International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

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1. A Hospital-Based Observational Study Evaluating Clinical Profile and Outcome of Diabetic Foot
Santosh Kumar, Anil Kumar
Aim: The study aims to find out the clinical profile and outcomes of patients with diabetic foot infections (DFI). Methods: This prospective observational study was conducted at the Department of Surgery, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. 100 patients with diabetes attending general surgery ward for diabetic foot ulcer management at Dmch Department of General Surgery, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India were included during the study period for the period of 8 months. Results: 100 patients were diagnosed as diabetic foot. In diabetic foot, the age of patients ranged from 19 to 80 years. 20 (20%) patients were between 21 to 40 years; 42 (42%) patients were between 41 to 60 years and 38 (38%) patients were above 60 years. Out of 100 patients with diabetic foot, 90 patients were treated by debridement, in which 35 patients had deranged lipid profile and 55 had normal lipid profile. Out of 100 patients with diabetic foot, 10 patients were treated by amputation, out of which 8 patients had deranged lipid profile and 2 had normal lipid profile. Patients with deranged lipid profile had increased chances of amputation. The hospital stay and serum creatinine values were significantly higher in patients with HbA1c>8.5. Out of 100 patients with diabetic foot; 30 (30%) patients had pseudomonas; 24 (24%) patients had E. Coli; 22 (22%) patients had Klebsiella; 21 (21%) patients had staphylococci and 3 (3%) patients had no growth on aerobic culture media. Conclusion: Diabetic foot pathologies are common in diabetics and pose serious health problems for developing countries. They seem to affect both sexes equally. The present study highlighted the significance of patients with DFU in tertiary care hospital in India context where diabetes is poorly controlled, there was also little awareness for foot care and delay in seeking treatment, as this will worsens the extent of tissue destruction.

2. A Retrospective Observational Assessment of the Factors Related to Poor Prognosis and Overall Survival Rates in Patients Diagnosed with Laryngeal Squamous Carcinoma
Akbar Zaman, Sami Ahmad, Mrinalini Raman, P. K. Lal
Aim: The aim of the study was to factors related to poor prognosis and overall survival rates in patients diagnosed with laryngeal squamous carcinoma. Methods: The present study was conducted in the Department of ENT, SKMCH, Muzaffarpur, Bihar, India for the period of 1 year. 100 patients were included in the study. Results: Age and denial of care were the factors related to patient delay, medical doctors, the first consult decision and the malpractice were statistically related to the professional delay. The mean of patient delay was 62.46 weeks and thought there was a difference between different groups of patient, the latest was not statistically significant. Same goes for the professional delay where the mean delay was 15.70 weeks. Conclusion: The TNM system is an anatomical means of classification, which takes into account neither the biological aggressiveness of the specific tumor nor the host’s immunological response. It was not developed to serve as a specific guideline for the management of a particular patient, nor does the system have the ability to predict the outcome of individual patients. Whereas physicians are focused on the concept of optimal treatment, patients are interested in their prognosis, and one of the most important tasks is to assess our present ability to predict the probable outcome for an individual patient with laryngeal cancer.

3. An Observational Study Assessing the Relationship between Body Mass Index and Physical Fitness in Adult Males
Abhishek Kumar, Akash Bharadwaj, Rashmi Sharma, Rita Kumari
Aim: The aim of the present study was to assess the relationship between body mass index and Physical fitness. Material & Methods: A prospective study was conducted in Department of Physiology, Nalanda Medical college, Patna, Bihar, India which includes participants adult male basketball players in the age group of 18-22 years. Sample size was 100 in number. Results: BMI was inversely correlated with measures of anaerobic power and muscle strength. The heart rate recovery was 96.4±18.2 and 98.2±20.2 in normal and overweight group respectively. Correlation (Pearson co-efficient r ) between BMI and physical fitness showed significant differences. Conclusion: There is negative effect of elevated BMI on selected parameters of physical fitness and sport performance Therefore achievement of optimal body mass should be considered by fitness trainers as means of physical fitness amelioration.

4. A Hospital Based Histopathological Assessment of Prostatic Lesions: An Observational Study
Lucky Sriwastwa, Khusboo Shrivastava, Sunil Kumar, C.P. Jaiswal
Aim: The aim of the present study was to assess the incidence, age distribution, gross and histopathological features of lesions of prostate and to classify tumours of prostate as per recommendations of WHO and to analyse cases of Adenocarcinoma of prostate according to Modified Gleason grading system. Methods: An observational study conducted in the Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India for the period of one year and 100 patients were included in the study. Results: All prostatic specimens were broadly classified into benign 85 (85%) and malignant 14 (14%). We reported 1 (1%) case of Prostatic Intra-epithelial Neoplasia (PIN). Maximum cases of BPH 35 (41.7%) were seen in the 61-70 years age group. Cases of BPH with co-existing chronic prostatitis were 7 (7%) and that with acute prostatitis were 3 (3%). Less frequent findings were BPH with basal cell hyperplasia 2 (2%) and BPH with squamous metaplasia 1 (1%). We reported 14 cases of adenocarcinoma prostate with modified Gleason Grading system. The most common score obtained was 7 in 6 cases out of the total 14 adenocarcinoma cases. The most common predominant grades observed in this study were grade 3 and grade 4. Conclusion: Maximum number of cases of adenocarcinoma was seen in 61-70 years age group. It is necessary to study all prostate biopsies in order to identify premalignant lesions, proliferative activity and grade of inflammation. Histopathological diagnosis and grading plays a definitive role in the management of prostatic carcinoma.

5. A Hospital Based Observational Sonographic Assessment of Gynecological Masses with its Pathological Correlation
Anuggya Mimansa, Singh Neeru Janeshwar
Aim: The aim of this study was to assess the usefulness of Gray Scale Ultrasound and Colour Doppler in differentiating benign and malignant adnexal masses in the population. Methods: The study was conducted in Department of Radiodiagnosis, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India over a one-year period. This study was done as part of dissertation for post graduate qualification in Radiodiagnosis. Ethical approval for this study was taken from Institute Ethical Committee. Participants were enrolled for this study after taking Informed Consent. Results: The mean age of patients with benign tumor and malignant tumor was 31.68±8.1 years and 50.37±12.7 years respectively. Mean volume of malignant adnexal masses (938.37±659.37) was significantly higher than benign adnexal masses (278.95±217.11). Score of 0 or 2 was given depending on absence or presence of thick papillary projection. Score of 0 or 4 was given depending on absence or presence of solid areas. Score of 0 or 4 was given depending on blood flow location. If no flow or peripheral flow was present, then 0 score was given. However, if central flow was present, then score of 4 was given. Using this scoring system in our study and taking cut off value for malignancy > 6, we found that out of total 50 patients, 35 (70%) had score between 0-5 and all of them were found to be benign on FNAC/histopathology. 15 (30%) cases had a score between 6-12, out of which 12 (80%) were malignant. Only 3 (20%) cases with score between 6-12 were benign. Conclusion: The Present study serves to emphasized the role of Ultrasound gray scale and Colour Doppler to differentiate benign from malignant adnexal mass and usefulness of Alcazar scoring system. Important parameters in this study, which helped in differentiating benign and malignant adnexal masses, were: thick papillary projection, thick septa and resistive index<0.4, high velocity/low resistance flow and moderate to abundant flow.

