Aim: The aim of this study was to find out the incidence of difficult airway and to develop a score that predict difficult airway in critical care unit. Methods: This study was conducted at Sri Krishna medical college and Hospital, Muzaffarpur, Bihar, India for two years. Patients were admitted due to acute respiratory failure with COPD, chronic kidney disease with pulmonary oedema, trauma with multiple bone fracture, head injuries with cervical spine injuries, septic shock with multiorgan dysfunction, congestive heart failure, liver cirrhosis with portal hypertension with hypotension, and other medical illness. Results: In two years, total, 3450 patients admitted in the ICU, out of them 2000 patients require invasive ventilatory support, out of 2000, ADA was found in 500 (25%) patients and PDA in 1300 (65%) patients and anatomical with physiological difficult airway (ADA+PDA) was found in total 200 (10%) patients. ADA is noted in total 500 (25%) of the patients, out of them 288 (57.6%) were male and 212 (42.4%) were female. DBMV were seen in 180 (9%) patients, DSDP in 60 (3%), DI in 160 (8%), DSA in 100 (5%) of the patients. Most common age group having DBMV >81year, 40 male followed by 61- 80year male 32 and DSDP is also common in age group 61 to>81yeras male, and DI is also most commonly noted in male >81 years, 32 followed by 61-81year male, 24 females. In our study 10% was very difficult airway due to anatomical and physiological reasons, 25% was difficult due to anatomical factors of patients and 65% are moderate difficult due to physiologically factors of the patients in ICU. Conclusion: Incidence of difficult airway is very high in ICU as compare to OT due to anatomical factors and physiological factors of the patients, so each and every patient requires different strategies of airway management in ICU.

Aim: The aim of the present study was to assess the nutritional status and morbidity pattern in children aged 6-60 months belonging to the rural area. Methods: The study was conducted in Department of Pediatrics, SKMCH, Muzaffarpur, Bihar, India  for the period of one year and Children belonging to six months of age to five years of age group in rural areas. A sample of 500 children was selected as the study population. Results: Out of the 500 children who were involved in the study, the majority were in the age group of 48-59 months- 200 (40%); female children with 260 (52%) outnumbered the male children; 450 (90%) children belonged to the Hindu religion. All the study participants were fully immunized. Based on the nutritional status according to WHO Growth Standards Reference (2006), the prevalence of underweight, stunting, and wasting was 220 (44%), 310 (62%), and 100 (20%), respectively. According to the measurement of mid-arm circumference, the prevalence of protein-energy malnutrition was found to be 20 (4%). The association between the gender and the nutritional status of the children – underweight, stunting, and wasting – was found to be statistically not significant with the p-value of 0.0744, 0.8574 and 0.5050 respectively. The association between the age group and the stunting was found to be statistically significant with a p- value of 0.000140. It was observed that the highest prevalence of morbidity was of anemia, 190 (38%), followed by upper respiratory tract infection, 100 (20%). Conclusion: The prevalence of stunting was found to be high compared to wasting and underweight among the study children. Nearly 1/3rd of the children had more than one morbid condition. Majority of the children presented with anemia, followed by acute respiratory tract infection. So ICDS needs to be strengthened to function more efficiently in averting malnutrition among children. A comprehensive, standardized, continuous, and intensive assessment of the nutritional status of children is recommended.

Aim: The aim of the present study was to assess the analgesic efficacy of bilateral ilioinguinal and iliohypogastric nerve block for post caesareans delivery under spinal anaesthesia. Methods: The present study was conducted in the department of Anesthesiology ESIC MCH, Bihta, Patna, Bihar, India from August 2021 to July 2022. 100 ASA I and II parturients who underwent non emergent caesarean delivery requiring spinal anaesthesia were included in this study. Parturients with severe preeclampsia, eclampsia, history of substance abuse, infection at needle insertion site, or allergy to local anaesthetics and declined to participate were excluded from the study. Results: The two groups were not statistically different regarding demographic variables. There were 60% and 56% nulliparous in group B and group C. In the present study, 70% and 72% had caesarean delivery once in group B and group C respectively. The two groups were not statistically different regarding parity and number of caesarean delivery. According to independent sample t-test, in both groups, mean changes in SBP, DBP and h were not significantly different (P>0.05). Pain severity scores were similar on arrival in the ward in both groups but were significantly decreased at 4 h, 6 h, 8 h, 12 h and 24 h in II-IH block group compared to a control group both at rest and on movement (P<0.001). Conclusion: Compared to no intervention, bilateral II-IH blocks in patients undergoing caesarean delivery with Pfannenstiel incision had significantly improved pain relief at rest and with movement and resulted in significantly less tramadol consumption in the first 24 h after surgery. These results support the use of bilateral II-IH blocks as part of a multimodal analgesic regimen.

Aim: The aim of the present study was to evaluate the prognostic ability of serum ferritin when estimated within 5 days of onset of illness in children with severe sepsis admitted to a pediatric intensive care unit. Methods: The Present prospective and observational study was conducted in Department of Paediatrics, DMCH, Darbhanga, Bihar, India. Study duration was of 1 year. Study was started after obtaining approval from institutional ethics committee. In present study 50 children satisfying study criteria were studied. Results: Boys (64%) were more than girls (36%) and mean age was 36.46 ± 13.64 months. Mean duration of illness before admission and duration of fever before admission was 5.37 ± 1.26 days and 4.23 ± 3.48 days respectively. 58% children received antibiotics before admission and 18% children had malnutrition. Common suspected source of infection was pneumonia (36%), Urinary tract infection (18%), Meningitis (18%), Intra-abdominal infection (6%) and from other focus (22%). Blood culture was positive in 23.3 %. Mean serum ferritin levels were 172.56 ± 118.3 ng/mL and ferritin ≥ 300 ng/mL was noted in 26%. According to severe sepsis criteria cardiovascular organ dysfunction (64%) was most common, followed by one or more Organ dysfunctions (40%) and acute respiratory distress syndrome (36%). We compared variables between cases with serum ferritin < 300 ng/ml (n=38) and cases with serum ferritin ≥ 300 ng/ml (n=12). We noted a statistically significant difference in cases of survivors, non-survivors, cases of multiorgan dysfunction syndrome (MODS), pediatric risk of mortality score (PRISM III) at 24 h and length of Pediatric intensive care unit (PICU) stay. Conclusion: Serum Ferritin levels can be helpful predictive marker of mortality in severe sepsis and higher ferritin is associated with increasing organ dysfunction.

Aim: The aim of our study was to compare between immediate and delayed cord clamping in preterm infants less than 37 weeks, and its effect on the outcomes of such babies. Methods: This randomized, controlled trial was conducted at Department of pediatrics, Sri Krishna Medical college and Hospital, Muzaffarpur, Bihar, India for the period of one year. Results: There were no significant differences in maternal characteristics. Artificial reproductive therapy and cesarean delivery numbers were not different between the groups. Similarly, there were no differences in other maternal variables such as chorioamnionitis, gestational hypertension or diabetes mellitus, preeclampsia, or poly- or oligohydramnios. Overall antenatal steroid administration and maternal magnesium exposure were similar between the groups. There were no significant differences in baseline neonatal characteristics between the two groups. Mean gestational age was 34 weeks in the ICC group compared with 34.1 weeks in the DCC group; mean birth weight was 2250 g in the ICC cohort compared with 2325 g in the DCC cohort. Male infants represented 35% in DCC group, compared to 38% in the ICC group. Red blood cell transfusion need in the first week of life was significantly lower in the DCC cohort compared with the ICC, although the use of pressor support or corticosteroids was not different. Phototherapy in first week of life was significantly higher in the DCC, but none of the infants in either groups received intensive phototherapy or exchange transfusion. Incidence of RDS and surfactant administration was significantly lower in the DCC cohort. A significant reduction was noted in the incidence of IVH in the DCC group compared with the ICC group. Conclusion: DCC, as performed in our institution, was associated with significant reduction in IVH and early red blood cell transfusions. DCC in preterm infants appears to be safe, feasible, and effective with no adverse consequences.

Aim: The aim of the present study was to assess the prevalence and clinical and epidemiological factors of thyroid dysfunction (TD) in Indian patients diagnosed with metabolic syndrome (MetS). Methods: The study was conducted in the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for one year. we had enrolled 400 patients with MetS. The study was conducted in accordance with the principles of the Declaration of Helsinki, International Council on Harmonization Good Clinical Practice (ICH GCP) guidelines, and Indian regulatory guidelines (Indian Council of Medical Research and Indian GCP guidelines). Results: In this study, we had enrolled 400 patients with MetS. The baseline demographic characteristics of these patients are shown. Of all the enrolled patients, 120 (30%; 95% CI: 23.83-32.32) were diagnosed with TD (mean age (SD): 47.9 (10.96) years; mean BMI: 30 ± 4 94 kg/m2), with a higher prevalence among women compared to men (91 (75%) vs. 30 (25%)).  Of the 400 MetS patients, overt hypothyroidism was reported in 78 (19.5%) patients and overt hyperthyroidism in 8 (2%) patients. Conclusion: Thyroid dysfunction is an important entity as a complication in metabolic syndrome patients. From various studies, it is a known fact that the incidence of thyroid hormone abnormality is more in females as compared to males.  The prevalence of TD in patients with MetS was high, indicating a possible interplay between thyroid status and MetS.

