International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

NMC Approved

Peer Review Journal

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1. A Dermatological Complications Despite of Lower CD4 Count in HIV Infected Patients
Sathish K.S., Monika. M. Gowda
Background: The present study attempt to know the prevalence of different association with dermatological complication in HIV infected patients. Methods: An observational study was conducted at Department of Dermatology and Venerology, KIMS Bengaluru during the period 2014-2015. PLHIVs who are received on ‘HAART’ with the age group 20-55 years were considered for the study population. Results: The overall prevalence of skin lesions in the age group 20-55 years of HIV infected patients was 36.0%, the scabies is the most communist manifestations in the study population it was expressed 40.0% with mean CD4 count was <225  micro /dL p<0.01 87.0% followed by Hz 0.89 p<0.01; CD4 count was 250 micro/dl,  Kaposi’s sarcoma 6.33% p>0.01; Drug eruptions 6.0%; Papular pruritic eruptions(7.67%) p<0.01; Nail pigmentations (10.50%)  p<0.01 and  Fungal infections- Candida 15.33 % p<0.01;  Lichenoid Eruption 6.33% and herpes simplex only one cases were seen 1.67% p>0.01. Conclusion: Early initiation of HAART (Highly active antiretroviral therapy), maintenance of better CD4 count, lack of malnutrition and cleanliness are the important factors to be taken care in HIV-infected children’s. The most common dermatological manifestation seen is Hz, nail pigmentation and scabies.

2. Evaluation and Future Perspectives of Gastro Retentive Dosage Forms
Rajesh Asija, Amarkant Tyagi, Anil Kumar Goyal, Seema Yadav
In past years, technological advances have been achieved to improve the therapeutic efficacy and medication bioavailability of oral dosage forms. In this situation, a variety of gastro retentive drug delivery systems (GRDDS) have been employed to increase the therapeutic effectiveness of medications with a limited window of absorption, instability at alkaline pH, solubility in acidic circumstances, and local stomach activity. The physiological status of the stomach and numerous factors that have an impact on GRDDS are covered in this review. Expandable, ultra porous hydrogel, bio/mucoadhesive, magnetic, ion-exchange resin, low- and high-density systems, and other recently utilised gastrointestinal technologies have also been reviewed along with their benefits and drawbacks. The importance of the in vitro and in vivo evaluation parameters of the different GRDDS, as well as their applications, are outlined. Future prospects for this technology are also highlighted in order to reduce the rate of stomach emptying in both the fasting and fed stages. Overall, this review are designing the GRDDS for its evaluation parameters and future perspectives.

3. Use of intranasal versus oral Midazolam as Preoperative Medication in Pediatric Patients
Pranchil Pandey, Chandra Shekhar Mishra, Kapil Prajapati, Pradyumna Kakodiya
Background and Objectives: Administering premedication to pediatric patients undergoing surgery is crucial to alleviate separation anxiety, reduce apprehension, and facilitate cooperation. This study aims to compare the effectiveness and safety of intranasal and oral midazolam in terms of sedation onset. Materials & Methods: The research cohort comprised 140 patients with ASA grade I and II, within the age range of 2-9 years, who were scheduled for elective surgeries at tertiary care medical hospital in India. The participants were randomly allocated into two groups, with each group consisting of 70 patients. Results: The onset of sedation was significantly quicker when midazolam was administered intranasally compared to the oral route. Both intranasal and oral administration of midazolam were equally effective in achieving sedation, with no statistically significant differences observed between the two routes. Furthermore, the vital signs of the patients remained stable throughout the procedure in both groups, and no significant differences were noted. Conclusion: Intranasal midazolam is faster acting, equally effective and safe as oral midazolam. It may be preferred over oral midazolam due to is faster onset of action, efficacy and safety profile.

4. A study on Correlation between Cytological Assessment of Thyroid Lesions and Thyroid Function
Rinku Bhagora, Sarika Rawat, Roshan Mandloi, Shivangi Rajput
Background and Objectives: Thyroid dysfunction is a prevalent condition, particularly among females. Fine needle aspiration cytology (FNAC) is widely recognized as the preferred method for evaluating thyroid nodules. The objective of this study was to establish a correlation between cytological findings and hormonal levels in thyroid lesions. Materials & Methods: This retrospective observational study conducted at a tertiary care hospital in India aimed to analyze the data of patients referred for fine needle aspiration cytology (FNAC) of thyroid lesions over a two-year period. The study also included the collection of thyroid function test (TFT) data, specifically measuring triiodothyronine, thyroxine, and thyroid stimulating hormone levels. FNAC results were classified according to the Bethesda System for Reporting Thyroid Cytology (TBSRTC) guidelines, and descriptive statistics were utilized to report the findings. Results: The study included a total of 236 cases, irrespective of gender and age. The mean age of the patients was 42.6 ± 5.12 years. Females were predominant, with a male-to-female ratio of 1:5. The majority of the thyroid lesions (206 cases) were classified as benign, with benign follicular nodules being the most common subtype (154 cases). Among Category II, 129 cases were euthyroid, 47 cases were hyperthyroid, and 60 cases were hypothyroid. Abnormal thyroid function test results were observed in patients with lymphocytic thyroiditis. Conclusion: Relying solely on hormonal status is insufficient for screening thyroid lesions. Cytology serves as the gold standard for diagnosing such lesions, and utilizing the TBSRTC for reporting them offers a rapid and efficient approach.

5. A Randomised, Controlled Clinical Study Comparing the Effectiveness of Pericapsular Nerve Group (PENG) Block Vs the Fascia Iliaca Compartment (FICB) for Pain Management After Hip Fracture
Abhayraj Yadav, Amey Dixit, Sanjay Kumar, Pranchil Pandey
Introduction: Commonly used in hip fracture surgery, fascia iliaca compartment block (FICB) has lately been criticized for providing insufficient pain relief. The effectiveness of the innovative pericapsular nerve group block (PENG) technique for hip analgesia is still being debated. The goals of this research were to examine how effectively PENG blocks work at relieving hip fracture pain and how they stack up against FICB.
The aim of this study was to determine whether the PENG block is a viable alternative to the FICB for the treatment of hip fracture pain. Methods: Following approval from Institutional Ethics Committee (IES-SSMC-0145), a prospective, randomized, comparative study was conducted at Shyam shah medical college rewa between 2020 and 2023. Group A (n=25) underwent FICB, and Group B (n=25) received PENG block, of patients who had suffered a hip fracture. Results: The two groups’ VAS scores before the block procedure did not vary significantly from one another (p=0.23). The VAS score was considerably lower in the PENG block group compared to the FICB group after 15 minutes of blocks and after 12 hours post-surgery (p=0.035 and p=0.024, respectively). The PENG block had a substantially longer first-time analgesic consumption compared to the FCIB (p=0.006). The overall amount of morphine consumed over the course of 24 hours was considerably lower in the PENG block compared to the FICB group (p=0.007). Conclusion: We conclude that the PENG block is superior to FICB for analgesia of hip fractures. However, further research with bigger sample numbers is needed to confirm the PENG blocks’ effectiveness and superiority over standard methods.

6. Prevalence of Impaired Fasting Glucose and Impaired Glucose Tolerance in the First-Degree Relatives of Patients with Type 2 Diabetes Mellitus
Sourabh Singh Dudve, Sarita Jalodiya, Pranchil Pandey, Sonu Rawat
Background and Objectives: Prediabetes is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). It poses a higher risk of progressing to diabetes, particularly in first-degree relatives (FDRs) of individuals with Type 2 diabetes. This study aimed to assess the prevalence of IFG and IGT in FDRs of individuals diagnosed with Type 2 diabetes mellitus (T2DM). Materials & Methods: 300 participants (201 males and 99 females) who were FDRs of patients with T2DM, aged 18 years and above, were selected from rural area of central Madhya Pradesh. Fasting blood sugar (FBS) and 2-hour postglucose blood sugar (PG2BS) levels were measured using a fully automated analyzer employing the enzymatic colorimetric. Results: The study revealed that prevalence of IFG among FDRs of individuals with T2DM was approximately 15.1%. Additionally, 12% of the participants were newly diagnosed with diabetes based on their FBS levels. Notably, only 14% of the subjects exhibited impaired PG2BS levels, and the prevalence of diabetes determined by this method closely aligned with the FBS method. Conclusion: The prevalence of diabetes is rapidly increasing, even in rural India. There is urgent need for preventive measures and interventions to curb the escalating rates and promote better health outcomes in these communities.

7. A Comparative Study of  Infusion Dexmedetomidine and  Infusion Magnesium Sulphate on Attenuation of  Hemodynamic Changes in Laparoscopic Surgery Under General Anaesthesia
Gyanendra Kumar, Bibha Kumari, Vivek Ranjan, Rajesh Ram, K H Raghwendra
Aim: The aim of the present study was to evaluate which premedication drugs dexmedetomidine or magnesium sulphate causes minimum haemodynamic instability in laparoscopic surgery. Methods: The present study was double blinded randomized, controlled study done in IGIMS, Patna between April 2019 to September 2020.Total 150 patients included in study and divided into three groups. Results: Age wise distribution of the Dexmedetomidine, Magnesium Sulphate & Normal saline showed that maximum patients of 50-60 years in Dexmedetomidine, maximum patients of 40-49 years in Magnesium sulphate and Normal Saline. The mean ± SD in Dexmedetomidine group was 40.50±12.50, Magnesium sulphate group is 40.96±11.58 and Normal Saline group was 40.30±10.87. Sex wise distribution of the Dexmedetomidine, Magnesium Sulphate & Normal saline shows that in dexmedetomidine Male 17(34%), and Female 33(66%), in magnesium sulphate, Male 23(46%) and Female 27 (54%), in normal saline Male 14(28%) and Female 36 (72%) respectively. On comparing the height and weight, no significant difference was found (P. value = 0.259) among the groups. The mean heart rate from basal to HR (T8) minute recording was statistically not significant between the groups. The mean SBP, DBP and MAP from basal to T8 minute recording was statistically not significant between group D and group M. Conclusion: In our study we found dexmedetomidine is highly selective and specific alfa-2 agonist and is superior to magnesium sulphate in attenuating the cardiovascular effects of pneumoperitoneum. Further research is required to reveal the usefulness of Dexmedetomidine as premedication in Laproscopic surgery.

8. A Hospital-Based Assessment of the Spectrum of Ovarian Lesions: A Retrospective Histopathological Assessment
Khushboo Shrivastava, Lucky Sriwastwa, Rajiv Kumar Jha, C.P. Jaiswal, Sunil Kumar
Aim: This study was undertaken to study the various histopathological patterns of ovarian lesions, their classification and relative distribution of these lesions. Methods: The study was undertaken as a retrospective systematic study using existing patient data retrieved from the records of the Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India during the period of 2 years. 200 ovarian mass specimens were received for evaluation, either as solitary specimens, or as part of total abdominal hysterectomy (TAH) specimens. Results: Majority of the Patients were in the age group of 10-39 years. A total of 170(85%) cases were unilateral while 20(15%) cases were bilateral. 39 cases were asymptomatic. Associated findings in specimens of Hysterectomy with salpingo-oophorectomy were also found. Most common was leiomyoma either alone or in combination with adenomyosis. Other associated findings were chronic cervicitis, carcinoma endometrium, carcinoma cervix; hydrosalpinx etc. Other non-neoplastic lesion were Cystic follicle (14 cases), Follicular cyst and Parovarian cyst (6 cases each), hemorrhagic cyst, ectopic gestation, Torsion ovary, Inclusion cyst and oophoritis. Conclusion:  Ovarian lesion comprises of wide spectrum of lesions and their presenting clinical, radiological and gross features are very similar. Hence Histopathology forms the mainstay of definitive diagnosis and categorization of these lesions.