6. Comparative Assessment of the Efficacy of Three Different Topical Anti-Fungal Drugs in the Management of Tinea Corporis and Tinea Cruris
Adil Inam
Aim: The aim of the present study was to assess the efficacy of topical amorolfine, luliconazole, sertaconazole, terbinafine in tinea corporis and tinea cruris. Methods: This was a prospective, randomized study was done in the Department of skin and VD, Jai Prakash Narayan Hospital, Gaya, Bihar, India for six months . It was a pragmatic study to assess the therapeutic response to certain topical antifungals in the current scenario of dermatophytosis. Total 200 clinically diagnosed healthy adult patients with tinea corporis and tinea cruris requiring topical antifungal therapy were include in this study. Results: Among 200 patients 90 were treatment naive, 50 were topical steroid (with or without antifungal) modified cases, 48 were partially treated with antifungals and 12 had used home remedies prior to the study. Luliconazole showed best improvement of pruritus (mean-1.45), erythema (mean-1.42) and scaling (mean- 1.49). Terbinafine showed the least improvement with mean being 0.64, 0.55, 0.73 for pruritis, erythema and scaling respectively. Difference in the mean values of improvement of luliconazole as compared to the other three drugs was significant for pruritus and highly significant for erythema and scaling. Total value of improvement in pruritus, erythema and scaling were calculated and patients were grouped into poor response (total score- 0, 1 & 2), moderate response (total score-3&4) and good response (total score-5&6). A total of 30 patients (60%) in luliconazole group showed good response as compared to the other drugs. These differences in the improvement of patients were statistically significant as compared to other drugs. Conclusion: We concluded that the Luliconazole may score over other 3 topical antifungals. Although it belongs to azole class, it seems to exhibits fungicidal activity. This study also signifies the role of topical antifungal alone in treating limited tinea corporis and cruris, thus boosting the confidence on topical therapy. Newer topical antifungals are more expensive and hence pharmaco-economical analysis should also be considered while prescribing them.

7. A Prospective Study of Factors Predicting Outcome of Trial of Void without Catheter in Patients with Acute Urinary Retention Secondary to Benign Prostatic Hyperplasia
N. Anil Kumar, Shashi Kumar, Komarabathini Rakesh Pradeep, N. Anirudh Suseel
Aim: This study was conducted with the objective to evaluate the parameters that can predict the success or failure of trial of voiding without catheter (TWOC) for acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH). Methods: A prospective study including 100 patients who were hospitalized for BPH-associated AUR was conducted at the Department of Genito-Urinary Surgery, Sri Venkateswara Institute of Medical Sciences, for 1 year to include male patients who were hospitalized for BPH-associated AUR. Out of total 100 patients enrolled in our study, 65 (65%) belonged to successful group while remaining 35 (35%) to failed group. Results: Majority of the patients belonged to the age group 61-80 years in the study. Majority of the patients belonged to the age group 61-80 years in the study. Total of 78% of patients in our study accepted having prior LUTS. Duration of symptoms was shorter in successful group and ranged from no prior LUTS to 18 months when compared to no prior LUTS to 20 months in failed group. Majority of the patients belonged to the age group 61-80 years in the study. Total of 78% of patients in our study accepted having prior LUTS. Duration of symptoms was shorter in successful group and ranged from no prior LUTS to 18 months when compared to no prior LUTS to 20 months in failed group. 45% had IPSS <15 and 53% had IPSS 15-30. PV was lesser in the successful group, it was not found to be statistically significant. We had 18 patients (18%) with grade I, 54 (54%) with grade II and 28 (28%) with grade III IPP. Conclusion: Severe lower urinary tract symptoms, prostatic pain during DRE, large urine volume after catheterization, and high blood urea are the predictive factors for TWOC failure in AUR due to BPH.

8. A Single-Centre, Prospective Assessment of the Complications of Functional Endoscopic Sinus Surgery (FESS)
Chandra Kant Diwakar, Ankita Sinha, Garima Singh
Aim: This clinical study was aimed to study complications of functional endoscopic sinus surgery (FESS) at a tertiary care hospital in southern Bihar region. Material & Methods: The present study was single-center, prospective, observational study, including 100 patients conducted in Department of ENT, Narayan medical College and hospital, Sasaram, bihar, India Study duration was of one and a half years. Results: Majority of patients were from 19-30 years age group (44%) followed by 31-40 years age group (28%). Male patients (70%) were more as compared to female (30%). In patients undergoing FESS, multiple surgeries were performed simultaneously such as uncinectomy (100%), middle meatal antrostomy (100%), anterior ethmoidectomy (100%), posterior ethmoidectomy (72%), sphenoidectomy (28%), frontal recess surgery (22%) and reduction of the middle turbinate (1%). In present study we noted only 1 major complication as CSF leak (2%) which was effectively managed by endoscopy. Few minor complications as synechiae requiring treatment (5%), periorbital emphysema (3%), epistaxis requiring packing (2%), periorbital ecchymosis (1%) and sinus infection (1%), all were managed conservatively and successfully. Conclusion: FESS is one of the most commonly performed operations in otorhinolaryngology and is generally a safe procedure, with a low rate of complications but as with any surgical intervention, it carries risks and major complications may occur.

9. A Hospital-Based Case Control Study Assessing the Autonomic Activity in Healthy Off Springs of Hypertensive and Normotensive Parents
Rashmi Sharma, Abhishek Kumar, Akash Bharadwaj, Rita Kumari
Aim: The aim of this study was to assess the relation between Family history, BMI and autonomic function tests in healthy off-springs of hypertensive parents. Material & Methods: The present study was conducted in 50 normotensive healthy off-springs of Hypertensive parents (Study Group) and 50 normotensive healthy off-springs of non-hypertensive parents (Control Group), in the age group of 18-21 years at department of Physiology, Nalanda Medical College, Patna, Bihar, India. Results: Height, weight and BSA showed significant difference in the study. There was significant increase in resting Respiratory rate and Resting Systolic Blood Pressure in study group compared to control group. There was significant increase in sympathetic function tests and insignificant increase in the readings of parasympathetic function tests. Conclusion: A cross-sectional study showed increase in prevalence of cardiac autonomic dysfunction more of sympathetic over activity in normotensive healthy off-springs of Hypertensive parents, compared to normotensive healthy off-springs of non-hypertensive parents.

10. A Hospital-Based Assessment of the Factors Associated with Anti-Depressant Medication Adherence in Women: A Cross-Sectional Study
Satish Kumar Sinha, Krishna Kumar Singh, Rakesh Kumar, Niska Sinha
Aim: The aim of the present study was to assess the factors associated with anti-depressant medication adherence in women attending an out-patient psychiatry department. Methods: The present study was conducted at department of Psychiatry, Jannayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India for one year. we proceeded by selecting 100 patients who were diagnosed with Depression. They attended the Psychiatry Out Patient Department. Results: Of the 100 subjects, 44 (44%) had mild depression, 48 (48%) had moderate depression and 8 (8%) had severe depression. The mean age of subjects on medication was 39.41 ±3.14 and mean age of subjects not on medication was 30.22 ± 4.32. The mean difference between two groups was statistically significant (P value < 0.001). There was no difference between these groups on any of the parameters, especially the severity of depression. Among the 70 patients who were on not taking medications regularly, 82.85% people had a low education about the nature and course of the illness, 80% people experienced some kind of side effects due to the antidepressant they were taking and 90% people had a poor family support. Conclusion: In this study, severity of depression was not associated with medication non adherence, married status and paid work status are factors associated with adherence to antidepressants. Stated reasons for nonadherence of medications include less education about the nature and outcome of depression, side effect profile and poor family support. Psychoeducation of patients & caregivers, carefully monitoring of medication adherence an ongoing follow-up are crucial to enhance adherence.