Aim: The aim of the present study was to assess the prevalence of anemia and various morphological patterns in geriatric population. Methods: A hospital based observational prospective study was undertaken in hematology section of pathology at Government Medical College, Bettiah, Bihar, India. Both males and females, age group 60 years and above were included in the study. The study was conducted after institutional ethical committee approval. Informed consent obtained from patients who are willing to participate in the study. Results: In the present study geriatric age group above 60 years were taken. Present study age of patients ranged from 60-90 years. Maximum number of patients was males, they constitute 270/500 (54%), whereas females constitute 230/500 (46%). The maximum number of cases was in the age group of 60-69 years i.e 260/500 (52%) which includes both male and female. All morphological types of anemia based on peripheral smear examination. Normocytic normochromic being the commonest among all morphological types of anemia which constitutes 30.2% (151/500) followed by normocytic hypochromic 22.8% (114/500), microcytic hypochromic anemia 23.4% (117/500), dimorphic anemia 12.4% (62/500), and macrocytic anemia 11.2% (56/500). Conclusion: Diagnosis of anemia and study of various morphological patterns, helps in directing towards the further investigations required to diagnosis the underlying etiology. It ultimately helps in the treatment.

Aim: The aim of the present study was to determine the levels of C-reactive protein and uric acid levels in preeclampsia pregnant. Methods: A case control study was conducted in 30 diagnosed preeclamptic pregnancy, 30 normal pregnant women of comparable gestational age in 3rd trimester admitted in the dept. of Obstetrics and Gynaecology at NMCH, Patna, India for one year. Results: Maximum number of PE cases belongs to age group of 31-35 years (60%) and maximum number of control group belongs to age group of 21-25 years (40%). It was also observed that mean age in control group is 25.5±3.6 (years), whereas in study group 29.5±4.2 (Years). In study group, maximum number of patients have severe proteinuria i. e. >+++ (55%), and in control group maximum number of patients have proteinuria of (+) (58%) which is considered as physiologically normal. But, both study and control groups mild proteinuria (++) is observed in 40% and 38% patients respectively. There was a significant difference of proteinuria between study group and control group (p=0.001). The mean values of serum uric acid and CRP levels always remain higher in study group than that of control group. The mean values of both serum uric acid and CRP levels in study group were near to their respective upper limits of normal range. There was a strong positive correlation between serum uric acid and blood pressure (systolic and diastolic) with highly significant. A positive correlation is also observed between serum uric acid and serum CRP level. Conclusion: Serum uric acid and CRP may be feasible to be used as biomarkers for identifying women at risk of preeclampsia. The aetiology of preeclampsia is not well established but having more information about the condition will help in the monitoring and treatment of the pregnant to ensure her and her baby are well.

Aim: The aim of the study was to compare the efficacy of immediate with delayed laparoscopic cholecystectomy. Methods: All patients presenting with acute cholecystitis to Department of General Surgery, JLNMCH, Bhagalpur, Bihar, India were included and study period was of 1 year. Sample size of the study was 50 patients fulfilling the inclusion criteria were invited to participate in the study and informed consent was taken. Results: There was no statistical significant difference found between distribution of subjects according to sex between 2 groups (ELC and LLC). There was no statistically significant difference found between the mean ages between 2 groups (ELC and LLC). There was no statistically significant difference found between fever, jaundice, vomiting, peri-cystic fluid collection, gallbladder perforation and bile duct injury between 2 groups (ELC and LLC). Mean duration of surgery was more in LLC when compared with ELC. There was a statistical significant difference found between duration of surgery and the 2 groups. Mean hospital stay was more in LLC when compared with ELC (6.48 days vs 3.84 days). There was a statistical significant difference found between hospital stay and type of surgery. Conclusion: Early laparoscopic cholecystectomy (ELC) surgery had similar intra and postoperative complications compared to delayed surgery in acute cholecystitis but were associated with a shorter surgery and lesser stay in hospital.

Aim: The aim of the present study was to assess the distribution and antimicrobial susceptibility patterns of lower respiratory tract infections over a six–month period in the medical and surgical intensive care units of a teaching hospital. Methods: This was a retrospective study conducted at Patna Medical College and Hospital,Patna, Bihar, India  for the period of 6 months. This institution is an academic teaching hospital and is one of the local tertiary referral units. Total number of patients (medical and surgical admissions) seen at our Institute during the study period was 1200; out of whom, 200 patients required intensive care. One hundred patients were enrolled for the study after considering the inclusion and exclusion criteria. Results: A total of 100 patients were included in the study, out of which 70 (70%) were males. Amongst different age groups, maximum patients were above 60 y (30%) and the least were between 18–30 y (12%). The underlying major medical conditions of the LRTI were diabetes mellitus (30%), respiratory pathology (20%), nephrological pathology (18%) and malignancy (14%). The bacteria were isolated predominantly from the tracheal aspirate (85%), compared to broncho–alveolar lavage (15%) with a statistically significant difference between them. Out of all the isolated organisms, A. baumannii (n = 30; 30%), P. aeruginosa (n = 24; 24%) and Klebsiella (n = 22; 22%) were the most positive isolates, S. aureus and Enterococcus were equal (n = 4; 4%). In the gram–negative isolates, A. baumannii was most susceptible to colistin (93.34%) followed by minocycline (80%) and amikacin (66.66%). With regard to P. aeruginosa, it was observed that only around half of the isolates were susceptible to doripenem (62.5%) and it was also observed that most of the isolates were resistant to all the commonly used antibiotics. In the gram–positive isolates, S. aureus was equally susceptible to linezolid (75%) and vancomycin (75%); and 100% of the isolates of Enterococcus were susceptible to vancomycin. Conclusion: Gram–negative pathogens were predominantly responsible for lower respiratory tract infections. Moreover, antimicrobial resistance rate was high with the most commonly used antibiotics and also to higher antibiotics such as carbapenems.

Aim: The aim of this study was to assess diarrhea prevalence and sociodemographic factors among under-five children in South Bihar region. Methods: This study was conducted in Department of Pediatrics, Jawahar Lal Nehru medical College and Hospital, Bhagalpur, Bihar, India  for the period of 9 months. A community-based cross-sectional study design was employed to collect data from households to assess diarrhea prevalence and associated factors. All households were in South Bihar region with mothers/guardians having under-five children with diarrhea. Results: A total of 500 under-five children and their mothers were enrolled during the study. Of these more than half, 57% (285/500), were males. Majority of mothers were in the age group of 25-34 years with mean age of 30.7%. Almost all respondents, married 93% (465/736), and house wives 86% (632/736).The educational status of mothers/guardians showed that 60% (300/500) of them were unable to read and write. The overall prevalence of diarrheal disease among under-five children was 21% (105/500). Of these, children who practice partial breast feeding were more infected with diarrheal disease, 18 (80/500), while 2% (10/500) of them who practice exclusive breastfeeding were less infected with diarrheal diseases. Conclusion: The study revealed that childhood diarrhea remains an important health concern in the study area. The highest rate of the occurrence of diarrhea was significantly seen among children aged 0-1 year old. Occurrence of diarrhea was statistically associated with child age of less than or equal to one, educational status of mother/guardians and breast feeding.

Aim: The objective of the present study was to evaluate various aspects of patients with fracture of lateral end of clavicle using different modalities of management. Materials and Methods: The study was conducted in the Department of Orthopaedics Jawahar Lal Nehru medical College & Hospital, Bhagalpur, Bihar, India for a period of 1 year. A total of 50 patients reporting to the Orthopaedics OPD and casualty with fractures of the lateral end of the clavicle were considered for the study. Complete details were taken regarding mode of injury, age, limb affected. Patients operated with pre-countered locking plate were included in Group A and those operated with clavicular Hook plates were included in Group B. Results: The average age of patients was 24.8 years, ranging from 18 to 28 years. 25 cases were operated in Group A (pre-contoured locking compression plate) and 25 cases were operated in Group B (clavicular hook plate). Road traffic accident being the most common mechanism of injury (70%) followed by self-fall (24%). The time from trauma to surgery ranged from 0-7 days with a mean of 4 days in both group. Based on the Constant-Murley score, 24% of the patients in the operative group had an excellent outcome, 48% had a good and 16% had satisfactory functional outcome. In group B, 16% showed excellent outcome, 44% satisfactory outcome and 32% showed satisfactory outcome. The functional outcome was significantly better in the operative Group A than in Group B during the period of follow up. Conclusion: In conclusion, precontoured locking plates provide adequate stable fixation for the lateral end clavicle fractures and are not associated with any major complications.

Aim: This study was aimed at assessing the frequency of elevated CRP in children with acute bronchiolitis and at comparing the clinical characteristics, laboratory and radiological findings, antibiotics use, and outcome according to CRP levels. Methods: This was a retrospective, cross-sectional, and analytical study where the electronic medical records of all patients with a clinical impression of acute bronchiolitis and were admitted to the pediatric department at JLNMC, Bhagalpur, Bihar, India for the period of one year were retrieved. During the study period, a total of 200 patients were admitted with a clinical presentation of acute bronchiolitis. 50 (25%) patients were excluded due to of unavailability of data of CRP levels. The remaining 150 (75%) patients were included in the study. Results: 85 (56.66%) patients were males. The most common clinical presentation was cough (115 (76.66%) patients) followed by fever (105 (70%) patients). Antibiotics were used in 80% patients. 6% patients required intensive care, 2 % had surgical intervention, 2% required endotracheal intubation, and 1 (1%) died. Patients with high CRP were older at presentation (P < 0:0001) and had more fever (P < 0:0001) and cough (P = 0:002), but lower hemoglobin level (P < 0:0001) compared to those with normal CRP. Fever (P = 0:016) and hemoglobin level (P = 0:002) were independent factors. Conclusion: Most children with acute bronchiolitis had high rate of elevated CRP values that did not correlate with the rate of bacterial coinfection. High CRP levels were found in older children, those presented with more fever and cough, and had a lower hemoglobin level despite that those factors were previously reported to be associated with disease severity and bacterial coinfection. This study also showed a high overall rate of antibiotic prescriptions in mostly viral disease.

