International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

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Peer Review Journal

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1. Adherence to Anti-diabetic Medications among Diabetic Patients and Factors Affecting it in the Rural Field Practice Area of MMIMSR, Mullana, District Ambala
Suryakant, Silvi Batham, Shubham Mohan Sharma, Purva Shoor
Abstract
Introduction: Type 2 DMone of the largest global health emergencies of the 21st century. Each year more number of people live with this condition. Globally, an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. Aims: To find adherence to antidiabetic medications and its affecting factors in diabetic patients. Settings and Design: The cross-sectional study was conducted in rural field practice area of Department of Community Medicine of MMIMSR. Methods and Material: A sample size of 400 local community was included. And a self-designed questionnaire was administered in the rural field practice area of our college. Time period of the study was from January 2019 to December 2019. Statistical analysis used: Analyzed by IBM SPSS version 20 Software. Results: Adherence to anti diabetic medications was 53.3%, non-adherence was 46.8%. Adherence to medication was more (54.1%) in males than in females (52.6%). Adherence to medication was maximum (63.2%) in the age group of (≥ 75 years). Adherence to medication was found maximum (60.0%) in people getting treatment from other non-allopathic doctors. Adherence to medication was found maximum (60.0%) in those who thought that stopping treatment could worsen their health status. Adherence was 55.0%among patients who benefited from treatment. Conclusions: In this study, adherence to anti diabetic medications was low. The factors found to be significantly associated with adherence were education, caste, number of tablets consumed, side effects of treatment, financial support for treatment and distance of medical facility from patients’ home.

2. Laparoscopy in the Management of Adnexal Masses
I. Siva Jyothi, Suneetha Maddi, Pothireddy Sruthi
Abstract
Background: Laparoscopic surgery has become the gold standard in the treatment of benign adnexal masses, whereas laparotomy remains the standard for the treatment of malignant tumors. Aims: To evaluate the safety and effectiveness of laparoscopy in the management of benign adnexal masses. Materials and Methods: This is a Observational study, conducted on 30 patients admitted to department of Obstetrics and Gynaecology, who were diagnosed with benign adnexal mass, confirmed with various blood investigations and USG, MRI, were subjected to laparoscopic procedures. All the patients were followed up with histopathology report. Results: 30 patients with adnexal masses admitted for the treatment had been evaluated and who underwent laparoscopy were included in the study. The mean age of the patients with adnexal masses in the study group was 32.4 years. The commonest presenting complaint in the study was pain abdomen in 24 (80%) patients. 23 patients had significant abdominal findings of which 13 (43.34%) had tenderness in lower abdomen. Among the study 21 patients were found to have mass felt in the fornix. In the present study 18 (69%) patients found to have simple ovarian cysts on ultrasonography. The marker CA-125 mean was 15.14 U/ML. The most common operative procedure done was ovarian cystectomy in 19 (63.34%) patients. The mean estimated blood loss in our study was 105ml. The mean ambulation time of the patients was within 6.4 hours. The mean time among the patients to oral feeds was within 7.23 hours. The mean length of the stay in the hospital was 8.13 days in the study population. Conclusion: Proper selection of cases, multidisciplinary team approach, expert laparoscopic surgical skills and good histopathological reporting are imperative for best patient outcomes.

3. A Comparative Study of Clinical Effects and Recovery Characteristics of Ketamine Versus Fentanyl when used as an Adjuvant along with Dexmedetomidine Infusion Intraoperatively in General Anaesthesia
B. Ravi, T. Badrinath
Abstract
Background: Reducing postoperative pain enhances the ability to breathe deeply and cough effectively, thereby protecting cardio pulmonary functions. This leads to better oxygenation and probable preservation of positive myocardial oxygen balance, which in turn reduces hospital stay and cost and increases patient satisfaction. Aims: This study compared the clinical effects and recovery characteristics of ketamine versus fentanyl when used as an adjuvant along with dexmedetomidine infusion intraoperatively. Methods: randomized prospective clinical study in which total of 60 patients of age 18-60 years undergoing major surgeries were divided into two groups: Group (D + K) received an intraoperative infusion of ketamine 0.5 mg/kg/h, while group (D + F) received fentanyl 0.5μg/kg/h along with intravenous dexmedetomidine 0.5 μg/kg/h. Intraoperative heart rate (HR), mean blood pressure, and oxygen saturation were recorded at 0 min, 10 min of induction, and thereafter every 30 min throughout the procedure. Ramsay sedation score (RSS) and visual analogue scale (VAS) score were measured at the end of the surgery, at 2 hours, 4 hours, and 6 hours. Results: Decreased in HR and mean blood pressure was more with a tendency of developing hypotension in the fentanyl group compared to the ketamine group. Post-anaesthesia care unit (PACU) stay, need for muscle relaxant and VAS score for pain were also significantly lesser in the ketamine group. Conclusion: Dexmedetomidine with ketamine provided better haemodynamic stability and reduced PACU stay compared to dexmedetomidine with fentanyl.

4. Study of Efficacy of Various Surgical Techniques in Use for Controlling Bleeding from Placental Bed in Cases of Placenta Previa
N. Spandana, K. Aravinda Sagar, K. Sravan Kumar
Abstract
Aims: To study the efficacy of conservative surgical techniques like Cho square compression sutures and Stepwise uterine devascularisation in controlling the bleeding from placental bed in cases of placenta previa. Materials and Methods: Prospective Observational study carried out to study of Efficacy of various surgical techniques in use for controlling bleeding from placental bed in cases of placenta previa‖ was conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Musheerabad from September 2015 to September 2017.A total number of 100 patients who were diagnosed to have Placenta Previa on USG were included in the study irrespective of their GA and parity. Results:  In cases of Placenta Previa without adherence Cho Square compression sutures were 100% effective and Stepwise Uterine Devascularisation was 79. 91% effective in controlling placental bed bleed, 9% (3 cases) underwent hysterectomy. Here p value is <0.05 (p=0.01) indicating a significant statistical difference between the two surgical procedures, with 100% success rate of Cho Square compression sutures. In cases of adherent placenta Cho Square compression sutures were 86% effective and Stepwise Uterine Devascularisation was 75% effective in controlling placental bed bleed,14% (2 cases) and 25% (1 case) underwent hysterectomy respectively. Here p value is >0.05 (p=0.3) indicating no significant statistical difference between the two surgical procedures. No statistical difference was noted between the two conservative surgical procedures in relation to blood loss and duration of surgery. The maternal mortality in this study was 0%. All mothers were discharged healthy as a result of good management by multidisciplinary team. Perinatal mortality in the present study was 15%. Prematurity, low birth weight, birth asphyxia and respiratory distress syndrome are the important factors leading to increased perinatal morbidity and mortality. Conclusion: Conservative surgical techniques like Cho Square compression sutures and Stepwise Uterine Devascularisation are effective in controlling placental bed bleed most of the cases.

5. A Comparative Study of Nebulised Dexmedetomidine Versusnebulised Lignocaine in Blunting The haemodynamic Responses to Laryngoscopy and Intubation in Elective Surgeries Under General Anesthesia
Perumalla Sravanthi, Mohd Heifzur Rahman, A. Anuradha, Baloji Ramavath, Julakanti Madhavi
Abstract
Background: Endotracheal intubation is a procedure where placement of endotracheal tube into the trachea through mouth or nose to maintain airway patency and it is associated with various hemodynamic stress responses. This response is mainly mediated by raised plasma adrenaline concentration. In patients with hypertension, raised intracranial pressure, cerebral vascular disease or with ischaemic heart disease, this cardiovascular response to intubation is more life-threatening in which increase in myocardial oxygen consumption can lead to myocardial infarction. Aims: This study is undertaken to compare dexmedetomidine to lidocaine as regards to its efficacy on attenuation of intubation response. Materials and Methods: It is a randomized control study conducted on 100 American society of Anesthesiologists physical status I and II patients aged between 18 to 45 years with Mallampati grade I and II. This study was undertaken in 2 groups Group D and Group L to compare HR, SBP, and DBP from the time of intubation till 10 minutes. The results were analysed using an unpaired t test, Chi-square test and ANOVA. Results: In present study decrease was seen in Systolic blood pressure in both groups. Group L had more decrease (21.2 mean) in systolic blood pressure than Group D (Mean 11.5). Decrease in Diastolic blood pressure was observed in both groups. Group L had more decrease (16.92 mean) in Diastolic blood pressure than Group D (mean 4.5). Decrease in heart rate was observed at 10 mins from pre-Induction. Statistical significance was observed on pre induction, induction, at the time of intubation, at 3 mins and 5 mins. Conclusion: Hemodynamic parameters in present study shows decrease in SBP, DBP and MAP was seen in both group. When compared Group L cases had more rate of decrease than Group D cases in SBP, DBP and MAP.

6. An Observational Study on the Role of Ultrasonographic Lung Aeration Score in the Prediction of Postoperative Pulmonary Complications
Bibha Kumari, Saurabh Kumar, Puja Kumari
Abstract
Aim: The aim of the present study was to identify characteristics with the potential of recognizing patients at risk by comparing the lung ultrasound scores (LUS) of patients with/without PPC in a 24-h postoperative timeframe. Material & Methods: This prospective, observational study was conducted between the duration of 6 months in the Department of Surgery, IGIMS, Patna. A total of 60 patients were enrolled. We recruited ASA 2–3 patients undergoing elective major abdominal surgery under general anaesthesia. LUS was assessed preoperatively, and also 1 and 24 h after surgery. Baseline and operative characteristics were also collected. A one-week follow up identified PPC+ and PPC- patients. Results:20 patients were assigned to the PPC+ group, 40 were evaluated in the PPC- population. Most conditions were similarly represented in both groups, none of the potential predictors were significantly different. Patients conforming to ASA 3 class were significantly more represented in the PPC+ group. LUS at baseline and in the postoperative hour were similar in both populations. Values of ARISCAT scores were significantly higher among PPC+ participants, otherwise, we did not detect important intergroup differences. LUS at 1 h was not significantly associated with PPCs with an OR of 0.7280. By contrast, 24th postoperative hour’s LUS was verified to be an independent and significant risk factor for PPCs, having an OR of 2.6348. Conclusion: Postoperative LUS at 24 h can identify patients at risk of or in an early phase of PPCs.

7. Clinico-Demographic and Laboratory Profile of Typhoid Fever in Children Reported to Health Care
Swesh Chandra, Debasis Kr Samanta
Abstract
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, Sub Divisional Hospital, Rajgir, District Nalanda, Bihar, India for one year on 200 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 (25%). The signs and symptoms of typhoid fever were analyzed according to age. Most of the symptoms were similar in both sexes. Almost all the signs and symptoms were more common in males as compared to females. Abdominal distention was significantly more in females as compared to males with a p-value of 0.01. 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 36 cases in the age group 5-15 and absent in other age groups. Anemia was found in 120 (60%) patients. Mean hemoglobin percentage of all cases involved in the study was 12.4% with SD of 1.5. 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.

8. Effect of Right- Left Differences in Ovarian Morphology on Ultrasonographic Diagnosis of Polycystic Ovarian Syndrome
Shubhanti Kumari, Kalpana Singh, Bhawana Tiwary, Huma Nishat
Abstract
Aim: The aim of the present study was to assess right – left differences in ultrasonographic markers of ovarian morphology and determine the impact on the diagnosis of polycystic ovarian morphology. Methods: The present study was conducted in the Department of Reproductive Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura Patna for one year. Women of reproductive age (21 – 38 y) were recruited from the general population. Women with PCOS (n = 50) were identified by the combined presence of oligomenorrhea and hyperandrogenism. Women with regular cycles and no evidence of hyperandrogenism were included as controls (n = 50). Results: Compared to controls, women with PCOS were of similar ages, but exhibited higher body mass indices, longer menstrual cycles, and higher modified hirsutism scores (All: p < 0.01). The proportion of women with hyperandrogenemia was greater in the PCOS group (40%) versus control group (0%) (p < 0.01). Mean FNPO, FNPS, and OV were higher in women with PCOS (All: p < 0.01). Significant correlations were detected between ovaries – both across markers and within groups. Of the three markers, FNPO showed the strongest correlation between ovaries (PCOS: ρ = 0.74, p < 0.01; Controls: ρ = 0.58, p < 0.01). FNPS and OV had moderate correlations between ovaries in women with PCOS but showed relatively weak relationships in controls. Conclusion: In conclusion, significant intra-individual differences were observed in ultrasonographic markers of ovarian morphology among controls and women with PCOS. FNPO showed the smallest differences between ovaries. Our data may be interpreted to mean that PCOM can be reliably diagnosed in a single ovary using FNPO, but not FNPS or OV.

9. A Review on Diagnosis, Pathophysiology and Effective Management Strategies of Scabies
Shafkat Hussain Malik, Sheikh Irshad Ul Haq, Riyaz Ahmad Bhat, Hanumanthrao C Patil, Rajesh Kumari Patil
Abstract
The contagious parasite dermatosis known as scabies is widespread. In addition to skin-to-skin contact, the mite Sarcopticscabietic var. Homospains can spread through faces, infected bedding, or infected clothing in cases of crusted scabies. The diagnosis is frequently clinical. The management of scabies is based on topical scabicides, mostly 5% permethrin, according to an updated Cochrane review published in 2010. Although it is illegal in many nations, oral ivermectin may still be helpful, especially for patients who are unable to tolerate or adhere to topical medication and in situations when there is an outbreak of scabies in a particular institution. To prevent the infection from growing further, patients should also be informed in-depth about it. Even in the absence of symptoms, cases brought on by close physical or sexual contact need to be treated methodically. Following therapy, hygienic measures ought to be taken. Little ones are most profoundly affected by it, making it the most influential factor. It continues to receive insufficient attention as a significant community fitness matter.

10. A Review on Diabetic Retinopathy: Classification, Risk Factors & Treatment
Manisha, Amandeep Kaur, Harinderjit Singh, Hanumanthrao Patil, Rajesh Kumari Patil
Abstract
The main factor contributing to visual loss in middle-aged adults is diabetic retinopathy. The management of this disease depends on maintaining blood pressure, blood lipids, and blood glucose. We examine the risk factors for the development of high-risk proliferative diabetic retinopathy (PDR), as well as other risk factors of DR such as hyperglycemia, obesity, hypertension, hyperlipidemia, puberty and pregnancy, and myopia, in order to ascertain the relationship between the severity or stage of diabetic retinopathy and associated risk factors. Early detection and prompt treatment allow prevention of diabetes-related visual impairment and to lessen the impact of DR-related visual loss. The use of laser therapy has been modified and for the development of severe visual loss or vitrectomy in eyes assigned to deferral of photocoagulation in this study, non-proliferative diabetic retinopathy is graded as mild, moderate, or severe based on the presence of hard exudates.

11. Fatty Liver: A Pragmatic Approach to its Diagnosis and Staging: A Review
Gurleen Kaur, Pankaj Kumar, Hanumanthrao C Patil, Gajendra Bhati, Rajesh Kumari Patil
Abstract
Patients with fatty livers have higher death rates from the liver and cardiovascular disease. Recognizing people at risk is the first step because many patients with fatty liver go untreated. With substantial liver illness often being undetected by doctors who rely on abnormal liver enzymes, there is a risk of missing opportunities for intervention. While liver biopsy is the most accurate way to identify and stage fatty liver, the majority of patients may be successfully identified non-invasively using assays that are frequently accessible in the clinic today. Ultrasonography, magnetic resonance imaging, computed tomography, and, most crucially, Fibroscan, which precisely assesses the stiffness of the liver, are additional procedures that are helpful for fatty liver diagnosis in the early and late stages.