11. An Observational Study Assessing the Association of Soap and Cream Use with the Occurrence of Skin Complications among Elderly Persons
Adil Inam
Aim: The aim of the present study was to assess the association of soap and cream use with the occurrence of skin complications among elderly persons in the tertiary care hospital in Bihar region. Methods: The study was carried out in Department of Skin and VD, Jai Prakash Narayan Hospital, (JPNH) Gaya, Bihar, India. The study population included individuals aged 60 years and above presenting to JPNH for medical attention and are admitted to the wards after presentation. A purposive cross-sectional sampling of 100 elderly patients that were admitted to the different wards of the hospital within a 3-month period was carried out. Results: In the present study, majority of the participants belonged to 65-74 years age group and there were male predominance. 70% were married, 36% were retired. 55% were staying with their spouse. 75% showed prevalence of skin complications among the study participants. Xerosis was the most common skin complication (55%), followed by itching (26%) and post bleaching-syndrome (19%). There was no significant difference in the distribution of the type of soaps used by gender. The distribution of post bleaching syndrome was significantly associated with a relatively high use of medicated soaps with post-bleaching syndrome. The distribution of post bleaching syndrome and age groups was found to be statistically significant. Conclusion: There was a considerable occurrence of post bleaching syndrome among the participants. In a bid to improve skin care among the elderly, it is important that the geriatric population is educated on the appropriate applications of skin care products for an improved quality of life.

12. A Hospital-Based Descriptive Assessment of the QoL amongst All Diagnosed Cases of Head and Neck Cancer
Sami Ahmad, Akbar Zaman, Sujeet Kumar, P. K. Lal
Aim: The aim of the present study was to assess the QoL amongst all diagnosed cases of head and neck cancer. Methods: This was a hospital-based, descriptive, cross-sectional study in which the quality of life of 50 patients diagnosed with head and neck cancer attending the out-patient Department of ENT, SKMCH, Muzaffarpur, Bihar, India were studied. The study was conducted for the period of one year. Patients presenting to outpatient department and fulfilling the following criteria were included in the study. Results: The highest number of cases was observed 50-59 years age group (28%), followed by 60-69 years age group (20%). The number of cases was significantly higher in males with 42 cases (84%) as compared to females who comprised only 8 cases (16%). When asked to state the aspect of lifestyle was most distressing/inconvenient for the patient in past one week (up to three choices per patient), the highest fraction of patients responded pain (56%), followed by appearance (38%) and chewing (36% each) and subsequently, swallowing (30%) and speech (32%). 30% patients responded that they can swallow certain soft solids, but cannot swallow certain foods. 48% had normal saliva. On being asked about the sexual aspect of their lifestyle, around 26% patients responded that they were a little dissatisfied, 16% patients were moderately dissatisfied and 4% patients were very dissatisfied with their sex lives. On being asked about their mood, around 38% patients stated that they were neither in a good mood nor depressed, while around 34% revealed that they were depressed about their cancer. Around 36% patients experienced shoulder stiffness. Conclusion: The study findings suggested that the treatment and intervention protocol for head and neck cancer patients should not only be focused on survival but also on ensuring QoL throughout the management intervention and stages of recovery.

13. A Hospital-Based Assessment of the Efficacy of Skin Suture versus Skin Stapler in Abdominal Surgeries: A Comparative Study
Ajit Kumar, Nitish Prabhakar, Khursheed Alam
Aim: The aim of the present study was to assess the efficacy between skin suture versus skin stapler in abdominal surgeries. Methods: The present study was conducted on 80 patients, who presented to the in-patient Department of General Surgery, Government Medical College, Bettiah, Bihar, India for one year. A total of 80 patients were categorized into 2 groups i.e., group A which was conventional suture group and group B which was staple groups with 40 cases in each group. In group A, wound closure was done with Prolene 2-0 cutting body (Lotus) using interrupted sutures. While in group B, wound closure was done with Covidien stapler. Results: The mean age among staples group was 36.54 years and among sutures group was 34.66 years. Majority of the patients belonged to the age group 30-40 years followed by 40-50 years. In the present study, out of 80 patients, 42 (52.5%) were male and 38 (47.5%) were female. In the present study, out of 80 cases, the commonest type of incision for surgical wound creation was McBurney’s incision: 16 in staplers and 18 in suture group. Midline incision was given in 11 cases in staplers and 14 cases in suture group, inguinal incision was given in 8 cases in staplers and 5 cases in suture group, sub- costal incision was given in 2 cases in each group, and paramedian incision was given in 2 cases in staplers and 1 in suture group. We observed that in staples group, 4 cases presented with clear discharge with grade (III) and 3 cases with purulent discharge with grade (IV) whereas in suture group, clear discharge with grade (III) was seen in 8 cases and purulent discharge with grade (IV) in 6 cases, rest of the cases healed normally or by with mild bruising. Pain while removal of staples or sutures is tabulated by using pain score with <2 and >2 in both the groups. In staples group, pain score was <2 in 90% of patients and in sutures group, it was 10%. Conclusion: The results indicated that skin closure by stapler can be preferred over conventional skin suture as it is easy to apply, easy application and easy to remove with less pain on removal ,easy on pockets of the patients and aesthetically acceptable.

14. An Outcome Assessment of Anatomical Reconstruction of Anterior Cruciate Ligament with Hamstring Graft
Deepak Kumar Nayak, Himanshu Chaudhary, Mohd Wamique Ansari
Aim: The objective of the present study was to assess the functional outcome of anatomical reconstruction of ACL with quadrupled hamstring graft. Methods: The present study was conducted in the Department of Orthpaedics, Institute of Medical Sciences, Banaras Hindu University, UP, India for the period of one year and 40 patients were included in the study who had undergone Anterior Cruciate Ligament reconstruction using quadrupled Hamstring graft. Results: The youngest patient was 20 years and the oldest patient was 51 years old. The maximum number of patients were in the age group of 18-25 (45%) followed by the age group 26-29yrs (25%). The mean age was 32.2 yrs. In our series of 40 patients, 34 patients (85%) were males and 6 patients (15%) female, (Male Predominance). It may be because of the involvement of males in outdoor activities like sports and motor vehicle accidents. Right knee was injured in 32 patients (80%) and left knee was injured in 8 patients (20%). Most of the ACL tears were caused by RTA (70%). Next common cause was sports activities (17.5%). Some patients (12.5%) got injured while doing daily activities like slip and fall. At the 9th month follow up 80% of the patient had excellent score which were 55% at the 3rd month. 15% of patient had good score and 5% of patient had fair score at the end of 9th month. None of the patient had poor score. 45% Patients were having instability and 25% cases presented with knee pain. 10% gave history of locking of knee, 20% presented with instability and knee pain. Diagnostic arthroscopy prior to ACL reconstruction confirms the medial meniscal tear in 35% cases and 12.5% lateral meniscal tear. Both the menisci were injured in 10%. 42.5% were isolated ACL injuries. Conclusion: Anatomical reconstruction of ACL with quadrupled hamstring graft gives better clinical outcomes. The advantages of using hamstring graft are reduced donor site morbidity and less anterior knee pain in long term follow up. It has better subjective and objective functional outcome with low graft rejection or failure rate.

