intestinal peristalsis (62%). Release of adhesions was done in 38% of cases, resection anastamosis in 20% of cases and release of adhesion with herniography done in 16% of the cases. Conclusion: The study concluded that maximum incidence of intestinal obstructions was reported in age group 31-60 years with male predominance. Abdominal pain was the consistent symptoms followed by obstipation. Post-operative adhesion was the most common cause of the intestinal obstruction. Malignancy and multiple comorbidities remains the major risk factor for the post-operative complications and mortality.

40. A Hospital-Based Assessment of the Functional Outcome of Dual Plate Osteosynthesis in Type V & VI Proximal Tibial Fracture: An Observational Study
Arnab Sinha, Santosh Kumar
Aim: 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, IGIMS, Patna, Bihar, India from April 2015-April 2017 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 36.54±14.16 years. 42 patients were male, while 8 were females. 10 patients had left side injury and 40 patients had right side injury. 44 patients had type V fracture and rest of the patients had type VI fracture. Out of 50 patients, 35 achieved excellent knee score (80-100), 18 achieved good (70-79), 6 achieved fair (60-69) and no patient had poor (<60) knee score. Mean range of knee flexion was 110 degrees. Complications included 6 superficial infection which were treated by IV antibiotics and surgical wound management, 1 had wound dehiscence and one had difficulty in walking. 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.

41. Open Tube Recanalisation for Those Planning Pregnancy after Tubectomy: Prospective Study
Shilpa Kumari, Indu Gautam, Lata Ratanoo, Gitika Sharma
Background: Tubectomy is permanent method of contraception and its about 10% people after tubectomy regret their decision and 1% want restore their fertility. Aim: To evaluate the pregnancy rate and analyse various factors affecting pregnancy after tubal recanalisation. Material and Methods: A prospective study was carried out on 61 patients for tubal recanalisation in the Obstetrics and Gynaecology Department of S.M.S. Medical College, Jaipur from June 2021 to May 2022. Out of which 9 patients conceived. Results: Success rate of recanalisation is nearly 10%. Patient have better chances who have age <35yr, post reversal tubal length >4cm, gone through laproscopic sterilisation has better success rate. Conclusion: Open tubal recanalisation remains feasible option for those planning pregnancy after tubectomy.

42. Laparoscopic Cholecystectomy in the Treatment of Acute Cholecystitis: Prospective Study of Outcomes and Costs Between Early and Delayed Cholecystectomy
Pankaj Kumar Porwal, Devendra Saini, Shashwat Vyas, Shubham Jain, Laxman Agarwal
Background: Acute cholecystitis, the inflammation of gall bladder is usually managed by delayed cholecystectomy in the past in view of increased risk of post-surgical complications due to the start of the era of minimally invasive surgery. But as the learning into this field has progressed it was found that early cholecystectomy also has better results in terms of reduced complications. The outcomes along with the cost benefit of each approach is to be considered in management of acute cholecystitis. Methods: The study was carried out on 100 patients which were equally divided into 50-50 in each group, Group A (Early cholecystectomy) and Group B (Delayed cholecystectomy). The variables which were assessed are duration of surgery, intraoperative findings, intraoperative difficulty in form of Calot’s dissection time, postoperative complications, duration of hospital stay. Results: It was found that mean duration of Surgery was 55.5±10.74 min in group A and 66.58±12.47 min in group B. Duration of surgery was comparatively more in group B than group A. Due to inflammation in the wall of gall bladder, wall thickness was found to be more In group B (4.75±1.28 mm) compared to mean thickness in Group A (4.19±1.18 mm). Mean time taken for Calot’s dissection was more in group B (23.74±6.23min) as compared to group A (16.5±4.76 min). Post-operative complications were seen in the patients of both groups and results were statistically insignificant. The length of hospital stay was comparatively less for group A patients than the group B with a mean value of 5.03±0.93 days whereas for group B 7.66±1.61 days which in turn reflect the better cost benefit of Group A compared to group B. Conclusion: The outcomes of early cholecystectomy in management of acute cholecystitis are comparatively better than delayed cholecystectomy making early cholecystectomy a better option of management in terms of operative time, complications and cost benefit in this present era of minimally invasive surgeries.

43. An Observational Study on Prediction of Difficulties During Laproscopic Cholecystectomy in Cases of Cholelithiasis by Preoperative Ultrasonography
Pankaj Kumar Porwal, Devendra Saini, Amit Yadav, Vineet Sharma, Laxman Agarwal
Background: Preoperative prediction of a difficult laparoscopic cholecystectomy not only helps in counselling the patient but also helps the surgeon to prepare better for intraoperative difficulties expected to be encountered. Methods: A total of 125 cases of elective laparoscopy performed at SMS Hospital & attached group of hospitals, Jaipur from May 2021 to December 2022 were included in the study. A preoperative ultrasonography (USG) score was formulated with seven parameters which were highly predictive of difficulties during surgery. Results: Of 125 patients studied, 42 (33.6%) were found to have difficulty during surgery in the form of adhesions, difficult calots dissection, spillage of bile and stones, vascular or biliary tree injury or bowel injury. Gall bladder wall thickness > 3mm, contracted or distended gall bladder wall, presence of pericholecystis fluid collection, large stone, emphysematous cholemiastitis, dilated CBD, gall stone mobility and transverse diameter of GB were the most accurate predictors for a difficulty in la paroscopic cholangoplasty. Conclusion: Pre-operative USG score is a good predictor of difficulties in a cholangio-pancreatoplasty.