12. Association of Vitamin D Deficiency with Positional Vertigo: A Case Control Study
Neha Banseria, Amit Jain, Hemant Kumar Jain, Shashank Tyagi
Abstract
Background and Objectives: Benign Paroxysmal Positional Vertigo (BPPV) stands as the most prevalent etiology of peripheral vertigo within the medical context. An essential component in bone mineralization and calcium homeostasis, Vitamin D3 bears crucial significance in physiological processes. Moreover, Vitamin D3 has been implicated in the pathogenesis of BPPV, thereby suggesting its potential as a viable therapeutic intervention. The primary objective of this study was to assess the potential association between BPPV and Vitamin D deficiency. Materials and Methods: An observational case-control study involving a cohort of 60 subjects, comprising 30 confirmed cases diagnosed with BPPV) and 30 control individuals. All participants underwent comprehensive examinations of the ear, throat, and nose to ensure accurate identification and classification. The assessment of Vitamin D3 levels was conducted in all subjects. Results: Among the BPPV cases, 35% exhibited normal levels of Vitamin D, while 37.5% presented with Vitamin D deficiency, and 27.5% demonstrated Vitamin D insufficiency. In the control group, 55% exhibited normal Vitamin D levels, whereas 22.5% each displayed Vitamin D insufficiency and deficiency. The mean concentration of Vitamin D in the BPPV case group was found to be 23.78 ± 10.43, whereas in the control group, it was 35.99 ± 15.99. This disparity between the two groups was statistically significant. Conclusion: There was a significant association between reduced Vitamin D concentration and idiopathic BPPV. This highlights the potential relevance of Vitamin D as a contributing factor in the pathogenesis of BPPV and suggests its potential role as a therapeutic target for managing this condition.

13. Serum Fructosamine: A Novel Marker for Assessing the Severity of Alcoholic Liver Disease
Nisha Mehta, Rahul Nair, Kinnari Prakashbhai Trivedi, Sandeep Singh Matreja
Abstract
Background and Objectives: The present investigation seeks to assess the utility of serum Fructosamine and glycated hemoglobin (HbA1C) as indicators for evaluating glycemic regulation and determining the severity and prognostic implications of chronic alcoholic liver disease. The central objective of this study is to discern the preeminent marker, either HbA1C or Fructosamine, for delineating these parameters within the context of chronic alcoholic liver disease. Methods: A cohort of 110 individuals, spanning both genders and aged between 20 and 70 years, who were diagnosed with chronic alcoholic liver disease, constituted the study populace. Additionally, 55 age and gender-matched healthy subjects were enlisted as controls. Within the patient cohort, further stratification into non-complicated and complicated subgroups was performed. Measurement of HbA1C levels was executed through the immunoturbidimetry technique, while serum Fructosamine levels were quantified using colorimetry employing nitro blue tetrazolium. The quantification of serum glutamic oxaloacetic transaminase (SGOT) adhered to the IFCC methodology, while serum total protein concentrations were determined via the biuret method. Results: In both the non-complicated and complicated chronic alcoholic liver disease patient cohorts, mean concentrations of HbA1C and serum total protein exhibited a decrement, whereas mean concentrations of serum Fructosamine and SGOT demonstrated an elevation. Notably, no statistically significant variance in serum total protein levels was discerned between non-complicated cases and control subjects. The mean HbA1C value displayed no substantial disparity between non-complicated and complicated cases. Noteworthy correlations surfaced, wherein SGOT evinced a notable inverse correlation with serum total protein, a significant direct correlation with serum Fructosamine, and no discernible correlation with HbA1C. Furthermore, a significant negative correlation materialized between serum total protein and serum Fructosamine. Conclusion: The findings of this research elucidate that serum Fructosamine surpasses HbA1C as a more efficacious marker for monitoring chronic glycemic regulation and gauging the severity of chronic alcoholic liver disease. These results underscore the pivotal role of serum Fructosamine in clinical assessments within the purview of chronic alcoholic liver disease and its metabolic ramifications.

14. Review of First 50 Home Care Visits by a Newly Developed Palliative Medicine Department in a Government Tertiary Care Centre In West India
Ashwin Mathur, Yogendra Singhal, Gaurav Sharma, Surendra Kumar Pingoliya, Shreeharsh, Devdutt Sharma
Abstract
Background: Palliative care helps to provide comfort and care to both patients and their family, thus promoting their quality of life. Palliative care provides psychological, physical and moral support to patients. The present study was aimed to determine the demographic characteristics of patients, prevalence of various signs, symptoms and psychosocial issues faced by the patients who are enrolled in home care. Materials and method: The study was conducted on 50 patients provided with home care support by palliative care team. Demographic characteristics, diagnosis, presenting symptoms, signs and psychosocial issues experienced by the patients were recorded. Data collected was analyzed statistically using SPSS version 20.0.  Results: Maximum cases were suffering with cancer of lungs (22%), followed by cancer of oral cavity (20%), with pain being most prevalent symptom. Most of the patients felt psychological distress of decreased social movement, and most of them were being fed through ryle’s tube, and subjected to wound care. Conclusion: Palliative home care helps in managing the patients suffering from various types of cancer, with most common management being wound care. On-going research in palliative care will further help to introduce new model of palliative care in the developing world.

15. Assessment of Clinicopathological Parameters in Patients of Acute-On-Chronic Liver Failure with Metabolic Syndrome and Diabetes Mellitus
Sonam Dubey, Devendra Chouhan, Hemant Kumar Jain, Sonu Rawat
Abstract
Background and Objectives: An intricate and symbiotic relationship prevails between diabetes mellitus (DM), metabolic syndrome (MetS), and hepatic afflictions such as liver cirrhosis, hepatitis, and liver carcinoma, wherein disruptions in glucose and metabolic equilibrium orchestrate a tightly interwoven linkage. However, the correlation between these conditions and the intricate domain of acute-on-chronic liver failure (ACLF) has remained insufficiently explored within recent years. Consequently, our investigation endeavors to elucidate the interplay between DM, MetS, and patients afflicted by ACLF, with the intent of harnessing this understanding as a predictive marker for disease prognosis. Materials and Methods: A cohort encompassing 41 consecutive ACLF patients aged 18 and above was meticulously assembled, incorporating their comprehensive clinical histories, subsequently dichotomized into distinct cohorts of DM/MetS and non-DM/non-MetS categories. Anthropometric measurements and biochemical analyses was performed. Results: DM/METS-afflicted patients exhibited conspicuous elevations across diverse demographic clinical parameters, alongside heightened levels of glycemic indices and lipid profiles. Conversely, discernible declines in protein profiles were noted, in comparison to the control counterpart of non-DM/non-MetS patients. Pertinently, concerning mortality incidence, a discernible elevation surfaced within the DM/MetS cohort, relative to the control group. Conclusion: A heightened mortality risk and protracted hospital sojourn for ACLF patients grappling with DM/MetS was observed. The convergence of DM and MetS within the context of ACLF correlates with accentuated disease gravity, ominous prognostic trajectories, and unfavorable sequelae. Hence, the expeditious identification and adept management of these intricate comorbidities assume pivotal significance in augmenting patient outcomes.

16. An Observational Study Assessing Correlation of Keratinized Tissue Width and Periodontal Indices Around Implant-Supported Fixed Partial Dentures
Priyata Ranjan, Roushan Kumar
Abstract
Aim: The aim of the present study was to assess the correlation of keratinized tissue width with periodontal indices around implant-supported fixed partial dentures (FPDs). Material & methods: A cross-sectional study comprised of patients with implant-supported FPDs one year after their prosthetic delivery. A total of 100 implants were evaluated. All the patients were thoroughly informed of the aims of the study and processes of examination, and written informed consent was obtained from them. Results: Altogether, 100 edentulous patients with a mean age of 63.1 (SD 6 6.9) years and with 66 restored dental implants were included in the study. A total implant (25%) was located in the maxilla and 75 implants (75%) in the mandible.  The periodontal indices were compared between the two groups with keratinized mucosa width <2 mm and ≥2 mm around dental implants. The results showed no significant difference in marginal gingival recession between the two groups (P>0.05). No significant difference was noted in radiographic marginal bone level, PD in different areas or the mean PD between the two groups (P>0.05). The correlation between KM and GI was not statistically significant and also the correlation between PI and KM was not statistically significant. (P=0.75) The correlation between BOP and keratinized mucosa width was not statistically significant too. Conclusion: Although this study did not show a significant correlation between the keratinized tissue width and peri-implant tissue health and consequently the implant success rate, long-term interventional studies are required to make a final judgment in this respect.

17. Assessment of Thyroid Function in Ckd Patients
Pallavi Anand, Chandan Kumar, Pankaj Hans, Md. Farid Alam Ansari, Jai Ram Singh
Abstract
Aim: The aim of the present study was to assess the prevalence of thyroid dysfunction and the correlation between thyroid dysfunction and severity of renal diseases in patients with chronic kidney disease. Material & Methods: A prospective study was conducted on 100 patients of whom were diagnosed to have chronic kidney disease in the Department of Physiology, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India in between the duration of 1 year. Informed consent was obtained from all the patients. Results: In the present study majority of study subjects were from 36 to 45 years of age group. The Mean ± SD of age in study group was 46.64 ±7.63 years as compared to 45.35 ± 6.34 in control group. Maximum patients belonged to the age group 36-45 years. In this study, there were higher numbers of male as compared to female in both these groups. The Case group (N=100) shows serum urea, serum creatinine and serum TSH are significantly higher (p<0.0001) in the cases compared to the controls. While serum fT3 was significantly low (p=0.01) and serum fT4 value was not significant in study group as compared to control group. Serum fT3 was significantly decreased with decrease in GFR which was positively correlated with eGFR in study group. Serum creatinine, urea and fT4 were negatively correlated with calculated glomerular filtration rate. Conclusion: CKD is a progressive disease and these patients are more prone to develop thyroid dysfunction, therefore monitoring of thyroid function should be regularly advised to such patients in order to prevent adverse events in relation to kidney and thyroid function.

18. A Retrospective Evaluation of the Outcome of Surgical Management of Local Complications of Acute Pancreatitis: An Observational Study
Alok Kumar, V.K. Gupta, R.K. Ajai
Abstract
Aim: This study aims to evaluate the indication and outcome of different surgical management modalities in local complications of acute pancreatitis. Methods: A hospital-based retrospective study was conducted in the Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India for one year. A purposive sampling method was utilized to recruit the patients. 400 patients were admitted to the surgery department with the diagnosis of acute pancreatitis or with complications of acute pancreatitis. Among them, 50 patients had local complications due to acute pancreatitis were included in the study. Results: Out of 50 patients, 60% were males. 50% had ethanol etiology and 36% had pseudocyst pancreatic fluid collection. According to the location, 66% were at body or tail. According to Clavien-Dindo classification, 34% were in grade 2 followed by grade 1 (22%) and grade 4 (22%). Conclusion: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.

19. Central Venous Gas Analysis: An Alternative to Arterial Blood Gas Analysis for Ph, Pco2, Bicarbonate, Sodium, Potassium and Chloride in the Intensive Care Unit Patients
Sumit Kumar Raman, Sanjeev Kumar, Ritu Singh
Abstract
Aim: This study was aimed to investigate the correlation of pH, PCO2, bicarbonate, sodium, potassium, and chloride (electrolytes) between ABG and central VBG in ICU patients. Material & Methods:  A randomized controlled comparative study conducted in the department of Anaesthesiology, at Indira Gandhi institute of Medical Sciences, Patna within duration of 12 months. 100 patients were randomly selected. Results: We have found, maximum number of the ICU patients were belongs to 51-70 years of age group i.e. 33(33%), next commonest age group was 31-50 years, it consisted 31% cases. 14% & 22% cases were belongs to 18-30 & >70 years of age group respectively. Male cases were predominantly higher than Female cases. Male was 62.0% and female was 38.0% respectively. Male & Female ratio was 1.63:1. We have found Mean and SD value of arterials Blood Gas Analysis among study population pH value was 7.41±0.03, PCO2 (mmHg) was 40.99±2.80, HCO3 (mEq/L) was 25.17±2.40, Na+ (mEq/L) was 130.19±6.66, K+ (mEq/L) was 3.06±0.40 & Cl- (mg/dl) was 93.74±2.59 respectively. We have found Mean and SD value of Central Venous Blood Gas Analysis among study population pH value was 7.35±0.04, PCO2 (mmHg) was 46.98±2.78, HCO3 (mEq/L) was 26.32±2.52, Na+ (mEq/L) was 128.91±6.65, K+ (mEq/L) was 2.99±0.40 & Cl- (mg/dl) was 92.47±3.89 respectively. We have found significant correlation between ABG pH & VBG pH. r factor was .290 and p value was 0.003. We have found positive correlation between arterial blood gas PCO2 & Central Venous Blood Gas PCO2 r factor was .961 and p value was <0.0001. Conclusion: Central venous pH, PCO2, and bicarbonate may be an acceptable substitute for ABG in patients admitted in the ICU. However caution should be exercised while applying electrolyte measurements.

20. Safety of Electroconvulsive Therapy (ECT) in Psychiatric Patients
Pranaw Kumar, Nilesh B. Shah
Abstract
Aim: The aim of the present study was to evaluate the safety of electroconvulsive therapy (ECT) in psychiatric patients. Methods: The Prospective cohort study was conducted in the Department of Psychiatry Lokmaanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India for the period of One year. Sample consists of patients are started on ECT for various indications and attending the psychiatry OPD or admitted in ward was included over a period of one year (n=144). Results: Out of 144 Patients All Patients show 30-45 minutes of Confusional state after the Procedure, Some form of Anterograde Amnesia ( deficits in acquisition and retension of newly learned material) during the course of ECT which mostly persist till 2nd week of last ECT, Some form of Retrograde Amnesia ( poor recall of information learned before the ECT) during the course of ECT which mostly persist till 1st  week of last ECT, Some form of forgetting and unable to recall previously learned information, during the course of ECT which mostly persist till 2nd week of last ECT. Out of 144 patients 10(6.94%) patients show signs of Prolonged post-ECT Amnesia during the course of ECT which last for less then 24 hours, personal identity of patients is not lost during this period. None of the patients show Global Amnesia. Out of 144 patients 16 (11.11%) shown Bladder incontinence during the procedure, 11(7.64%) complains of Nausea on the day of procedure, 6(4.17%)  Vomitted on the day of procedure, 21(14.58%) complained of Bodyache, 22 (15.28%) complained of Headache, 14 (9.72%) suffer from Fever on day of procedure and 1 (0.69%) suffer from Cortical Blindness but recovered within 24 hr. None of the patient died during the procedure. Conclusion: The present Prospective cohort study was conducted in a tertiary care hospital to study the safety and of ECT. ECT has been considered the most effective intervention for different psychiatry diseases but not in common practice, there may be variety of factors that contribute to the low and uneven rate of ECT use. Perhaps the most important considerations are the stigma associated with receiving the treatment on the part of patients and in recommending or administering the treatment on the part of professionals. This study design to break some barrior, fear of safety and stigma associated with it. Since only one patient suffer from serious side effect (cortical blindness) in the study that also resolve in 24 Hr. Side effects are temporary and resolve after the course of ECT like anterograde amnesia, retrograde amnesia and forgetfulness. Some patient shown post ECT prolonged amnesia. Other side effect like headache, nausea, vomiting, bodyache, fever can occur after the procedure. Hence ECT is a safe procedure and its therapeutic effects outweigh the adverse effect of the procedure.

21. A Study Evaluating Gynecological Disorders among Geriatric Women: An Observational Study
Sneha Bhushan, Tanu Kumari, Anupama Sinha
Abstract
Aim: The present study was conducted to assess gynecological disorders among geriatric women. Material & Methods: The present prospective, observational, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India over a period of one year which comprised of 200 women aged >65 years old. All subjects were enrolled after they agreed to participate in the study after signing written informed consent. Results: Out of 100 patients, 86% belonged to age group 65-74 years. The study population was 70% from rural and 30% urban areas. Only 15% of the patients were literate. Geriatric women had higher number of pregnancies. Their mean age at menopause was 50.15±5.35 years and mean duration of menopause was 20.11±4.64 years. Something coming out of vagina (SCOV, 24%) and Postmenopausal bleeding (PMB, 31%) were the two major presenting complaints. Amongst the co-morbidities, Hypertension was the single most common followed by Anaemia, Diabetes mellitus, Thyroid disorders, Heart diseases. Presence of multiple co-morbidities complicates the diagnosis, treatment and natural course of individual gynaecological health problems in older women. The most common gynaecological disorder was genital tract malignancies (34%), followed by POP (24%) and urogenital infections (17%). Of those with genital malignancies, 32 had carcinoma cervix, 7 had carcinoma ovary, 7 had carcinoma endometrium, and 2 had carcinoma vulva. Conclusion: Pelvic organ prolapse and genital malignancy are the major gynaecological causes of hospital admissions in the patients above 60 years. Postmenopausal period is an important part of a woman’s life. The geriatric phase is even more important as ageing also becomes a factor.