9. A Hospital-Based Assessment of the Utility of Abdomen Sonography Parameters that Predict the Conversion from Laparoscopic to Open Cholecystectomy
Kunal Choudhary, Loveleen Kaur
Aim: The aim of the present study was to find the utility of abdomen sonography parameters that predict the conversion from laparoscopic to open cholecystectomy. Methods: This observational study was conducted in department of General Surgery, SRIMS and Sanaka Hospital, Durgapur, West Bengal, India for the period of 12 months. A total of 100 patients were included in the study. Patients were explained the risks and benefits of the procedure. Results: In the present study, there were 65 male and 35 females. Most of the patients belonged to 51-70 age group. Of 100 patients, 16% had a conversion to open cholecystectomy. There was no statistically significant difference between the two groups in relation to age groups and gender. There was no statistically significant difference between the two groups in relation to abnormal gallbladder, presence and number of calculi, size of the calculus (>6 mm), gallbladder thickness (>4 mm), pericholecystic collection, adhesions/fibrosis and size of the common bile duct. Conclusion: Of 100 patients, 16 (16%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.

10. A Hospital-Based Study to Evaluate the Technique of Preperitoneal Mesh Repair of Incisional Hernias
Roshani Prasad, Binod Kumar Jaiswal
Aim: The aim of the study was to evaluate the technique of preperitoneal mesh repair of incisional hernias. Material & Methods: This prospective clinical study consists of 100 patients with incisional hernia managed by Preperitoneal mesh repair in Department of General Surgery, JLNMCH, Bhagalpur, Bihar, India during the period of 1 year. Results: In the present study, there were 30 male and 70 females. Most of the patients belonged to 31-50 years age group. 45 (83.32%) patients had midlines incision causing the incisional hernia. This was followed by Pfannensteil incision in 6 (11.66%) and paramedian incision in 4 (6.66%) patients. Major wound infection was encountered in 5 patients (8.34%) but the mesh was not removed in any of the cases. Only 7 patients had seroma formation. There were no postoperative complications in 80% of cases. Conclusion:  Preperitoneal meshplasty found to be efficient method of incisional hernia repair with less post- operative complications.

11. Assessing Pattern of Cervical Pap Smear Cytology At A Tertiary Hospital: An Observational Study
Rubaiya Ahmad, Mahesh Prasad, Pankaj Kumar Patel
Aim: The present study is intended to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital and to correlate it with clinical findings. Methods: The prospective study was carried out at department of Pathology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India during for the period of two years and total 1000 patients were screened. The patients were in the age range of 19-69 years, having complaints like watery vaginal discharge, bleeding per vaginal, intermenstrual bleeding, post-coital bleeding, something coming out per vagina, foul smelling discharge and itching in private parts. Results: The result showed that maximum number of cases was in the age group 30-39 years constituting 36% of the total cases followed by age group 20-29 yrs. The oldest case was of age 65 years. Minimum percentage (2%) of cases were under 60-69 age group. The result depicted vaginal discharge was the commonest chief complaint followed by lower abdominal pain. Total 46% showed inflammatory lesion, 1% showed atrophy, 0.5% showed ASCUS, 0.5% showed LSIL, 0.5% showed HSIL, 0.5% showed SCC, 10% showed metaplasia. Conclusion: This study emphasized the importance of Pap smears screening for early detection of premalignant and malignant lesions of cervix.

12. Rummaging The Inevitability of Death: A Retrospective Study on Maternal Mortality at A Tertiary Care Hospital in Rural India
Ruchi Birendra
Background: Pregnancy, while considered a physiological state, entails the risk of major maternal morbidity and, in some cases, death. This is related to a variety of issues that may arise during pregnancy, childbirth, or afterwards. Maternal mortality has far-reaching consequences for the family, society, and nation. Maternal mortality is commonly regarded as a human development indicator in a country, determining people’s health status. Objectives: To assess the maternal mortality ratio and the causes of maternal death at a tertiary care hospital in rural India. A retrospective hospital-based analysis of 45 maternal deaths over a period of 1 year was done in a tertiary care hospital. Results: There were 8112 deliveries and 7880 live births throughout the study period. 45 maternal deaths occurred giving MMR ( Maternal Mortality Ratio) of 571 per 100,000 live births. Obstetrical haemorrhage was the most common direct cause, and anaemia was the most common indirect cause. The age range of 20 to 25 years old was critical. The majority were primigravida, and the majority of deaths occurred in unbooked cases, referred from outside. Conclusion: The majority of maternal deaths can be avoided by making the best use of already available MCH facilities, locating any gaps in the health care delivery system, spotting high-risk pregnancies early on, and promptly referring them to tertiary care facilities.

13. Retrospective Comparative Assessment of Maternal Outcome in Teenage Pregnancy
Sneha Bhushan, Anupama Sinha
Aim: The objective of the study was to evaluate the maternal outcomes of teenage pregnancy in a tertiary care teaching hospital. Material & Methods: A retrospective comparative study was conducted in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. The objective was to evaluate the maternal outcomes of teenage pregnancy. For each case next 3 consecutive singleton deliveries in the age group of 20-30 year were selected as controls. Results: The total number of deliveries during the study period was 5551, of which 266 (4.7%) were teenage pregnancies. After following the exclusion criteria, 250 teenage mothers remained in the study. Reasons for exclusion were pre-existing medical disorders (n = 6) and incomplete records (n = 4). The incidence of birth asphyxia, respiratory distress syndrome and neonatal hyper bilirubinemia were significantly more in babies born to teenage mothers. Conclusion: Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenager group (≤17 years) was most vulnerable to adverse obstetric and neonatal outcomes.

14. A Hospital Based Study to Evaluate Peripheral Smears with Hypersegmented Neutrophils and Classified the Etiological Factors
Suman Kumar, Archana Kumari
Aim: The aim of the present study to evaluate peripheral smears with hypersegmented neutrophils and classified the etiological factors. Methods: The current investigation was carried out at the department of Pathology, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for one year from 1 May 2022 to 30 April 2023. Using geimsa stained peripheral smears, the hematology laboratory examined EDTA blood samples for neutrophil hypersegmentation. The presence of five or more neutrophils with five lobes per 100 or any neutrophils with six or more lobes is referred to as neutrophil hypersegmentation. 100 cases like these that met the inclusion criteria were used as the sample size. Results: Males made up the majority of cases, and cases primarily between the ages of 40 and 60. 40% of cases had microcytic hypochromic anemia, which was a key contributor to the cases. Only 10 of the 40 individuals with normocytic, normochromic blood images had subnormal levels of either vitamin B12 or folic acid, according to the results. The remaining 30 individuals had normal levels of folic acid and vitamin B12. So it follows that 30% of the 100 individuals with hypersegmented neutrophils in the peripheral smear were pure microcytic hypochromic anemia without any vitamin B12 or folic acid deficiency. Conclusion: The present study indicated that other than the already established causes of neutrophil hypersegmentation, microcytic hypochromic anemia, myelodysplastic syndromes and inflammatory conditions also can cause hypersegmented neutrophils in peripheral smears.

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

16. A Retrospective Record Evaluation of  Cervical Cancer Screening Using Liquid-Based Cytology (LBC)
Archana Kumari, Suman Kumar
Aim: The objective of this study was to address this preventable cancer burden and also to determine a fraction of pap cervical smear finding through LBC. Methods: From the period of one year from 1 May 2022 to 30 April 2023, a retrospective record review was performed for a total of 100 women who were referred from Department of Obstetrics and Gynaecology at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for Pap cervical smear to the Department of Pathology. Results: It was observed that among women with abnormal cytology, majority of the cytology presented as ASC-US with 50% (50/100), LSIL 5% (5/100), ASC-H 25% (25/100), 15% (15/100) were High grade squamous intraepithelial lesion (HSIL), while 4% (4/100) were Squamous cell carcinoma and adenocarcinoma stood at 1% (1/100). Conclusion: The result from this retrospective analysis was to address the disease burden through representative data, highlight the need of effective screening programme and availability of HPV testing for uniformity of management and treatment according to the national recommendations. LBC can be a better alternative to conventional smear because of lower rate of unsatisfactory smears.

17. A Hospital Based Observational Assessment of the Post-Operative Morbidity with Relation to Pre-Operative Albumin Status, in Patients Undergoing Emergency Abdominal Surgery
Manoj Kumar Shaw, Shanker Bharti, Anjani kumar Anjan, Rajesh Narayan
Aim: The aim of study was to assess the post-operative morbidity with relation to pre-operative albumin status, in patients undergoing emergency abdominal surgery. Material & Methods: In this hospital based observational study, 100 patients undergoing emergency abdominal surgery at Department of General Surgery, Bhagwan Mahavir Institute of Medical Science, Pawapuri, Nalanda, Bihar, India  were included. Hypoalbuminemia was diagnosed if serum albumin level was less than 3.5 gm/dl. Types of surgery and postoperative complications were included in the study. Any association between preoperative serum albumin level and postoperative morbidity was assessed. Study period was of 2 years. Pre-operatively, 50 patients had hypoalbuminemia (serum albumin <3.5 g/dl) and 50 patients had normal albumin levels (≥3.5 g/dl). Results: Of the 100 patients studied, 65% were male and 35% were female. Pre-operatively, 50 patients had hypoalbuminemia (serum albumin <3.5 g/dl) and 50 patients had normal albumin levels (≥3.5 g/dl). Most of the patients belonged to 38-57 years in the present study. The most common indication for emergency abdominal surgery was peptic ulcer perforation 35 (35%), followed by acute intestinal obstruction 30 (30%). Surgical site infection was commonest complication found in 29 (29%) cases. Wound dehiscence was found in 11 (11 %) cases. Mean length of hospital stay was found to be higher i.e. 8.72±5.60 days in patients with hypoalbuminemia, compared to 7.35±4.16 days with those having albumin level ≥3.5 g/dl. Conclusion: Preoperative albumin is a useful low-cost prognostic predictor for predicting surgery outcome.

18. An Analytical Case-Control Assessment of the Association between Elevated Maternal Serum β-hCG Levels and HDP
Manoj Kumar Shaw, Shanker Bharti, Anjani kumar Anjan, Rajesh Narayan
Aim: The objective of the present study was to determine the association between elevated maternal serum β-hCG levels and HDP. Methods: This was a hospital based observational study conducted in the Department of Obstetrics and Gynecology, BMIMS, Pawapuri, Nalanda, Bihar, India over a period of 18 months after taking approval from the ethical committee.  This study included 300 pregnant women, grouped into cases of 200 pregnant women with hypertensive disorders of pregnancy and control of 100 normotensive women. Serum β-hCG levels were measured and compared in both groups. Results: Out of the 200 hypertensive women in the study group, there were 40 (20%) patients with gestational hypertension, 44 (22%) with non-severe preeclampsia, 80 (40%) with severe preeclampsia and 36 (18%) with antepartum eclampsia. The mean age of normotensive mothers in control group was 24.88 years and that of hypertensive mothers in the study group was 24.48 years. The difference in parity of mothers was statistically significant (p<0.05) with a greater number of primigravida in the study (hypertensive) group as compared to control (normotensive) women. The mean of SBP mothers with HDP was 150.70±18.72 mmHg and that of normotensive mothers was 110.40±10.15 mmHg which was statistically significant (p<0.001). The difference in gestational age between the two groups was statistically significant (p<0.05). Mean gestational age was 37.3±2.7 weeks in the normotensive group and 35.5±3.3 weeks in the hypertensive group. Conclusion: As HDP cause significant maternal and fetal mortality and morbidity, early diagnosis may improve maternal and perinatal outcome by ensuring appropriate management. Serum β-hCG level was higher in hypertensive disorders of pregnancy when compared to normotensive women. The levels are also higher in severe preeclampsia patients when compared with non- severe preeclampsia; and in primigravid hypertensive women in comparison to multigravida hypertensive women.