Aim: The present study was carried out to assess the possible relation between serum PRL levels and frequency of T. gondii infection in humans. Material & Methods: A prospective study was conducted in the Department of General Medicine, Patna Medical College and Hospital, Patna, Bihar for the period of 6 months.   Men and women aged 15–55 years with no clinical complications participated in this cross-sectional study. A total of 500 blood samples were collected from individuals who had been referred for PRL measurement. Results: Of the total participants, 70% were women and 30% men. Of 500 blood serum samples, 162 samples (32.4%) had anti-Toxoplasma IgG. Participants were divided into five age groups of below 19, 20–30, 30–40, 40–50, and above 50 years. According to the age of participants, the prevalence of anti-Toxoplasma IgG in 500 blood serum samples was as follows: <19 age group, (21.7%); 20–30, (32.43%); 30–40, (34.85%); 40–50 age group, (30.90%); and >50 age group, (42.10%). Of 350 serum samples of women, 68 (28.3%) had anti-Toxoplasma IgG while of 150 serum samples of men 57 (38%) had anti-Toxoplasma IgG antibody. In total, of 343 serum samples, 245 (49%) were considered as normal range of PRL, 20 (4%) and 235 (45%) samples were considered as hyperprolactinemia and hyperprolactinemia, respectively. Conclusion: The results of the current study confirmed the previous studies based on immunoregulatory role of PRL and indicated that high levels of PRL could be related to T. gondii sero- negativity in women.

Aim: The present study was carried out to determine the changes brought on by perceived stress in the leukocyte profile of young adults. Methods:  The study design was approved by the Institutional Ethical Committee , Patna Medical College, Patna, Bihar, India. The study population consisted of the students’ attending classes in the department of Physiology, Patna Medical College, patna, Bihar, India for one year. The study procedure and objectives of the study were explained to the students. Participation in the study was solely on a voluntary basis. Out of the 70 students, 50 students gave written informed consent to take part in the study giving a response rate of about 71%. Results: The mean PSS score of the study participants was found to be 19.14±6.36. In response to how frequently they felt nervous or stressed during the last month, 36% (18 nos.) responded “Sometimes” and an equal percentage responded “Often/Always”. Based on the PSS scores, the students were grouped as “Not stressed” (PSS score 1-10), “Mildly stressed” (PSS score 11-20), “Moderately stressed” (PSS score 21- 30) and “Severely stressed” (PSS score 31-40). None of the study participants had PSS score greater than 30. For each group of study participants, the average N:L ratio was calculated. The Pearson correlation coefficient (r) was calculated to study the relation between the PSS score and the relative percentages of the different leukocytes as well as the N:L ratio. A positive correlation was found between the PSS score and percentage of neutrophils, monocytes and N:L ratio. A negative correlation was found between PSS score and percentage of lymphocytes, eosinophils and basophils. Conclusion: Several researchers have put forward the concept of use of DLC parameters such as neutrophilia, lyphocytopenia or N:L ratio as an adjunct to the measurement of adrenal glucocorticoids, especially Cortisol, for studying the stress response. There is ample evidence which suggests that there is a close relationship between the responses of the leukocytes and the adrenal hormones to stress.

Aim: The aim of the study was to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH). Methods: This was a prospective observational study conducted at Department of General Medicine, AIIMS Patna, Bihar, India for one year. A total of 50 patients were recruited in this study. Results: Mean ± SD age, BMI and WC were 42.23±12.79 years, 26.49±4.82 kg/m2 and 94.12±19.81 CM, respectively. There was no significant age, BMI and WC difference between male and females’ group. Central obesity was present in 84%, 80% and 85.71% all, males and females respectively and there was no significant difference between males and females. Diabetes mellitus (DM) was present in 30%, 53.34% and 20% all, males and females respectively. Anti-TPO antibody was present in 34%, 20% and 42.85% all, males and females respectively. At one-year follow up examination 11 (18.97%) patients progressed to OH (defined as TSH ≥10 IU/L). In anti-TPO positive group rate of progression to OH was 29.42% while in negative group it was 16.16%. Rate of progression was significantly higher in anti-TPO positive group as compared to negative (p<0.023). Conclusion: In a cohort of 50 patients followed for one year only the presence of anti-TPO antibody was predictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.

Aim: The aim of the study was to compare the postoperative analgesic efficacy of epidural Ropivacaine and Ropivacaine with Tramadol in adults undergoing abdominal surgeries under general anesthesia. Methods: The study was a prospective non-randomized, double arm, single-blind, controlled study conducted at Department of Anaesthesiology, Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar for one year after obtaining written informed consent. The study was started after getting the approval of Institutional Ethics Committee. In our study, 50 subjects were included. Results: In our study while analyzing the age distribution, in the Ropivacaine group, the majority of the study subjects belonged to the 31-40 years age class interval (n=10, 40%) with a mean age of 43.07 years. In patients belonging to Ropivacaine group, the majority of the study subjects belonged to ≤ 240 minutes duration of postoperative analgesia class interval (n=24, 96%) with a mean duration of postoperative analgesia of 220.57 minutes. In the Ropivacaine with Tramadol group majority belonged to 300-360 minutes duration of postoperative analgesia class interval (n=15, 60%). The association between heart rate distribution and intervention groups is considered to be non-significant since p-value was > 0.05 as per unpaired t-test. The association between mean peripheral capillary oxygen saturation distribution and intervention groups is considered to be nonsignificant since p-value was > 0.05 as per unpaired t-test. The association between mean respiratory rate distribution and intervention groups is considered to be nonsignificant since p-value was > 0.05 as per unpaired t-test. Conclusion: We concluded that the addition of 1 mg/kg of Tramadol improves the postoperative analgesic efficacy of epidural 0.2% Ropivacaine by prolonging the duration of analgesia and providing good sedation with no significant hemodynamic alterations, nausea, vomiting and pruritus.

Aim: Our main objective was to study the efficacy of laparoscopic appendectomy as well as conversion rate of laparoscopic appendectomy to open appendectomy. Methods: A Hospital based retrospective study of patients who had undergone laparoscopic appendectomy at emergency theatre of department of General Surgery Jawaharlal Nehru medical college and hospital, Bhagalpur, Bihar, India for the period of 12 month were included for this study irrespective of age and sex. This hospital based retrospective study was carried among 50 patients who had undergone emergency laparoscopic appendectomy. Results: 26 patients out of 50 patients who had undergone emergency laparoscopic appendectomy were between 20 years to 40 years of age. Among them 18 (36%) were male and 32 (64%) were female with mean age of 28 years±12.88 years standard deviation (range=13-58 years). During this, it was found that most of cases (43 out of 50, i.e., 86%) were diagnosed as acute appendicitis, 1 (2%) case as appendicular lump, 2 (4%) cases as appendicular abscess, 4 (8%) cases as appendicular perforation peritonitis. The duration of hospital stay was shorter as 3 days for most of the patients (34%) under study. Conversion rate from laparoscopic appendectomy to open appendectomy was only 12% with cause being uncontrolled bleeding, perforation of base of appendix and appendicular lump, without any known mortality and case of redo during period of this study. Conclusion: Laparoscopic appendectomy is safe and efficient procedure with shorter hospital stay and less post-operative complication.

Background: SARS-Cov-2 infection during pregnancy causes adverse effects on the maternal and foetal outcome. In order to minimize the adverse outcomes of COVID-19 infection, Government of India recommends COVID-19 vaccination during antenatal period with Covaxin and Covishield. Despite the recommendation of vaccination by the Government of India, there are few clinical trials and still there exists a gap in the knowledge and awareness of outcome of pregnant women after COVID-19 vaccination during pregnancy. Materials and Methods: This is a prospective observational study conducted in 50 antenatal women who were already vaccinated at a tertiary care hospital in Southern India from August 2021 to October 2021. All antenatal women who were already vaccinated and attending the OPD were considered for further follow-up. Results: This study was conducted among 50 antenatal women who received COVID-19 vaccination during pregnancy. Among these antenatal women, 27 (54%) were multigravida, 23(46%) were primigravida, 32(64 %) completed 2 doses of covid vaccination, and 18(36%) took a single dose in antenatal period. Among the vaccinated 27(54%) pregnant women had no symptoms after vaccination. Though 23(46%) women had symptoms after vaccination, symptoms are mild and resolved within 48 hours. All vaccinated antenatal women were observed till delivery, among them 46 (92%) had term deliveries, 4(8%) had preterm deliveries and  8[16%] new-born babies required NICU admission. Conclusion: COVID-19 vaccination was not associated with adverse immediate pregnancy outcomes or new born complications. Hence COVID-19 vaccination is strongly recommended in antenatal period.