22. A Hospital Based Cross Sectional Study Assessing the Level of Knowledge of Diabetic Patient Regarding Hypoglycaemia and its Association with Various Demographic Parameters
Satyendra Kumar, Akhilesh Kumar, Satish Kumar
Abstract
Aim: The aim of the present study was to assess the level of knowledge of diabetic patient regarding hypoglycaemia and to find out the association between the levels of knowledge of diabetic patient on hypoglycaemia with their selected demographic variable. Methods: An institution-based, descriptive, cross-sectional study was conducted among 200 sampled diabetic patients admitted to medicine ward and visiting medicine OPD who were selected through purposive sampling technique at Nalanda Medical College & Hospital, Patna, Bihar, India. Results: Out of 200 samples, a majority (54%) of them was in the age group above 40% years, and 52% of them were female. Regarding educational status, 48% had obtained primary level of education, remaining 7% of them had completed above secondary level of education, and most of them 35% were unemployed, majority 45% of them had an earning income between (Rs. 5000-9000). Maximum 90% of them follows Hinduism, 77% of them had have diabetes mellitus with duration between 1-10 years, with the insulin therapy contributes 10% with twice a day and  3% of them were on once a day. Regarding symptoms, nearly 72% of the sample had experienced hypoglycemia. More than half of the sample 60% had a dietary pattern of 3 times a day. More than half of the samples 53% of them had fair knowledge on hypoglycemia and 26% of them were having good knowledge and the remaining 21% of them had poor knowledge regarding hypoglycemia respectively with the overall mean and SD 34.6±15.25. Conclusion: The study’s findings highlighted the fact that most diabetes mellitus patients had a fair understanding of hypoglycemia. The health care personnel should also take time and efforts to educate patients about the sign and symptoms of hypoglycemia. So that hypoglycemic episodes and morbidity could be reduced or prevented at primordial level.

23. Clinico-Etiological Profile of Patients Presenting with Urinary Bladder Carcinoma: An Observational Study
Barun Kumar
Abstract
Aim: The aim of the present study was to find out common causes of urinary bladder carcinoma in patients presenting to tertiary care centre. Methods: The present study was conducted in the Department of General Surgery, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India on all newly diagnosed bladder cancer patients for the period of one year. There were 200 patients included in the present study. Results: The mean age of presentation of carcinoma urinary bladder was 54.36±14.26 years (30-89 years) with the maximum number of patients being in the age group of 60-69 years 25% followed by 30-39 years 21%. 92% of the patients of carcinoma urinary bladder in our study were non-smokers. The history of UTI was present in only 20% of the patients of carcinoma urinary bladder. The maximum number of patients of carcinoma urinary bladder was Hindus followed by Sikhs. The maximum number of patients of carcinoma urinary bladder was farmers by occupation followed by labourers (mainly workers of dye, chemical, fertilizer industry and housewife in female’s subset). The maximum number of patients of carcinoma urinary bladder belonged to A+ blood group followed by B+ and the least number of patients belonged to O- blood group. Conclusion: We concluded that the majority of the patients turned out to be non-smokers and A +ve blood group in contrast to the strong predilection of smoking and bladder cancer.

24. A Hospital-Based USG Assessment of Gynecological Masses with its Pathological Correlation: An Observational Study
Mamta Singh, Amar Kumar Singh, Renu Rohatgi, Usha Kumari
Abstract
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 Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar, India over a one year period. This study was done as part of dissertation for post graduate qualification in Obs and Gyne. Results: The mean age of patients with benign tumor and malignant tumor was 32.64±8.2 years and 50.25±12.8 years respectively. Mean volume of malignant adnexal masses (932.38±648.32) was significantly higher than benign adnexal masses (280.80±210.12). 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.

25. A Hospital Based Observational Assessment of the Histopathology of Benign Proliferative Breast Lesions in Peritumoral Area of Carcinoma Breast
Manish Kumar Jha, Md. Imteyaz Alam, Madhu Bharti, Poonam Kumari
Abstract
Aim: The aim of the study was to determine histopathological features of different subtypes of carcinoma breast and correlate with the presence of proliferative lesions of breast in peritumoral area. Methods: This Observational study was conducted for a period of 1 year at department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India and A total of 100 cases that satisfied the inclusion criteria were included in this study. Specimens were received in 10% Formalin. Clinical details, gross findings including tumor size were noted. Results: Age group of patients included in the study ranges between 32 to 76 years with a mean age of 54 years. Majority of the patients belonged to 51 to 60 years seen in 35 (35%) cases. 44 (44%) cases belonged to postmenopausal age group, 37 (37%) and 17(20%) belonged to perimenopausal and premenopausal age group respectively. In the present study, 55 (55%) of tumors were located at the right side, 45 (45%) at the left side breast. None of the patients had bilateral carcinoma. Of the 100 cases included in the present study 82 (82%) were Invasive Ductal Carcinoma of No Special Type (IDC NST). Most common findings in peritumoral area of breast were non proliferative epithelial lesions 53 (53%). Conclusion: The present study concluded that non-proliferative breast lesions were the most predominant histological lesion in peritumoral area. Histopathological examination of peritumoral area in mastectomy specimens is a simple and valuable method that helps to stratify the risk of carcinoma in contralateral breast.

26. A Case Control Study Assessing Cognitive Performance during Acute Mental Stress in Type 2 DM Patients
Suman Kumar Saurav, Anand Kumar, Vibha Rani, Rajiva Kumar Singh
Abstract
Aim: The objective of the present study was to assess cognitive dysfunction in Type 2 DM during acute mental stress without overt cerebrovascular disease or other vascular risk factors. Material & Methods: The present study was conducted in the Department of Physiology, Patna medical college and Hospital, Patna, Bihar, India for five months, 100 subjects within the age group of 30–55 years were included in the study. Informed consent was taken by each subject. They were cleaved into two groups. Group 1 comprised of randomly chosen 50 diagnosed cases of Type 2 DM at least 2 years of duration. Group 2 comprised of 50 age and gender-matched controls. Results: There was no significant difference in age in cases and controls. The mean age of Type 2 DM group was 47.3 years and the control group was 45.5 years. There was a significant statistical difference between weight and BMI. The result showed a significant difference in ART and VRT, both simple and choice in Type 2 DM and controls. There was significant difference ART and VRT, both simple and choice during resting and during mental stress and these RTs were more prolonged in Type 2 DM when compared to controls. Conclusion: The present study concluded that mental stress in Type 2 DM does affect cognition, where grades of deterioration may be related to the difficulty of the given task (mental stress) and prevalence of central nerve deficits and peripheral nerve deficits seen as side-manifestation of Type 2 DM.

27. An Observational Retrospective Evaluation of Neonatal and Maternal Risk Factors for Indirect Hyperbilirubinemia
Bheemsen Kumar, Sanjay Kumar Nirala, Sanju Kumari, Gopal Shanker Sahni
Abstract
Aim: This study was aimed at determining neonatal and maternal risk factors of indirect hyperbilirubinemia, at comparing neonates with risk factors and those without, and at assessing the type of management according to hyperbilirubinemia severity. Methods: This study was an observational retrospective study conducted Pediatrics Department at SKMCH, Muzaffarpur, Bihar, India for one year. Data was collected and reviewed through electronic and printed medical records of all neonates. Initially, 575 medical records were reviewed. Duplicate registries of those who were readmitted for indirect hyperbilirubinemia management (n = 32) were removed, and they were included in the total data only once of the first presentation. Patients with insufficient data (n = 43) were also removed as a first step. Total 500 neonates were included in the study. Results: In the present study, there were 52% were male neonates and 48% females neonates. 80% neonates were full term. 60% women belonged to age group 25-35 years. 65% women underwent normal vaginal delivery. 40% new borns and 60% mothers had O blood group. 95% new borns and 90% mothers had positive Rh factor. Of 500 neonates, 400 (80%) had risk factors for neonatal indirect hyperbilirubinemia. ABO incompatibility is the commonest factor and was found in 200 (40%) patients, followed by G6PD deficiency which was found in 160 (32%).  Maternal age (>25 years) was the commonest risk factor and found in 420 (84%) mothers, followed by cesarean section delivery, which was found in 160 (32%) mothers. Three (1.7%) neonates had positive blood cultures. Seven neonates had positive urine cultures (8%). The rest showed mixed growth between the previous organisms (9.3%). Skull ultrasound was done for 35 (8.7%) infants. Abdominal ultrasound showed hepatosplenomegaly and biliary sludge, each in two patients. Conclusion: ABO incompatibility, G6PD deficiency, and older maternal age (>25 years) were the commonest neonatal and maternal risk factors for developing neonatal indirect hyperbilirubinemia. Male newborns, reticulocytosis, and IVIG use were associated with these factors.

28. Assessment of Serum Sodium Levels in Chronic Liver Disease (CLD) Patients and its Association with the Severity of Disease: An Observational Study
Amit Kumar Nirmal, Rajeev Kumar, Abilesh Kumar
Abstract
Aim: This study was done to study the serum sodium levels in chronic liver disease (CLD) patients and establish its association with the severity of disease in such patients. Material & Methods: An observational cross-sectional study with 100 cases of chronic liver disease was done in the Department of General Medicine, JLN Medical College, Bhagalpur,, Bihar, India for 1 year. Results: All patients had abdominal distension. It was observed that patients from group A had jaundice (p<0.05) and altered sensorium (p<0.001) significantly more commonly as compared to those from group B and C. Alcohol consumption was reported by 90% of the patients. Serum sodium levels was not significantly associated with alcohol consumption. Among all examination findings, icterus (p<0.05) and clubbing (p<0.01) were found to be significantly more common among patients from group A, as compared to patients from group B or C. Pallor, pedal edema, signs of liver cell failure and organomegaly were not significantly associated with serum sodium levels in our study population. hepatic encephalopathy (p<0.01), hepatorenal syndrome (p<0.01) and coagulopathy (p<0.01) were found to occur significantly more common among patients from group A, as compared to those in patients from group B or C. We observed that mean direct bilirubin, alanine transaminase, aspartate transaminase and alkaline phosphatase were significantly higher among group A patients as compared to those from group B or C respectively. Conclusion: Patients with lower serum salt levels had a substantially higher MELD score and CPS. Low blood sodium levels were linked to more severe liver disease, greater complications, and increased death. As a result, we urge that serum salt levels be checked on a frequent basis in patients with chronic liver disease.

29. A Hospital Based Assessment of Sepsis and its Markers in Renal Failure Patients on Hemodialysis: An Observational Study
Rajeev Kumar, Amit Kumar Nirmal, Rajkamal Choudhary
Abstract
Aim: The present study was conducted to study the presence of bacteremia, markers of sepsis and Inflammation in renal failure patients on hemodialysis, along with correlation of hematological abnormalities with sepsis in such patients. Material & Methods: The present study was conducted at department of General Medicine, JLN Medical College, Bhagalpur, Bihar, India for one year and total of 100 patients of both sexes who were diagnosed as case of renal failure which include both acute kidney injury (AKI) and CKD on basis of clinical history, examination, biochemical markers and were advised for hemodialysis were included in the study. Results: In our study among 100 patients of renal failure on hemodialysis the mean age in our study was 44.76±14.46 years with 65 male patients. Out of 100 patients 20 (20%) had positive blood and catheter tip culture and 80 (80%) of patients had negative blood and catheter tip culture. Out of 20 patients with sepsis 4 (20%) were in the age group between 15–25 years, 4 (20%) were in the age group between 26–35 years, 3 (15%) were in the age group 36–45 years and 9 (45%) were above 45 years of age. All 20 (100%) patients had episode of fever with chills and rigor, 9 (45%) patients had redness and pain at hemodialysis catheter site, 6 patients (30%) were confused, disoriented or comatose and 4 (20%) patients had hypotension. Among 20 patients of renal failure with sepsis, none had TLC less than 4.8/cumm (leucopenia), 5 (25%) patients had count between 4.8–10.8/cumm and 15 (75%) patients had TLC more than 10.8/cumm. Conclusion: Patients requiring hemodialysis, who are having non modifiable risk factors like age, sex other risk factors for infection should be controlled to reduce incidence of infection.

30. A Hospital-Based Outcome Assessment of Submuscular Plating for Diaphyseal Long Bone Fractures: An Observational Study
Angad Kumar Choudhury, Dilip Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate the functional and radiological outcomes of paediatric femur diaphyseal fracture treated with locking compression plate. Material & Methods: The clinical, radiological and functional results of Submuscular plating were evaluated in 50 patients operated in between the duration jan 2018 to December 2019 for fracture shaft humerus, shaft of femur and shaft of tibia. All the surgeries were carried out by a single surgical team at Department of orthopaedics, Jawahar Lal Nehru medical college and Hospital, Bhagalpur, Bihar, India. Results: Among the study group, 34 were males, and 16 were females. There was a male preponderance. The youngest age among patients was six years old and the oldest age was 14 years old. The average age was 10.60 (2.08) years. Right side fractures 28 (56%) were more compared to left side fractures 22 (44%). Considering the mode of injury, road traffic accident accounted for 58%, other injuries like fall during playing sports were seen in 18%, fall from height accounted for 8%. For types of fractures, 18 (36%) fractures were transverse, 12 (24%) fractures were comminuted, 16 (32%) fractures were oblique, and 4 (8%) fractures were spiral. In our study, the average union time in group one was 10.5 weeks. Early complications in the form of superficial infection were in 2 patients. Late complications in the form of thigh pain in 6 patients. Cases of knee stiffness and delayed union were in 3 patients each. The functional outcomes were evaluated and 45 (90%) were excellent, 4 (8%) were satisfactory and 1 (2%) were poor. Conclusion: Once properly planned and executed correctly the submuscular plating for diaphyseal long bone fractures is one of the reliable treatment modality. It is minimally invasive technique that allows early mobilization with satisfactory radiological and functional outcome with minimal complications.

31. A Hospital-Based Assessment of the Drug Utilization Pattern in Cardiovascular Disease Patients
Ram Babu Raman, Asha Kumari, Sushil Kumar
Abstract
Aim: The aim of the present study was to evaluate the drug utilization in cardiovascular disease at a teaching and referral hospital in Bihar region. Methods: The present study was conducted at Department of Pharmacology, DMCH, Darbhanga, Bihar, India for the period of 6 months. A total of 500 prescriptions of the patients attending cardiology OPD of the selected hospitals over a period of 6 months were randomly identified and included in this study. Results: Based on the results obtained it is found that male patients 60% had high frequency of cardiovascular incidences when compared to female patients 40%. Out of 500 patients, 34% of patients (Male 22% and Female 12%) belong to the age group of 51–60 years which was considered to be highest percentage when compared to all other age groups and 9% of patients (Male 4% and Female 5%) present in the age group of 71–80 years which were considered to be lowest percentage among all age groups, these demographic data reveal the influence of gender and age in disease and prescribing pattern. During this study, different adjustable risk factors associated with CVDs were also observed in the patients particularly 4% of inadequate diet, 5% of physical inactivity, 18% of tobacco consumption, 22% of alcoholics, and 30% of obesity. In our study, a total of 75 (15%) of prescribed drugs were found to be FDCs, rest of the drugs 425 (85%) were prescribed as single dose. Aspirin + Clopidogrel combination is found to be highly prescribed FDC (40%) among all, next to that Telmisartan + Hydrochlorothiazide (15%) and Amlodipine + Atenolol (10%) were highly prescribed. Conclusion: Polypharmacy and least use of generic name were observed in the study which may affect the rationality. The use of antiplatelets, statins, and angiotensin-converting enzyme-inhibitors was appropriate, but furosemide overuse is of major concern. Therefore, appropriate prescription writing improvises treatment compliance in the patients, which results in rationality.