44. Association Between Serum Level of Homocysteine and Hypertensive Disorder of Pregnancy
Indu Gautam, Sushama
Background: The homocysteine-mediated vascular changes are similar to those associated with preeclampsia, therefor, a hypothesis has been proposed that hyperhomocysteinemia may be associated this condition. Homocysteine may provide the missing link in the etiology of preeclampsia. Material & Methods: A sample size of Hundred patients 100 (50 patients per group) was calculated at 99% confidence interval at 5% acceptable margin of error by epi info software version 7.2. Enrollment of study participants was done from pregnant women >20 weeks of gestation admitted in Zenana Hospital, Department of Obstetrics and Gynaecology for delivery. Results: In the present study, positive correlation between age of patient and serum homocysteine although not statistically significant. It also shows positive correlation between high blood pressure of women and serum homocysteine and it is statistically significant. There is a positive correlation of BMI which is also statistically significant. There is negative correlation of period of gestation with serum homocysteine and it is not significant statistically. There is positive correlation of birth weight of baby with serum homocysteine. the mean serum homocysteine level in women who underwent LSCS, is 15.45 ± 6.26 μmol/L and in women who delivered by vaginal route is 13.11 ± 5.6 µmol/L. The mean serum homocysteine level is significantly higher in LSCS as compared to cases undergoing vaginal delivery. Conclusion: We concluded from the present study that the serum homocysteine level is significantly elevated in women with hypertension and that serum homocysteine level has positive correlation with blood pressure.

45. Effect of Intra-operative Ketamine on Post- operative Catheter Related Bladder Discomfort in Abdominal Surgeries: A Randomized Double Blind Interventional Controlled Study
Gaurav Sharma, Mayuresh Hanchnal, Rakesh Kalappa
Background: Urinary catheter insertion peri-operatively may result in feeling of elevated urinary urgency, frequency and discomfort at supra-pubic region collectively these symptoms are referred as Catheter related bladder discomfort (CRBD). We evaluate the effect of intra operative ketamine in prevention of CRBD after elective abdominal surgeries in the post-operative period. Methods: Ninety patients undergoing elective abdominal surgery were randomized into two equal groups of 45 subjects each. Group A received IV normal saline and group B received 0.5mg/kg IV ketamine after induction of anesthesia, but before urinary catheterization. The study compared incidence and severity of CRBD, Visual analogue scale(VAS) score and presence of side effects related to ketamine up to 12hr (hour) in the post-operative period. Results: The Incidence of CRBD in post-operative period was significantly lower in group B (ketamine) compared to group A (p-value <0.01). Reduction in severity of CRBD was noted at 0hr and 1hr in group B. The mean VAS score at incision site was significantly lower (P<0.05) in group B as compared to group A at 0, 1 and 2 hour period. No statistically significant difference was noted in number of cases who showed side effects between the two groups. Conclusion: Intra-operative 0.5 mg/kg of IV ketamine before urinary catheterization can reduce incidence and severity of CRBD as well as provide prolonged post-operative analgesia without significant side effects during the post-operative period.

46. Comparing Arthroscopic and Open Fixation for Posterior Cruciate Ligament Avulsion Injury: A Prospective Study
Pravin Patil, Mahesh Soni
Background: One of the most important parts that keeps the knee stable during flexion and rotation is the posterior cruciate ligament (PCL). Avulsion fractures at the PCL’s attachment site are frequent because of the PCL’s extreme durability. It is commonly accepted that anatomically reducing and fixing PCL avulsion fractures is necessary for full restoration of PCL function. The main causes of unsatisfactory outcomes from conservative therapy include fracture non-union and functional impairment. Many surgeons believe that the PCL’s misplaced or unstable tibial avulsion fracture should be minimized and physically corrected utilizing a variety of methods. Avulsion fractures of the posterior cruciate ligament (PCL) are not particularly common, but they are the most prevalent type of avulsion fracture around the knee, with anterior cruciate ligament avulsions coming in second. PCL injuries frequently manifest as avulsion fractures from the tibial connection. In the event that a PCL avulsion fracture is not surgically repaired, the knee joint may experience further alterations. Aim: Comparing arthroscopic and open fixation for posterior cruciate ligament avulsion injury. Material and Method: The Department of Orthopedics was the site of the prospective observational study. Prior to performing any surgical operations, informed consent was sought from every subject. The surgical procedures that study participants underwent followed conventional protocols. Functional results of the patients were evaluated both before and after surgery. Patients with PCL injuries between the ages of 18 and 65 were included in this study. A total of twenty-five patients who had torn PCLs were chosen and given PCL repair advice. Prior to surgery, a clinical examination was conducted and recorded using radiographs, namely an X-ray taken from the lateral and anteroposterior views. To rule out soft tissue injuries, magnetic resonance imaging (MRI) was performed. Limited computed tomography (CT) images were used to learn more about the fracture shape. Results: The comparison of the age group in that only 2 patients (08%) were in the less than 30 years age group in the open reduction group compared to serve (28%) participants in the arthroscopic group. 28% of the open procedure group were in the >45 years age group compared to 16% in the arthroscopic group. However, no significant difference was seen. Comparing gender distribution 8 people (32%) were males in the open reduction group compared to seven (28%) participants in the arthroscopic group. Conclusion: After a secure fixation, surgically fixing a PCL avulsion fracture from its tibial connection with a CC screw yields excellent outcomes. Because of its straightforward, safe, easy, and sufficient exposure techniques that need little soft tissue incision, it has now become the accepted standard of care. It has a short learning curve and may be done without a great deal of experience. This method is linked to good joint function recovery, few problems, and a suitable fixation. It has consistently resulted in positive clinical, functional, and radiological outcomes without causing any long-term impairment.

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