15. An Observational Cross Sectional Study to Evaluate Association between BMI and Severity of Diabetes Mellitus
Vikash Kumar, Mantun Jha, Shadab Raheel
Aim:  The aim of the present study was to investigate the association and quantify the relationship between BMI and severity of diabetes mellitus. Material & Methods: This analytic cross-sectional study was performed in the department of Medicine IPD of Lord Buddha Koshi Medical College, Saharsa, Bihar, India for one year. The final sample included 500 individuals who had a baseline BMI ≥18.5 kg/m2 (200 cases and 300 controls). Results: Compared with control individuals, the case individuals had higher baseline BMI values (mean ± standard deviation: 32.8 ± 8.2 kg/m2 vs. 28.2 ± 6.4 kg/m2, p < 0.01). Cases were more likely to be younger, male, and to have higher healthcare resource use as measured by costs during the 12-month pre-index period than controls. Cases were also more likely to have experienced comorbidities related to diabetes and/or obesity and used medications related to diabetes or obesity during the 12-month pre index period than controls. The relative risks displayed a similar pattern: the relative risk was 1.5 (95%CI: 1.4–1.6) for overweight adults, 2.5 (2.3–2.6) for adults in Obesity Class I, 3.6 (3.4–3.8) for adults in Obesity Class II, and 5.1 (4.7–5.5) for adults in Obesity Class III. We found that the change in the magnitude of the ORs from one BMI category to the next was larger for individuals in higher BMI categories than individuals in lower BMI categories, as illustrated by the increasing slope of the lines connecting the ORs and, to a lesser degree, the lines connecting the relative risks. These patterns of ORs and relative risks imply that individuals in higher BMI categories were increasingly more likely to be diagnosed with T2D than individuals in lower BMI categories (p < 0.05). Conclusion: The present study concluded that that not only is BMI strongly and independently associated with the risk of being diagnosed with T2D, but also that the magnitude of this positive association is larger for higher BMI values.

16. A Cross-Sectional Observational Evaluation of Thyroid Function Test in Post-Menopausal Women
Sonal, Abu Nasar
Aim: The aim of the present study was to investigate the thyroid function status among postmenopausal women. Methods: A cross-sectional study was performed among 100 women aged 45–80 years who attended the Department of Biochemistry, Government Medical College and Hospital, Bettiah, Bihar, India conducted in the duration of three months .  Among these 90 female subjects, 40 were hypothyroid females and 50 were hyperthyroid females. They were divided into postmenopausal hypothyroid postmenopausal hyperthyroid, and control groups. 10 females were taken in the control group. Results: A total of 90 females including premenopausal (n=50) post-menopausal (n=40) with thyroid dysfunction and euthyroid females with normal menstrual cycle (Control group= 10) were assessed for T3, T4 and TSH level. Mean TSH value for postmenopausal hypothyroid females was 10.30 ±3.42 μg/dl, for FT3 value was 2.05 ±0.82 pg/dl and mean value for FT4 was 0.46 ±0.34 μg/dl (P<0.01). Mean value for TSH was 0.85 ±0.90 μg/dl, for FT3 mean value was 10.64 ±2.24 pg/dl and mean value for FT4 was 2.85 ±1.01 μg/dl (P<0.01). In hyperthyroid premenopausal females serum TSH level was significantly lower than the control group (P<0.01). Serum FT3 level was significantly higher in hyperthyroid premenopausal and postmenopausal females as compared to control group (P<0.01). Conclusion: In view of the results obtained from the current research and considering the previous reports, there is a possibility of a shift in the activities of thyroid hormones with age. Considering the improved life expectancy and the fact that the activities of thyroid hormones could influence the reproductive and other metabolic pathways, it is important for us to have a better understanding of the activities of thyroid hormones as a person ages for appropriate management.

17. Clinico-Demographic Profile and Outcome Assessment in a Paediatric Intensive Care Unit: A Retrospective Observational Study
Archana Singh, Shireen Fatima, Binod Kumar Singh
Aim: The aim of the present study was to analyze demographic profile and outcome in a tertiary care hospital Pediatric Intensive care (PICU) in Bihar region. Methods: This was a hospital based retrospective study, done on patients admitted to Paediatric ICU of Nalanda medical College and Hospital, Patna, Bihar, India for the period of one year. Total 200 patients were included in the study. Results: According to the socio demographic pattern, age distribution of patients showed that < 1year were 50 (25%), 1-5 years were 90 (45%), > 5yrs of age were 60 (30%). There was a male preponderance 140 (70%), males were 60 (30%). The mean age was 5.25±6.4 years. Out of the total cases 200, 150 (75%) were medical cases and 50 (25%) were surgical cases. The mean PRISM III score was 15.5 (4-36). The average length of PICU stay was 8.40 ±5.5. The major diagnostic categories of medical patients were neurological 40 (20%), respiratory 36 (18%) and cardiac 12 (6%), renal 30 (15%), infectious 20 (10%), hematological 12 (6%), gastrointestinal 26 (13%), others including surgical and trauma cases 24 (12%). The outcome noted was, out 200 patients admitted to paediatric ICU, 176 (88%) were discharged. About 20 (10%) patients went against medical advice. About 4 (2%) patients were referred at parent’s request. Conclusion: Respiratory illness, infectious diseases, neurological problems and poisoning are the most common cause for PICU admissions. But seronegative dengue cases, electric shock, reemergence of scrub typhus, are being increasingly diagnosed. So, emphasis is therefore placed on high index of suspicion for this type of conditions. We also recommend better manpower and infrastructure to improve the outcome of patients admitted to PICU.


18. Role of Fine Needle Aspiration Cytology in Neck Swelling in Tertiary Care Centre in South West Bihar
Sanjeev Ranjan, Ravi Ranjan Singh, Sanjeew Kumar, Kumari Pallavi, Tutor, Gaurav Kumar Singh
Aim: The aim of the present study was to assess the prevalence of different types of neck lesions and to test the utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of neck lesions. Methods: The present study include outdoor and indoor cases of palpable neck swelling in Department of pathology, in NMCH, Sasaram for the period of 12 months. Patients of all age and sex were included and proper clinical history was taken. The patient were positioned to allow the most optimal digital palpation of the mass. The present study included 500 cases. Results: Site wise distribution of head and neck FNAC showed lymph nodes lesion (32%) was the predominant site followed by thyroid lesions (30%), miscellaneous (23%) and salivary gland lesions (15%). The youngest patient in the study was 2-year-old and the oldest was 78 years of age with mean age of 36.84 years and 36 year median and peak incidence of age group was third decade. Head and neck lesions were cytologically categorised into nonneoplastic (52%), neoplastic (45%) and remaining (3%) were inadequate due to scant cellularity and haemorrhagic aspirate. Out of 160 (32%) cases of lymphnode lesions, most common lesion was reactive lymphadenitis (30%) followed by granulomatous lymphadenitis (27.50%). In malignant lesions, metastasis from squamous cell carcinoma was the predominant finding (12.50%) followed by non-Hodgkin’s lymphoma (1.25%), metastasis from adenocarcinoma (0.62%). Total 75 (15%) cases of salivary gland lesions were observed. Conclusion: In our study most common nonneoplastic, benign neoplastic and malignant neoplastic lesion are reactive lymphadenitis, colloid goiter of thyroid and metastasis of squamous cell carcinoma in lymphnode. Study has made, it clear that FNAC is one of the best investigation one can ask for with fairly good accuracy. Hence we conclude that fine needle aspiration cytology is simple, rapid, safe diagnostic tool for differentiating nonneoplastic from neoplastic lesions of palpable neck region.