32. Assessing the Variations of Posterior Condylar Foramen in Dry Human Skulls: An Observational Study
Meeta Sahai, Vinita Sinha, Rajendra Prasad
Abstract
Aim: The aim of the present study was to assess the variations of posterior condylar foramen in dry human skulls. Methods: The present study was conducted at Anugrah Narayan Magadh Medical College, Gaya, Bihar, India and the material for this study consisted of 30 dry human skulls. Results: Out of the 30 dried adult human skulls studied, posterior condylar canal was present in 20 skulls (66.66%) and absent in 10 (33.34%). Bilateral presence was seen in 15 skulls out of the 20 skulls and unilateral presence in 5 skulls. Out of the 5 skulls showing unilateral posterior condylar canal, 3 skulls showed its presence on the left side and 2 on the right side respectively. Conclusion: A thorough knowledge about the variations of the posterior condylar canal and the structures passing through it is essential for any clinician or surgeon dealing in the region to avoid unwanted complications.

33. A Prospective Randomized Controlled Trial Evaluating Ultrasonic Verses Monopolar Electrocautery Dissection of Gall Bladder in Laparoscopic Cholecystectomy
Shanker Bharti, Rajesh Narayan
Abstract
Aim: The aim of the present study was to compare the use of monopolar electrocautery and ultrasonic dissection of gall bladder in laparoscopic cholecystectomy in terms of intra-operative and post-operative parameters. Material & Methods: A prospective randomized controlled trial within the duration of 1 year undertaken in Department of General Surgery, Bhagwan Mahavir institute of medical science, Pawapuri, Nalanda, Bihar, India. It included 100 patients undergoing laparoscopic cholecystectomy. Results: There was no significant difference between the groups in terms of age (years) (p=0.840). There was no significant difference between the various groups in terms of distribution of age (p=0.414). The p value for sex distribution was found to be 0.115 which was statistically insignificant. There was a significant difference between the 2 groups in terms of operative time (minutes) (p≤0.001). There was a significant difference between the 2 groups in terms of number of times lens cleaning done (p≤0.001). 6% of the participants in the group A had gall bladder perforation while 22% of the patients in group B had gall bladder perforation. There was a significant difference between the various groups in terms of distribution of gall bladder perforation (p=0.012). There was no significant difference between the various groups in terms of distribution of biliary leak (p=0.484). None of the participants in either of the groups had Common bile duct and bowel injury. 4% of the participants in the group A and group B had drain (output nature: bile). Hence, there was no significant difference between the groups in terms of duration of hospital stay (days) (W=1258.000, p=0.920). Conclusion: Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.

34. A Hospital Based Cross Sectional Study to Evaluate the Impact of a Short-Term Training in Emergency and Trauma
Shanker Bharti, Anjani Kumar Anjan, Rajesh Narayan
Abstract
Aim: The aim of the present study was to evaluate the impact of a short-term training in emergency and trauma in a tertiary teaching hospital in Bihar region. Methods: The present study was designed to effectively train the resident doctors, nursing staff and other health-workers posted in the casualty and emergency wards providing Emergency services at department of General Surgery, Bhagwan Mahavir institute of medical science, Pawapuri, Nalanda, Bihar, India for six months. Results: The overall evaluation of pool A shows a pre-test mean of 38.72±0.92 revealing a low level of knowledge) which improved significantly to 72.18±0.90 post training (p value=0.0000). Conclusion: This study showed that this training is an adequate training programme to teach the basics emergency and trauma skills and been successful in increasing knowledge, despite the variations in the vision of different subject specialities.

35. A Prospective Observational Study Assessing the Efficacy and Acceptability of Medical Abortion with Mifepristone and Misoprostol in Early Pregnancy
Rashmi Kumari, Priti Kumari, Krishna Sinha
Abstract
Aim: The current study was planned to evaluate the efficacy and acceptability of medical abortion with low dose mifepristone (200mg) and oral or vaginal 400 mcg misoprostol in early pregnancy (≤ 7weeks of gestation) in Indian women. Methods: A prospective observational study was conducted in the Department of Obstetrics and gynaecology, JLNMCH, Bhagalpur, Bihar, India in between the duration of 1 year. A total of 100 early pregnancy abortion seeking women with amenorrhoea of less than or equal to 7 weeks (49 days) from the first day of last menstrual period were taken and counselled to participate in the study. Results: There were no significant differences in baseline characteristics between groups in age or parity. The complete abortion rate did not differ significantly between the groups. In the early group complete abortion rate was 92% and in the late group 94%. The majority of women in both groups were satisfied with the treatment. The participants were also satisfied with sufficient information received before the abortion and the pain medication. In both groups, most of the women answered that they were either very satisfied or satisfied with feeling calm and safe during the abortion, the treatment and the bleeding met their expectations. No significant difference was observed in experienced pain and duration of bleeding. Conclusion: Nevertheless, medical abortion is a revolutionary technique and our study results indicate that mifepristone-misoprostol medical abortion can complement available surgical services and help meet the long-standing need for safe abortion.

36. Clinical Profile of Acute Viral Hepatitis and its Outcome in Children at Tertiary Care Hospital
Priti P. Patel, Jagruti K. Konkani, Avani Divyang Dhangar
Abstract
Background: Hepatitis is a contagious disease caused by different types of viruses, causing temporary or permanent damage to liver cells. Hepatitis in children constitutes a significant population of hospital admissions in India. The present study was undertaken with the objectives to investigate clinical profile, complications and outcome of viral hepatitis in children and to correlate laboratory investigations with clinical outcome. Methods: This prospective observational study was carried out December 2019 to September 2021. All children >1 month and <12 years of age with clinical symptoms and sign of acute viral hepatitis with proven laboratory investigations admitted in paediatric ward were included in the study. All data of history, examination, investigation, diagnosis and management was recorded systemically in proforma. Data thus collected was subjected to statistical analysis. Results: The mean age of study patient was 6.88±2.85 years and 75% of them were male. Majority of patients presented with symptoms of yellow sclera (94.44%) followed by fever (75%). Icterus was most common clinical sign seen in 94.44% patients followed by pallor in 83.33% patients. Liver function tests of all patients were deranged. Hepatomegaly was seen on ultrasonography in 75% patients. Viral hepatitis A (58.33%) was most commonly present. All patients with viral Hepatitis A and E were discharged after successful treatment, while 14.28% of Hepatitis B and 20% of Hepatitis C patients expired. Conclusion: Hepatitis A virus is commonest causative agent of acute viral hepatitis with good prognosis. Timely done serological viral markers supported with liver function test are good enough to diagnose and prognosticate the admitted case.

37. Saline V/S Metronidazole for Peritoneal Lavage in Postoperative Peritonitis Patients: A Comparative Study
Vishal Khimajibhai Balat, Drupad Girishbhai Patel, Ankit Mahendrabhai Prajapati, Hardik Monghajibhai Chaudhary
Abstract
Background and Aims: Peritonitis management is challenging due to its high morbidity and mortality rates. Peritoneal lavage, an irrigation technique, is used for peritonitis treatment. This study compares saline and metronidazole lavage effectiveness after surgery to offer insights into optimal management. This study aims to compare saline and metronidazole peritoneal lavage in terms of clinical outcomes like infection resolution, complications, hospital stay, and mortality. Materials and Methods: 114 patients with perforation peritonitis were divided into two equal groups. One received metronidazole and saline lavage, while the other received saline only. Outcomes like wound issues, abscesses, sepsis, and hospital stay were compared using the chi-square test. Results: The mean age was similar in both groups. Metronidazole group had fewer wound issues, less sepsis, fewer infections, and shorter hospital stays. Conclusions: Metronidazole peritoneal lavage is significantly superior to saline in reducing sepsis and hospital stays. It’s a safe and effective method for lowering complications and expediting recovery.

38. Outcome of Extended Trochanteric Osteotomy (ETO) in Revision Total Hip Arthroplasty
Hariprasad K.A., Avinash G.C., Bharath M., Yogananda Gali Hanumaih
Abstract
Background: Total hip arthroplasty (THA) has a very high rate of success and long-term dependability, although there are a few circumstances where the femoral component must be revised. Through the use of a controlled cortical fracture, extended trochanteric osteotomy (ETO) is a technique that makes it possible to expose the proximal femur. The present study was done to assess the outcome of extended trochanteric osteotomy (ETO) in revision total hip arthroplasty. Material & Methods: The present prospective study was conducted at Department of Orthopaedics among 32 patients admitted to hospital for revision total hip arthroplasty during the period of study. Extended trochanteric osteotomy (ETO) procedure was used in revision total hip arthrolasty. All procedures were performed via the posterior approach. The recorded data was analyzed using SPSS Version 23.0 (SPSS Inc., Chicago, Illinois, USA). Results: 15.6% of patients had age less than or equal to 55 years while 84.4% patients had age more than 55 years. Out of 32 patients 28.1% were male and 71.9% were female. The most common cause for failure of index injury was implant breakage/failure (37.5%) followed by aseptic loosening (21.8%), periprosthetic fracture (18.7%) , prosthetic joint infection (9.3%) and dislocation/subluxation (6.2%). Only 1 patient died after the operation and 3 had infection. Requirement of second r-THR was needed in 9.3% of patients. Conclusion: ETO is a secure and effective procedure that can be applied during revision hip surgery. It produces a stable union with comparatively few difficulties when correctly executed, repaired methodically utilizing cables or wires, and supported by autologous bone graft.

39. Functional Outcome of ACL Reconstruction using Hamstring Graft Augmented with Internal Bracing using Fibre Tape
Yogananda Gali Hanumaih, Hariprasad K.A., Avinash G.C., Bharath M.
Abstract
Introduction: A tear in the anterior cruciate ligament, is a commonly observed outcome of a knee sprain. The present study was conducted to find out the functional outcome of ACL reconstruction using hamstring graft augmented with internal bracing using fibre tape. Material & Methods: The prospective study was conducted among 50 patients admitted to Department of Orthopaedics for ACL reconstruction for a period of one year. The following test were done : Lysholm knee score, Anterior Drawer test, Lachman test and Pivot shift test both pre and post operatively. The results were analyzed using SPSS version 23.0. Results: Mean age of patients were found to be 28.34±8.33 years and male patients were more in number (76%) as compared to female patients (24%). The patients showed improvement in grades at 12 weeks and 6 months follow up. Conclusion: In our study, it was discovered that the patients showed good performance at 12 weeks and 6 months in terms of grade improvement on the anterior drawer test and the Lachman test. The 6-month follow-up time was a constraint on our investigation. Additional clinical testing of this procedure is required to evaluate the long-term outcomes, the impact of graft protection, and the clinical behavior of the resulting collagen fibertape.

40. Randomized Prospective Double-Blind Study Assessing Efficacy of the Dexmedetomidine on Haemodynamic Stress Response during Laryngoscopy and Intubation
Anant Prakash, Rahul Kumar, Krishna Kumar
Abstract
Aim: The aim of the present study was to assess the efficacy and safety of dexmedetomedine in attenuating haemodynamic stress response to laryngoscopy and endotracheal intubation. Methods: This randomized prospective double-blind study carried out in 200 patients aged 20-60 years of asa physical status of I and II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation at Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar, India for one year. Results: Patient characteristics in terms of age, gender and weight were comparable in both the groups. On comparing the changes in heart rate between group c and group d at various specific timing, there was significant difference between the two groups (p<0.05). On comparing the changes in SBP and DBP between group c and group d at various specific timings, there was statistically significant difference between the two groups (p<0.05). The difference in sedation score was significant between group c and group d after drug administration (p<0.001). Sedation did not cause respiratory depression in any patient. Conclusion: Dexmeditomidine in a dose of 1 mcg/kg given half an hour before induction effectively blunts the hemodynamic response to laryngoscopy and endotracheal intubation and provides stable hemodynamic through the surgery and provides good and safe level of sedation without respiratory depression in routine surgery.

41. To Observe and Evaluate the Clinical Characteristics and Outcomes of Individuals Diagnosed with Diabetic Foot Infections (DFI)
Dharmendra Kumar
Abstract
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 General Surgery, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. 200 patients with diabetes attending general surgery ward for diabetic foot ulcer management at Department of General Surgery, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India, included during the study period for the period of 1 year. Results: 200 patients were diagnosed as diabetic foot. In diabetic foot, the age of patients ranged from 19 to 80 years. 42 (21%) patients were between 21 to 40 years; 86 (43%) patients were between 41 to 60 years and 36 (36%) patients were above 60 years. Out of 200 patients with diabetic foot, 180 patients were treated by debridement, in which 70 patients had deranged lipid profile and 110 had normal lipid profile. Out of 200 patients with diabetic foot, 10 patients were treated by amputation, out of which 16 patients had deranged lipid profile and 4 had normal lipid profile. Out of 200 patients with diabetic foot, 140 patients had HbA1c more than 8.5 and 60 patients had HbA1c <8.5. Mean hospital stay of patients with HbA1c> 8.5 was 10.40 days. Out of 200 patients with diabetic foot; 62 (31%) patients had pseudomonas; 46 (23%) patients had E. Coli; 42 (21%) patients had Klebsiella; 40 (20%) patients had staphylococci and 10 (5%) 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.

42. Paruresis – Why to Shy? – A Case Series
Sopan Sardesai, Suvaran Sagar Bajpai, Vaibhav Chaturvedi
Abstract
Introduction: Paruresis (Shy Bladder Syndrome) refers to the inability to initiate or sustain effective urination (micturition) in situations where there is a perception of scrutiny, or potential scrutiny, by others. It is associated with significant distress, impairment of social and occupational functioning, and reduced quality of life. Individuals with paruresis report significant difficulty in initiating and/or sustaining urination in situations where they perceive scrutiny of their actions or the outcome of their actions. Individuals with paruresis often also report a moderate or severe degree of embarrassment or shame associated with their symptoms.  Aim: To describe clinical profile and management of Paruresis cases. Materials & Methods: This case series reports three cases of paruresis visiting the OPD of a tertiary level teaching hospital. The paruresis cases were diagnosed by DSM-V and data collected. Discussion: The aim of this case series is to describe an unusual subtype of social anxiety disorder whose most important finding is the avoidance of using public toilets. Currently, this disorders fall under the category of social anxiety disorder. As paruresis have low prevalence (approximately 3%) in patients with anxiety disorders the diagnosis of these events is not easily achieved by health professionals. Its false association with organic disease and scanty knowledge about it in health professional leading to underdiagnosis of this conditions and the difficulty for the patients to seek help.  Pharmacological treatment recommends the use of selective serotonin reuptake inhibitors, β – blockers and other agents. However, pharmacotherapy used in the treatment of social anxiety disorder has shown low efficacy for paruresis. Cognitive behavioural therapy approaches are useful in treating these diseases.

43. I-Gel Insertion Conditions and Hemodynamic Parameters: A Comparison of Injection Propofol and Injection Sodium Thiopentone
Rinkal V. Ramoliya, Sandeep Kumar R Chavda, Bhaumik K. Saradva, Yogesh Kumar Vaghasiya
Abstract
Background and Objectives: General anesthesia’s respiratory effects require precise airway management. Laryngoscopy and intubation can induce adverse reflex responses. Supraglottic airway devices (SGADs), like the I-gel, offer alternatives, reducing invasiveness. This study compares I-gel insertion conditions using propofol and thiopental, considering hemodynamic responses and adverse effects. The I-gel is becoming vital in diverse surgical scenarios, making this research significant for effective airway management. Materials and Methods: This study, conducted at the Gujarat Adani Institute of Medical Sciences (GAIMS) between October 2018 and July 2020, involved 80 ASA grade I and II patients aged 10 to 60 years undergoing elective surgeries. Patients were randomly assigned to either Group P (Propofol) or Group T (Thiopental) for anesthesia induction. The study assessed insertion conditions and monitored hemodynamic parameters. Data analysis was performed using Graph Pad Prism with significance set at P < 0.05. This research aimed to determine the preferable agent for anesthesia induction for better insertion conditions during surgeries with spontaneous ventilation and a maximum duration of 2 hours. Results: Ease of insertion, an essential factor in airway management was reported to be superior with Propofol. Both Propofol and Thiopental induced a drop in blood pressure and heart rate immediately after SGAD insertion. However, there were no significant differences in vital signs and oxygen levels during the post-operative period, indicating that both agents were well-tolerated in this context. Conclusion: Propofol proved superior for I-gel insertion due to faster induction, better insertion conditions, and minimal adverse effects compared to thiopental, making it the preferred choice for this procedure.