Aim: The aim of the present study was to compare the maternal and neonatal complications of caesarean delivery performed in the second stage compared with the first stage of labor. Material & Methods: This was comparative cross-sectional study between first stage and second stage cesarean section done in  Sri Devaraj URS Medical College, R.L. Jalappa Hospital and Research Centre, Tamaka, Kolar, Karnataka, India from May 2021 to May 2022. After taking exclusion and inclusion criteria into consideration, total of 80 cesarean sections were taken, out of which 30 underwent section in second stage and 50 in first stage. Results: Majority were in the age group of 20-25 years 40% in group 1 and 46.44% in group 2. Primigravida formed the majority of study population 72% in group 1 and 80% in group 2. Most important indication for first stage cesarean section is failed induction 32%. Arrest of descent-malposition is the most common indication for second stage cesarean section 60%. Incidence of PPH was more in group 2, i.e., 15 out of 30 cases (50%) where as in group 1 it was 4 out of 50 cases (8%) only. In neonatal outcome, we got the results stating that the most common neonatal outcome was respiratory distress with 50% in group II and group I with 20% only. Conclusion: We observed from the study that majority were in 20-25 years range and most common indication for group I was fetal distress whereas for group II it was malposition. Most common maternal outcome was PPH and neonatal outcome was respiratory distress. The cesarean section in second stage labour was directly related to increase incidence of PPH, fetal distress and admission to NICU. When operative intervention in the second stage of labour is required, the options, risks, and benefits of vacuum, forceps, and Cesarean section must be considered.

Aim: The aim of the present study was to evaluate the feasibility, stone‑free rate, and complications of RIRS in children <5 years of age. Methods: All children less <5 years of age with a stone size <2 cm (renal/proximal ureteric), who underwent RIRS at Sri venkateshwar institute of medical sciences, Tirupati, India for the period of two years were included in this retrospective study. A total of 50 children with 64 renal units met the inclusion criteria. From our hospital database, demographic data, complete history, clinical examination findings, laboratory reports of complete hemogram, serum biochemistry, urine analysis, and urine culture were retrieved. Results: A total of 50 pediatric patients were evaluated, out of whom, 4 had bilateral renal stones (54 renal units). Out of these 50 renal units, 4 patients had multiple stones in the same renal unit. The youngest child was a 4‑month‑old boy who presented with anuria due to bilateral upper ureteric stones. The most common location of the stone was the pelvis and the lower pole. Stones were most commonly of the mixed composition (46%), followed by calcium oxalate dihydrate (22%). Conclusion: Pediatric RIRS is a promising option in young children as it offers an acceptable stone free rates and a low incidence of high grade complications. However, it requires expertise and should be offered at tertiary care centres.

Aim: The aim of the present study was to compare the bupivacaine heavy and 2-chloroprocaine for saddle block in perianal day care surgeries. Methods: This observational study conducted in the Department of Anesthesiology, SNMMCH, Dhanbad, Jharkhand, India for 12 months. We included 50 patients in each group. Results: The mean time for eligibility to discharge from hospital between groups were statistically significant with p value <0. 001. Group A had less mean time (234.58± 20.80 min) compared to group B (340.60±15.55 min). The mean time for length of stay in PACU was less in group A (64.36±6.50 min) as compared to group B (76.24±8.45 min) with p value of <0.001. Mean time taken to ambulate was statistically significant with group A having less mean time (180.40±20.32 min) compared to group B (270.30±20.50 min), with p value of < 0.001. The time taken to void was statistically significant with group A having less mean time (220.50±20.50 min) compared to group B (310.30±22.60 min), with p value of <0.001. There was no difference between the two groups in terms of demographic criteria. Conclusion: In conclusion saddle block with 2-Chloroprocaine provides satisfactory surgical anesthesia for perianal surgeries when compared to low dose hyperbaric Bupivacaine with earlier hospital discharge and shorter PACU stay and time to ambulation and micturition.

Aim: The objective of the present study was to predict neonatal respiratory distress by evaluating the colour doppler of the foetal pulmonary artery. Methods: This was a hospital based observational study conducted among Department of Radiology, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India for one year. 100 pregnant women who presented for institutional delivery in Obstetrics ward. Results: 40 (40%) participants were < 2.25 & remaining 60 (60%) participants were > 2.25 Pulsatility index of pulmonary artery. 40 (40%) participants were < 0.9 & remaining 60 (60%) participants were > 0.9 Resistive index of pulmonary artery. 42 (42 %) participants were < 0.305 & remaining 58 (58 %) participants were > 0.305 AT/ET ratio of pulmonary artery. 60 (60 %) participants required neonate oxygen support > 24 hours. AT/ET ratio had sensitivity of 95.31 % (95 % CI 86.91 % to 99.02 %) in predicting respiratory distress. Specificity was 93.48 % (95 % CI 82.10 % to 98.63 %), false positive rate was 6.52 % (95 % CI 1.37 % to 17.9 %), false negative rate was 4.69 % (95 % CI 0.98 % to 13.09 %), positive predictive value (PPV)was 95.31 % (95 % CI 86.91 % to 99.02 %), negative predictive value (NPV) was 93.48 % (95 % CI 82.1 % to 98.63 %), & total diagnostic accuracy was 94.55 % (95 % CI 88.51 % to 97.97 %). Foetuses with MPA PI < 2.25, 2 (5%) developed no respiratory distress & foetuses with MPA PI > 2.25, majority of 57 (95 %) developed respiratory distress. Difference in proportion of PI between neonate respiratory distress was statistically significant (P value < 0.001). Foetuses with MPA RI < 0.9, 2 (5 %) developed no NRD & foetuses with RI > 0.9, majority of 57 (95 %) developed NRD. Difference in proportion of RI between neonate respiratory distress was statistically significant (P value < 0.001). Conclusion: The Study found that all parameters, pulmonary artery RI, PI, & AT/ET ratio showed good performance as predictors of RD development in neonates. It is recommended that a foetus with AT/ET <0.305 be delivered in a well-equipped hospital with respiratory support facilities, as it is at risk of developing neonatal RD.

Aim: The aim of the present study was to assess the infective profile of patients with ear infections in lower Bihar region. Material & Methods: The study was conducted as a prospective study in the Department of ENT, SKMCH, Muzaffarpur, Bihar, India for the period of 10 months. During this period, 200 patients with ear infections/ear discharge were included in the study. Results: 23% patients were aged 0-20 years. 35% patients were in the age group 21-40 years, 25% patients were in the age group 41-60 years, 15% patients were in the age group 61-80 years and 2% patients were in the age group 81- 100 years. 48% patients were diagnosed as acute suppurative otitis media (ASOM), 50% patients were diagnosed as CSOM and 2% patients were diagnosed as external auditory canal furunculosis (EAC furunculosis). Acinetobacter baumani was present in 1% patient, Burkholderia cepacia in 2% patients, Enterobacter cloacae was present in 1% patient, Escherichia coli in 6% patients, Klebsiella pneumoniae in 4% patients, mould in 11% patients, Proteus mirabilis in 1% patient, Providential rettgeri in 1% patient, Pseudomonas aeurginosa in 24% patients, Staphylococcus aureus in 34% patients, Staphylococcus epidermidis in 6% patients, staphylococcus hemolyticus in 1% patient, Staphylococcus saprophyticus in 1% patient, Staphylococcus xylosus in 1% patient and no growth seen in 6% patients. Gram positive organisms are detected in 43%, Gram negative organisms detected in 40%, fungal infection detected in 11% and no organism detected in 6% of the aural swab samples. Conclusion: The present study concluded that, ear infection is a major health problem in developing countries and Staphylococcus aureus was the commonest infective organism detected.

Aim: The aim of the present study was to study clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital. Methods: The Present study was single-center, retrospective study, conducted in Department of ENT, at SKMCH, Muzaffarpur, Bihar, India . We studied total 100 case records. Case records of patients with sudden onset sensorineural hearing loss examined from last one year were considered for present study. Results: All patients were compared according to recovery status. Recovery was noticed in 40 patients (40%) while no or less than 50 % recovery was noticed in 60 patients (60%). Majority of patients were from 41-60 years age group (43%) followed by from 21-40 years age group (30%). In patients with recovery, mean age was 41.87 ± 9.34 years as compared to patients without recovery as 50.51 ± 10.78 years and difference was statistically significant (p<0.05). Gender was comparable among total patients as well as patients with or without recovery and difference was statistically not significant (p>0.05). Hypertension (35%), diabetes (20%), dyslipidemia (20%) and thyroid disorder (8%) were common comorbidities noted among patients. Vertigo was significant in patients without recovery (62.50%) as compared to patients with recovery (37.50%) and difference was statistically significant (p<0.05). Tinnitus was comparable in patients with recovery (40%) as well as patients without recovery (60%) and difference was statistically not significant (p>0.05). Degree of hearing loss was mild (8%), moderate (10%), moderately severe (20%), severe (25%) and profound (37%). Incidence of patients without recovery was increased with increase in severity of hearing loss and difference was statistically significant (p<0.05). Conclusion: In patients with sudden onset sensorineural hearing loss age less than 40 years, no comorbidities, lesser degree of hearing loss, early (<14 days) initiation of treatment are factors associated with recovery.