19. A Hospital Based Comparative Assessment of Immunohistochemistry with Conventional Histopathology for Evaluation of Lymph Nodes
Suryajita Kumar Singh, Bipin Kumar, Anju Kumari
Aim: The aim of the present study was to assess the comparison of immunohistochemistry with conventional histopathology for evaluation of lymph nodes. Methods: The present study was conducted at Department of Pathology, IGIMS, Patna, Bihar, India from January 2016 to July 2017. 100 women with breast cancer were included in the study. Results: All 100 breast cancer women recruited in this study had a clinically N0 axilla. The average age was 50.5 years (range 33–70 years) with 40 women (40%) being premenopausal and 60 (60%) postmenopausal. As per size the tumors were classified as T1=23 (23%), T2=57 (57%) and T3=17 (20%). On conventional histopathology, 40/100 (40%) of the sentinel nodes were positive for malignant deposit while 60/100 (60%) was negative. On IHC for EMA, 41/100 (41%) were positive for malignant deposit while 59/100 (59%) were negative. Histopathological evaluation of the remaining nonsentinel nodes dissected out of the mastectomy specimen was also done. Out of 45 sentinel node positive cases on histology, additional metastatic non-sentinel nodes were found in 30 patients while in 15 patients, the sentinel node was the only positive node. Conclusion: The best method for the pathological assessment of the sentinel node in breast cancer has not been agreed upon. Immunohistochemical (IHC) techniques are generally thought to be more sensitive as compared to conventional histopathology.

20. Assessment of the Pattern of Weight Gain in Pregnant Women and Effect on Maternal and Neonatal Outcome: A Comparative Observational Study
Mamta Rani
Aim: The aim of the present study was to assess the pattern of weight gain in pregnant women and effect on maternal and neonatal outcome in Bihar region. Methods: The present study was conducted at BMIMS, PAWAPURI, Nalanda, Bihar, India for two years and 1000 women were enrolled in the study. In the present study, only single pregnancy outcomes were investigated. Pre-pregnancy BMIs were classified into 4 types namely: underweight, normal, overweight and obese women. Results: There were significant differences in age, educational levels, occupations and family member among the 4 pre-pregnancy BMI groups. In maternal outcomes, there were significant differences in the delivery mode, GDM and Gestational Hypertension (GHp) among the 4 pre-pregnancy BMI groups. For neonatal outcomes, there were significant differences in birth weights and GA among the 4 prepregnancy BMI groups. Conclusion: Overweight and obesity before pregnancy and excessive GWG were linked to an increased risk of GDM, GHp, macrosomia and LGA. In clinical practice, physicians can guide pregnant women to manage and control weight gain during pregnancy in order to reduce the risk of adverse pregnancy outcomes. Women of childbearing age can be advised on the importance of maintaining an optimal BMI when planning to become pregnant. The risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights.

21. Application of Artificial Intelligence in the Management of Glaucoma and its Prognosis
Subodh Kumar Agarwal, Anurag Rawat, Swarnima Saxena, Dipan Samanta, Firdoos Jaman
Background: Glaucoma is a chronic progressive optic neuropathy characterized by damage to the optic nerve and visual field loss. About 2.1 million people were found to have blindness by developing Glaucoma worldwide. Glaucoma, after macular degeneration, is the second most common reason for irreversible blindness 2.93% of people aged 40-80 years have Glaucoma, among which many suffer open-angle Glaucoma. The evolution of Artificial Intelligence also revolutionized the examination and treatment processes. AI has suitably fit itself in this ophthalmic diagnosis. It is so because it highly magnifies even the deepest chambers of the optic region, thereby creating ease for ophthalmologists. Aims: To analyze the efficacy of the selected programmed classifiers in the early detection of Glaucoma for proper diagnosis and management at the early stage for better prognosis. Methods: A cross-sectional study was conducted on healthy and Glaucoma patients. All the patients underwent ophthalmic evaluation, and the tests were completed within six months. The study selected seven machine learning classifiers trained for early diagnosis of Glaucoma and to differentiate effectively from the normal eye. These classifiers were used appropriately in the early diagnosis of Glaucoma. The study statistically analyzed the outcomes generated by these classifiers. Results:  The study found an Area Under Curve (AUC) of 0.851, the worldwide vC/D, or vertical cup/disc ratio, was at best. The global GPS has the highest AUC of the seven GPS sectoral metrics (0.834). While not significantly better than global vC/D, RPART AUC in all 95 variables significantly improved over global GPS. Compared to both global vC/D & global GPS, SVM-radial, including all 95 parameters, showed a significant improvement. Conclusion: The study concluded that these classifiers are significantly efficient in differentiating the glaucomatous eye from healthy ones at an early stage.

22. A Hospital Based Observational Study to Evaluate Branching Pattern of The Splenic Artery in the Human Cadaveric Spleen
Pallavi Sharma, Srikant  Pandey, Rashmi Prasad
Aim: The aim of the present study was to see the branching pattern of the splenic artery in the human cadaveric spleen. Material & Methods: This observational study was carried out in the Department of Anatomy, NMCH, Patna, Bihar, India for one year. The present study was conducted on 50 Human cadaver spleens, irrespective of their age and sex, fixed in 10% formalin solution, collected from the department of Anatomy department. The gross dissection was done by following the guidelines of Cunningham’s Manual. Results: Two primary segmental branches were seen in 35 (70%) specimens, three primary segmental branches were seen in 13 (26%) specimens and four primary segmental branches were seen in 2 (4%) specimens. The mean distance between the termination of splenic artery and the hilum of the spleen was 2.4 cm. The range was extending from 0.5 cm to 6.4 cm. The extra-parenchymal anastomosis of primary segmental branches was seen in 4 (8%) specimens. The intra-parenchymal anastomosis was seen in 2 (4%) and sub-capsular type of anastomosis was seen in 2 (4%) specimens. Conclusion: The spleen is a highly vascular and friable organ. It is the largest of secondary lymphoid organ, which contains 25% of the body’s lymphoid tissue and has both haematological and immunological functions. Total splenectomy is commonly done after a splenic injury, which leads to decrease in the immunity and predisposes the normal host to overwhelming life-threatening infections and also creates an altered haematological picture. To overcome this, partial splenectomy can be done by ligating a particular segmental branch of splenic artery.

23. Study of Pattern of Serum Electrolytes and Lipid Profile Level in type 2 Diabetic Patient Attending Tertiary Care Hospital AGMC and GBPH
Rajib Debbarma, Dilip Kumar Das, Asis Debbarma, Swapan Sarkar
Background: Poor glycemic control diabetes mellitus patient experiences dyslipidemia and serum electrolyte imbalance. The relationship between glycemic control, serum electrolyte and lipid profile is complex and is related to a number of factors like age, BMI, associated conditions. Tripura has the highest prevalence of diabetes and pre diabetes among the north-eastern state of India. This study was planned to assess the pattern of serum electrolyte and lipid profile and their relationship with HbA1c in type 2 diabetes patients attending tertiary care hospital Agartala Government medical college and GBPH, in Tripura. Methodology: HbA1c, serum electrolyte ( sodium, potassium, calcium) and lipid profiles (Cholesterol, triglyceride, HDL-C, LDL-C) were determined in 164 type2 diabetic patients between the age group 30 to 70 years. It was a hospital based cross-sectional study. Result: Descriptive statistics were expressed as mean and standard deviation. The study shows decrease in the mean of serum sodium (p value = 0.006) and potassium (p value = 0.010) and increase in the mean of serum calcium (p value = 0.001) with different label of HbA1c (i.e. group I = < 7%, group II = 7 to 8 %, group III = >8) and it was found to be statistically significant. The present study also revealed statistically significant increase in the mean of serum triglyceride ( p value = 0.014) and decrease in the mean of HDL-C (p value < 0.001) with different level of HbA1c. Whereas increase in the mean of serum cholesterol (p=0.258) and LDL-C (p=0.111) with HbA1c level were not statistically significant. Pearson’s correlation analysis was performed and found that serum cholesterol (r = 0.301, p<0.01), triglyceride (r = 0.275, p<0.01), LDL-C (r = 0.359,p<0.01) and serum Calcium (r = 0.449, p <0.01) showed direct and significant correlation with HbA1c. Whereas HDL-C (r = -0.467, p<0.01), Serum Sodium (r = -0.363, p <0.01) and Serum Potassium (r = -0.285, p< 0.01) showed inverse significant correlation with HbA1c. Conclusion: This study provides an overview and enriched our knowledge regarding electrolytes imbalance and dyslipidemia in type 2 diabetes and highlight for early detection of complications of type 2 diabetes mellitus which will be very much helpful for the prompt management and better outcome.

24. To Develop and Validation of RP-HPLC Method for Estimation of Mycophenolate Mofetil in Pure and Pharmaceutical Tablet Dosage
Mo Firoj Tanwar, Dilip Agrawal, Sulekha Mandal
The present work is aimed at development and validation of RP HPLC method which is simple, specific, precise, and accurate for estimation of Mycophenolate Mofetil and its process-related impurity in bulk and pharmaceutical dosage forms. Extensive literature survey revealed no method for estimation of the above said. The characterization of synthesized impurities by using FTIR, NMR and MS. The RP-HPLC method was developed according to ICH Q2B guidelines for quantitation of impurity in bulk and formulations. The method was validated as per ICH guidelines. The method was found to be linear, precise, accurate, robust and rugged. The present study focuses on the various steps, parameters involved in HPLC condition. Various applications of this system also discussed. HPLC process development is important in case of drug discovery, drug development and pharmaceutical products. It can be adopted apparently for routine quality control study of research and formulation tests. The method is carried out on a Symmetry C18 (4.6 mm ID × 150 mm, 5 µm, Make: X-Terra) with a mobile phase consisting of acetonitrile and potassium dihydrogen phosphate buffer of pH=4.0 in the ratio 65:35 volume/volume at a flow rate of 0.7mL/min. The detection of eluted components is carried out at a wavelength of 216 nm. The retention time of mycophenolate mofetil is found to be 2.647min. The developed method is validated in terms of accuracy, precision, linearity, limit of detection, limit of quantization. The linearity limits, LOD and LOQ of the developed method are found to be 10-50, 0.052 and 0.171 µg mL-1 , respectively. The developed method is found to be simple, fast and economic and hence it can be used as an alternative method in quality control.