44. Dengue Severity and Liver Enzymes: An Investigative Cross-Sectional Study
Bhaumik K. Saradva, Rinkal V. Ramoliya, Sandeep Kumar R Chavda, Yogesh Kumar Vaghasiya
Abstract
Background and Objectives: This study at Geetanjali Medical College and Hospital, Udaipur, assessed Dengue severity and its association with liver enzyme levels in 153 Dengue-positive patients. Materials and Methods: The study included 101 males and 52 females, with age groups 21-40 (DF), 41-60 (DHF), and 61-80 (DSS) most affected. Exclusion criteria included malaria, liver cirrhosis, viral hepatitis, and hepatotoxic drugs. Liver Enzymes were estimated using standard biochemical methods. Clinical profile of patients was recorded. Results: Common complaints were fever, abdominal pain, rash, vomiting, headache, and joint pain. Bleeding occurred in 28.75% of cases. AST was elevated (> 40 U/L) in 91.5% of patients. DF had 87.3% raised AST (mean 154.17), while DHF and DSS had 100% elevation (mean 355.87 and 814.79, respectively). ALT was elevated (> 40 U/L) in 89.5% of patients. DF had 84.3% raised ALT (mean 91.7), while DHF and DSS had 100% elevation (mean 136.6 and 368.86, respectively). Conclusion: This study reveals a significant link between elevated liver enzymes (AST and ALT) and Dengue severity. Higher elevations were seen in severe cases, suggesting potential as markers for Dengue prognosis and severity assessment.

45. Exploring Risk Factors Linked to Acute Respiratory Tract Infections in Children Aged 1 Month to 5 Years: An Observational Study
Darshan Nayakpara, Jayesh Borsaniya, Bansi Kavar, Khushbu Maheta
Abstract
Background and Objectives: Acute respiratory tract infections represent a significant burden of morbidity and mortality, particularly among children in developing nations. These infections are responsible for a substantial 40% of mortality in children under the age of five. To investigate this matter, we conducted an observational study spanning a 12-month period at G.G. Hospital in Jamnagar. Our primary objective was to identify the risk factors associated with acute respiratory tract infections in children aged between one month and five years. Materials and Methods: Our study focused on a cohort of 150 pediatric patients aged between one month and five years, selected based on predetermined inclusion and exclusion criteria, and following a standardized format and flow chart. We systematically assessed various potential risk factors associated with acute respiratory tract infections. Results: Out of the 150 patients included in our study, 58% were male, and 59% hailed from rural areas. A substantial 60% of them were preterm and had low birth weight. A smaller but notable proportion, 7.3%, had a history of meconium aspiration syndrome. Malnutrition was prevalent in 25% of the cases, and 47% of the children had received incomplete immunization. Furthermore, 61% of the participants were found to be anemic, and 33% belonged to a lower socioeconomic class with limited educational backgrounds. Additional observations revealed that 28% were not primarily breastfed, and 28% were exposed to bottle feeding. Conclusion: In conclusion, our study highlights the profound impact of various risk factors, including socioeconomic status, perinatal factors, environmental conditions, and nutritional aspects, on the incidence of acute respiratory tract infections among children. These factors not only contribute to the onset of infections but also influence the prognosis and overall survival of affected patients.

46. Prevalence of Temporomandibular Joint Disorders among Patients with Cervical Spine Pathologies
Sagar V Hansalia, Deepa V Sommanek
Abstract
Background: Temporomandibular Joint Disorders (TMD) are multifactorial conditions affecting the masticatory system. The potential connection between TMD and cervical spine pathologies (CSP) has been highlighted in recent literature, but the relationship’s depth and nuances remain under-investigated. Objective: To determine the prevalence of TMD in patients with confirmed cervical spine pathologies. Methods: In this cross-sectional study, 146 patients with diagnosed CSP were evaluated. Standardized questionnaires for TMD diagnosis were administered, and the presence of cervical spine pathologies was confirmed via radiographic imaging. The correlation between the type and severity of CSP and TMD was then analyzed. Results: Of the 146 patients studied, 63 (43.2%) were identified with TMD. The most prevalent cervical pathologies among TMD patients were cervical disc degeneration (57.1%) and cervical spondylosis (28.6%). A notable positive correlation was observed between the severity of CSP and TMD symptoms (r=0.62, p<0.01). Conclusion: Patients with cervical spine pathologies exhibit a heightened prevalence of TMD when compared to the general population. This data underscores the significance of dual assessment for TMD in patients with CSP. Further exploration is necessary to decipher the biomechanical and neurological interplay facilitating this association.

47. Clinical Profile and Short Term Outcome of Neonates Requiring Assisted Mechanical Ventilation
Nayan J Patel, Prashant Ram
Abstract
Background: Assisted mechanical ventilation is a crucial intervention in the care of critically ill neonates. Understanding the clinical characteristics and immediate outcomes of neonates undergoing mechanical ventilation is essential for optimizing their management. Methods: This retrospective study was conducted with spanning a of six months period. A total of 186 neonates who required assisted mechanical ventilation were included based on predefined criteria. Data were collected from medical records and analyzed to determine demographic profiles, indications for ventilation, clinical presentations, associated complications, and short-term outcomes. Results: the clinical profile and short-term outcomes of 186 neonates requiring assisted mechanical ventilation. In Table 1, an exploration of the clinical profile and short-term outcomes showcases a significant association between the presence of complications and mortality (χ² = 12.63, p < 0.05). Among the neonates studied, 75 experienced complications, and among them, 30 faced mortality, whereas 111 did not have complications, with 12 encountering mortality. Additionally, Table 2 highlights the influence of gestational age on neonatal outcomes. The distribution of indications such as respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), and others are significantly linked to gestational age categories (χ² = 26.03, p < 0.05), revealing higher occurrences of RDS, MAS, and other indications among preterm neonates. Discussion: The findings of this study align with and extend existing literature regarding neonatal assisted mechanical ventilation. The observed indications and complications underline the complex nature of neonatal critical care. Factors contributing to short-term outcomes warrant comprehensive assessment to enhance clinical decision-making. Conclusion: This study sheds light on the clinical profile of neonates requiring assisted mechanical ventilation, emphasizing the importance of tailored interventions in neonatal intensive care units. The outcomes underscore the need for continued research and collaborative efforts to optimize ventilation strategies and improve neonatal outcomes.

48. Cross-sectional Study of Otitis Media in Children: Prevalence, Risk Factors, and Impact on ENT Health
Mukesh N Dodia, Ravi J. Makvana, Krutika Sonvane, Bhavik Patel
Abstract
Background: Otitis media (OM) is a common condition affecting children worldwide. The prevalence, associated risk factors, and its impact on ear, nose, and throat (ENT) health remain significant concerns for pediatricians and ENT specialists. Objective: This study aimed to estimate the prevalence of OM in children, identify its risk factors, and evaluate its effect on ENT health. Methods: A cross-sectional study was conducted involving children presenting to pediatric clinics. Clinical examinations, parental interviews, and medical record reviews were performed to diagnose OM, ascertain risk factors, and assess the impact on ENT health. Results: Out of the 416 children assessed, a significant number displayed symptoms of OM. The main risk factors associated with OM were identified, and its implications on ENT health, including hearing impairment, speech delay, and recurrent respiratory infections, were documented. Conclusion: Otitis media is prevalent among children, with multiple associated risk factors having a considerable impact on ENT health. Early diagnosis and intervention can mitigate the adverse effects on a child’s ENT health.

49. Assessment of Nasal Polyposis Prevalence and Associated Factors in a Cross-sectional Study of ENT Patients
Devanshi Modi, Kerul Prajapati, Aswini, Swati Mishra
Abstract
Background: Nasal polyposis is a common condition among patients presenting to ENT (Ear, Nose, and Throat) clinics. Understanding its prevalence and associated factors can guide better management and treatment. Objective: This study aimed to determine the prevalence of nasal polyposis and to identify the associated risk factors among patients attending an ENT clinic. Methods: A cross-sectional study was conducted among 88 patients presenting to the ENT clinic. Standardized clinical examination, endoscopy, and a structured questionnaire were used to identify the presence of nasal polyposis and gather data on potential associated factors. Results: Among the 88 patients examined in the ENT department, nasal polyposis was identified in 15 individuals, representing 17% of the study cohort. Analysis of associated risk factors revealed allergic rhinitis as the predominant condition, observed in 10 patients (or 66.7% of those diagnosed with polyposis). Chronic sinusitis followed closely, being present in 8 individuals (53.3% of those with polyposis), while aspirin sensitivity was identified in 5 patients, which equates to 33.3% of the nasal polyposis subgroup. Within this sample, there were no statistically significant correlations between the occurrence of nasal polyposis and demographic factors like age, gender, or smoking habits. Conclusions: Nasal polyposis was found in 17% of the ENT patients, with allergic rhinitis, chronic sinusitis, and aspirin sensitivity being the most significant associated factors. Further research is needed to explore these associations in larger populations and investigate potential interventions to reduce the burden of nasal polyposis.

50. Association of Serum Protein and Bilirubin with Dengue Severity
Sandeep Kumar R Chavda, Bhaumik K. Saradva, Rinkal V. Ramoliya, Nidhi S. Patel
Abstract
Background and Objectives: This study at Geetanjali Medical College and Hospital, Udaipur, assessed Dengue severity and its association with serum Liver function parameters in 153 Dengue-positive patients. Materials and Methods: The study included 101 males and 52 females, with age groups 21-40 (DF), 41-60 (DHF), and 61-80 (DSS) most affected. Exclusions included malaria, liver cirrhosis, viral hepatitis, and hepatotoxic drugs. Serum Liver function parameters and haematological parameters were measured using standard biochemical tests. Results: In our study of 153 patients, bleeding was observed in 44 individuals (28.75%), predominantly in DHF (94.6%) and DSS (64.3%) cases, with no bleeding in the DF group. We found significantly higher mean hemoglobin levels in DSS patients compared to DF and DHF cases, Conversely, mean platelet counts were significantly lower in the DSS group compared to the DF group and DHF group. Regarding bilirubin levels, among 157 patients, mean total bilirubin was 1.56 ± 0.17, 1.56 ± 0.16, and 3.59 ± 0.83 mg/dl in the DF, DHF, and DSS groups, respectively. Mean direct bilirubin levels were 0.48 ± 0.06, 0.48 ± 0.06, and 1.83 ± 0.73 mg/dl in the DF, DHF, and DSS groups, respectively. In terms of protein levels, mean total protein was 6.24 ± 0.49, 6.26 ± 0.57, and 6.19 ± 0.31 gm/dl in the DF, DHF, and DSS groups, respectively, while mean serum albumin levels were 3.46 ± 0.32, 3.44 ± 0.31, and 3.51 ± 0.34 gm/dl in the DF, DHF, and DSS groups, respectively. Conclusion: As dengue severity increased, serum bilirubin levels also rose. No significant associations were found between mean serum total protein, albumin, and globulin levels and the severity of dengue in our study. Future research should focus on identifying patient-specific risk factors for hepatic impairment in dengue infection.

51. A Retrospective Evaluation of the Role of Ultra Sonography in Diagnosis and Early Prediction of Severity of Dengue Fever: An Observational Study
Sanjay Kumar Nirala, Vineeta, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to evaluate the sonographic findings in children with dengue fever (DF) and to determine its role in predicting the severity of the disease. Material & Methods: The retrospective study was done in Department of Pediatrics. Serological test NS 1antigen, Dengue IgM and IgG Antibody tests were performed. 70 patients were found serologically positive for dengue, were referred for Ultrasound scanning of the abdomen and thorax. Results: Among the total of 70 instances, 42 were identified as male, while the remaining 28 were identified as female. Among the total of 70 instances examined, it was seen that 4 cases were classified as belonging to the age group of less than 1 year, while 20 cases fell within the age range of 1 to 5 years. Additionally, 22 cases were found to be between the ages of 6 and 10 years, while the remaining 24 cases were categorized as belonging to an age group above 10 years. Among the total of 70 confirmed cases, 50 cases were categorized as belonging to the moderate dengue group, while the remaining 20 cases were classified as severe dengue fever patients. All instances had symptoms of elevated body temperature. Approximately 48.57% of the patients exhibited symptoms of vomiting, while 57.14% had discomfort in the belly. Additionally, 64.28% of the cases presented with Petechiae, and 52.85% displayed melena. Out of the total sample size, 32 individuals (45.71%) exhibited hepatomegaly, 18 individuals (25.71%) had splenomegaly, and 21 individuals (30%) presented with hypotension. In the dengue fever group, 55 individuals (78.57%) exhibited gall bladder wall edema, 40 individuals (57.14%) had ascites, 36 individuals (51.42%) presented with pleural effusion, 42 individuals (60%) had hepatomegaly, 22 individuals (32.42%) showed splenomegaly, and 11 individuals (15.71%) displayed perinephric edema. In the severe dengue group, all 20 individuals (100%) had gall bladder wall edema and ascites, 17 individuals (85%) had pleural effusion, 12 individuals (60%) had hepatomegaly, 8 individuals (40%) had splenomegaly, and 9 individuals (45%) had perinephric edema. Conclusion: There was a notable positive correlation seen between the severity of thrombocytopenia and the presence of aberrant ultrasonography characteristics.

 

52. Functional Outcomes Following Locking Compression Plate Surgery for Bilateral Forearm Fractures: A Prospective Study
Angad Kumar Choudhury, Dilip Kumar Singh
Abstract
Aim: The objective of the study was to evaluate the functional outcome of both bone forearm fractures with locking compression plate. Methods: This prospective study was conducted in the Department of Orthopaedics, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. A total of 100 patients were included in our study. The study was conducted after obtaining written informed consent from the patient and patient attenders and patients who met the inclusion and exclusion criteria were studied. Results: Our study population age ranged from 18 to 60 years, 18 years being the youngest patient and 60 years our oldest patient. Mean age of our study population was 32.4 years. Majority of the patients belonged to 21-30 and 51-60 years age group (25%). There were 64% male and 36% females. About 55% of the participants (n = 55) had a fracture on the left side and 45% of the participants (n = 45) had a fracture on the right side. There was a significant restriction in the movements at the elbow and radioulnar joints following the injury and fixation. The mean flexion (active) at the elbow improved from 112° at four weeks to 142° at 24 weeks. A restriction of about 22° in elbow extension at four weeks normalized to 0° at 24 weeks. The degree of pronation was more compromised than supination. However, both significantly improved over 24 weeks of the postoperative period. The range of palmar flexion improved from 45° at four weeks to 68° at 24 weeks. The range of wrist dorsiflexion improved significantly over time from 47° at four weeks to 87° at 24 weeks. Complications were found among 7 (7%) patients. Conclusion: Stable fixation is needed to establish fracture union and satisfactory function. Thus, ORIF with LCP may safely and effectively repair both bone forearms.