Background: Proteinase inhibitors (Antitrypsin and Anti chymotrypsin) have been identified in trophoblasts and play an important role in placental implantation by modulating maternal immune response towards fetus. Studies have shown the association of antitrypsin and antichymotrypsin with preeclampsia and fetal growth restriction, hence we attempted to study the correlation of maternal serum markers with fetal growth restriction. Objective: To find correlation between maternal serum proteinase inhibitory activities at 11-14 weeks with second trimester fetal growth parameters and birthweight. Materials and Methods: Prospective observational study, from 2014 to 2016 done in a tertiary care hospital. 198 antenatal women were recruited at 11-14 weeks out of which 7 were excluded from the study, 191 women analysed. Maternal serum was collected at 11-14 weeks and tested for antitrypsin and antichymotrypsin levels, ultrasound growth parameters were measured at 18-20 weeks; birth weights of newborns of the patients delivered during the study period (134) were noted and analysed. Results: The median values of antitrypsin and antichymotrypsin calculated in our study population were 71.2U/ml and 91.6U/ml respectively. No association was found between antitrypsin and biparietal diameter, head circumference, femur length and estimated fetal weight at 18-20 weeks. A statistically significant association was noted between antitrypsin levels and abdominal circumference. No association was noted between antichymotrypsin levels and any of the growth parameters. No association was noted between antitrypsin levels and birth weight. Though there was an apparent association between antichymotrypsin and birthweight, statistical significance (p- 0.059) was not proven. Conclusion: Maternal serum antitrypsin and antichymotrypsin may have role in predicting early fetal growth restriction.

Fine-needle aspiration cytology (FNAC) is an invaluable tool in the management of thyroid lesions with a high degree of accuracy. With the main goal of verifying benign lesions and preventing unnecessary surgery, FNAC of the thyroid gland is currently a well-established, first-line diagnostic technique for the examination of diffuse thyroid lesions as well as of thyroid nodules. The objective of the study was to compare the findings of cytological and histopathological features of thyroid lesions. Materials and methods: The present study was carried out in the Department of Pathology, Pacific Institute of Medical Sciences over a period of 18 months from April 2021 to September 2022. A total of 100 patients with thyroid lesions were studied by FNAC and results were compared with histopathology wherever possible. Results: Majority of cases (29%) in the present study were in middle age group (31- 40 years) followed by 23% cases seen in (51-60 years) age group. Male female ratio was 1:8.09. We found that the most common benign diagnosis seen by cytology was colloid goitre (53%) and malignant was papillary carcinoma (10%). Histopathology showed same diagnosis in 85 out of 100 as diagnosis by cytology. For malignant lesions, both sensitivity and specificity were 100.00%. For benign lesions sensitivity ranged from 78.57% to 93.48% for various lesions, while specificity ranged from 81.48% to 100%. For malignant lesions both PPV and NPV were 100%. For benign lesions PPV ranged from 81.13% to 100% while NPV ranged from 92.21%to 93.62%. Conclusion: The Bethesda system review of thyroid FNAs for reporting provided accurate cytological diagnosis. In reporting thyroid cytology, it represents uniformity and consistency with increased clinical importance and higher predictive value. The utility of the diagnostic test depends on the nature of the disease, experience and knowledge of cytopathologist.

The systemic effects of medicinal medicines are best achieved by the oral mode of administration, yet low drug solubility presents a significant issue for formulation scientists. The solubility and solubilization procedure have been explored in this research. Drugs are divided into four groups according to their solubility in water using the BCS classification system. The BCS system’s Class II and Class IV compounds have poor solubility. Several categories of variables are discussed, each of which affects the drug’s soluble nature. We employ a number of different approaches or procedures to enhance the solubility as well as bioavailability of drugs that are poorly soluble. Co-solvency, nanonization, Particle size reduction, hydrotrophy, pH adjustment,  sonocrystallization, the supercritical fluid (SCF) process, solid dispersion, inclusion complexation, self-emulsifying or microemulsifying systems, and liquisolid techniques are all covered here. In this review, we have looked at how several techniques may be utilized to increase the drug’s solubility in water.

The objective of the study was to explore the objectives, advantages and disadvantages of sustained release matrix tablet. Different types of sustained release matrix tablet have been explained briefly along with various types of polymers that are used during the formulation. Various preparation methods are discussed here. There are certain physicochemical factors and biological factors which affect the release of drug from the matrix are also discussed briefly. These matrix tablets also have to go through many evaluation tests like thickness, hardness of tablet, friability, weight variation, determination of drug content and in-vitro dissolution test.

Oral route if drug delivery has been used from many decades and it is one of the most preferred routes of administered. Mouth dissolving tablets (MDTs) are the tablets which gets disintegrates very quickly and release medicaments instantaneously. In the present study we have discussed about ideal properties of MDTs along with their advantages and disadvantages. Different types of manufacturing technique are employed such as Freeze drying, Molding, Tablet Molding, Direct Compression, Spray drying and Mass Extrusion, which are discussed below. There are many evaluation parameters like General Appearance, Size, Shape, Thickness and diameter, Uniformity of weight, Hardness of tablets, Friability of tablets, Disintegration time, In-vitro dispersion time test, Wetting time, Water absorption ratio, In vitro dissolution test as well as Accelerated Stability study for MDTs.

The convenience of administration and improved patient compliance are important in the design of oral drug delivery system which remains the preferred route of drug delivery inspite of various disadvantages. Fast disintegrating tablets (FDTs) have received ever- increasing demand during the last decade, and the field has become a rapidly growing area in the pharmaceutical industry. The popularity and usefulness of the formulation resulted in development of several FDT technologies. These techniques render the disintegration of tablet rapidly and dissolve in mouth in five seconds without chewing and the need of water which is advantageous mainly for pediatrics, geriatrics and patients having difficulty in swallowing tablets and capsules. Formulation of a convenient dosage form for administration, by considering swallowing difficulty and poor patient compliance, leads to development of orally disintegrating tablets. Conventional preparation methods are spray drying, freeze drying, direct compression, Molding, and sublimation while new technologies have been developed for the production of orodispersible tablets.

Aim: The aim of the study was to assess the role of CT in evaluating the efficacy of laparoscopic treatment in the management of intra-abdominal ruptured liver abscess. Methods: This was retrospective observational research that was carried out on patients diagnosed with intra-abdominal burst liver abscess at the Department of Radio-diagnosis, Lord Buddha Koshi Medical College and Hospital in Saharsa, Bihar, India, for five months. The study was given the green light by the Hospital Ethical Board. The study consisted of participation from fifty different patients. In this study, we included all of the cases that were diagnosed with a burst liver abscess based on radiology and laparoscopic investigation. The information that was recorded included demographics, clinical features, and computed tomography. Results: The mean age of the 50 people in the study group was 54.615.5 years (range: 24-85 years). In the study, there were more guys than women. Most of the people had diabetes mellitus (30%), followed by bacterial pneumonia (20%), high blood pressure (8%) and bile duct stones (4%). Most of the patients had abdominal pain (94%), felt sick and didn’t want to eat (94%), had a fever (80%), and had peritonitis (76%). The average amount of time between getting a fever and getting a CT was 8.4 days (the range was 1-30 days). The size of the liver abscess ranged from 4 to 14 cm, with an average of 8.2 cm. In 18 patients, there was only one abscess, and in 32 patients, there were more than one. Unilobar involvement was seen in 46 patients. In 40 patients, the abscesses were fully drained, and in 10 patients, there was gas inside the abscess. All of the patients had free fluid inside their peritoneum. Most of the time, the right lobe was affected and not the left. Conclusion: A liver abscess that has burst is more dangerous to your life than one that hasn’t burst. It is important to get a quick and accurate diagnosis and to start surgery right away. Most of the cases came on quickly, and most of the time, the right lobe is affected. The most usual sign was a pain in the stomach. CT scans are the best way to find out about hepatic abscesses and their complications.

Aim: The aim of the present study was to evaluate the correlation of ultrasound with X-Ray for determining the amount of aspirated effusion and evaluate pleural effusion. Methods: The present study was conducted at Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India, for a period of 8 months.  The source of data for this study includes a total of 30 patients referred to the Department of Radio-Diagnosis Imaging for chest radiography and ultrasonography from OPD/IPD/ED of Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar. Among these, 18 (60%) were male, and 12 (40%) were female, with an average age of 36.4 years. Results: Results from USG showed 15 (50%) males and 5 (16.66%) females had pleural effusion in the right lung, whereas 7 (23.34%) females and 3 (16.66%) males had pleural effusion in the left lung. In x-ray images, 12 (40%) males and 6 (20%) females showed pleural effusion in the right lung, and 6 (20%) females and 6 (20%) males had effusion in their left lung. The average volume of effusion in males was 35.50 in the left lung and in the right lung was 120.40. In average female effusion in the right lung was 102.90, and in the left was 64.36 mL. For the right lung minimum volume of fluid level was 36.4 ml and 340 mL was the maximum volume, and the average volume was 93.98 mL. In the left lung minimum of 36.4 ml of fluid was detected, and the maximum recorded was 220.2 mL, and the average volume recorded was 60.1 mL. Conclusion: USG is some distance superior to simple X-Ray in locating minimal pleural & also for quantification of effusion pleural furthermore, interventions like a pleural faucet can also be done. USG can locate the low amount of fluid presence, even less than 3 ml, while X-ray fails to help diagnose such a low quantity of fluid.