19. A Randomized Comparative Assessment of the Efficacy of Terbinafine and Itraconazole in Increased Dosages and Duration in the Treatment of Tinea Corporis and Tinea Cruris
Satya Prakash Singh, Asha Kumari, Ram Babu Raman
Aim: This study was designed to compare the efficacy of terbinafine and itraconazole in increased dosages and duration in the treatment of tinea corporis and tinea cruris. Material & methods: In this randomized comparative study carried out at Department of Pharmacology, DMCH, Laheriasarai, Darbhanga, Bihar, India for 11 months, patients of tinea cruris and tinea corporis were randomly divided into two groups of 100 each and were given oral terbinafine (Group I) and oral itraconazole (Group II) for 4 weeks. The scores and percentage change in scores of pruritus, scaling, and erythema were evaluated at 2 and 4 weeks. Results: The mean age of patients was 32.48±12.18 and 31.29±11.15 years respectively, in group A and group B. Group A had 35 (70%) males and 15 (30%) females, while in group B there were 34 (68%) males and 16 (32%) females. Tinea corporis et cruris (40 patients in group A and 34 patients in group B) was most common type of dermatophytic infection followed by tinea cruris (6 patients in group A and 10 patients in group B) and tinea corporis (4 patients in group A and 6 patients in group B). Statistically, there was no significant difference between two groups for symptom scores for all the three symptoms at baseline. Improvement in all the three symptoms (erythema, scaling and pruritus) was seen from the first follow-up at 2 weeks itself. Conclusion: Itraconazole has shown a higher mycological and clinical cure rate when compared to Terbinafine. Patients who were prescribed Terbinafine have indicated that there is a growing resistance to the drug and increased chances of failure of treatment of dermatophytic infections, failure of therapy also add to the financial burden on patients.

20. To Study Prevalence and Pattern of Psychiatric Comorbidities among Thyroid Dysfunction Patients at Tertiary Care Hospital
Patidar Isha, Bodliya Mayuresh, Siddharth Rathore
Thyroid hormones can directly or indirectly affect almost all systems in the body, therefore changes in their serum levels can have negative effect on human health. Various types of thyroid disorders have been observed in 5%–10% of the population. There is limited literature on the rates of thyroid dysfunction among patients with major psychiatric disorders in the Indian population. This study aims to study prevalence and pattern of psychiatric comorbidities among thyroid dysfunction patients at tertiary care hospital. Methodology: The study was a observational study, which was conducted at R.D. Gardi Medical College, Ujjain. A sample size of 161 was calculated. Thyroid dysfunction patients attending the OPD and also those admitted in IPD of C. R. Gardi hospital were studied. Clinical information were obtained by interviewing. Brief Psychiatric Rating Scale (BPRS), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) based diagnostic criteria for clinical evaluation of psychiatric conditions was used. Result: Among 161 study participants, 113 (70.2%) were females and 48 (29.8%) were males. Mean age of presentation was 40.81 years (SD 13.322). Hypothyroidism was present in 142 patients (88.2%)  and hyperthyroidism  was  present  in  19  patients  (11.8%). In our study population it was found that 83 (51.6%) cases had psychiatric comorbidity. In the hypothyroid group, psychiatric comorbidity was present in 72 (50.7%) patients.  In hyperthyroid group, psychiatric comorbidity was present in 11 (57.9%) patients. Conclusion: Thyroid dysfunction is commonly associated with comorbid psychiatric disorder. So timely detection and treatment of psychiatric comorbidities are very necessary while treating the patients of thyroid dysfunction. Our study identify high Psychiatric comorbidities in the thyroid dysfunction patients.

21. Use of Diagnostic Laparoscopy for Individuals with Chronic Abdominal Pain of Unclear Diagnosis: A Cross-Sectional Study
Kinjal Dodiya, Jekee Patel, Himarshi Upadhyay, Sanjay R Chauhan
Background and Objectives: Chronic abdominal pain poses a significant clinical hurdle in terms of accurate diagnosis. Within this context, laparoscopy, a minimally invasive procedure, offers potential benefits for both diagnostic and therapeutic purposes in individuals afflicted with chronic undiagnosed abdominal pain. Consequently, the principal aim of this study was to evaluate the utilization of laparoscopy as an investigative approach in the diagnosis and management of patients grappling with chronic abdominal pain. Materials & Methods: This study encompassed a cohort of 100 individuals who presented with chronic abdominal pain. Comprehensive data regarding demographics, clinical characteristics, as well as medical and surgical backgrounds were documented. Specific information pertaining to the pain, encompassing its severity assessed through the visual analog scale (VAS) score, duration, location, and nature, was also recorded. Furthermore, routine and radiological investigations were conducted as part of the diagnostic process. Subsequently, the patients underwent diagnostic laparoscopy, employing either an open or closed technique under general anesthesia. To assess the postoperative outcomes, pain evaluation was performed using the VAS score. Results: Among the participants, a notable majority experienced chronic abdominal pain. Fever was reported by 42.15% of the patients, and a history of lower segment cesarean section was identified in 5.31% of the cases. The surgical interventions most frequently conducted were adhesionlysis and appendectomy. Importantly, a statistically significant improvement in postoperative pain relief was observed. Conclusion: Laparoscopy effectively diagnoses and relieves pain in chronic abdominal pain patients, emphasizing adhesions and inflamed appendix as significant factors. Larger studies are needed for validation, but laparoscopy remains a valuable diagnostic and management tool.

22. Use of Haematology Reports as a Tool for Early Clinical Exposure in Undergraduate Medical Students
Dharmishtha Dodiya, Swati Mahajan, Ashok Solanki, Ankur N Sarvaiya
Background and Objectives: Early Clinical Exposure (ECE) aims to bridge the gap between pre-clinical and clinical subjects, offering early exposure to the healthcare system using laboratory reports and clinical scenarios. This study aimed to explore student attitudes and difficulties encountered during the implementation of ECE in 1st MBBS Physiology. Materials & Methods: A total of 133 students were included in this study, who had completed both the theoretical and practical components of their hematology classes. To create a realistic setting, clinical scenarios and laboratory forms were developed using genuine laboratory reports obtained from the pathology department. Subsequently, group discussions and consultations with faculty members were conducted. Throughout the process, careful attention was paid to the students’ attitudes, which were duly observed and recorded. Results: A significant majority of students expressed positive views towards this instructional approach, considering it both engaging and superior to conventional methods. They perceived it as instrumental in enhancing comprehension of theoretical and practical concepts, as well as facilitating improved exam preparation and clinical correlations. However, approximately half of the students either agreed or remained uncertain about the level of difficulty associated with ECE. Conclusion: The positive student attitude towards Early Clinical Exposure (ECE) signifies its successful integration of basic science and clinical subjects. ECE facilitates a better understanding of the relevance of basic science and makes subject concepts easier and more interesting. However, the challenges faced by students should be acknowledged, and additional practice sessions may be warranted.

23. Is Intranasal Midazolam Superior To Its Oral Administration For Preoperative Anaesthestic Sedation In Pediatric Patients?
Sunil kumar Nagjibhai Bhadiyadara, Ankita Patel, Tushar R Baria, Priyanka Dhirubhai Patel
Background and Objectives: The administration of premedication to pediatric patients undergoing surgery is essential to alleviate separation anxiety, reduce apprehension, and promote cooperation. The primary objective of this study is to compare the effectiveness and safety of intranasal and oral midazolam in terms of sedation onset. By assessing the sedation onset, the study aims to determine which route of midazolam administration is more efficient and well-tolerated in pediatric patients. Materials & Methods: The research cohort consisted of 164 patients categorized as American Society of Anesthesiologists (ASA) grade I and II, ranging in age from 2 to 9 years. These patients were scheduled to undergo elective surgeries at a tertiary care medical hospital in India. The participants were randomly assigned to two groups, with each group comprising 82 patients. Results: The study findings revealed that the onset of sedation was significantly faster when midazolam was administered intranasally compared to the oral route. However, 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 in this regard. Conclusion: Based on the study findings, intranasal midazolam demonstrates faster onset of action, comparable effectiveness, and a similar safety profile to oral midazolam. Therefore, intranasal midazolam may be preferred over the oral route due to its quicker onset of action, as well as its efficacy and safety.