 

53. Assessing Clinico-Etiological and Bacterial Profile in Patients with Sepsis and its Markers in Renal Failure on Hemodialysis
Ashraf Azam, Vinyanand Jha
Abstract
Aim: The present study was conducted to study the presence of bacteremia, markers of sepsis and Inflammation in renal failure patients on hemodialysis, along with correlation of hematological abnormalities with sepsis in such patients. Material & Methods: The present study was conducted at department of General Medicine for one year and total of 200 patients of both sexes who were diagnosed as case of renal failure which include both acute kidney injury (AKI) and CKD on basis of clinical history, examination, biochemical markers and were advised for hemodialysis were included in the study. Results: In our study among 200 patients of renal failure on hemodialysis the mean age in our study was 45.65±15.35 years with 140 male patients. Out of 200 patients 50 (25%) had positive blood and catheter tip culture and 150 (75%) of patients had negative blood and catheter tip culture. Out of 50 patients with sepsis 9 (18%) were in the age group between 15–25 years, 9 (18%) were in the age group between 26–35 years, 8 (16%) were in the age group 36–45 years and 24 (48%) were above 45 years of age. All 50 (100%) patients had episode of fever with chills and rigor, 24 (48%) patients had redness and pain at hemodialysis catheter site, 16 patients (32%) were confused, disoriented or comatose and 10 (20%) patients had hypotension. Among 50 patients of renal failure with sepsis, none had TLC less than 4.8/cumm (leucopenia), 10 (20%) patients had count between 4.8–10.8/cumm and 40 (80%) patients had TLC more than 10.8/cumm. 40 (80%) patients’ blood culture was positive for S. aureus, and E. coli found in blood culture 6 (12%) patients, Acinectobacter in 2 (4%) patient and Candida in 2 (4%) patients. Among 50 patients of renal failure on hemodialysis with sepsis 12 (24%) patients had internal jugular line for hemodialysis, 4 (8%) had subclavian line and 34 (68%) had femoral line for hemodialysis. Conclusion: Patients requiring hemodialysis, who are having non modifiable risk factors like age, sex other risk factors for infection should be controlled to reduce incidence of infection.

 

54. Determining the Association of Measles Antibody Titres with Nutritional Status in Paediatric Population: Hospital Based Cross-Sectional Study
Mani Shankar, Babli Kumari, Rajnish Kumar, Avinash Kumar Sahay
Abstract
Aim: The aim of the present study was to find out any association of measles antibody titres with nutritional status in children 1 to 12 years. Methods: This hospital based cross-sectional study was conducted in the duration of five months on 1–12-year-old children attending the Pediatric O.P.D. of Department of Pediatrics with the objective of finding out the seroprevalence and anti-measles antibody levels, and studying their association with age, gender, as well as nutritional status of these children. Results: A significant proportion (62.50%) of the overall participants had received vaccination for measles. Nevertheless, the statistical analysis did not reveal a significant correlation between age and vaccination status (p=0.164). There were no statistically significant differences identified in the baseline parameters between the vaccinated and unvaccinated groups, except for the mean weight for age Z score, which was considerably lower in the unvaccinated group. A total of 38.34% of the individuals aged ≤5 years had severe wasting, also known as severe acute malnutrition, while 35% displayed moderate wasting. Among children aged five years and older, 23.34% exhibited extreme thinness, while 13.33% were classified as thin. Additionally, just two cases, accounting for 0.6% of the sample, were identified as overweight. A significant proportion of the vaccinated individuals aged five years or younger, namely 43%, exhibited severe wasting, often known as severe acute malnutrition. Additionally, 35% of the participants had moderate wasting. A strong statistical correlation was found between BMI Z scores (in individuals aged ≥5 years) and seropositivity, indicating that children with higher BMI Z scores had a greater likelihood of becoming seropositive. Likewise, a statistically significant correlation was found between height-for-age Z scores and seropositivity, indicating that children with greater height-for-age Z scores exhibited higher levels of seropositivity. Conclusion: Children’s nutritional condition is related to their measles antibody titres and the measles immune globulin (GMT) of measles specific IgG antibody.

 

55. Assessing Role of Blood Flow Measurements in Spiral Artery by Transvaginal Color Doppler Sonography (CDS) in Predicting Endometrial Pathologies: An Observational Study
Geeta Rani, Sachin Kr Singh
Abstract
Aim: The aim of the present study was to investigate the diagnostic value of blood flow measurements in spiral artery by transvaginal color Doppler sonography (CDS) in predicting endometrial pathologies. Material & Methods: 100 patients presenting with abnormal uterine bleeding and requiring endometrial assessment were included in this prospective observational study. Endometrial thickness, structure and echogenicity were recorded. Pulsatility index (PI) and resistive index (RI) of the spiral artery were measured by transvaginal CDS. Endometrial sampling was performed for all subjects. Sonographic and histopathologic findings were compared. Results: Mean age, parity, and endometrial thickness of the participants were 44.14±2.48 years, 3.3±2.18 and 12.48±6.44 mm respectively. The histopathological diagnoses were as follows; 40 cases (40%) endometrial polyp, 10 cases (10%) endometrial hyperplasia, 11 cases (11) submucous myoma, 8 cases (8%) endometrium cancer, and 30 cases (30%) nonspecific findings. There were significant correlations between spiral artery PI and RI and different endometrial histologies. Conclusion: Endometrial pathologies are associated significantly with endometrial spiral artery Doppler changes.

 

56. Efficacy of Canalolith Repositioning Manoeuvre in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Comparative Study – Epley’s Manoeuvre vs Semont’s Liberatory Manoeuvre
Lakshmi Unnikrishnan, Siddharth Kumar
Abstract
The study was carried out to compare the efficacy of Epley’s manoeuvre with that of Semont’s manoeuvre in the treatment of Dix Halpike positive cases of BPPV in the department of ENT, JLNMCH, Bhagalpur Between October 2021 to October 2022. Two groups of 50 patients each were assessed. Weekly canalolith repositioning manoeuvres were done, till they got complete symptomatic relief, with a maximum of 6 sessions and were followed up for 6 months. There DHI scores were assessed both before and after treatment. Though Epley’s manoeuvre has proved its efficacy since ages, we observed that Semont’s manoeuvre too had a significant impact on DHI scores and was found to be easily understood by the patient and which helped in its ease of performance. Hence, this study stresses on advocating Semont’s liberating manoeuvre, which is much simpler and scientifically efficient in treating BPPV.

 

57. Outcome of Percutaneous Balloon Mitral Valvotomy in Patient with Rheumatic Mitral Stenosis: A Single Centre Experience
Nirav Kumar, Ravi Vishnu Prasad, Akanksha Sinha, Chandrabhanu Chandan, Gautam Kumar
Abstract
Aim: The aim of the present study was to evaluate MR severity and its changes after BMV in patient with rheumatic mitral stenosis. Material & Methods: We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between) in between the duration of 2 years, functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated. Results: Complete pre-and post-BMV evaluation was performed in 150 patients (100 females) at a mean age of 45.80 ± 14.36 (range = 20 to 76) years. There were 96% females and 79% females in increased MR severity and MR severity without change respectively. The patients with an increased MR degree after BMV had a significantly higher calcification score and a lower MVA before BMV. The patients with an increased MR degree after BMV had a significantly higher calcification score and a lower MVA before BMV. MR increased in tandem with an increase in the calcification score. Most cases with increased MR post BMV had commissural MR in the anterior commissure and were more likely to have commissural rupture. After BMV, MVA significantly increased, whereas PAPs, LA pressure, MVPG and MVMG were significantly reduced. Conclusion: In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV.

 

58. Assessing Efficacy of Autologous Platelet Rich Fibrin Matrix versus Zinc Oxide and Phenytoin Paste in Non-Healing Ulcers: A Comparative Study
Birendra Prasad
Abstract
Aim: The aim of the present study was to compare the therapeutic efficacy of autologous PRFM versus triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in non-healing ulcers. Methods: The present clinical trial was conducted in the Department of Skin and VD, for December 2019 to November 2020. A total of 60 patients were included in the study with the age range 20–70 years. Patients with non-healing ulcers were selected from the outpatient department. Results: A total of 60 cases of non-healing ulcers of varying etiologies were treated using autologous platelet rich fibrin (PRF) at weekly intervals for maximum frequency of 6 sittings respectively. Most of the patients belonged to the age group 40-50 years. The mean age of the patients was 36.4 ± 12.08 years. Out of 30 ulcers in group A, there were 10 (33.34%) venous ulcers, 4 (13.33%) traumatic ulcers, 9 (30%) diabetic ulcers and 7 (23.33%) trophic ulcers. Out of 30 ulcers in group B, there were 9 (30%) venous ulcers, 6 (20%) traumatic ulcers, 10 (33.34%) diabetic ulcers and 5 (16.66%) trophic ulcers.  The length of non-healing ulcer ranged from 3 months to 14 months with a mean of 6.54±1.78 months. Group A showed a mean reduction in the ulcer area by 8.23 mm2 which was highly significant (P-value = 0.0002). Group B showed a mean reduction in the ulcer area by 4.79 mm2 which was also significant (P-value = 0.015). Conclusion: This procedure is simple, patient‑friendly, cost‑effective, painless and can be performed as an outpatient procedure. We concluded that autologous platelet-rich fibrin matrix is much more effective than the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in the treatment of non-healing ulcers.

 

59. An Observational Assessment of the Biomechanical Factors Working Around Hip Which Leads to Implant Failure
Angad Kumar Choudhury, Dilip Kumar Singh
Abstract
Aim: The Purpose of this study was to evaluate biomechanical factors working around hip which leads to implant failure. Material & Methods: This was an observational study. All 20 cases below 75 years of age with proximal femoral fracture [fracture Inter-trochanteric & Sub-trochanteric included] fixed with PFN irrespective of the centre where surgery was performed attending routine out-door of Department of Orthopaedics for one year with implant failure were registered for the study. Results: In our study we registered total of 20 cases with mean age of registered cases was 64.86 + 8.50 years. 15 patients (75%) were male and 5 (25%) were females. Except 3, all cases of implant failure in our study were categorized as unstable type according to EVAN’s & A.O. classifications preoperatively. Out of 20 cases registered, pattern of implant failure in our study were 6 cases (30%) had implant failure pattern of Z- effect, 5 cases (25%) had implant failure pattern of reverse Z-effect; 2 (10%) had breakage of nails; 1 cases (5%) had both screw breakage with varus collapse; 3 (15%) had single upper proximal screw breakage; & 3 cases (15%) were associated with spiral fracture femur just distal to the tip of PFN. Conclusion: Proper implant selection is critical and should be done on an individualized patient and fracture pattern basis. Poor surgical technique, implant-related issues, delayed fracture union, and poor patient compliance and health status alone or in combination can lead to breakage of the implants requiring challenging treatment options. Prevention of such catastrophic complications is crucial for the patient’s health and quality of life. Biomechanical study of the broken implant may provide useful information regarding failure causes and guide future treatment. Surgeons and mechanics should work hand in hand for implants evolution in order to optimize patient treatment.

 

60. Clinico-Demographic Profile and Outcome Assessment of Complications in Children Presented with Severe Acute Malnutrition (SAM)
Anshuman, Shashi Prabha
Abstract
Aim: The aim of the present study was to identify the children with SAM from the patients admitted in Department of Pediatrics, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna. Methods: This observational study was carried out on admitted patients in Department of Pediatrics, IGIMS, Patna, from January 2022 to February  2023. WHO criteria were used to define severe acute malnutrition. All children between 6 months to 5 years of age with severe acute malnutrition admitted in Department of Pediatrics were included. Results: Out of 144 SAM children 69 (47.9%) children belongs to age groups 6-12 month while 45 (31.25%) belongs to age group 13-24 Month and rest 30 (20.9%) children of age group more than 24 month. A total of 79 children (54.86%) were male while 65 children (45.14%) were female. A total of 119 cases (82.63%) had their weight for height/length below – 3 SD. 43 cases (30%) had visible severe wasting and 30 cases (20.83%) had bilateral pedal edema. All the SAM cases in study population had MUAC < 11.5 cm (100%). Only 38.20 % of patient (55 cases) had received exclusive breast feeding upto to 6 months of age while 89 cases (61.80%) had received partial breastfeeding. In the partial breast-feeding group almost all (89) children received feeding by bottle. Almost all of bottle-feeding baby received diluted cow milk. A total of 84 cases (58.3%) had received complete immunization according to their age while 60 cases (41.7%) had received only partial immunization. Conclusion: The current study has been an attempt to observe the prevalence and outcome of common complication of severe acute malnutrition in hospitalized children between 6 months to 5 years. Prevalence of Malnutrition is almost similar in both the sexes with slight male dominance. Most of the malnourished child are in the age group of 6 to 12 months, and mean age of presentation was 18.94 month.

 

61. A Case Control Study Evaluating Thyroid Profile in Patients of Liver Cirrhosis: An Observational Study
Ashraf Azam, Vinyanand Jha
Abstract
Aim: This study was conducted to study thyroid dysfunction in patients of liver cirrhosis and any association between severity of liver cirrhosis and thyroid profile. Methods: This case-control study was conducted in the Department of Medicine. A total of 200 liver cirrhosis patients (case) and equal number (200) of healthy controls were included in this study. The study was conducted for the period of two years. Results: A total of 200 liver cirrhosis cases (150 males and 50 females) and 200 apparently healthy controls (120 males and 80 females) were included in the final analysis. The mean age was 46.34 ± 8.24 years for cases and 47.23 ± 6.34 years for controls. Controls as compared to cases had higher free T3 (fT3) (2.48 ± 0.44 vs. 1.64 ± 0.52 pg/ml) and free T4 (fT4) (1.28 ± 0.32 vs. 1.16 ± 0.46 ng/ml), although the difference was significant only for free T3. On the contrary, TSH values of cases were found to be significantly higher as compared to that of controls (3.57 ± 0.90 vs. 3.02 ± 0.64 μIU/ml). Low T3 syndrome and hypothyroidism were common thyroid disorders (24% and 18%), normal thyroidal illness syndrome with low T4 and high T4 were observed among 16% and 12% cases, whereas out of 200 controls, 180 (90%) did not have any abnormality in thyroid functions. Only 14 (7%) cases were diagnosed as normal thyroidal illness syndrome with high T4 abnormality. The difference in thyroid dysfunctions between cases and controls was found to be significant statistically. Conclusion: Liver disease cases as compared to controls had significantly lower fT3 levels and significantly higher TSH levels. Mortality rate of liver disease cases with thyroid dysfunction was also found to be significantly higher.

 

62. An Observational Assessment of the Role of Liver Function as an Indicator of Malaria in Endemic Regions and as a Marker of Disease Severity
Ashraf Azam, Vinyanand Jha
Abstract
Aim: This study was to evaluate the role of liver function as an indicator of malaria in endemic regions and as a marker of disease severity. Material & Methods: This was an observational cross-sectional study conducted in central laboratory, department of pathology, central laboratory, department of biochemistry, and out-patient department, department of medicine over a period of one year, and included 100 microscopy proven malaria positive cases. Results: Among the 80 Plasmodium vivax cases studied, all the three liver function parameters show increased frequency of derangement with increase in parasite load with SGPT and SGOT showing maximum frequency of derangement in severe category, 72.72% (n=16) and 86.36% (n=19) respectively. Among the 20 cases of Plasmodium falciparum studied, also, maximum frequency of derangement is seen in severe parasitemia in all the liver function parameters except SGPT, which shows more derangement in moderate parasitemia with all the cases involved (100%, n=4). In all the cases of malaria studied, all the three parameters show increased frequency of derangement with increase in parasite load, with most frequent derangement seen in severe parasitemia. Bilirubin- 50% (n=18), SGPT- 80.55% (n=29) SGOT-83.33% (n=30). While comparing vivax and falciparum malaria, all the LFTs studied show greater derangement in Plasmodium Falciparum when compared to Plasmodium vivax, with greatest difference seen in bilirubin levels. Conclusion: We concluded that altered liver function in form of hyperbilirubinemia and increased liver enzymes in a patient with acute febrile illness increase the probability of malaria, hence directing the clinician along the correct path of further work-up and accurate treatment.