25. The Study on the Effect of Cantharidine and Its Derivates on Tumor Cells
Ramesh Pareek, Nishant Agarwal, Kartikey Kumar, Omprakash Choudhary, Mohit, Mohd Shariq
Millions of people worldwide die from cancer each year, making it the greatest danger to the survival of the human race. Historically, natural substances have been seen as viable cancer therapeutic options. Traditional medicine has utilised the terpenoid cantharidin (CTD), which was extracted from blister beetles, extensively. Chinese drugs to treat cancer and other diseases. CTD has been shown to inhibit both the heat shock transcription factor 1 (HSF-1) and protein phosphatase 2A (PP2A), which are possible targets for its anticancer effect. Even though it contains certain toxins, CTD’s tremendous anticancer potential cannot be understated since cancer-specific delivery of the drug might mitigate its fatal consequences. Additionally, a number of compounds have been created to lessen its toxicity. The anticancer action of CTD is shown in both in light of substantial studies, both in vitro and in vivo cancer models exist. Additionally effective when used in conjunction with radiation and chemotherapy, CTD can also target some cancer cells that have developed a resistance to certain drugs. The goal of this mini-review is to analyse and condense current findings about the molecular underpinnings and anticancer potential of CTD. CTD’s relevant anticancer properties might be used to create a potent anticarcinogenic medication.

26. Small Intestinal Neoplasms: A 5-Year Observational Study from Central India
Purti Agrawal Saini, Akanksha Jain, Kamal Malukani, Atishay Jain, Amit V Varma
Background: Small intestinal tumors are rare and constitutes for 1-3% of all gastrointestinal tract tumors. Non –neoplastic lesions are much commoner than neoplastic lesions in small intestine.  Neoplasms have not been given much consideration in the literature because of their low prevalence and non specific symptomatology. Thus, the present study was conducted to analyze the demographic and histomorphologic characteristics of the small intestinal neoplasms. Material & Methods: This five-year cross-sectional study was conducted at a tertiary care teaching institute in central India. A total of 27 cases were studied, which were diagnosed on resected specimens and biopsies. The demographic characteristics and gross findings were noted from case records, and a detailed microscopic examination of slides was done from departmental archives. The data was analysed and compared with previous similar studies. Results: Small intestinal neoplasms accounted for 5.95% of total small intestinal lesions in the present study. Benign tumors (adenoma and hyperplastic polyps) were 18.5%, and malignant tumors were 81.5%. Ileum was the commonest site (59.26%) for benign as well as malignant tumors. Among 22 cases of malignant tumors, primary adenocarcinoma accounted for the majority (31.81%) of the cases, followed by non-Hodgkin lymphoma (18.18%), metastatic adenocarcinoma (13.64%), carcinoid tumour (11.11%), gastrointestinal stromal tumor (9.09%), metastatic squamous cell carcinoma (7.40%), and primary squamous cell carcinoma (3.70%). Conclusion: Knowledge of the clinical presentation, radiologic and endoscopic findings, and histomorphologic features of various neoplastic lesions is key to the early and correct diagnosis of small intestinal tumors.

27. Role of Natural Herbs in Sunburn: A Review Report
Shankar Lal Soni, Nikita, Tanu Sharma, Janvi Sharma, Akshay Sharma
Herbs have been utilized for ages in both medicine and cosmetics. It is commonly recognized that they have the ability to beautify, cure, and improve a variety of skin conditions. There is a constant need for UV radiation protection and avoidance since ultraviolet (UV) radiation can result in sunburns, wrinkles, lowered immunity against infections, accelerated ageing, and cancer by their negative impacts. Herbs and herbal products have a high potential primarily because of their antioxidant properties. The major function of antioxidants, which include vitamins (vitamin C, vitamin E), flavonoids, and phenolic acids, is to fight against free radical species, which are the primary cause of a number of undesirable skin changes. Despite the considerable potential for skin protection offered by isolated plant chemicals, entire herb extracts displayed superior potential because of their intricate structure.
Numerous studies have demonstrated that the polyphenols in green and black tea reduce the negative effects of UV exposure on the skin. Aloe gel is thought to stimulate skin and aid in the development of new cells. According to spectrophotometer tests, a concentrated extract of Krameria triandra absorbs 25 to 30% of the UV radiation that octyl methoxycinnamate normally absorbs. Coconut, peanut, olive, and cottonseed oils only block off roughly 20% of UV radiation, compared to sesame oil’s 30% UV resistance. The result of the interaction between naphthoquinone and keratin is a “sclerojuglonic” molecule, which offers UV defiance. Research and the development of new cosmetic trends are based on the traditional uses of plants in medicine and beautification.

28. Mitapivat: An Overview
Vani Madaan, Vandana Sharma, Ishita Gupta, Itisha Jain, Janvi Deshmukh, Rahul Gupta
Mitapivat is used to treat hemolytic anemia( a condition in  which more red blood cells are destroyed than made into the body) in people with pyruvate kinase deficiency. Mitapivat is in a class of drugs called pyruvate kinase activators  .mitapivat increases pyruvate kinase which results in increment in lifespan of red blood cells. Mitapivat comes as a tablet which is taken orally. It’s generally taken with or without food 2 times a day. Mitapivat is taken around the same times every day. Patient should Follow the directions on prescription label precisely. It shoud not be taken more, less or take it or more frequently than specified by the doctor.

29. Anti-Diabetic Management: Eugenia Jambolana
Ashok Kumar Sharma, Akriti Agrawal, Kshitiz Kant, Vatsal Khandelwal, Madhvi Agrawal, Azaz Ahmed
Diabetes is a global health issue that affects millions of people worldwide. As of 2019, an estimated 463 million people had diabetes worldwide accounting for 8.8% of the adult population. It is a condition when either insufficient or ineffective insulin production occurs in the body. The pancreatic beta-cells produce more insulin as a result of insulin resistance in conditions like diabetes or obesity. There are several types of diabetes, including type 1, type 2, type 3, and gestational. 90–95% of people with diabetes have type 2, which is characterized by both decreased insulin synthesis by the pancreatic beta cells and impaired insulin release in response to high blood glucose level. Eugenia jambolana, also known as black plum or jamun, is a fruit bearing tree that has been traditionally used in Ayurvedic and Unani medicine for the treatment of diabetes. Several studies have investigated the anti-diabetic properties of Eugenia jambolana and have found that it may have potential as a natural treatment for diabetes. According to reports, eugenia jambolana has a hypolipedemic effect: it lowers blood triglycerides, free fatty acids, and cholesterol. This analysis demonstrates that Eugenia jambolana significantly affects blood sugar regulation. Additionally, it has good potential for managing diabetic mellitus as it is defined in conventional medical systems, and that too without suffering any severe adverse effects. Eugenia jambolana contains several bioactive compounds, including jambosine, which has been shown to have hypoglycemic effects by promoting the uptake of glucose by cells and inhibiting the breakdown of carbohydrates into glucose. The fruit also contains antioxidants, which can help protect against oxidative stress and inflammation, both of which are associated with the development and progression of diabetes. Overall, while more research is needed to fully understand the potential anti-diabetic properties of Eugenia jambolana, it shows promise as a natural treatment option that may help improve blood sugar control and reduce the risk of diabetes-related complications. However, it is important to speak with a healthcare professional before using Eugenia jambolana or any other supplements to treat diabetes or any other medical conditions.

30. Prospective Observational Study to Establish the Effect of age On Lung Function test of Healthy Non-Smokers
Kumari Abha, Chandrakant Prasad, Dinesh Kumar
Aim: The present study was done with an aim to establish the age effect on lung function test of healthy non-smoking people belonging to the rural region. Methods: A prospective study was conducted on 240 patients attending the OPD in Government medical college, Bettiah, Bihar, India for the period of one year. Both male and female subjects with age ranging from 11 to 60 years (and above), non-smoking individuals with normal cardiac and respiratory functions, meeting the inclusion criteria and completing the pulmonary function tests (PFT), were selected. Results: Out of the total subjects studied, 132 were males and 82 females, with group B having maximum number of males (28). Younger group, i.e., 11-20 years group has a high value for FEV1. As is evident from data analysis, the mean values of FEV1 showed almost a linear relation with ageing, with a small bending of curve between group A and group B. PEFR showed a rise among group A and B (11-20; 21- 30), reaching 7.20±1.70 (L/sec) for group C (31-40 years), and then showed a significant decline reaching to 3.90±0.98 (L/sec) for the age group F, i.e., >60 years. Conclusion: Considerable differences in the respiratory patterns of healthy individuals and the elderly, suggest that age actually impacts the lung function. Understanding these changes helps detect and prevent the respiratory dysfunctions in the elderly.

31. Assessment of the Incidence and Risk Factors Associated with Sore Throat after General Anesthesia with Endotracheal Intubation: An Observational Study
Deepak Kumar, Bhagwan Das, Pramod Kumar Sinha
Aim: The aim of the present study was to determine the incidence and associated risk factors of postoperative sore throat following general anesthesia with endotracheal intubation. Methods: The study was conducted at department of Anesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya, India for 12 months and patients who underwent endotracheal intubation under general anesthesia were enrolled in the study. A total of 100 patients were included into the study. Results: A total of 100 patients were included into the study. The study showed majority of the subjects were aged between 18-65 age group and 60% were male in the study. Out of the patients who develop postoperative sore throat 26 patients (86.66%) were found between 18 and 65 years and 4 patients (13.34%) aged above 65 years. Majority of the patients underwent general surgery (35%) followed by endocrine, neurologic and orthopedic 15% in each. Majority of the patients belonged to ASA 1 (64%) and mallampati 1 (65%). The size of ETT mostly used was 6.5 mm in 36 patients followed by 6 mm in 34 patients. In 52 patients, 4 number laryngoscope blade was used. 6.5 mm size of ETT was used followed by 6 mm. We found that size of Endotracheal intubation and size of laryngoscope blade showed statistically significant association with the post-operative sore throat with the size of ETT. Conclusion: The result of this study showed that the larger the size of ETT and laryngoscope blade, the higher the incidence of postoperative sore throat. Even though endotracheal intubation is mandatory for good airway protection during surgical procedures, we recommend using the smaller ETT size (6 mm, 6.5 mm ID) and smaller laryngoscope blade (size 2, size 3).

32. A Hospital Based Single Center Study Assessing the Trigger Tool Method (TTM) in Detection, Monitoring, and Reporting of Adverse Drug Reactions (ADRS)
Naveen Kumar, Asha Kumari, Kanchan Kumari
Aim: The aim of the present study was to evaluate the trigger tool method (TTM) in detection, monitoring, and reporting of adverse drug reactions (ADRs). Methods: This prospective, continuous, single‑center study was conducted in the Department of Pharmacology of DMCH, Laheriasarai, Darbhanga, Bihar, India in two phases over 15 months. Phase I (6 months) of the study was observational, whereas Phase II (9 months) was interventional. Results: A total of 1135 patients were admitted during the Phase I (6 months) of which 500 patients, who met with the inclusion criteria were included. The mean age of patients was 44.36 ± 18.02 years, and mean length of hospital stay was 4.26 ± 3.27 days. Of 55 triggers (PTTL), a total of 34 triggers were found 1202 times in 325 patients. DT (780 times) was the most commonly observed triggers followed by LT (325 times) and PT (105 times). Similarly, LT were observed 325 times in patients. PT was observed in 105 times. It was apparent that more than one trigger was associated with a single ADR. It was further observed that patients in whom more than five triggers were present showed >30% “yield” in terms of detection of an ADR. Among positive triggers, nine DT were detected 65 times. While three PT, one ST, and one LT were detected 24 times, 16 times, and 1 time, respectively. Conclusion: The reporting system is operational at the study site and ADRs are being reported using a standard form. Patients recovering from the reactions following the withdrawal of the suspected drug, and the majority of ADRs were mild. TTM can be used as an add‑on tool to existing methods like spontaneous method for the health‑care professionals for better detection of ADRs in the pharmacovigilance program. However, further research is required to explore the feasibility and acceptability of TTM.