Aim: The aim of the present study was to evaluate the effect of three doses of prophylactic antibiotic an hour before a surgical intervention with the chosen standard antibiotic with regard to the conventional use of same antibiotic for 5 to 7 days. Methods: The present prospective analytical study was conducted on 200 Patients attending outpatient Department of General surgery, Government Medical College and Hospital, Bettiah, Bihar, India for the period of 18 months. Results: There was no significant variation between data of the two groups based on age. Mean hemoglobin level in group I was 12.06 with SD of ±1.60 and in group II it was found to be 11.70 with SD of ±1.25. Mean serum protein levels in group I was 6.65 with SD of ±0.72 and the same in group II was 6.64 with SD of ±0.74. There was no significant difference between both the groups based on diabetes and addiction. No significant difference was found for post-operative infection on day 3 and day 5. There was no significant difference between both the groups based on the type of surgery. There was no statistical significant difference between both the groups based on Southhampton grade. Conclusion: A minimal dose antibiotic prophylaxis is equally efficient and has added advantage of reducing the duration of hospital stay and cost of medicines for the patients. Hence minimal dose antibiotic is better than a routine long term antibiotics therapy.

Aim: The objective of the present study was to assess association between socio-demographic, behavioural and clinical risk factors of diabetic foot and response of patients to various treatment modalities. Methods: A prospective study was conducted in the Department of General Surgery, Government Medical College, Bettiah, Bihar, India for 12 months. 100 patients were included in the study. All patients who presented to surgical outpatient department or were admitted via emergency to the surgical wards with signs and symptoms of diabetic foot during the 12 months period were included. The study was conducted after obtaining approval from institutional ethics committee. Results: Out of 100 patients in study, 42 (42%) were in the age group of 51-60 years followed by 26 (26%) in the age group 61-70 years. There was a male preponderance in the study with 70 (70%) patients out of 100 being males. Majority of the study subjects were literate with overall literacy rate being 60%. 96% study subjects belonged to low class. Among the 100 patients, 25 (25%) were unmarried showing lack of support and care and rest (75%) were married. Labourers accounted for 35% of study participants, farmers constituted 30%, businessmen 17% and others 18% of study subjects. Among the 100 study participants, 44 (44%) either smoked or chewed tobacco and 36 (36%) consumed alcohol. Majority (90%) of the patients were sedentary, 5% performed light physical activity while the remaining 5% performed moderate physical activity. Most of the participants had type II diabetes for >10 years. 80% of study participants had family history of diabetes. 92% of study participants were overweight (BMI 25-29.9) and remaining 8% were obese (BMI ≥30). Hypertension was present in 75% of study participants, ischemic heart disease in 60% and hypercholesterolemia in 70%. Conclusion: Diabetic foot is a common complication of long-standing diabetes. Several socio-demographic factors like advancing age, low socio-economic status, lack of family support, occupations involving risk of trauma to foot contribute to the risk of developing diabetic foot in diabetics. Hence it is essential to educate all the diabetic patients at risk about good glycemic control, risk factors, proper foot care, periodic foot examination and neurological examination of lower limbs, prompt treatment of foot lesions and regular follow-up.

Aim: The aim of the present study was to estimate the postoperative astigmatism after small‑incision cataract surgery (SICS) done at the end of 1 and 3 months. Methods: The present study was conducted at Bhagwan Mahavir Institute of Medical Sciences for 10 months and total of 100 patients were included in this observational longitudinal study. These patients underwent manual SICS with implantation of Posterior chamber intraocular lens (PCIOL). Results: The age group 70–79 had the highest frequency 40% followed by 60-69 years 34%. 90% patients had 0.00-1.00 astigmatism and 75% had WTR type of astigmatism. In the current study, patients with mature senile cataract and immature senile cataract, fulfilling the inclusion criteria were selected. The observations achieved showed a maximum of 45 (45%) patients with NO II, followed by 35 (35%) with NO III, 15 (15%) with Mature senile cataract (MSC), and 6 (6%) with NO IV. The patients with a lesser length of incision had lesser SIA, as these incisions were present in the astigmatically neutral funnel. The average distance from the limbus that is considered normal is 1–1.5 mm. In the present study, there were 60 (60%) patients with distance from limbus ≤1.0 mm, while 30 (30%) had distance ranging between 1.1 and 1.5 mm and 10 (10%) had distance ≥1.5 mm. Conclusion: We concluded that SIA is directly related to the length of incision, distance from the limbus, and suturing techniques. The SIA estimated in resident‑operated SICS cases was found to be between 1.75 and 2.5 D at the end of 1 and 3 months. SICS induces less surgically induced astigmatism, less inflammation, less complications influencing the overall visual prognosis and quick stabilization of refraction, hence providing better and rapid visual rehabilitation in the postoperative period.

Aim: The purpose of the present study was to examine the relationship between dynamic trunk balance and BES Test scores in elderly women. Methodology: 50 women volunteers aged 60 years or more from ANMMCH, Gaya, Bihar who could walk unaided were enrolled. The evaluation items were the BES Test total score, the scores of each of the six elements of the BES Test, dynamic sitting balance, static postural balance, and muscle strength (back muscle, iliopsoas muscle, and quadriceps). The BES Test total score and the scores for each of the six elements of the BES Test were measured. The COG deviation was recorded using a microcomputer with the participant standing unaided in the upright position with the eyes open for 30 s and then with the eyes closed for 30 s. The total movement of the COG during measurement was calculated as the total length. To assess muscle strength, the strengths of the iliopsoas and quadriceps muscles were measured twice on each side with a hand-held dynamometer, and the mean values of the left and right sides were used. Back muscle strength was measured twice as the isometric muscle strength using a strain gauge with subjects in the prone position, and the maximum value was used. Results: This study included 50 elder women of age more than 60 years. Mean age of all the volunteers was 69+8 years. Volunteers had a mean height of 146+9 cm and mean weight of 50+14 Kg with a mean body mass index ratio 22.9+5.2 Kg/m².  The mean BES Test total score was 84.9±10.8 in this study. According to the results, mean total length of center of gravity trajectory was 1438.9±449.5 mm (Dynamic sitting balance). Mean trajectory for static postural balance was 83.8±43.1 cm. Muscle strength of back extensor, iliopsoas, and quadriceps muscle was 154.2±68.8, 122.0±27.1, and 147.2±30.4 respectively. Conclusion: From this study, it can be said that the relationship between the evaluation of the single leg standing by BES Test and the total COG trajectory length during dynamic sitting balance was affirmative of previous reports. In elderly women, the trajectory length of the COG during dynamic sitting was negatively correlated with the BES Test total score.

Aim: Comparison between two different drugs in treatment of infertility among PCOS patient. Materials and Methods: The present Randomized control trial was conducted in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar among PCOS patients diagnosed on the basis of revised Rotterdam 2003 criteria. In this clinical trial out of 100 patients, 50 patients received Clomiphene Citrate 100 mg (group A) and rest 50 patients received Letrozole 2.5mg (group B) daily since day 2-6 or 3-7 of menstrual cycle. Result: Monofollicular development was statistically significantly, greater in the group B. There was also statistically significant difference between the two groups in endometrial thickness (CC 7.16±1.05mm, Let 9.68±1.15mm). Similarly, the ovulation rate was 83% in group A and 90% in group B. The pregnancy rate was 21% in group A and 35% in group B. Conclusion: The present study concluded that though Clomifen Citrate group showed good ovulation rate but final outcome was poor.

Aim: The study evaluated the clinical, radiological, and functional outcomes of hip hemiarthroplasty in elderly with fracture neck of the femur. Methods: The study was department of Orthopaedics at JLNMCH, Bhagalpur, Bihar, India. Data of patients above 60 years who were operated on for fracture neck of the femur by bipolar hemiarthroplasty for 12 months were retrieved from the Department of Orthopaedics, JLNMCH, Bhagalpur, Bihar, India. The sample size was 100. Results: The predominant mechanism of injury was trivial falls in 68 (68%) patients followed by motorcycle accident in 28 (28%) patients and vehicular accident in 4 (4%) patients. 55 patients were female, and 45 patients were male. All the patients were ambulatory with or without support before the fracture. 94 patients received cemented femoral stems; the remaining 6 received press-fit ones. Majority of the patients had hypertension followed by diabetes. 20 patients had excellent Harris Hip scores, and 10 had fair scores. The remaining 70 patients had good Harris hip scores. Conclusion: The present study modular bipolar hemiarthroplasty provides better pain relief with early mobilization and a good level of return to daily routine activities with minimal complications. The overall complications following hemiarthroplasty were acceptable. Targeted medical intervention that focuses upon susceptible patient groups may reduce morbidity, mortality, and improve survival.

Aim: The aim of the present study was to study changes in vital parameters in relation to different feeding methods in preterm newborns. Material& Methods: This was a prospective analytical observational study conducted in Department of Pediatrics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India for the period of two years. Sick preterm newborns are admitted to Neonatal Intensive Care Unit (NICU), and stable preterm newborns weighing more than 1500 gm are admitted to Neonatal Intermediate Care Unit. We collected 350 observations from 100 newborns. Results: There was rise in RR at 5 min in the majority of groups except the GF group. After 5 min, it reduced gradually towards baseline at 3 hours after feed in the majority of the groups except the SG and BSG groups. There was rise in PR at 5 min in majority of groups except in the BS and GF groups. After 5 min, it reduced gradually towards baseline at 3 hours after feed in the majority of the groups except in the BF and BS groups where it reduced below the baseline. We noticed the trend towards nonsignificant rise in SPO2 immediately after feed in the SF, BG, and SG groups while in the GF, BS, and BSG groups there was nonsignificant reduction. There was a sharp reduction at 5 min in the majority of the groups except GF. Mean SPO2 reached towards baseline at 3 hours after feed in the majority of the groups except the SF group where it was below baseline. In the BF group, the mean SPO2 increased significantly immediately after feed. Conclusion: Vital parameters changed after different types of feeding methods and at different PMA. A further multicentric prospective study is needed to understand the effect of different feeding methods and PMA on vital parameters.