24. Patients’ Perceptions Regarding Preoperative Informed Consent: A Tertiary Care Hospital Based Survey from India
Hemangi A. Virani, Ajay Mahendra Tiwari, Piyushkumar M. Pargi, Dhagash Gautamkumar Patel
Background and Objectives: The doctor-patient interaction depends heavily on patient autonomy, often known as the freedom to make healthcare decisions without being pressurised, and informed consent, a thorough process of information disclosure. In India, however, there hasn’t been much investigation into informed consent. As a result, the study’s objective was to evaluate patients’ knowledge of and comprehension of informed consent as well as their perspectives at a tertiary care facility in western India. Materials & Methods: A cross-sectional survey was carried out. Patients who had undergone elective or urgent surgery in several surgical departments were the focus of the survey. A pre-structured questionnaire was used to randomly choose 405 post-operative patients for interviews. Results: Only 69.81% of patients were told about their prospective procedure, a sizeable fraction of them had little knowledge of it. Additionally, only 33.80% of patients were aware of other treatment alternatives, which is a significantly low number. About half of the patients (45.71%) were informed about the type of anaesthesia used, while only 13.57% were informed about the potential consequences. Notably, despite the existence of data that clearly show otherwise, patients believed that informed permission was not acquired in 5% of cases. Conclusion: Informed consent is essential in clinical practise because it safeguards patients’ rights and lowers the risk that they would sue medical professionals for treatment-related problems. It is crucial to educate medical professionals and other healthcare workers on the value of getting informed consent.

25. A Hospital Based Observational Study Assessing Risk Factors Associated with Primary Open Angle Glaucoma in Diabetic Patients
Pranay Kumar, Rajesh Kumar Singh, Gopal Prasad Singh, Rajiv Kumar Singh
Aim: Prevalence and risk factors associated with primary open angle glaucoma in diabetic patients in a tertiary care centre. Methods: This cross-sectional study was done the Department of Ophthalmology, SKMCH, Muzaffarpur, Bihar, India for the period of 1 year. All documented diabetic cases attending Department of  Ophthalmology giving consent for work up for the study, IOP > 21 mmHg (by Schiotz tonometry) with visual field defects, IOP > 21 mmHg (by Schiotz tonometry) with optic nerve head changes, Optic nerve head changes with visual field defects and Normal IOP with no visual field defects or optic nerve head changes, with asymmetry of IOP in both eyes of > 5 mmHg were included in this study. Results: The results of the study show clear cut evidence of increased incidence of POAG in diabetic patients, which was 8%. The distribution of age in the study population ranges from 35 to 71 years. The mean age of study participants was 52.69 years and a SD of 10.69 years. There is a significant association between age and POAG. No significant association was found between gender and POAG. No significant association was found between duration of DM and prevalence of POAG. POAG was found to be more in patients with a family history of glaucoma. Conclusion: Patients with diabetes are at increased risk of open-angle glaucoma, Glaucoma family history and retinopathy are the main risk factors for open-angle glaucoma in the early years of diabetes. Gender of patients, duration of diabetes and medication used for control of diabetes were found to be insignificantly related to glaucoma.

26. A Study to Assess the Clinicopathological Profile and Outcome of Surgical Therapy of Abdominal Tuberculosis
Sekhar Chakraborty, Bimal Kumar Chatterjee, Shahid Ahmed
Aim: The aim of this study was to assess the clinicopathological profile and outcome of surgical therapy of abdominal tuberculosis. Material & Methods: This study was conducted in Department of General Surgery, Jagannath Gupta Institute of Medical Sciences & Hospital, Budge Budge, Kolkata, West Bengal for the duration of 1 year. A total of 100 patients with intestinal tuberculosis were included in the study. Results: It was noted that out of 100 patients, 43 (43%) were in the age range 15-30 years, followed by 27 (27%) in the age group 46-60 years, and 18 (18%) in the age group 61-75 years. The average age was 44.76±17.43 years. Most common presentation was abdominal pain followed by vomiting, distension and constipation. Out of the 70 patients, 58% were female. Intraoperatively, it was found that 42 patients had stricture, 32 patients with perforation, and 14 patients with adhesion. Intraoperatively, it was found that 42 patients had stricture, 32 patients with perforation, and 14 patients with adhesion. Based on location of pathology it was found that terminal ileum was involved in 49 cases (49%). Ileocaecal junction illness affected 38 patients (38%), while proximal bowel disease affected 13 patients (13%). Conclusion: The disease is characterised by young age at presentation, delayed manifestation, poverty, and high morbidity and mortality in this region. These issues must be addressed in order to provide the best possible treatment for these individuals. The key to an early and successful diagnosis of abdominal tuberculosis is extreme monitoring in patients with abdominal symptoms.

27. A Hospital-Based Study Assessing Association of Vitamin D with HbA1C Levels in Patients with Type 2 Diabetes Mellitus
Anand Kumar, Vibha Rani, Suman Kumar Saurav, Rajiva Kumar Singh
Aim: The aim of the study was to find out whether this correlation between vitamin D and Diabetes is present or not and have tried to correlate Vitamin D with HbA1C levels in patients with Type 2 diabetes mellitus mainly. Material & Methods: The present cross -sectional study was conducted in the Department of Physiology, Patna medical college and Hospital, Patna, Bihar, from October 2022 to April 2023, on newly detected and known patients with T2DM. Total 200 participants were included in the study, out of which 100 type 2 diabetic patients were included as case (Group A) & 100 healthy people as control (Group B). Results: Among diabetic patients having abnormal Vitamin D level, majority (65%) were having insufficiency, only 20% were having overt vitamin D deficiency in Diabetic patients. In the study population, the mean age of group A (case) was 50.45±10.42 years while that of group B (control) was 46.74±10.42 years. 65% of group A were male and 35% female. Group B (control) had 42% males and 58% females. In patients with controlled diabetes as per HbA1C criteria, the prevalence of sufficient, Insufficient and Deficient Vitamin D was 12, 28 and 8 respectively, where in patients with uncontrolled diabetes it was 5, 35 and 12 respectively. There was a significant association between the maintenance of euglycemia and severity of Vitamin D level in diabetic patients, as the p value is less than 0.05. Hypertension was most common co-morbidity found in diabetic group followed by ischemic heart disease. Conclusion: There was an inverse association between Vitamin D and HbA1C in patients with type -2 Diabetes Mellitus. Lower Vitamin D levels are associated with poor glycemic control. That means in case of low Vitamin D the study reveals high HbA1C. Vitamin D deficiency is prevalent in Diabetes mellitus Type 2 so by supplementation of vitamin D can improve glycemic controls in patients of Diabetes mellitus Type 2.

28. Cervical Pap Smear Cytology at a Tertiary Hospital and its Correlation with Clinical Findings: An Observational Study
Rimjhim Kumari, Pallavi Mehra, K. M. Prasad, N. K. Bariar
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: This cross sectional study was carried out at Department of Pathology, Patna Medical College and Hospital, 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.