33. Efficacy and Safety of Monoclonal Anti-RHD Immunoglobulin with Polyclonal Anti-RHD Immunoglobulin for the Prevention of Maternal RH-Isoimmunisation: A Comparative Study
Vinita Sahay
Aim and Objective: To compare the efficacy and safety of monoclonal anti-Rhesus (anti-D) immunoglobulin (IgG) with polyclonal anti-D IgG in the prevention of maternal Rh-soimmunisation. Material and Methods: A comparative clinical trial was conducted in the obstetric inpatient department of 3 hospitals in Patna, Bihar between January 2018 to December2019.100 Rh-D negative women, not sensitized to Rh antigen, and delivering Rh positive babies, received postpartum intramuscular administration of monoclonal or polyclonal anti-DIgG.The main outcome was assessed by the proportion of subjects protected from Rh-isoimmunisation, identified by a negative indirect Coombs test(ICT) result at day 180 after anti-D IgG administration and the incidence of adverse effects. Results:50 subjects each were allotted to monoclonal and polyclonal group. ICT results at day 180 was negative in all 50 of monoclonal gp whereas 1 had positive and 49 had negative ICT among polyclonal gp.5 minor adverse events were reported all unrelated to the interventional drug(3 in monoclonal and 2 in polyclonal gp). None developed immunogenic reaction to the monoclonal Anti-D. Discussion and Conclusion: The efficacy and safety of the monoclonal and polyclonal preparation of Anti-D were comparable to each other in the prevention of maternal Rh-isoimmunisation.

34. A Prospective Observational Study Assessing Glycemic Status in Diabetes-Naïve Patients on Statins
Kanchan Kumari, Asha Kumari, Naveen Kumar
Aim: The aim of the present study to explore the possible diabetogenic effect of statins, the mechanism of this effect, and various comorbidities associated with this causation. Material & Methods:  It was a prospective observational study carried out for a period of one year in the Department of Pharmacology, DMCH, Laheriasarai, Darbhanga, Bihar, India. A total of 132 patients were recruited and 100 completed the entire study. Results: Male patients were nearly twice higher than females (65/35%). Majority of the patients were in between the age group of 60-65 years. Hyperlipidemia (94%) was the main etiology for prescribing statins followed by ischemic heart disease (55%). Nearly 72% of patients had hypertension as a concomitant disease. A total of 72% patients received ACEIs/ARBs as concomitant drugs followed by low dose aspirin (65%). Different strengths of HMG-COA inhibitors were prescribed, out of which Atorvastatin 40 mg was most frequency prescribed statin followed by atorvastatin 20 mg. Statin treatment on insulin resistance was interpreted by using homeostatic model assessment and quantitative insulin sensitivity check index (HOMA) value of greater than 2.27 was considered as insulin resistance. All patients who developed NODM had >2.27 which could be indicate that statin users developed insulin resistance is might be a probable mechanism. QUICKI score of<0.357 was considered as severe insulin resistance; again, all patients who developed NODM had severe insulin resistance in the present study. A total of 55 (55%) study participants developed mild to moderate drug related adverse effects (ADRs). Statin‑induced myalgia (54.54%) was the most common ADR, followed by headache (36.36%), GI complaints (25.45%). ADRs associated with statin treatment were classified according to the WHO‑UMC causality assessment scale. Conclusion: Statins have a mild-to-moderate risk of developing NODM. The dose of statins is an important factor that increases the risk of diabetes in statin users.

35. A Hospital Based Prospective Comparative Assessment of the Efficacy of Laser vs Pneumatic Lithotripsy for Mid and Distal Ureteric Stone: A Comparative Study
Rakesh Kumar, Ahsan Ahmad,   Nikhil Ranjan
Aim: The aim of the study was to compare the efficacy of the laser versus pneumatic lithotripsy. Methods: This was a hospital based prospective comparative study conducted in department of Urology, Igims, Patna, Bihar, India for the period of one year. A prior informed and informed consent was taken from all eligible patients. Patients with mid or distal ureteric calculi of 5 mm or more, or failed medical management were included in the study. Stone size less than 5 mm, nephrolithiasis on same side of ureteric stone, pregnancy, bleeding disorder and patient not giving consent were excluded from the study. 100 cases were studied over the period of one year and divided into two groups, pneumatic and laser group. Results: There was no significant difference in male to female ratio in both groups (60% male in group 1 vs 70% male in group 2). The stone clearance at 6 weeks was seen in more patients in laser group (96%) than in the pneumatic group (84%). When both the groups were compared, the result was statistically significant (p= 0.022). When two techniques were compared for the stone clearance for mid ureteric stone, it was found that 92% in laser group had complete stone clearance in contrast to 80% in pneumatic group and the difference was statistically significant. Similarly when stone clearance rate was compared for distal stone, 100% patients in laser group and 90% in pneumatic group achieved the stone clearance at 6 weeks follow up however it was statistically not significant. Conclusion: In conclusion, according to our results, by using both techniques, acceptable results were achieved. However, in the pneumatic group, the duration of operation was shorter and the cost was less than LL. There was no major complication with any statistically significant differences between the 2 groups.

36. A Randomized Comparative Clinical Assessment of Postoperative Analgesic Efficacy of Epidural Ropivacaine and Ropivacaine with Tramadol in Patients Undergoing Abdominal Surgeries: A Prospective Clinical Study
Rakesh Kumar, Ahsan Ahmad,   Nikhil Ranjan
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 randomized, double arm, single-blind, controlled study. The study was conducted in patients scheduled for abdominal surgeries done under general anesthesia at Anugrah Narayan Magadh Medical College and Hospital, Gaya, India for one year.The sample size was determined based on the study. 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.

37. Assessment of the Effectiveness of Various Management Strategies in the Management of Liver Abscess: An Observational Study
Manish Kumar
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, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for the period of 12 months. Total number of patients was 200 included in this study with the diagnosis of liver abscess admitted in the surgery ward. It was an Observational, Prospective and Retrospective study. 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.

38. Effects of Phototherapy on the Serum Magnesium Level in Neonates with Indirect Hyperbilirubinemia: A Prospective Cohort Study
Nitish Kumar, Sujit Kumar Baranala
Aim: The aim of the present study was to determine the effect of phototherapy on serum magnesium level in term neonates with hyperbilirubinemia. Material & Methods: A prospective hospital‑based comparative study was conducted on 100 eligible neonates admitted in Department of Pediatrics, AIIMS, New Delhi, receiving phototherapy from January 2019 to December 2019. After approval of the ethical committee, informed consent was obtained from the parents of the selected neonates. This study included 100 full‑term neonates who were subjected to phototherapy for treating neonatal hyperbilirubinemia according to the guidelines of the American Academy of Pediatrics. Results: Our study included 100 full‑term neonates with jaundice who received phototherapy for treating neonatal indirect hyperbilirubinemia, comprising 60 (60%) males, and 40 (40%) females, with the mean gestational age of 38 ± 0.7 weeks and mean postnatal age of 5.4 ± 1.3 days. There were 32 (32%) neonates delivered by normal vaginal delivery and 68 (68%) neonates delivered by cesarean section. Mean birth weight was 3.1 kg. The mean difference of jaundice onset age, intrauterine age, admission weight and mother’s age were not significant. The amount of total serum bilirubin decreases in all groups. The serum total magnesium level and its changes were reported in three groups before and after phototherapy. Conclusion: In the present study, the serum magnesium level showed a significant reduction only in the double phototherapy method and remained in the normal range in the other two groups. On the other hand, in all three treatment groups, the level of serum magnesium before the treatment was normal and did not increase significantly.

39. An Observational Assessment of the Prescription Pattern of Antimicrobials in the Treatment of Uri in Patients of Paediatric Age Group
Sushil Kumar, Asha Kumari, Satya Prakash Singh
Aim:  The aim of the present study was to analyze the prescription pattern of antimicrobials used in pediatric patients with respiratory tract infections attending a tertiary care hospital. Material & Methods: A cross-sectional observational study including 200 pediatric patients with repiratory tract infection was conducted in department of pharmacology Darbhanga Medical College and Hospital , Darbhanga, Bihar, India in collaboration with department of pediatrics over a period of 12 months. It was performed in accordance with the Declaration of Helsinki and institutional ethics committee approval was obtained before initiation of the study. Results: Total 200 pediatric prescriptions were analysed of which 110 (55%) were male and 90 (45%) were females. Number of children diagnosed with URTI was 128 (64%), whereas 72 (36) children had LRTI. Total 80 (40%) children belonged to age less than 5 years and 120 (60%) were between the age range of 5-18 years. On analysis of 128 prescriptions with URTI, it was found that 52 children were prescribed Co-Amoxiclav, a fixed dose combination (FDC) of amoxicillin and clavulanic acid and azithromycin was prescribed to 3 children. Paracetamol for fever and cough syrups containing antiallergic, antitussives and expectorants were also prescribed for symptomatic relief. Out of 170 prescriptions of paracetamol, 140 were generic and cough syrups were prescribed in generics in all the prescriptions. 250 were in syrup formulations whereas 110 were injectables and 38 tablet formulations. Conclusion: The analysis reflected that the prescriptions were in accordance with the national guidelines with the predominant use of β lactam antibiotics for treating both URTI and LRTI. Positive trend toward monotherapy was observed.

40. A Hospital-Based Assessment of the Efficacy of Quadratus Lumborum Type-II and Erector Spinae Plane Block in Patients Undergoing Caesarean Section under Spinal Anaesthesia: a Comparative Study
Ravi Kumar, Rupali Raj
Aim: The aim of the present study was to assess the efficacy of quadratus lumborum type-II and erector spinae plane block in patients undergoing caesarean section under spinal anaesthesia. Methods: The present study was conducted at Department of Anaesthesia & Intensive care NMCH, Patna, Bihar, India and 100 pregnant women preparing for an elective cesarean delivery with spinal anaesthetic have been randomly assigned to one of two groups; QLP group and ESP group. Results: There was no statistically significant difference in age, height, weight BMI, ASA and duration of surgery between the two groups. There was no statistically significant difference in mean arterial pressure and heart rate based on intra-operative between the two groups. There was no statistically significant difference in mean arterial pressure and heart rate based on post-operative between the two groups. There was no statistically significant differences exist between QLB and ESB regarding VAS score. Conclusion: Ultrasound guided quadratus lumborum and erector spinae blocks provide an effective modality for control of postoperative pain associated with caesarean section. In patients undergoing caesarean section, both ultrasound-guided quadratus lumborum and erector spinae block have been linked to no significant side effects.

41. Correlation between Chest CT Severity Score and Oxygen Requirement in Patients with COVID-19 Infection in the Indian Population in a Tertiary Healthcare Set-Up
Padma V Badhe, Swapnil Moharkar, Sambhaji Paval, Shreeshail Adke, Sana Khan, Khushboo Tekriwal
Aim: The study aimed to correlate the chest CT severity score and oxygen requirement in patients with COVID-19 infection in the Indian population in a tertiary healthcare set-up. Methods:  A cross-sectional retrospective hospital-based study included 138 patients conducted at the Department of Radiology, in a tertiary healthcare centre in Western India from 1st December 2021- 30th November 2022. Results: Out of 138 subjects in this study, the maximum number of subjects (55) required no oxygen support, 22 subjects were on nasal prongs, 30 were on face masks and 26 subjects required NRBM. The least number of subjects (5) were on HFNC/BIPAP. Most of the patients with a mild CT severity score (86.1 %) required no supplemental oxygen while the majority of the patients with severe CT severity scores (60%) were on NRBM. There is a positive correlation between the chest CT severity score and the oxygen requirement in these patients. Conclusion: The COVID-19 pandemic shows waxing and waning, frequently exhibiting a significant surge in cases, particularly with the appearance of more potent SARS-CoV-2 viral subtypes. As of 8 April 2023, there are 31,194  active COVID-19 cases in India with the number rising steadily.  There is a significant statistical correlation between the chest CT severity score and the oxygen requirement of COVID-19 patients. Our study thus confirms that CT severity score can be a useful tool to access disease severity and guide prompt management.