 

63. A Prospective Observational Study Assessing the Effect of Pregnancy Induced Hypertension on Maternal and Fetal Outcomes
Vidya Paul, Seema
Abstract
Aim: The aim of the present study was to assess the effect of pregnancy induced hypertension on maternal and fetal outcomes. Methods: A prospective observational study One hundred women with pregnancy-related hypertensive disorders admitted for delivery were included in the study. Results: A total of 2,000 births were performed within the designated timeframe at the hospital under investigation. Among the whole sample, a subset of 100 cases (5%) were identified as instances of pregnancy-related hypertension disorders, and these patients were selected for inclusion in the research. The average age of the participants was 22 ± 6 years. The average systolic pressure was found to be 158.92 ± 13.87 mmHg, while the average diastolic pressure was measured at 104.66 ± 6.34 mmHg. Additionally, the mean gestational age was determined to be 35.95 ± 2.849 weeks. The primary hypertension condition associated with pregnancy was eclampsia, accounting for 43% (n=43) of cases, followed by preeclampsia, which accounted for 25% (n=25) of cases. All of these ladies were monitored for the occurrence of any complications. Complications did not arise in 33% of the women. Postpartum haemorrhage (PPH) emerged as the most prevalent complication among the cohort of women who had one or more problems during or after childbirth. The majority of women diagnosed with postpartum haemorrhage (PPH) had symptoms of either preeclampsia or eclampsia. Following postpartum haemorrhage (PPH), placental abruption emerged as the second most prevalent maternal complication. The majority of women who had placental abruption were diagnosed with pregnancy-induced hypertension (PIH). Conclusion: The hypertension diseases that were most often seen in this study were preeclampsia and eclampsia. Placental abruption and postpartum haemorrhage were identified as the most often seen maternal problems. The foetal problems most often seen were meconium aspiration syndrome, followed by preterm delivery, intrauterine growth restriction (IUGR), and low birth weight (LBW).

 

64. A Hospital Based Prospective Comparative Assessment of the Retinal Nerve Fibre Layer Thickness in Different Types of Amblyopia
Tania, Nidhi, Amresh Kumar
Abstract
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 types of amblyopia. Material & Methods: This prospective study was conducted on consecutive patients diagnosed with amblyopia seen at Department of Ophthalmology of a tertiary care centre in South Bihar, India for a duration of one & half years. 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 fulfilled the study criteria and were included in 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.

 

65. Assessment of the Changes of Corneal Nerve-Morphology and Tear Indices in Patients with Neurotrophic Keratitis (NK)
Amrendra Kumar, Parambir Kumar Bharti, Anita Ambastha, Gyan Bhaskar, Bibhuti P Sinha
Abstract
Aim: The aim of the present study was to characterize changes of corneal nerve-morphology and tear indices in patients with neurotrophic keratitis (NK) treated with recombinant human nerve growth factor (rhNGF). Material & Methods: This study was conducted in Department of Regional Institute of Ophthalmology for one year, and followed the tenets of the Declaration of Helsinki. The diagnosis and treatment processes were described in detail to the patients and their families, and informed consent was signed with the consent of the patient’s families. 30 patients with NK diagnosed in Department of Regional Institute of Ophthalmology were collected. Results: Corneal fluorescence staining using a slit lamp showed that all patients had corneal epithelial defects. After 2wk of treatment, complete corneal healing was observed in two eyes of one patient; after 4wk of treatment, corneal ulcers were completely healed in four eyes of three patients; and after 8wk of treatment, all corneal ulcers of patients were completely healed. After 8wk of rhNGF treatment, the score of corneal fluorescent staining was significantly lower than that of the baseline, and the difference was statistically significant. There was no significant difference in the height of the tear river before and after rhNGF treatment (P=0.212), with the same height of the tear river after stimulation (P=0.089). After 8wk of treatment, there was a significant increase in the thickness of the lipid layer (P=0.048). The density of subbasal nerve fibers significantly increased from the second week to the eighth week after treatment, which was statistically significant (P<0.01). At the same time, the corneal nerve fiber density increased gradually with the progression of treatment. When the density of nerve fibers increased, the number of ramification and bifurcation points of subbasal nerve fibers significantly increased (P=0.002, P=0.004). Conclusion: RhNGF can increase the density of corneal sub-basal nerve fibers, promote the healing of persistent corneal epithelial defects and corneal ulcers in patients with NK, also improving tear function partially.

 

66. Normal Tension Glaucoma versus Primary Open-Angle Glaucoma: A Comparative Study
Parambir Kumar Bharti, Amrendra Kumar, Anita Ambastha, Gyan Bhaskar, Bibhuti P Sinha
Abstract
Aim: The study was conducted to determine the functional and structural differences between NTG and POAG, to assess the rate of conversion of NTG into POAG and its early intervention. Material & Methods: A comparative study including 200 patients attending the Department of Regional Institute of Ophthalmology screened during the period of 2 years. Results: Mean age was found to be 57.73 years in NTG and 56.04 in POAG. NTG was more common in females (60%), whereas POAG was more common in males (72%). Systemic involvement was more common in NTG (70%). There was no significant difference in CDR between two groups. Temporal (30%) and inferior (40%) NRR thinning was more common in NTG, whereas bipolar thinning (56%) was more common in POAG. Retinal Nerve Fiber Layer (RNFL) was significantly thinner in POAG in all four quadrants. There were no significant changes in MD and PSD values of Visual fields (VF) between NTG and POAG. NTG showed localized field defects which were closer to centre of fixation, while it was diffuse and denser in POAG. No significant changes were observed in VF on follow up. Conclusion: These differences between NTG and POAG suggest that the pathogenesis of NTG includes IOP and IOP independent risk factors, while IOP is the main risk factor in POAG. The parameters assessed determine the risk and progression of NTG to POAG.

 

67. Comparative Study of Efficacy of Topical Olopatadine (0.1%), Bepotastine (1.5%) and Alcaftadine (0.25%) in Mild to Moderate Allergic Conjunctivitis
Saurabh Tripathi, Nidhi, Amresh Kumar
Abstract
Aim: The aim of the present study was to compare the efficacy and safety of Alcaftadine 0.25%, Olopatadine hydrochloride 0.1%, and Bepotastine besilate 1.5% ophthalmic solutions in the treatment of allergic conjunctivitis. Methods: A prospective study was conducted on 210 patients of allergic conjunctivitis visiting  Department of Ophthalmology of a tertiary care hospital in south Bihar after random selection. Randomly generated treatment regimens were sealed within opaque envelopes and were allocated to the patients after obtaining their informed consent. A total of 210 patients were enrolled in this study. All the cases were divided into three groups (Group A, B and C). Results: Mean age of group A patients was 27.33 ± 10.30 years, group B patients was 29.61 ± 9.31 years and group C was 28.82 ± 9.81 years. There was male predominance in all the three groups. At day 1, Total ocular symptom score (TOSS)  of group A, B and C was 7.49 ± 2.48, 7.63 ± 2.28 and 7.56 ± 2.36 respectively. As compared to 1st visit and last visit (14 days) followed up TOSS was greatly reduced in group A and C than group B cases. Conjunctival hyperaemia had reduced in all the treatment groups but there was a significant reduction in Alcaftadine and Bepotastine treatment groups at 14th day compared to olopatadine group (p = 0.0001). In this present study, degree of hyperaemia was highly significantly decreases in 4th visit as compared the 1st visit in all group of patients. Hyperaemia in group A and C patients were greatly reduced as compared to group B patients. Conclusion: All three topical ophthalmic medications used in the study are safe and effective in the treatment of allergic conjunctivitis. However, Bepotastine and Alcaftadine appear to outweigh Olopatadine in resolving the symptoms of allergic conjunctivitis.

 

68. An Observational Study Assessing the Association between Physical Activity & and Dietary Habits among Adolescents
Rakhi Kumari, Ratnesh Kumar, Neelu Raj, Amit Kumar
Abstract
Aim: The current study aimed to focus specifically on objectively assessed physical activity & and dietary habits among adolescents. Methods: The present study was conducted in the Department of Community Medicine at DMCH, Darbhanga, Bihar, India for one year and cross-sectional data were collected. Data were obtained from adolescents (12–16 years) recruited from three secondary schools in Bihar. Staff at participating schools selected a subset of their classes for participation. All students from nominated classes (n = 200) were eligible and received written information on the project. Consent was sought from parents prior to the study and adolescent participants provided assent before completing written surveys during class. Results: A higher proportion of boys, compared to girls, ate breakfast on more than 5 days/week (p < 0.01). A higher proportion of younger adolescents, com- pared to older adolescents, met the physical activity recommendations and did not meet the recommendations for fruit and vegetable consumption (p < 0.01). For adolescents with two risk behaviours, the most prevalent cluster was formed by not meeting the physical activity and fruit and vegetables recommendations. A higher proportion of girls, compared to boys, had the cluster pattern of not meeting the recommendations for physical activity and breakfast consumption. (p < 0.01). A higher proportion of boys, compared to girls, and older adolescents, compared to younger adolescents, had the most prevalent single risk factor of not meeting the recommendations for physical activity (p < 0.01). A higher proportion of younger adolescents, com- pared to older adolescents, had the single risk factor of not meeting the recommendations for fruit and vegetable consumption (p < 0.01). Conclusion: Many adolescents fail to meet multiple diet and physical activity recommendations, highlighting that physical activity and dietary behaviours do not occur in isolation. Future research should investigate how best to achieve multiple health behaviour change in adolescent boys and girls.

 

69. A Prospective Study to Evaluate the Predictive Value of Transvaginal Cervical Length between in First Trimester and Second Trimester by using TVS
Geeta Rani, Sachin Kr Singh
Abstract
Aim: The aim of the present study was to evaluate the predictive value of transvaginal cervical length between in first trimester (11 to 13+6 weeks) and second trimester (20 to 24 weeks) by using TVS. Material & Methods: This prospective observational study of 200 pregnant women attending ANC OPD . The pregnant women were scanned for cervical length between 11-14 weeks and 20-22 weeks of gestation, using USG machine with TVS probe (Mindray DC-7). Results: 52% of women in the study group are in the age group of 21-25 years. Median age was 23 years. Minimum age of the subject studied being 18 years and maximum being 34 years. Cervical length at 11-14 weeks in majority of the pregnant women studied was between 3.6-4.0 cm. Minimum cervical length measured was 3 cm and maximum 5 cm. Mean±SD= 3.94 cm± 0.41, Median= 4 cm. Cervical length at 20-22 weeks in majority of the pregnant women studied was between 3.1-3.5 cm with mean cervical length being 3.37 cm. 85% of the subjects studied, had full term. 60 (30%) patients had< 0.5cm reduction in cervical lengths (Group A), 130 (65%) had reduction in cervicallengthsfrom0.5-1cm (group B) and 10 (5%) had reduction in cervical lengths >1cm (Group C). deliveries, whereas 12% had preterm deliveries. Conclusion: Findings of this study confirms those of previous studies that have found an inverse relation between the length of the cervix, as measured by transvaginal ultrasonography during pregnancy, and the frequency of preterm delivery. The cervical length measured at 11-14 weeks and 20-22 weeks gestation was decreased in asymptomatic women with single to n pregnancies was useful for identifying patients at increased risk for preterm delivery was found in the study.

 

70. A Hospital-Based Study Assessing the Correlation of the Duration of Diabetes Mellitus, Microalbuminuria, Hyperlipidaemia with the Severity of Diabetic Retinopathy: An Observational Study
Chandana Kumari
Abstract
Aim: The present study was carried out with an aim to study the concordance and correlation of microalbuminuria, dyslipidemia with the severity of Diabetic Retinopathy in type II diabetes mellitus patient and to provide a possible basis for explanation of mechanisms governing this relationship Material & Methods: This was a hospital based cross sectional study conducted in the Department of Ophthalmology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for one year . 200 patients were included in this study. Results: A total of 200 subjects of either gender were included in our study, out of which 110 (55%) were females and rest were males 90 (45%). Majority of the patients lied in the age group of 40-60 years (55%) followed by 60-80 years (28%) and below 40 years (14%), while only 6 (3%) patients were aged above 80 years. 40% had diabetes <10 years followed by 30% having diabetes from last 10-20 years. 70% patients had grade 0 micro-albuminuria. 55% patients had total cholesterol level at borderline. Proportion of Group I (No retinopathy) was higher in younger patients. Another statistically significant association was found between the severity of retinopathy and duration of diabetes (p < 0.001). A statistically significant association between microalbuminuria grade and severity of retinopathy was observed (p < 0.001). Proportional difference in severity of retinopathy in patients with different total cholesterol levels was found to be statistically significant (p = 0.001). Conclusion: Duration of diabetes and microalbuminuria had been found to be the independent risk factors for diabetic retinopathy, but serum cholesterol levels did not show an independent role in our study. The findings in present study endorsed the view that microalbuminuria poses a risk for diabetic retinopathy which is affected by duration of diabetes, level of glycemic control and lipid levels.

 

71. A Retrospective Study on Patterns of Preanesthetic Usage in Surgical Branches at a Tertiary Care Hospita
Pragati Saxena, Kuldeep Kumar Patel, Mohanbabu Nema, Sanjay Kumar
Abstract
Background and Objectives: Preanesthetic medications are administered prior to surgical procedures to ensure patient comfort and mitigate the adverse effects of anesthesia. These medications play a crucial role in alleviating the stress and apprehension associated with surgery, thereby facilitating the surgical process. Investigating the patterns of preanesthetic medication usage provides valuable insights into contemporary trends and identifies avenues for enhancement. This study aimed to evaluate the utilization patterns of preanesthetic medications across different surgical specialties within a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted which retrospectively gathered data from inpatient records of individuals who underwent surgeries within various departments a tertiary care hospital in India. Collected data were subjected to analysis using SPSS software version 19. Results: A comprehensive analysis of 567 inpatient records was undertaken. Among the preanesthetic agents employed, alprazolam emerged as the most prevalent choice. In terms of gastroprotective medications, pantoprazole was the most frequently used agent. Notably, ondansetron stood as the dominant antiemetic. Conclusion: The study contributes to a deeper understanding of contemporary preanesthetic medication trends within diverse surgical specialties. Alprazolam, pantoprazole, and ondansetron surfaced as the prevailing preanesthetic drugs employed.

72. A Comparative Study of Intravenous Propofol and Inhalational Sevoflurane for Preoperative Induction
Pragati Saxena, Kuldeep Kumar Patel, Mohanbabu Nema, Sanjay Kumar
Abstract
Background and Objectives: Propofol is commonly used for anesthesia induction, while Sevoflurane is favored for pediatric inhalational induction and adult needle-phobic patients. This study aims to compare Propofol and Sevoflurane induction agents and their impact on intubation conditions, particularly in relation to Sevoflurane’s interaction with vecuronium, a non-depolarizing muscle relaxant. Methods: ASA Grade I and II patients (20-65 years) undergoing surgeries were randomized into two groups. Group P received Propofol induction, and Group S received Sevoflurane induction using vital capacity breath technique (8% Sevoflurane). Results: Propofol induced more significant blood pressure reduction, though induction time was slightly shorter. Sevoflurane heightened vecuronium’s effects. One Sevoflurane subject experienced laryngospasm (excluded). Four Propofol patients had injection pain. Both groups had instances of groaning, while Sevoflurane group showed induction-related coughing. Conclusion: Propofol and Sevoflurane exhibit similar induction speed. Sevoflurane enhances non-depolarizing muscle relaxant effects during induction, making it preferable for patients intolerant to brief blood pressure decline.