29. Nerve Fibre Layer Thickness in Different Types of Amblyopia: A Comparative Study Evaluation of the Retinal
Rajesh Kumar Singh, Gopal Prasad Singh, Pranay Kumar, Rajiv Kumar Singh
Aim: The aim of the present study was to test the hypothesis that eyes with amblyopia may have thicker retina, retinal nerve fiber layer thickness (RNFLT) was investigated in patients with different amblyopia. Material & Methods: This prospective study was conducted on consecutive patients diagnosed with amblyopia seen at Department of Ophthalmology, SKMCH, Muzaffarpur, Bihar, India in between duration of One year.The study protocol and the methods adhered to the tenets of the declaration of Helsinki for the use of human subjects in biomedical research. Results: Thirty‑eight eyes (38 patients) with anisometropic amblyopia, 25 eyes (25 patients) with strabismic amblyopia, 40 eyes (40 patients) with mixed amblyopia, and 10 eyes (10 patients) with anisometropia without amblyopia were included. Thirty‑eight eyes (38 patients) with anisometropic amblyopia, 25 eyes (25 patients) with strabismic amblyopia, 40 eyes (40 patients) with mixed amblyopia, and 10 eyes (10 patients) with anisometropia without amblyopia fulfilled study criteria and were included for the study.  Average RNFL thickness in anisometropic amblyopia and strabismic amblyopia was similar, and the difference was statistically insignificant compared with the fellow normal eyes (P = 0.5 and 0.6, respectively). All RNFL parameters in amblyopia groups were not statistically significantly different from the normal group. The difference between all the peripapillary parameters in strabismic amblyopia, anisometropic amblyopia, and mixed amblyopia compared with the normal group was not statistically significant. Differences between all the macular parameters with OCT in strabismic amblyopia, anisometropic amblyopia, and mixed amblyopia compared with the normal group were not statistically significant. Conclusion: Our study showed that RNFL thickness was similar in amblyopic and non‑amblyopic eyes between all three amblyopia groups.

30. Spectrum of Different Cutaneous Granulomatous Lesions with its Clinico-Histopathological Correlation to Reach Etiological Diagnosis
Tulika Singh, Pallavi Mehra, K. M. Prasad, N. K. Bariar
Aim: This study was conducted with the aim to evaluate the spectrum of different cutaneous granulomatous lesions with its clinico-histopathological correlation to reach etiological diagnosis. Materials and Methods: The present observational study was conducted in the Department of Pathology, Patna Medical College and Hospital, Bihar, India for the period of 2 years. This prospective cross-sectional study enrolled 120 cases of skin biopsies after histopathological confirmation of granulomatous lesions. Results: Among 120 cases were studied in which male predominance was noted with 73(60.84%) cases and females constituted 47(39.16%) case providing M: F ratio of 1.5:1. Most of the patients were noted in age group of 20 to 30 years i.e 45(37.5%) cases followed by 23(19.17%) case in 30 to 40 years. 85% of cases were seen below 50 years of age in our study. Infectious granulomatous dermatoses were very common, only 2 cases of sarcoidosis were found.  Most cases of infectious dermatoses were noted in 20 to 30 years comprising 45(37.5%) cases. Leprosy remained the significant causative reason for infectious granulomatous dermatoses succeeded by tuberculosis of skin. Borderline tuberculoid leprosy was found to be predominant, constituting 30 (25%) cases followed by indeterminate and lepromatous leprosy both had 26(21.67%) cases, tuberculoid leprosy 21(17.5%) case and 10(8.33%) of borderline lepromatous. Lupus vulgaris constituted 2 cases (1.67%) and only 2 (1.67%) case of sarcoidosis was found. Conclusion: The most frequent cause of cutaneous granuloma was leprosy, which was followed by TB, fungal infection, and foreign body response. The most prevalent subtypes of leprosy were borderline tuberculoid leprosy and tuberculoid leprosy.

31. Medical Thoracoscopy in Undiagnosed Pleural Effusion: Initial Experience from a Tertiary Care Hospital of Eastern India
Md Arshad Ejazi, Satyadeo Choubey, Manish Shankar, Susayan Konar
Background: Today medical thoracoscopy or pleuroscopy is the gold standard approach for making a diagnosis of undiagnosed pleural effusion, as it is a safe and cost effective intervention. The aim of the study is to identify the diagnostic value and yield of medical thoracoscopy in the identification of exudative pleural effusion cases with undiagnosed cause. Method: This is a hospital based descriptive type of observational study done on ninety nine (99) patients, those presented with moderate to massive pleural effusion fulfilling inclusion criteria of study at department of Pulmonary Medicine IGIMS Patna Bihar between 2021-2022. Under local anaesthesia , a semi rigid thoracoscope was used for thoracoscopy. Data related to histopathological and thoracoscopic finding of patients were collected and analysed. Results: Ninety-nine (99) patients in total were enrolled in the study. These ninety-nine (99) patients ranged in age from 18-80 years, with 57 male and 42 female. Multiple variable sized pleural nodules (46.5 %) were the more frequent gross thoracoscopic finding followed by mass lesion (15.2 %). Most common histopathological diagnosis was malignancy (62.6 %) with metastatic adenocarcinoma being the most common subtype (45%). Conclusion: Medical thoracoscopy is a safe minimally invasive and cost effective method with significant diagnostic yield in the evaluation of undiagnosed exudative pleural effusion with very few complications.

32. An Experiment Comparative Assessment of Intranasal Steroids Sprays Alone V/S Intranasal Steroids with Intranasal Antihistamines Sprays in Patients with Allergic Rhinitis
Priyanka Patel, Urvishbhai Patel, Amit B. Chavda, Kritika Nigam
Aim: The aim of the present study was to compare intranasal steroids sprays alone v/s intranasal steroids with intranasal antihistamines sprays in patients with allergic rhinitis. Methods: The Present study was conducted in Department of ENT, GMERS Medical College, Himmatnagar, Gujarat, India. Study type was comparative, prospective study of one year duration. Results: In present study, 200 patients were randomly divided in group A (n=100) and group B (n=100). Majority of the patients belonged to 18-25 years age group. Age and gender distribution was comparable among both groups and difference was not significant statistically. All the parameters of TNSS before treatment, after 2weeks of treatment and after 4 weeks of treatment were analysed using ANOVA test (as it was found to be parametric in distribution) in the subjects treated with combination therapy and it was noted that statistically significant difference was found in all the parameters of all three groups (p < 0.0001). It was found that two groups were matched for activities, practical problem, nose symptoms, other symptoms. Eye symptoms were found to be significantly higher in steroid therapy group compared to combination therapy group. It was observed that in the steroid therapy group, mean percentage improvement was found to be 16% (0 weeks to 2 weeks) and 4% (2 weeks to 4 weeks) whereas for combination therapy group, the same was found to be 30% (0 weeks to 2 weeks) and 22% (2 weeks to 4 weeks). Conclusion: The management of AR includes patient education on avoidance of allergen as well as pharmacotherapy and allergen specific immunotherapy. Combination of intranasal steroids with intranasal antihistamines sprays has significant reduction of symptoms when compared to intranasal steroids spray alone.

33. Evaluation of Anemia in Patients of COPD: An Observational Retrospective Study
Rajesh P Pimpaldara, Amit Jitendrabhai Asari, Nitesh K. Patel, Sandeep Singh Matreja
Background and Objectives: Chronic obstructive pulmonary disease (COPD) is characterized by chronic airway obstruction resulting from persistent inflammatory processes. As a prominent contributor to premature mortality and morbidity in adults, COPD often coexists with various comorbidities, including anemia. This study aimed to retrospectively investigate the prevalence of anemia in a hospital-based population. Materials and Methods: This retrospective hospital-based study encompassed 456 clinically diagnosed COPD patients who received medical care at a tertiary care teaching hospital in India. A meticulous analysis was conducted on 234 patients who fulfilled the specified inclusion criteria. The diagnosis of anemia was determined based on the World Health Organization (WHO) criteria. The statistical analysis was performed employing IBM SPSS version 21.0. Results: The mean age of the COPD patients was 67.34 years for males and 66.82 years for females. Among the 234 patients investigated, 25.05% males exhibited Hb levels below 13 g%, while 33.15% females manifested Hb levels below 12 g%. Regarding hematocrit levels, 24.31% males displayed values below 39%, and 33.11% females presented values below 36%. Conclusion: The findings revealed that the prevalence of anemia in males was 26.1%, and in females, it was 34.3%, as indicated by the Hb measurements. Similarly, when assessed based on Hct values, the prevalence of anemia was 25.6% in males and 34.2% in females. Additionally, we observed a higher occurrence of anemia in advanced age groups for both males and females.