42. An Analytical Case Control Study Assessing the Factors which Influence the Risk of Emergency Cesarean Delivery in Induced Labors at Term
Priyanka Kumari, Sushma Singh, Prof Geeta Sinha
Aim: The aim of this study was to identify those factors which influence the risk of emergency cesarean delivery in induced labors at term. Material & Methods: A case–control study was conducted in the Department of Obstetrics and Gynaecology, PMCH, Patna, Bihar, over a period of one year A total of 300 women were studied, out of which 130 women delivered by emergency caesarean section and 170 women delivered vaginally. The cohort included all women with a live singleton fetus in the cephalic position and induced at term (C37 weeks). Cases were women who delivered by emergency caesarean section and controls were women with a vaginal delivery among the cohort. Informed consent was taken for all patients. Results: Using logistic regression analysis, all comparisons are estimated and expressed as OR with 95 % CI. Factors associated with cesarean delivery were analysed. Our study had shown that maternal age C35 years, BMI C30 kg/m2, nulliparity, preinduction Bishops score less than 5, gestational diabetes mellitus, and intrauterine growth restriction are significantly associated with caesarean delivery. The presence of epidural analgesia, gestational hypertension, post term pregnancy, and premature rupture of membranes was not associated with significant increase in cesarean delivery if labor was induced at term. Conclusion: A vaginal delivery is the best choice for both mother and child. However, it is better to take those patients with multiple risk factors for elective cesarean section rather than inducing them at term. Women with multiple risk factors for caesarean can be taken up for elective cesarean section rather than inducing them at term.

43. A Randomized Clinical Assessment of the Effect of 3-Different Doses of Dexmedetomidine on Hemodynamics and Anesthetic Depth
Himanshu Shekhar
Aim: The aim of the present study was to evaluate and compare the effect of different doses of Dexmedetomidine on Heart rate, Blood pressure, oxygen saturation and depth of anaesthesia. Methods: The present study was conducted in Department of Anaesthesiology, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for one year. 150 patients in the age group of 20 to 60 years. Patients were ASA I-II, scheduled for open cholecystectomy. Results: The enrolled patients fulfilling all the inclusion and exclusion criteria were divided into three groups with 50 patients in each group. Group A (n=50) 0.5µg /kg of Dexmedetomidine in NS (Total volume 10 ml). Group B (n=50) 0.75µg/kg of Dexmedetomidine in NS (Total volume 10 ml) Group C (n=50) 1 µg/kg of Dexmedetomidine in NS (Total volume 10 ml). There were more females than male in all the three groups. Mean Age in group A, B and C were 42.18±11.19, 41.69± 11.20 and 43.67± 9.25 respectively. All the three groups were comparable with respect to age of the patients (p>0.05). The groups were also comparable in terms of Sex, BMI and ASA grade (p>0.05). The groups were comparable in terms of duration of surgery and interval between start of Dexmedetomidine infusion and Extubation (p>0.05). Conclusion: The attenuation of Extubation response was almost similar with Dexmedetomidine in dose of 0.75μg/kg and 1μg /kg. However with increase in dose from 0.75μg/kg to1μg /kg there was significant increase in the side effects in the form of bradycardia (p<0.05). So we concluded that 0.75μg/kg is the single best dose of Dexmedetomidine for attenuation of Extubation response.

44. Clinic- Demographics and Outcome Assessment of Ventral Wall Hernia Repair- A Hospital Based Retrospective Study
Santosh Kumar Sharma
Aim: The aim of this study was to shed the light on the most common predictive factors for the occurrence and rate of complications associated with hernia repair. Material & Methods: A retrospective observational study with total 100 patients was included, conducted at Department of General Surgery, NMCH, Patna, Bihar, India from January 2022 to December 2022. After approval by the Institutional Ethics Committee, the study was conducted for the period of one year. Results: 75 patients were females and 25 males in the present study. The mean age of patients was 36.4 with the oldest patient in our study being 90 years. The mean BMI for the studied population was 32.8. The mean duration of hospital stay was 3.5 days. Previous abdominal wall surgery was the most common risk factor (40 of the patient) followed by pregnancy (35 patient), chronic constipation (15 patient), chronic chough (5 patient). There was a significant correlation between age of patients and duration of admission (p value 0.003) however no significant correlation between gender and duration of admission was found. Para umbilical hernias were the most common operated hernia in our study (35 hernia) followed by umbilical (30 hernia), incisional (22 hernia). Type of hernia did not have a significant effect on outcome or duration of hospital stay, nor on the risk of recurring emergency surgery. Most common complication was seroma/hematoma developing in 10 of patients and 4 patients had a recurrence within the follow up period.

45. A Correlation between Sleep Deprivation and Cognitive Performance in Nurses Working in Shifts in SRG and SHKBM (Janana) Hospital, Jhalawar Medical College
Akash Bharadwaj
Background: Nursing health professionals works for prolonged day and night shifts that leads to deprived sleep, affecting cognition and concentration, increased fatigue, compromised health, decreased alertness and detrimental effect of working capabilities. The present study was planned to assess the prevalence of Sleep Deprivation among nurses working in shift and its impact on their cognitive performance. Materials and Method: 90 staff nurses were divided into two groups; day and night shift workers (45 each) were assessed for sleep deprivation and cognition impairment using PSQI and MoCA respectively. Both the tests were conducted twice, at the end of eight hour duration day or night shift work, after 3-4 days of the commencement of shift. The data was collected, tabulated and statistically analysed using SPSS version 20.0 software. Results: Among day and night shift workers, female (62.22%) and male (40%) predominance was observed respectively. 68.89% day shift workers had good sleep quality, whereas only 37.78% night shift workers had good sleep quality. In day and night shift workers, total component score was 31 and 17 for good quality of sleep respectively, showing a significant difference (p-value<0.05) statistically. Intergroup comparison between night and day care workers was done in relation to global PSQI score, showing a significant difference (p-value<0.05) statistically. Global PSQI and cognitive Score was more in day shift workers than in night shift workers  with a statistical significant difference (p-value<0.05). Conclusion: The night shift workers have a poor quality of sleep than day shift workers. We also found that poor quality of sleep has strong association with reduced cognition. We suggest that replacing current shift system with slowly rotating shift system and optimization of sleep-wake strategy could improve sleep quality of nurses.

46. Correlation of Hepatic Profile to Severity of Dengue Fever in Children: A Retrospective Cross-Sectional Study
Sanjeevini N.B., Shanthala D., Rajeshwari, Indumati V.
Background: Dengue infection is caused by the bite of Aedes mosquito. All four dengue virus can cause the disease which present as a mild illness, dengue fever to severe forms like dengue hemorrhagic fever or dengue shock syndrome. Liver dysfunction in dengue varies from mild injury with elevation of AST and ALT to severe hepatic injury. The aim of our study was to assess the prevalence of hepatic dysfunction in children with dengue fever and to correlate hepatic profile to severity of dengue fever. Aim: To correlate the hepatic profile in children with dengue fever, dengue haemorrhagic fever and dengue shock syndrome. Materials and Methods: Retrospective Cross-Sectional Study, where data collection was done from January 2021 to December 2021 in patients with dengue antigen positive admitted in paediatric ward, ICU and reports from Biochemistry CDL, VIMS Ballari. Total 122 study population were divided into 3 groups, Group A: Dengue fever (81 Patients), Group B: Dengue haemorrhagic fever (26 patients) and Group C: Dengue shock syndrome (15 patients) constitutes 67%, 21% and 13% respectively. The various laboratory blood parameters that included in the study were Platelet count, PT, APTT, AST, ALT, TP and Albumin. Results: There is statistical significant decrease in Platelet count, Total Protein and Albumin level as severity of dengue fever increases. There is statistical significant increase in PT, APTT, AST and ALT level as severity of dengue fever increases. In the present study, the hepatic profile (mainly transaminases) is correlated with platelet counts, there is significant negative correlation was found as severity of Dengue fever increases. But there is no significant correlation between transaminases and PT, APTT, Albumin, Total protein level as the severity of dengue fever increases. Conclusion: We conclude that by investigating simple and low cost tests like transaminases, platelet count, PT, APTT, Total protein, albumin levels in dengue fever, helps in early intervention and management of disease which can reduce mortality due to dengue fever.

47. A Study on Clinical, Ultrasound and Laboratory Profile of Dengue Infection in Adults
Ravi Kanth Mamidipalli, J. Thirupathi Rao, B. Srinivas, Gullipalli Kusuma
Introduction: Dengue is one of the most rapidly spreading vector-borne viral diseases world wide and its incidence in India is also on the rise due to increasing urbanization. It has variable clinical presentation and can affect all age groups. The disease has a spectrum of dengue fever, dengue hemorrhagic fever and dengue shock syndrome. The laboratory values to be looked for include hematological and serological tests.  Aim of the study: To determine the clinical, ultrasound and laboratory findings in adult patients with dengue infection. Materials and Methods: This was a Retrospective, hospital based study. Dengue patients were studied for clinical presentation, hemoglobin, total leucocyte count, platelet count, peripheral smear examination, NS1Ag, serum dengue IgM and IgG. Ultrasound was performed wherever required. The duration of hospital stay of patients was studied. Observations and Results: Total 53 cases of dengue were studied. There were 45 (84%) male patients and only 8 (15%) female patients and the male to female ratio was 5.6:1. Fever was universal and was noted in all 53 patients. Headache, myalgia and gastrointestinal symptoms were most commonly observed. NS1Ag was positive in 79.2% cases and 11 cases were positive for serum IgM. Leucopenia, elevated hematocrit and moderate thrombocytopenia were common findings. Mild hepatosplenomegaly was common on ultrasound. The average hospital stay was 3 to 4 days. Conclusion: Dengue fever can affect all age groups and has a varied clinical presentation with most common features of fever, headache, myalgia, and emesis. It commonly affects adult males. The laboratory results often show elevated hematocrit, low total leucocyte count, thrombocytopenia, and mildly elevated liver enzymes. Serological tests help to differentiate between a primary and secondary infection and have clinical implications.

48. A Study on Risk Factors and Clinical Profile of DKA in Type II Diabetes Mellitus in a Teaching Hospital, Telangana
Alekhya Allenki, Sarada Alla, Elka Suresh
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Together with hyperglycemic coma, diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of diabetes mellitus (DM).Defined by the triad hyperglycemia, acidosis, and ketonuria, DKA can be inaugural or complicate known diabetes.Although DKA is evidence of poor metabolic control and usually indicates an absolute or relative imbalance between the patient’s requirements and the treatment, Materials and Methods: Prospective study was conducted in the department of general medicine atMamata academy of medical sciences ,Bachupally on 120 DKA patients for duration of 1 years from March 2022 to April 2023. Diagnosis of DKA was made by the presence of (1) Plasma glucose level of 250mg/dl or higher (2) Serum bicarbonate level of 15mEq/lt or lower (3) Arterial blood pH of 7.3 or lower or a venous blood pH of 7.25 or lower (4) Presence of moderate or large urine ketones. Results: In this study, the minimum age of presentation was 40 years and the maximum age of presentation was 75 years. The maximum number of cases was found in the age group 51 – 60 years (46.6%) and the minimum number of cases was found in the age group up to 50 years (27.7%). The Overall mean age of presentation is 56.6 years.58.3% were Males and 41.6% were females Most common comorbid condition was HTN accounting 50% (60/120), 8.3% ( 10/120) had CKD, CAD and hypothyroidism. No comorbidities in 25% (30/120) patients. Conclusion: A significant proportion of DKA occurs in patients with type 2 diabetes and many of these cases can be prevented with proper patient education and effective communication with a health care provider.