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, Darbhanga Medical College and Hospital Laheriasarai, Darbhanga, Bihar, India for one year after permission from institutional ethics committee. 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.

Aim: The aim of the study was to find the role of cell block technology as an alternative to biopsy in identifying liver lesions. Material & Methods: A Retrospective study with 500 cases was done at department of Pathology, IGIMS, Patna, Bihar, India in between July 2015 to Jan 2017 . FNAC of the liver lesions were done and smears were prepared for routine staining (HE, PAP, and MGG), the rest of the material was submitted in 60% ethanol for cell block preparation. Usefulness of cell block preparation was evaluated, and the final diagnosis correlated with the biopsy results. Results: There were 60% male and 40% females. Hepatocellular carcinoma was in the range of 46-82 years with a mean of 66.4 years while metastatic age range was 40-80 years with a mean of 58.2 years. On cell block, with or without immunohistochemistry, 75 cases (15%) were positive for hepato-cellular carcinoma, 380 cases (76%) were positive for metastatic lesions, 10 cases (2%) were suspicious of malignancy and 35 cases (7%) were designated as benign lesions. Morphology was observed from the smears obtained with MGG, PAP and H&E routinely from the cell block preparation. Special stain was PAS (to look for mucin) and reticulin (to look for trabecular strand) was also performed on cell block preparation.  A detailed statistical analysis showed sensitivity of all the lesions diagnosed through cell block method to be 97.50% with positive predictive value of 98% and P-value highly significant at <0.00001. Diagnosing metastatic carcinoma was also very accurate with positive predictive value of 98.2%. Primary lesion like hepatocellular carcinoma with 100% positive predictive value, 92.8% sensitivity and significant P-value had very precise results on cell block. However, differentiating the various types of metastatic lesions on cell block was less on target with accuracy ranging from 66.66% to 100% for various carcinomas. Conclusion: High precision of validity results of cell block technology in comparison with biopsy highlights its pivotal role in conjunction with supportive tests for diagnosing and differentiating liver lesions as well as identifying primary sites in liver metastasis.

Aim: The objective of the present study was to assess cervical dysplasia in relation to socioeconomic status and various environmental high-risk factors. Methods: A prospective study was conducted in the Department of obstetrics and gynaecology, BMIMS, Pawapuri, Nalanda, Bihar, India for one year . Total 200 Married women who have pre- and post-menopausal age group were included in this study. Results: Incidence of mild dysplasia was 52.5% followed by 30%Moderate dysplasia and 17.5% Sever dysplasia. The maximum age incidence of dysplasia has been found in the age group 20-30 years 40% and followed by 30-40 years 18% and above 50 years we found only 8%. The percentage positivity of cervical dysplasia was higher in lower socioeconomic group. A high incidence is noted in those who are illiterate (45%) and followed by up to 8th standard and 12th standard and only 6 were graduate. Incidence of dysplasia high in rural 65% and 35% in urban area and Most of these women were married before the age of 20 years. Out of 200 cases; 80% were from Hindu patients while 15% belonged to belonged to Muslims and 5% cases were from other religion. The most common symptoms was vaginal discharge was present in 65% patients followed by backache and pain abdomen 10%, Menstrual complaint 7.5%, Intermenstrual bleeding 6% and Post-menopausal bleeding 2.5%, Postcoital bleeding 5%, Pruritus vulva vagina 4%. Conclusion: Dysplasia is a neoplastic precursor of invasive disease. It is important to identified the high risk population and suggest social measure to motivate and educate women for a positive attitude towards cancer consciousness to make the screening program useful for prevention cervical dysplasia.

Aim: The aim of the present study was to estimate the clinical prognosis of patients with diagnosis of acute kidney injury. Methods: The present study was conducted in Upgraded  Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India for two years and 200 patients were included in the study. Results: In the present study, 66% were male and 34% were females. 35% had low PRSIM classification followed by very high 26%. 80% had pre-renal AKI. Patients with a maximum KDIGO stage 3 AKI during PICU stay was associated with higher use and duration of mechanical ventilation in comparison with patients with maximum stages 1 and 2. The mean time of mechanical ventilation was 4.7 days for patients with a maximum KDIGO stage 1 AKI, 5.7 days for a maximum KDIGO stage 2, and 8.5 days for a maximum KDIGO stage 3. Conclusion: Acute kidney injury, established and classified according to KDIGO as severe and its maximum stage, was associated with worse clinical outcomes; early therapeutic efforts should focus on preventing the progression to severe stages.

Background: In developing countries despite advances in antibiotic therapy Bacterial meningitis remains a significant cause of morbidity and mortality. It is commonly diagnosed on basis of clinical presentation and cerebrospinal fluid analysis (CSF). But at times atypical CSF findings are encountered over cases of clinically suspected bacterial meningitis and sometimes due to prior antibiotic use, which puts the treating physician in dilemma regarding initiation of antibiotics. Therefore, an early and a confirmed diagnosis is required for managing such cases and to achieve a favorable outcome. Various studies suggest Procalcitonin to be a promising biomarker for diagnosing bacterial infections. But there are also studies which suggest serum procalcitonin and CSF procalcitonin to be a superior bio-markers in differentiating Bacterial from another non-bacterial meningitis. Therefore, this study is undertaken to find out a biochemical marker to diagnose Bacterial meningitis with increased accuracy which will help the clinicians to differentiate Bacterial meningitis from other common infective meningitis, for proper therapeutic decisions with the following objectives Aim: A comparative study of cerebrospinal fluid Procalcitonin and serum procalcitonin in patients with bacterial meningitis. Material and Method: This observational and analytical study was carried out in the Department of General Medicine, among patients admitted under Department of General Medicine and Department of Neurology with a sample size of 60 following inclusion and exclusion criteria. The subjects were evaluated, data collected, blood samples were sent for routine investigations and Lumbar puncture was done in favorable subjects. The CSF analysis was done along with serum and CSF procalcitonin. The test for CSF and Serum procalcitonin were conducted using a Sandwich immunodetection method using ichroma PCT analyzer. The results were analysed using appropriate statistical methods. Results: In our study it was observed that the elderly age group has a higher association with meningitis. The occurrence of Bacterial meningitis shows a significant seasonal pattern, mostly during winter. Subjects of bacterial meningitis has the longest duration of hospital stay. The predictive value of both serum and CSF procalcitonin are higher in cases of Bacterial meningitis in comparison to non-bacterial meningitis. The ROC analysis concluded that the diagnostic accuracy of CSF procalcitonin is slightly higher but statistically not significant in diagnosing Bacterial meningitis. The Cerebrospinal fluid and Serum procalcitonin were not significant in cases of Viral meningitis and Tubercular meningitis making it a poor biomarker in this meningitis. Conclusion: Both serum and CSF procalcitonin are better markers in diagnosing Bacterial meningitis and to differentiate them from another non-bacterial meningitis. The study was conducted in context of high morbidity and mortality of Bacterial meningitis and associated complications and the need for a better bio-marker in early diagnosis of Bacterial meningitis and initiation of prompt and proper treatment. The data was analyzed and observations were discussed along with relevant contemporary literature and other studies. Further research works needs to be done on combined use of Serum as well as CSF procalcitonin in cases of Bacterial meningitis.

Aim: The aim of the present study was to assess the association between BMI, blood pressure and age. Methods: A cross-sectional study was carried out in department of physiology, Government medical college, Bettiah, Bihar, India for one year age ranging from 20 to 70 years among 200 male patients. The subjects were divided into five different age groups with ten years interval each to study the age trend of height, weight, BMI, and BP. Results: The differences in mean BMI was statistically significant between all the age groups except for 40–49 yr and 50–59 yr age groups. The differences in mean height were statistically significant only between 50– 59 yr and 60–70 yr age groups, whereas among the rest of the groups, the differences were statistically non-significant. The differences in mean systolic BP between different age groups were statistically nonsignificant. The mean values of both the systolic and diastolic BP increased from underweight to normal and then to overweight and obese category. It showed that mean systolic and diastolic BP increased with increasing BMI level. There was also significant (P < 0.05) positive correlation between age and BMI, but the magnitude of correlation of age with systolic and diastolic BP (P < 0.01) was more than that of age with BMI. Conclusion: BMI was found to be associated with age independently. Although the magnitude of correlation differed, there was significant positive correlation among BMI, age, systolic and diastolic BP. Odd ratios showed overweight/obese subjects to be more likely to have hypertension than those with normal BMI.

Aim: The current study was undertaken to compare Resting, peak exercise, 5 min after exercise respiratory rates and respiratory rate recovery following Astrand-Ryhming step test and Peak expiratory flow rates (PEFR) between students of Medical Education (ME)). Material & Methods: The present study was conducted at Government medical college, Bettiah, Bihar, India. The study was conducted on 100 healthy medical students after completion of 1 year of course in the college. Permission to conduct the study was obtained from the institutional ethical committee and principal of the college. Results: The comparison of mean resting, peak exercise, and 5 min after ARST respiratory rates showed that all the differences were statistically highly significant. The increase in respiratory rate at the end of Astrand-Rhyming Step test (ARST) and Percent recovery respiratory rate (Percent RRR) at the end of 5 min recovery after ARST over pre -test between showed significant results. The mean PEFR±1SD in ME students was 460.2±66.4 and the difference was statistically highly significant. Conclusion: The present study revealed that the important parameters of pulmonary fitness like Respiratory rates and PEFR among ME students. Beneficial effects of exercise are well known since the ancient Vedas. The present attractive education system has helped to improve the education standards, but the non-active sedentary stressful life has made the youth physically unfit. Regular physical activity is an essential part of the healthy life style and should be encouraged among medical students.