34. A Cross-Sectional Evaluation of C Reactive Protein in Children with Pyogenic Meningitis
Prakash J Vidja, Gouri Diwan, Deepa Dinesh Joshi, Sandeep Singh Matreja
Background and Objectives: Bacterial meningitis constitutes a significant global public health concern. C-reactive protein (CRP) serves as a suitable diagnostic marker to differentiate between bacterial and aseptic meningitis, particularly in cases with negative bacterial culture results in both blood and spinal fluid samples. This study aims to assess the serum level of CRP in pediatric meningitis cases of bacterial origin. The primary objective of this study was to estimate the serum CRP levels in pediatric meningitis cases caused by bacterial pathogens. Materials and Methods: This hospital-based descriptive cross-sectional study was conducted at a tertiary care hospital located in India utilizing 250 samples. Cerebrospinal fluid samples were collected following standard guidelines. Bacterial identification and antimicrobial susceptibility testing were performed using automation. CRP levels were quantitatively estimated using a solid-phase, sandwich-format immunometric assay with a gold antibody conjugate. Results: The median age of the cases was 4.1 years (1–5.3). Among the bacterial isolates, Escherichia coli was the most prevalent, followed by Klebsiella pneumoniae. Elevated serum CRP levels were observed in 29.33% of the participants. Significantly higher serum CRP levels were found in cases with Gram-negative bacterial etiology. Conclusion: This study demonstrates a significant association between serum CRP levels and meningitis caused by Gram-negative bacteria. The findings suggest that elevated serum CRP may serve as a potential diagnostic marker for identifying bacterial meningitis cases with a Gram-negative etiology.

35. Jaggery and Turmeric in Luymphy Diseases: A Review
Mali Ram Lochhab, Khushbuddin, Kailash Mahawar, Vinod Kumar Kumawat, Laxman Singh, Madhuri Shringirishi, Sanwar Mal Yadav
Curcumin is a compound disengaged from turmeric, a plant known for its restorative use. As of late, there is a developing interest in the clinical local area in recognising novel, minimal expense, safe particles that might be utilised in the treatment of provocative and neoplastic illnesses. A rising measure of proof proposes that curcumin may address a viable specialist in the treatment of a few skin conditions. We analysed the most important in vitro and in vivo examinations distributed to date in regards to the utilization of curcumin in fiery, neoplastic, and irresistible skin sicknesses, giving data on its bioavailability and security profile. Besides, we played out a computational examination about curcumin’s cooperation towards the major enzymatic targets distinguished in the writing. Our outcomes recommend that curcumin may address a minimal expense, very much endured, successful specialist in the treatment of skin sicknesses.

36. COPD Diseases Management with Herbal Drugs: A Review
Shahil Shah, Chaman Kejariwal, Kailash Mahawar, Vinod Kumar Kumawat, Laxman Singh, Madhuri Shringirishi, Sanwar Mal Yadav
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition characterized by persistent airflow limitation and inflammation of the airways. Traditional treatment approaches, such as bronchodilators and corticosteroids, have limitations in terms of side effects and long-term efficacy. Herbal medicine has gained significant attention as a potential alternative or complementary therapy for COPD management. This project aims to investigate the efficacy of herbal drugs in the treatment and symptom management of COPD. A comprehensive literature review will be conducted to identify and analyse relevant studies, clinical trials, and systematic reviews published up until September 2021. The primary focus will be on herbal drugs commonly used in traditional medicine systems, including Ayurveda, Traditional Chinese Medicine, and other indigenous healing practices. The project will explore the mechanisms of action of herbal drugs in COPD, including their anti-inflammatory, antioxidant, bronchodilatory, and immunomodulatory properties. It will also examine the safety profile of these herbal drugs, potential drug interactions, and adverse effects, if any. The identified herbal drugs will be categorized based on their constituents, formulation types, dosage, and administration methods. Furthermore, this project will assess the clinical evidence supporting the use of herbal drugs in COPD management, including their impact on lung function, exercise tolerance, dyspnea (shortness of breath), quality of life, exacerbation frequency, and inflammatory markers. The project will also analyse the limitations and challenges associated with conducting clinical trials in this area, such as standardized evaluation criteria and placebo-controlled studies. The findings of this research project will contribute to the growing body of knowledge on herbal drugs used in COPD and provide healthcare practitioners and patients with evidence-based information on their potential benefits and risks. The results will also help in identifying gaps in current research and highlight areas that require further investigation to establish the role of herbal drugs in COPD treatment.

37. Evaluation of Factors for Effective Treatment and Recurrence in Obstetric Fistula Surgery
Arun Kumar Pargi, Devendra Chouhan, Sonam Dubey, Piyusha Mahashabde
Background and Objectives: Obstetric fistulas (OF) arising from prolonged and obstructed labor remain a significant challenge in developing countries. This study aims to investigate the contributing factors influencing the recurrence and treatment outcomes of OF in a cohort of patients attending a tertiary care hospital in India. Materials and Methods: A total of 100 patients who underwent surgical intervention for OF at an Indian hospital were enrolled in this study. These patients were closely monitored for a duration of 3 months as part of the post-operative follow-up. The efficacy of the treatment was evaluated based on the absence of incontinence or the necessity to use dry pads. Recurrence of OF was defined as the persistent need for incontinence pads either immediately after the surgical procedure or following a period of initial dryness. Results: Type I OF cases were predominant among the patients. Approximately 21% of the patients exhibited vaginal fibrosis during the surgical intervention. The pericervical region emerged as the most frequently encountered location of the fistula. Following the 3-month follow-up period, the recurrence rate was found to be 28%. Among the recurring cases, type IIBb OF was the most prevalent. Conclusion: The presence of fibrosis, as well as the location of the fistula, particularly in the urethral region, were identified as independent factors significantly influencing the likelihood of recurrence of OF. Understanding these factors can contribute to improved management and treatment outcomes of OF, ultimately addressing this challenging obstetric condition in developing countries.

38. A Hospital-Based Study Evaluating Infragluteal Fasciocutaneous Flap for Management of Recurrent Ischial Pressure Sore
Sanjay Kumar, S. K. Jha, P. D. Verma, R. K. Ajay
Aim:  The aim of the present study was to determine the feasibility of infragluteal-fasciocutaneous flap in recurrent ischial pressure sore. Material & Methods: In this study 30 patients suffering from recurrent ischial sore with scars of previous surgery were managed with infragluteal fasciocutaneous flap in between October 2019 to August 2021. Wound bed was prepared by surgical debridement and negative pressure wound therapy in each case. In two cases, gracilis muscle flap was used as adjuvant to fill up the residual cavity. Donor area of flap was primarily closed. Results: In the present study, there were 12 females and 18 male. RTA, fall from height were the etiologies in the study. The median length of stay durations were 9 and 15 days and no statistically significant difference in median length of stay duration was found between the groups. In this respect, no statistical difference was found between the two groups. Conclusion: Infragluteal fasciocutaneous flap is reliable option for managing recurrent ischial sore as it transposes well‑vascularised thick fasciocutaneous flap from adjacent posterior thigh and its bridge segment can be further used in case of recurrence.

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