49. A Hospital Based Comparative Assessment of MRI Findings versus Intraoperative Findings in Patients of Fistula in ANO: An Analytical Study
Santosh Kumar, Anil Kumar
Aim: The aim of the present study was to compare MRI findings to intraoperative findings in patients of Fistula in ANO. Methods: The study was conducted over a period of 12 months in Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. All cases of Fistula in Ano confirmed by clinical and radiological parameters were admitted in Department of Surgery. 50 patients were included in the study. Results: Out of 50 patients admitted, position of external opening of fistula tract was anterior to transverse line in 32 (64%) patients. In 18 (36%) patients position of external opening was posterior to transverse line. Out of 50 patients admitted, position of external opening of fistula tract within 3cm distance from anal verge was seen in 40 (80%) patients. In 10 (20%) patients position of external opening was >3cm distance from anal verge. Out of 50 patients admitted, 46 (92%) patients had single external opening of fistula tract and 4 (8%) patients had multiple external openings of fistula tract. Out of 50 patients, in 38 patients correlation was seen between MRI finding and Intraoperative finding in Fistula in Ano. No correlation was seen between the MRI finding and Intraoperative finding in 12 patient. Conclusion: MRI is a valuable and accurate preoperative investigation for evaluation of perianal fistula activity and abscess localization, so it can aid surgical decision making. Moreover, MRI allowed accurate fistula detection, internal opening identification, and evaluation of its relation to sphincters, so it can help surgical procedure planning. To summarise, evaluation of a Fistula in Ano by MRI, provides most of the details necessary for accurate evaluation.

50. A Case Control Study to Investigate Cord Blood Mean Platelet Volume (MPV) of Infants of Diabetic Mothers (IDM)
Abhishek Kumar, Rashmi Sharma, Akash Bharadwaj, Rita Kumari
Aim: The aim of the present study was to investigate cord blood mean platelet volume (MPV) of infants of diabetic mothers (IDM). Methods: Present study was conducted at Department of Physiology in Nalanda Medical College, Patna, Bihar, India. It was a prospective case control study conducted in 100 newborns. The approval of ethics committee was obtained. They were divided in to 50 Diabetic women with singleton pregnancy between 37-40 gestational weeks (study group) and 50 age matched healthy pregnant women as control group. Results: The result showed significant difference in  maternal, BMI and HbA1c between the study groups. Apgar score assessment at birth did not show any significant difference between two groups. Demographic characteristics of the newborns between two groups were not significant. Platelet count was significantly higher in control group than in diabetic group. MPV was significantly higher in IDM group. There was no significant difference in Platelet distribution width (PDW) between two groups. Conclusion: Mean Platelet volume and other platelet-related parameters is a simple procedure, available in most hospital laboratories. It is useful for representing the potential oxidative stress of IDM. Hence, there is need to create more awareness by pre-pregnancy counselling of know diabetics as well as screening for potential gestational diabetics. MPV may be used as a marker for follow-up of diabetic patients.

51. A Hospital-Based Assessment of Mannheim’s Peritonitis Index in Patients of Perforation Peritonitis: An Observational Study
Santosh Kumar, Anil Kumar
Aim: The aim of the present study was to evaluate Mannheim Peritonitis Index in predicting the outcome of surgery in patients with peritonitis. Methods: A prospective observational study to assess the efficacy of Mannheim’s peritonitis index in 200 cases of perforation peritonitis patients was conducted in department of General Surgery, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of one year. Results: In our study; 82% were below the age of 50 years and 80%were males. Organ failure was found to be present in 27% of patients. The most common isolated organ failure was renal (5%) followed by cardiovascular (4%) and the combination of two was 7%.The combination of renal; pulmonary and cardiovascular system was at 1%. The majority of patients 64% in our study had an MPI score of <21 while 20% patients had MPI scores between 21 to 29 and 16% had MPI score >29. The majority of patients 85.5% were discharged and 14.5% expired. Patients with MPI score > 29 had max mortality (62.5%) and with MPI between scores, 21-29 had 20% mortality whereas the least mortality recorded in MPI score < 21(0.78%). Conclusion: We concluded that MPI scoring is a reliable predictor of death in perforation peritonitis patients and can be helpful in planning and evaluating future treatments with great ease. We would like to recommend its use in the prognostic evaluation of secondary peritonitis cases.

52. Obesity as Risk Factor in Type-2 Diabetes Mellitus in Middle Aged Women: A Case Control Study
Akash Bharadwaj, Rashmi Sharma, Abhishek Kumar, Rita Kumari
Aim: The aim of the present study was to evaluate the obesity as risk factor in type-2 diabetes mellitus in middle aged women. Methods: The study was conducted at Department of physiology, Nalanda Medical College, Patna, Bihar, India for the period of 10 months. 100 volunteer women of age 35 to 55 years were selected as subjects. Results: Within group I, the mean values of FBS, HDL, TG & VLDL were higher with more significance (p<0.01). Within group II, the mean values of W/H RATIO, FBS, HDL,TG & VLDL are higher with more significance (p<0.01). Within group III, the mean values of W/H RATIO, FBS, HDL,TG and VLDL are higher with more significance (p<0.01). The mean values of TC and LDL are higher with less significance (p<0.05). Within group IV, the mean values of BMI,W/H RATIO, FBS, HDL,TG and VLDL are higher with more significance (p<0.01). The mean values of TC and LDL are higher with less significance (p<0.05). Conclusion: The role of genes, lifestyle and other factors contributing to rapid increase in the incidence of type 2 diabetes. The core aims are to bring forward the new therapy strategies and cost-effective intervention trials of type 2 diabetes. The present study revealed that the mean values of waist hip ratio of obese women of group I, II. III and IV showed statistically highly significant increase in values respectively. The mean values of fasting blood sugar of obese women of group I, II, III and IV showed statistically highly significant increase in values respectively.

53. A Hospital-Based Assessment of the Efficacy and Acceptability of Pomegranate Effervescent Granules (PEGS) in Dyspeptic Patients
Satya Prakash Singh, Asha Kumari, Sushil Kumar
Aim: This study aimed to assess the efficacy and acceptability of pomegranate effervescent granules (PEGs) in dyspeptic patients. Material & Methods: This hospital-based study was conducted by the Department of Pharmacology, DMCH, Laheriasarai, Darbhanga, Bihar, India for nine months. The granules, prepared from peel extract of pomegranate, were made available in sachets of 2.5 g with dose of, 1 sachet dissolved in 200 ml (1 cup) of water, twice a day after meals for 28 days. Gastrointestinal Symptom Rating Scale (GSRS) scores to assess symptoms of acid peptic disorders at day 0, 15, and 29 along with the taste of formulation were the main study outcomes. Results: The results showed that in the Punica granatum treatment group with a dose above 500 mg/kg, Ulcer Area (mm2) was 126.44±1.26 and Ulcer Inhibition % was 85.65. In the Punica granatum treatment group with a dose of 250 mg/ kg Ulcer Area (mm2) was 455.60±8.48 and Ulcer Inhibition % 42.83. In the omeprazole treatment group, Ulcer Area (mm2) was 620.20±11.49 and Ulcer Inhibition was 25.55. While in the control group Ulcer Area (mm2) was 822.00 ± 25.75 and Ulcer Inhibition % 15.75 And this Ulcer Inhibition % in the Punica granatum treatment groups was significant compared to the omeprazole treatment group and the control group (P=0.0001). The highest zone of inhibition (13 mm) was recorded against Y. enterocolitica and S. enterica compared with selected studied bacteria. The second highest zone of inhibition was 10.5 mm observed against B. cereus. Conclusion: PEGs proved to be palatable, patient-friendly, safe, and efficacious in resolving symptoms of dyspepsia in acid peptic disorders.

54. A Descriptive Observational Study Determining the Effect of Various Topical Agents in Chronic Plaque Type Psoriasis
Adil Inam
Aim: The aim of this study was to determine the effect of various topical agents in chronic plaque type psoriasis. Methods: The present study was carried out on patients having chronic plaque type psoriasis vulgaris attending dermatology OPD of Department of Skin and VD Jai Prakash Narayan Hospital, Gaya, Bihar, India. After obtaining, written, informed and signed consent patients suffering from stable chronic plaque type psoriasis involving less than 10% of body surface area and those had neither applied topical for last 2 weeks and nor taken systemic drugs for psoriasis for last three months, were enrolled. Total 150 patients were enrolled and were divided in three groups comprising of 50 patients in each group. Results: No significant difference was noted between study groups. Further on comparison of individual groups it was found that significant difference was present between PASI at 8 weeks between group A and group B (p=0.032), group A and group C (p=0.024) but between group B and group C (p=0.942) difference was not significant. It was found that 14 (48%) out of 50 subjects attained PASI 50 in group A, 31 (62%) out of 50 patients in group B and 32 (64%) out of 50 patients in group C. Physician global assessment scale shows that in Group A, 13 (26%) patients had excellent response, 10 (20%) patients had good response, and 11 (22%) patients had fair response whereas 16 (32%) patients had poor response. In group B, 17 (34%) patients had excellent response, 19 (38%) patients had good response, and 6 (12%) patients had fair response whereas 8 (16%) patients had poor response. In group C, 20 (40%) patients had excellent response, 17 (34%) patients had good response, and 3 (6%) patients had fair response whereas 10 (20%) patients had poor response. Conclusion: We concluded that the combination therapy is effective, well tolerated with minimal side effects and better compliance was seen. Ammonium lactate can also be considered as one of the topical option as a monotherapy and also as a maintenance therapy.

55. A Hospital-Based Assessment of the Clinical and Laboratory Profile of Typhoid Fever in Infants and Children: An Observational Study
Archana Singh, Binoy Shankar, Prashant Kumar Jha
Aim: The aim of the present study was to assess the clinical and laboratory profile of typhoid fever in infants and children with possible gender differentiation. Methods: The present study was a hospital-based, prospective and a cross-sectional study that was carried out at Department of Pediatrics, SKMCH, Muzaffarpur Bihar, India for one year on 100 subjects that were selected using purposive sampling technique. Results: Most of the patients were in the age group of 5-15 years (68%) followed by 1-5 years (26%). The signs and symptoms of typhoid fever were analyzed according to age. Headache, anorexia and irritability were statistically significant symptoms for typhoid fever (p<0.05). The most frequently observed signs were abdominal distention, splenomegaly and hepatomegaly. Coated tongue was found only in the age group 5-15. Rose spots were not observed in any of the cases. On the analysis of the signs according to age, there were no significant differences in the frequency of any signs in the three age groups. Relative bradycardia was present in 4 cases in the age group 5-15 and absent in other age groups. Anemia was found in 55 (55%) patients. Mean hemoglobin percentage of all cases involved in the study was 10.5% with SD of 1.7. Conclusion: Typhoid fever is still a serious public health concern that mostly affects school-age children. Public health measures include the provision of clean water for drinking, proper sanitation, education on the illness and how it spreads, and excellent hygiene habits may be used.