Aim: The aim of the present study was to compare outcomes of mesh fixation with metallic versus delayed absorbable suture material in inguinal hernia through laparoscopic surgery. Material & Methods: This was prospective study conducted in the Department of General Surgery, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India during the period of one year. Total 200 male patients who underwent laparoscopic surgery were included in the study. Results: In group 1, the patients’ mean age of 53.7 years and in group 2 mean age of 50.5 years in group 2. In group 1, 25 patients having right and 26 patients have left, 26 patients have unilateral hernias and 23 patients have bilateral hernias while in group 2 there were 38 patients having right, 20 patients have left, 25 patients have unilateral hernias and 17  patients have bilateral inguinal hernias. There was no statistical significant difference was found between two groups except for the appearance of the post-operative pain after 1 month (p<0.05). The appearance of post-operative paresthesia in both surgical groups, there was more number of patients had developed paresthesia group 1 as compared to group 2 but it was not statistical significant. There was more number of patients had developed complications group 1 as compared to group 2 barring ecchymosis which was more common in group 2. There was no statistical significant difference was found between two groups. Conclusion: In Laparoscopic surgery, a straightforward, safe, and efficient alternative to tension-free open mesh fixation with delayed absorbable suture material. With There are fewer odds of chronic groin discomfort and paresthesia following air knot fixation compared to the conventional way of fixation.

Aim: The aim of the present study was to assess the effectiveness of dapaglifozin in the management of T2-DM in combination with other hypoglycemic agents (OHAs) or insulin, in terms of improving HbA1c and fasting blood glucose, among diabetic patients. Material & Methods: This study was a retrospective observational study conducted at department of Pharmacology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for one year. All adult diabetic patients who were prescribed Dapagliflozin during the period of one year, total 200 patients were included in the study. FBG, HbA1c collected through hospital records from General Medicine and Endocrinology. Patients who stopped drug before 3 months period were excluded. Results: The mean age of patients was 54.46±6.14 years, in total 45 patients 70% (140) were male and 30% (60) were female. The mean fasting blood glucose and HbA1c levels at baseline were 9.31±0.77% and 182±32.88 respectively. In this study, all patients received dapagliflozin as an add-on therapy in combination with ongoing diabetic treatment. In the follow-up period, Paired T test was used to evaluate the difference in HbA1c and FBG following treatment with dapagliflozin. P values for the changes in FBG and HbA1c from baseline were significant (p=0.001 & p=0.001, respectively). Conclusion:  Dapagliflozin as an add-on therapy significantly reduced the HbA1c level and fasting blood glucose of Type-2DM patients, in a 3-month treatment period. Due to the frequency of genitourinary tract infections, caution is indicated while treating the patients.

The aim of the present study was to evaluate and compare the mini PCNL and standard PCNL for the treatment of renal stone of size 10-30 mm. Material & Methods: A randomized prospective study of the patients presented to the department of urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India with calyceal or pelvic kidney stone (10–30 mm) in the period of 2 years. All procedures performed in this study involved human participants with written informed consent in accordance with the ethical standards of the institutional research committee. Results: The mean age of patients was 36.4 ± 9.4 and 34.6 ± 6.5 years in sPCNL and mPCNL respectively. The patient characteristics and stone characteristics in both groups were comparable with mean stone size of 21.9 ± 2.5 mm in sPCNL and 20.4 ± 3.7 mm in mPCNL group. There was no significant difference in total post-operative time, overall stone free rate (96.4 ± 3.7% vs 95.5 ± 4.5%) and postoperative complications and total hospital stay in both groups. Post-operative drain site leak was higher in sPCNL group. The drop in post-operative haemoglobin (3.2 ± 0.4 gm% vs 1.5± 0.8 gm%) was significantly less in mPCNL than sPCNL (p < 0.05). In subgroup analysis the total stone free rate was higher in mPCNL for multiple and calyceal stones. Significantly greater number of patient underwent tubeless PCNL in mini PCNL group than standard PCNL. Conclusion: Mini PCNL is as effective as standard PCNL with fewer bleeding complications in management of medium sized nephrolithiasis.

Aim: The aim of the present study was to study changes in vital parameters in relation to different feeding methods in preterm newborns. Material& Methods: This was a prospective analytical observational study conducted in Department of Pediatrics, AIIMS, New Delhi India from September 2017 to August 2019. Sick preterm newborns are admitted to Neonatal Intensive Care Unit (NICU), and stable preterm newborns weighing more than 1500 gm are admitted to Neonatal Intermediate Care Unit. We collected 350 observations from 100 newborns. Results: There was rise in RR at 5 min in the majority of groups except the GF (gavage feeding) group. After 5 min, it reduced gradually towards baseline at 3 hours after feed in the majority of the groups except the SG (spoon feeding followed by gavage feeding) and BSG (breast feeding followed by spoon feeding followed by gavage feeding) groups. There was rise in PR at 5 min in majority of groups except in the BS (breast feeding followed by spoon feeding) and GF groups. After 5 min, it reduced gradually towards baseline at 3 hours after feed in the majority of the groups except in the BF(breastfeeding) and BS groups where it reduced below the baseline. We noticed the trend towards nonsignificant rise in SPO2 immediately after feed in the SF (spoon/paladai feeding), BG (breast feed followed by gavage feeding), and SG groups while in the GF (gavage feeding), BS, and BSG groups there was nonsignificant reduction. There was a sharp reduction at 5 min in the majority of the groups except GF. Mean SPO2 reached towards baseline at 3 hours after feed in the majority of the groups except the SF group where it was below baseline. In the BF group, the mean SPO2 increased significantly immediately after feed. Conclusion: Vital parameters changed after different types of feeding methods and at different PMA. A further multicentric prospective study is needed to understand the effect of different feeding methods and PMA on vital parameters.

Aim: The aim of the present study was to evaluate effectiveness of various management strategies in the management of liver abscess. Material & Methods: The present study was carried out in the Department of General Surgery, Government Medical College, Bettiah, Bihar for the period of 8 months. Total number of patients was 200 included in this study with the diagnosis of liver abscess admitted in the surgery ward. Results: Highest incidence was noted in age group of 51-60 years (32%) with a mean age of 48.82 years. Out of total 200 cases, 160 patients were male and 20 patients were female. Out of 200 patients 160 patients had liver abscess cavity of size 51-500cc (80%) followed by 20 patients who had <50 cc size cavity. Out of 200 cases 60 patients were treated with percutaneous needle aspiration with 16G metallic needle, 40 patients were treated with Percutaneous pigtail catheterisation, 20 patients were treated conservatively whereas 20 patients required surgical drainage. In the present study we can observe that 35 of 60 cases had volume aspirated between the range of 51-150 cc which correlates to high no of patients with residual liver abscess less than 20 cc (25 of 60 cases). 30 of 60 cases (50%) were treated with a single aspiration along with antibiotics. 25 of 60 cases (41.66%) required second aspiration attempt. 3 of 60 cases required three attempts of aspiration and only 2 cases required fourth attempt of aspiration. Conclusion: The present study concluded that conservative treatment with only intravenous antibiotics can be done for liver abscess with size less than or equal to 5 cm and volume less than 50 CC. Percutaneous needle aspiration is the best treatment modality for liver abscess measuring 5 10 cm, Percutaneous pigtail catheter drainage is a choice of treatment for large cavity size more than 10 cm and abscess having thick unliquified pus.

Objective:  To assess the efficacy of endonasal endoscopic dacryocystorhinostomy  with nasal flap preservation and flap removal technique, in patients with chronic dacryocysytitis secondary to the nasolacrimal duct obstruction. Methodology: This prospective study is including 60 patients who underwent endoscopic DCR complaining from continuous epiphora due to acquired nasolacrimal duct obstruction attending OPD in the department of Otorhinolaryngology, GMERS medical college,  Himatnagar, Gujarat. Patients included in the study had been subjected to our standard pre operative evaluation included a complete history and physical examination, lacrimal sac syringing, probing of the canaliculi and nasal endoscopy. All route in and specific investigations required for GA is done. The subjects assigned to either group A or group B depending on intra-operative nasal mucosal flap position. Group A patients were treated with repositioning of nasal mucosal flap on bare bone and group B patients were treated with the removal of nasal mucosal flap and the bare bone was covered with abgel. Result: All 60 patients were reviewed for 1week, 4week 3months and 6 months. Among 60 patients 44 (73.3%) patients were female and 16(26.6%) patients were male. The youngest patient found in the study was 14 years old boy, and eldest was 72 years old female. Epiphora (100%) was most common presenting symptom. In 34 eyes (group A), flap preservation was done and in 34 eyes (Group B) flap removal DCR was performed. In 3 month postoperative visit, the results are showing that there is no statistical significant difference between the two groups  Overall, the success rate of the procedure in group A is 100% when compared to group B ( 97.05%),  Whereas 1 eye (2.9%) in group B were in failure in terms of epiphora. Comparison of surgical outcome between two groups was statistical insignificant (P=0.93). Conclusion: There is not much difference in the success rate of surgery if mucosal flap is sacrificed. So it is of no matter whether to preserve or to remove the mucosal flap.