56. Hematological Parameters versus Peripheral Smear in Anemic Patients: A Comparative Study
Lucky Sriwastwa, C.P. Jaiswal, Sunil Kumar
Aim: The present study was designed to find out the association between cell counter generated hematological parameters and peripheral smear findings in the diagnosis of anemia. Methods: This study was carried out in Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India for 12 months. 100 patients with low Hb level with reference to age and sex were selected for the comparison of PS findings with that of cell counter parameters. Results: Anemia was more common in our study was age group more than 60 years (32 out of 100 cases, 32%) followed by between 41 to 50 years (26 out of 100, 26%). In males, normocytic normochromic anemia was more common (38 out of 52 cases,) and in females, microcytic hypochromic anemia was more common (34 out of 40 cases). Out of 40 cases of microcytic hypochromic anemia 33 cases showed low MCV but 6 cases showed normal MCV. When compared, the anemia diagnosed based on MCV values and by manual examination there was a significant difference. Out of 52 cases of normocytic normochromic anemia, 46 cases showed normal MCV level. 37 cases of Microcytic hypochromic anemia had high RDW which was normally expected but 26 cases of Normocytic normochromic anemia showed raised RDW. Conclusion: Despite all the advances in laboratory sciences, peripheral smear examination remains an important diagnostic tool in diagnosis of anemia.

57. An Outcome Assessment of Surgical Management in Lumber Disc Spine: An Observation Study
Arnab Sinha, Santosh Kumar
Aim: The aim of the present study was to evaluate the surgical outcome in the treatment of Lumber Disc Prolapse (LDP). Methods: The present study was conducted in the Department of Orthopaedics, IGIMS, Patna, Bihar, India from December 2016 to  November  2017  and 50 patients were selected. Results: Mean follow-up time of our study was 36.50 ± 15.60 months (minimum 12 months). Mean preoperative VAS for radicular pain and low back pain were 9.18 ± 1.89 (standard deviation [SD]) and 6.90 ± 4.31 SD, respectively. Mean preoperative VAS for back pain was higher in women than men. The mean age of the patients were 44.18 ± 10.50 years ranging from 26-70 years. The mean age of the male patients was 38.5 ± 13.5 years and a female patient was 39.8 ± 16.2 years. Though the mean age of the female patients a little bit higher than the male, but the mean difference was not statistically significant (p>0.05). Data indicated that maximum number of the patients was in age group >40 years (40%) followed by 30% in the age group 21-30 years, 26% in the age group 31-40 years and 4% were in the age group <20 years. Out of 50 patients, 23 (46%) had disc prolapse at level L4-L5, 12 (24%) had at L5-S1, 5 (10%) had L1-L2, 3 (6%) patients had disc herniation at L2-L3 and 6 (12%) had at L3-L4. Conclusion: Regarding the subjective assessment of current study patients, it was observed that most (75%) of the patients had excellent functional outcome, 15% good, 7% fair and 3% had poor functional out-come according to modified Macnab criteria.

58. A Hospital Based Observational Assessment of the Clinico Microbiological Profile of Patients with Fungal Corneal Ulcer
Gopal Prasad Singh, Pranay Kumar, Rajesh Kumar Singh, Rajiv Kumar Singh
Aim: To evaluate the clinical features, laboratory diagnosis and microbiological profile of fungal keratitis. Method: A prospective cross-sectional study was conducted on 50 patients with features of corneal ulcer presenting to the Department of Ophthalmology SKMCH, Muzaffarpur, Bihar, India during the period of 12 months. Corneal ulcer with or without intact epithelium were included in the study. Clinical diagnosis of fungal keratitis was made on the basis of following features: dry raised slough, stromal infiltrate with feathery edges, satellite lesions and thick endothelial exudate. A standardized proforma was filled up for each patient documenting socio-demographic features duration of symptoms, history of trauma, associated ocular and systemic conditions, prior therapy received, and all other clinical findings including visual activity. Results: Out of the 50 patients of corneal ulcers included, mycotic etiology was established in 27 cases [54%]. Out of 30 fungal corneal ulcer cases males (19, 70.4%) were affected more than females (8, 29.6%). Majority of the patients were more than 40 years of age (11, 40.7%) followed by 31-40 years of age group (7, 25.9%). Most patients were from rural areas (17, 62.9%). Corneal trauma (22, 81.5%) was the most common predisposing factor. 4 patients (14.8%) had co-existing ocular diseases responsible for development of fungal keratitis. Use of topical steroids predisposing to fungal keratitis accounted for 3 cases (11.1%) and associated systemic diseases were seen in 7 cases (25.9%). Conclusion: A good clinical evaluation aided by microbiological support will help in better diagnosis and treating the corneal ulcer. In cases of fungal corneal ulcer, Fusarium spp is the most common organism responsible followed by Aspergillus spp.

59. Assessment of Forced Vital Capacity and Peak Expiratory Flow Rate and its Association with Progesterone Level in Pregnancy: Hospital Based Observational Study
Vibha Rani, Suman Kumar Saurav, Anand Kumar, Rajiva Kumar Singh
Aim: This study was conducted to assess FVC and PEFR and to correlate with Progesterone levels in different trimesters of pregnancy. Material & Methods: The present observational study was carried out in the department of Physiology, PMCH, Patna, Bihar. Total of 100 subjects were taken for the study. The subjects were taken from the department of Obstetrics & Gynaecology OPD from Patna medical college and Hospital, Patna, Bihar, India. These subjects were divided into four study groups. Each group consist of 25 subjects. Results: In the present study, weight and BMI showed significant difference in anthropometric measurements. Decrease in FVC in 1st (p<0.000), 2nd (p<0.000) and 3rd (p<0.000) trimesters of pregnancy when compared to control group was significant. In between the three trimesters there was no significant decrease (p> 0.05) in FVC values. There was significant and positive correlation of FVC and progesterone in the first and third trimester of pregnancy. Decrease in PEFR levels in 1st (p<0.000), 2nd (p<0.000) and 3rd (p<0.000) trimesters of pregnancy was significant when compared to control group. Amongst the three trimesters there was significant decrease (p<0.001) in third trimester when compared to 1st and 2nd trimester. There was significant and positive correlation with the progesterone in the first trimester of pregnancy. There was a positive correlation in all 3 trimesters of pregnancy and significant in 1st and 3rd trimester. Conclusion: The progesterone levels did not have any significant association with the pulmonary function test during gestation.

60. A Hospital Based Observational Study Assessing Outcome of Tympanoplasty with Cortical Mastoidectomy using Temporalis Fascia with and Without Tragal Cartilage Support
Urvishbhai Patel, Amit B. Chavda, Priyanka Patel, Khushbu Kumari
Aim: The aim of this study was to evaluate the benefits of the tympanoplasty with cortical mastoidectomy using temporalis fascia with and without tragal cartilage support in terms of graft uptake and hearing improvement 6 months post procedure. Methods: This retrospective study was conducted in the Department of ENT, GMERS Medical College, Himmatnagar, Gujarat, India for one year. 50 patients were carefully screened and selected from those who underwent cortical mastoidectomy with type I tympanoplasty for mucosal type of chronic otitis media quiescent stage with conductive hearing loss. Results: In group A patients 32% were male (8) and 68% were female patients (17). In group B patients: 36% were male (9) and 64% were female (16) patients. In group A patients, the age wise distribution was 8 patients (32%) in 25 to 35 years, 7 patients (28%) in 35 to 45 years, 6 patients (24%) in 15 to 25 years, 4 patients (16%) in 45 to 55 years. In group B patients, the age wise distribution was 11 patients (44%) in 25 to 35 years, 8 patients (32%) in 35 to 45 years, 3 patients (12%) in 15 to 25 years, 3 patients (12%) in 45 to 55 years. In group A patients the duration of disease was around 6 months to 1 year in 13 patients (52%), 1 to 3 years in 8 patients (32%) and 3 to 5 years in 4 patients (16%). In group B patients the duration of disease was around 6 months to 1 year in 15 patients (60%), 1 to 3 years in 7 patients (28%) and 3 to 5 years in 3 patients (12%). In group A patients successful neo membrane was formed graft taken up in 23 patients (92%), unsuccessful in 2 patients (8%) whereas in group B patients successful neo membrane was formed in 24 patients (96%), failure noticed in 1 patients (4%). In group A patients, the hearing improvement taken into account with air bone gap closure of > 10 dB in 20 patients (80%), <10 dB in 5 patients (20%) whereas group B patients the hearing improvement with airbone gap closure is > 10 dB in 21 patients (84%), < 10 dB in 4 patients (16%). Conclusion: It can be concluded that the post-operative closure rate of tympanic membrane was high and audiologic improvement was satisfactory with perichondrium cartilage island graft. It can be preferred in reconstruction of tympanic membrane in revision cases because of their resistance to poor feeding, recurring infections, and retractions.

61. A Comparative Study on Elective Laparoscopic Cholecystectomy with and Without Antibiotic Therapy
Privy Varshney, Anubhav Arya, Mitnala Siva Sai Akshay, Hardeep Balyan
Objective: The present study was undertaken to evaluate the rate of infection in laparoscopic cholecystectomies, and to assess the usefulness and efficacy of antibiotic prophylaxis.
Methods: A comparative study of 394 cases of Cholelithiasis who underwent elective la paroscopy in the Rama Medical College Hospital and Research Center, Pilkhuwa, Hapur, Uttar Pradesh, during study period of January 2023 to May 2023. Patients were divided into study group and control group. All the patients were categorized into study and control groups. Results: The mean age of the patients in the study group was 69.2 +- 4.3 years. In the control group 1 patient developed fever, in study group 7 patients (3.6%) developed pus discharge from port site, in which IV antibiotics were continued in the post-operative period till the time of discharge is calculated to be 3.6%. In study group 5 patients (2.5%) had pus discharge. Conclusions: One single dose of prophylactic intravenous antibiotic, administered at induction of anesthesia, is sufficient to prevent postoperative infective complications in patient undergoing elective LAPC.

62. Comparative Study of Conservative Management, Ultrasound Guided Needle Aspiration and Ultrasound Guided Pigtail Drainage of Uncomplicated Amoebic Liver Abscess
Anubhav Arya, Privy Varshney, Hardeep Balyan, Mitnala Siva Sai Akshay
Background: Ultrasound guided aspiration and pigtail catheter insertion in ultrasonographic guidance are safe procedures without any major or life threatening complications. This study was conducted in The Department of General Surgery and Radiodiagnosis in Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, on patients who were admitted from casualty and outpatient department with a diagnosis of amoebic liver abscess (ALA). Methods: A total of 60 patients were identified as the study group for the purpose of thesis. The mean duration of symptoms at presentation in Study Group I was 15.710.77, in Group II was 14.110.34 and in Group III was 16.49.37. VAS was measured at completion of 48 hours of therapy allotted to each group. The change in TLC in these patients was statistically significant (p=0.00). Results: In Group I (16/20) patients, the mean hospital stay was 5.750.68 and 4.470.72 days, respectively. Group II (17/20) cases showed no improvement in VAS. Group III (20/20): The mean TLC was 84401522.947 cells/mm3. In Group II (20/20), 4 nonresponders (20 %) of Group I, were shifted to Group II and 3 non-responders (15 %) from Group II, were moved to Group III due to persistent pain & fever and no improvement of TLC & abscess size. Conclusion: Our study shows marked and rapid clinical, biochemical and radiological improvement in patients of ALA treated with USG guided indwelling catheter drainage along with medical treatment particularly in large abses or abcess containing thick pus.

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