73. Anti-Diabetic Properties of Trigonella Foenum-Graecum
Aditya Prakash, Amrendra Kumar, Kailash Mahawar, Vinod Kumar Kumawat, Laxman Sngh, Madhuri Shringirish, Sanwar Mal Yadav
Abstract
Millions of individuals throughout the world suffer with diabetes, a chronic lifestyle illness. Diabetes 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 characterised by both decreased insulin synthesis by the pancreatic beta cells and impaired insulin release in response to high blood glucose levels.
Fenugreek, commonly referred to as methi, is an herb that has long been used for a variety of purposes in Ayurvedic and Chinese medicine. The plant’s seeds and leaves contain a number of advantageous substances, including as saponins, flavonoids, and alkaloids, which add to its health advantages. Fenugreek has been proven to have a number of possible health advantages, including the ability to aid digestion, lower blood sugar levels, and reduce inflammation. Additionally, it has been used to raise male testosterone levels and increase milk production in nursing moms. Fenugreek also has antioxidant qualities that may help it guard against several chronic diseases. To completely comprehend the efficiency and safety of fenugreek for various uses, more research is necessary. Additionally, fenugreek may cause interactions with some drugs and have negative effects, such as nausea. So, before using fenugreek or any other herbal therapy, it’s crucial to see a healthcare provider.

74. Demographic, Clinical, Radiological and Microbiological Profile of HIV-TB Coinfected Patients
Priyanka Das, Gopal Krushna Sahu, H.K Sethy, Abinash Dandasena, N. Akshaya, Indira Priyadarshani, Parthiba Pramanik
Abstract
Background: The rising incidence of tuberculosis among HIV-positive people, estimated at 5-8% per year, the high HIV seroprevalence among tuberculosis patients, the occurrence of tuberculosis among AIDS patients, and the concurrent increase in tuberculosis notifications all point to a link between tuberculosis and HIV. The impact of HIV-TB coinfection on resource-limited countries has alarming social and medical implications, and already overburdened health facilities must now deal with a rapidly growing tuberculosis epidemic. Therefore, our study aimed to assess the demographic, clinical, radiological, and microbiological profile of HIV-TB coinfected patients. Methods: A total of 150 HIV seropositive adult tuberculosis patients who were admitted to the IPD of the Pulmonary Medicine Department and attended the OPD and ART centre were studied. It is a cross-sectional, observational, descriptive study of HIV seropositive patients with tuberculosis. Results: The study involved 15-65-year-old patients with respiratory symptoms, including cough (50%), lymphadenopathy (29%), pallor (51%), oral candidiasis (19%), icterus (4%), tachypnoea (13%) and pedal oedema (3%). Extra-pulmonary, pulmonary, and disseminated TB was present in 63%, 28% and 9% of patients. Considering zonal distribution, upper-zone infiltrations were observed in 4% of cases, whereas mid and lower-zone infiltrations were observed in 12%. Furthermore, consolidations (7%), fibro-cavitary lesions (4%), pleural effusion (21%), pneumothorax (1%), and hilar lymphadenopathy (8%) were also found in the patients. Microbiological profiles showed 60% of patients with upper zone lesions exhibited sputum +ve PTB, while 40% had sputum -ve PTB. Conclusion: Many patients were undernourished, with a BMI of <18.5 kg/m2. Common symptoms included cough and pallor. Extra-pulmonary TB was the most common type of HIV-TB coinfection. Zonal distribution was more in mid and lower zones. The most frequently encountered radiological findings included pleural effusion and infiltrations. Sputum positivity was more common in upper-zone lesions.

75. Assessing Correlation IOL Power and Refractive Error in Superior Phacoemulsification: A Pre- and Post-Operative Comparative Study
Jyoti, Sachin Kumar, Pradeep Karak, Rajnandani
Abstract
Aim: The aim of the present study was to assess the correlation between preoperative calculated IOL power and post-operative refractive error in superior phacoemulsification. Methods: The study design was retrospective analysis which included 200 post-operative cataract patient data at department of Ophthalmology who underwent superior phacoemulsification surgery for the period of two years. The surgeries were done by four different surgeons of equal competence. A scan was done by US biometry and IOL master. Results: 24% patients had 0 refractive error followed by 18% had >0.25- ≤0.5 refractive error. The mean post op spherical equivalent refractive error was -0.34 SD 0.76. A total of 39 percent had spherical equivalent less than or equal 0.25(0-0.25).57 percent patient had refractive error of less than or equal to 0.50. 70 percent patient had refractive error upto 0.75 D. t Test were applied and the pearson correlation value between the IOL power and post op spherical equivalent error was -0.097. Thus there was a no correlation between calculated pre op IOL power and post op spherical equivalent significant as p value came as 0.34. (r = -0.097, p= 0.34). Correlation between axial length and refractive error were negligible but not statistically significant in as in our study as p value was 0.34 which is more than 0.05. (r =0.096, p = 0.34). Conclusion: Our study with its result showed that there was no statistically significant correlation between IOL power and post op refractive error and so there is no way that we can guess about the residual refractive error on the basis of IOL power.

76. Assessment of Bandage Soft Contact Lenses as a Primary Treatment for Traumatic Corneal Abrasions (TCA): A Prospective Study
 Jyoti, Sachin Kumar, Pradeep Karak, Rajnandani
Abstract
Aim: The aim of the present study was to use bandage soft contact lens (BSCL) as a primary treatment for traumatic corneal abrasion [TCA]. Methods: The present prospective study was conducted on 100 patients with TCA attending the out-patient department of Ophthalmology for one year. Hydrophilic therapeutic BSCLs were used. Before subjecting the patient to therapeutic BSCL therapy, informed consent has been obtained, a detail clinical history and thorough local examination was done, all patients diagnosed and treated for a superficial TCA after fulfilling the following criteria. Results: The commonest cause of injury was direct minor trauma (80% of cases), with cosmetic & optical contact lenses related problems accounting for 20% of presentations, visual acuity was documented correctly in 90% of adult and pediatric group and difficult to documented in children less than 6-year-old 10%. Traumatic corneal abrasion treated with bandage soft contact lens has an apparent advantage over the traditional pressure patch in terms of reduced pain, speedier healing, and an advantage of faster rehabilitation, facilitation epithelial healing, and proper surface hydration. Conclusion: Our study advised that the therapeutic BSCL is the first-line approach is a safe and effective modality for treating TCAs & significantly shortens the time to resume normal activities. While BSCLs were applied for straightforward TCA &suitable continuation nursing for TCAs was strongly effective. We concluded that the results support the hypothesis that BSCLs used in the primary treatment of TCAs offer certain advantages over conventional PP.

77. Cross-Sectional Observational Research on Effect of Obesity on Electrocardiographic P-Wave Dispersion among Healthy Adults
Harshwardhan, Amitayush, Suman Saurabh, Rajiva Kumar Singh
Abstract
Aim: The aim of the present study was to investigate the dispersion of P–wave in healthy young adults. Methods: The study was conducted in the Department of Physiology for 10 months. Design of the study was cross-sectional observational and a total 100 young healthy adults both male and female aged between 18 to 40 years participated voluntarily in the study. Written informed consents were taken from all the participants after explaining the study protocol. Results: There was no significant difference in age, sex and height between obese and non –obese group but a significant difference were found in weight and BMI between groups. Obese group had higher SBP, DBP, HR, maximum P-wave duration, minimum P-wave duration and P-wave dispersion compared to non-obese and statistically significant (p<0.001) was found. Conclusion: It can be concluded that apparently healthy obese individuals may have higher anthropometric values and abnormal P–wave findings. Hence the present study gives an insight on the variations in P-wave in healthy adults who are obese and thereby helps in creating awareness so that; they can change their lifestyle in order to prevent the onset of the deleterious effects of obesity on their health.

78. A Hospital-Based Study to Determine Post‑Vaccination Symptoms after the First Dose of Covishield Vaccine among Health Care Workers
Jay Jyoti, Kumar Vikas, Dinesh Kumar, Amita sinha
Abstract
Aim: The aim of the present study was to determine post‑vaccination symptoms after the first dose of the Covishield vaccine among healthcare workers at a tertiary care centre. Material & methods: A descriptive cross‑sectional study in Department of Community Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India from Jan 2022 to December 2022. Data on adverse effects following vaccination with the first dose of Covishield vaccine were collected from healthcare workers through online surveys and interviews. Baseline characteristics were described with frequency, percentages, and mean. Associations between categorical variables were assessed using the Chi‑square test. Results: In the present study, majority of the participants were male (95%) and 95% had no allergy from the vaccine. 92% had COVID‑19 infection and 60% workers were in clinical department. The majority of the respondents reported post‑vaccination symptoms. The most common symptoms were pain at the site of injection, myalgia, tiredness, fever, headache, nausea, giddiness, diarrhea, and redness at the site of injection. Rare symptoms reported included anaphylaxis, peri‑orbital edema, breathlessness, vomiting, and passage of red-coloured urine. Conclusion: The symptoms reported in the study were those already known to be the general side effects associated with vaccines. The information obtained from this study will aid in health promotion activities related to COVID‑19 vaccination.

79. Clinico-Etiologic and Demographic Profile of Neonatal Respiratory Distress: An Observational Study
Sushil Kumar Pathak, Jaymala Mishra, Saroj Kumar, Binod Kumar Singh
Abstract
Aim: The aim of the present study was to assess the demographic and etiological profile of neonatal respiratory distress in a tertiary care-centre in Bihar. Material & Methods: A prospective observational study conducted in the Department of Pediatrics in between the duration of 2 years. During the study period, 500 neonates were included in the study. Results: Neonatal respiratory distress was more common in male babies but difference was not statistically significant. Neonatal respiratory distress was more common in preterm babies than term babies and relative risk was statistically significant. Neonatal respiratory distress was more common in LSCS born babies than NVD born babies and relative risk was statistically significant. P value less than 0.01 was statistically significant. History of PROM, MSAF, GDM and maternal pyrexia were risk factors for the neonatal respiratory distress. Tachypnea, central cyanosis, chest retractions, grunting and abnormal heart rate were major signs of neonatal respiratory distress. On admission to NICU the majority of neonates had SpO2 at room air between 70-75 and therefore depicts the importance of early appropriate optimal ventilation measures. The most common causes of the neonatal respiratory distress were TTN, RDS, MAS and the sepsis. Conclusion: Early diagnosis of specific cause for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. The TTN was the most common cause of distress in term newborns, followed by perinatal asphyxia, meconium aspiration, neonatal sepsis, and congenital heart diseases (CHD). Therefore, timely diagnosis and management of these conditions is very imperative to discharge an intact neonate from the NICU.

80. A Hospital Based Prospective Study Assessment of UTI among Pregnant Women Due to E. Coli: An Observational Study
Rizwan Ahmad, Sanjay Nag
Abstract
Aim: The aim of the present study was to investigate UTI among pregnant women due to E. coli, to know its antimicrobial drug susceptibility pattern and correlate antibiogram. Methods: This prospective study was conducted at the Department of Microbiology for one year, Participants were recruited from among pregnant women. Mid-stream urine samples were obtained in a sterile wide-mouth container. A total of 100 samples were collected. Results: Among 100 samples tested, E. coli could be isolated from 43 samples with colony count of 105 CFU/ml of urine and a prevalence rate of 43%. The majority of pregnant women were in their 2nd and 3rd trimester. The mean age of the participants was 24 years. Most of the urine samples were obtained from pregnant women in the age range of 18 to 23 years. Pregnant women in the age range of 27 to 29 years contributed to the least number of samples. The rate of infection was high among the participants in the age group of 18-23 years.  Of the 43 isolates, biofilm formation was detected in 28 isolates by all the three methods for biofilm detection. All isolates showed the highest resistance to the antibiotic Ampicillin (93.34%), followed by Amoxicillin- clavulanic acid (53.34%), Cefuroxime (33.34%) and Ceftriaxone (33.34%). E. coli isolates which formed biofilm displayed a significant increase in the resistance pattern to all the antibiotics and proved to be statistically significant. Conclusion: The association between virulence factors and antibiogram was perceived in our study. Hence, screening for virulence factors and antimicrobial sensitivity must be scheduled along with the other standard tests for pregnant women. In addition, routine urine cultures would help in timely detection of UTI.

81. Clinicopathological and Radiological Study of Thyroid Swelling
Jitendra Kumar, Badal Kumar
Abstract
Aim: The aim of the present study was to correlate between clinical findings and ultrasonography findings. Methods: The prospective study of patients who attended the OPD in the Department of ENT, from September 2017 to September 2019 Patna Medical College and Hospital, patna for management of thyroid swelling was conducted. 52 patients were included in the study. Results: Age wise distribution of 52 cases in our study shows maximum incidence of thyroid swelling in age group between 30-40 Years. In the present series the ratio of female to male is 4.77:1. We had 43 female patients and 09 male patients. The duration of swelling ranges from 1 month to 12 years. The chief complaints in the study were swelling in front of the neck. The other complaints being hoarseness of voice, difficulty in swallowing (Dysphagia), clinically evident hyperthyroidism founding 6 cases (11.5%) & evidence of hypothyroidism found in 3 cases (5.8%). Thyroid swelling was tender in one case. Fixity and cervical lymphadenopathy found in 5 cases and 2 cases respectively. Conclusion: Thyroid swellings are not an uncommon problem. It is no longer justified to reset all thyroid nodules and a more selective surgical policy should be followed. The technical problems and the difficulties in interpretation of FNAC can be minimised with continued practice and experience. In case of strong suspicion of malignancy, a negative FNAC should be read with caution. In many such cases repeat FNAC or ultrasound guided FNAC can improve the accuracy.

82. Outcome Assessment of Cataract Surgery in Diabetic and Non-Diabetic Patients: A Prospective Case-Controlled Study
Sangeeta,  Rajesh Tiwary
Abstract
Aim: The aim of the present study was to compare the visual outcome following cataract surgery in diabetics and non-diabetics. Material & Methods: A Prospective case-control study including was conducted at department of Ophthalmology for one year. 100 eyes in the diabetic group and 100 eyes in the non-diabetic group that underwent small incision cataract surgery with posterior chamber intraocular lens implantation. Age, sex, surgical technique, follow up and pre- and postoperative best corrected visual acuity (BCVA) were evaluated. Results: In this study highest number of patients were in the age group of 60-65 years that is 50 (50%) in diabetics & 43 (43%) in control group. In this study patients above 65 years of age were excluded. Remaining 50 (50%) of the patients in diabetics & 57 (57%) of the patients in control group were below 60 years. Of the 100 patients in the diabetic group, majority of patients 65 (65%) had good glycaemic control (FBS: 70 – 110 mg/dl). 5 (5%) patients had low blood sugar levels at the time of examination (<70 mg/dl). Their blood sugar normalized eventually and they were operated. More importantly, 30 (30%) patients had high fasting blood sugar levels (FBS> 110 mg/dl). The highest fasting blood glucose value recorded was 143 mg/dl. The two main co-existing pathologies were psuedoexfoliation and myopia. There were 10 (10%) patients in diabetic group and 12 (12%) patients in the non-diabetic group that had psuedoexfoliation. Among the myopia, there were 5 cases in diabetic group and 6 cases in non-diabetic group. The final visual outcome was recorded using Snellens visual acuity chart and the values were converted to logMAR units for statistical analysis. Majority of the patients, 70 (70%) in the diabetic group and 76 (76%) in the non-diabetic group had visual acuity of 6/12 or better at the end of 6 weeks of follow up. Only 5 patients in the diabetic group and 6 patients in the non-diabetic group had visual acuity less than 6/60. Conclusion: Cataract surgery in diabetic patients without retinopathy led to favourable and comparable visual outcomes to that of non-diabetics. The incidence of postoperative complication was more in the diabetic group.

83. Assessment of Antiplaque Properties of Herbal Toothpaste Containing Propolis: A Randomized Clinical Study
Nikita Raman, Samir Jain
Abstract
Aim: The aim of this study was to evaluate the antiplaque efficacy of an herbal toothpaste containing propolis in comparison with a control group. Material & Methods:  A single-blind parallel clinical trial including 80 patients (40 females and 40 males)was conducted in Department of Dentistry. All subjects were given verbal and written information about the study. Results: Out of 80 subjects, 40 were males and 40 were females with mean age of 22.76±1.44 years. There was no significant difference in the mean MGMPI scores between the three groups (Propolis, Dabur, Pepsodent) at baseline. But when they were compared after 24 h significantly (P = 0.01) highest mean MGMPI score was observed in Pepsodent group (45.40±5.08) followed by Dabur (39.51±2.29). Propolis showed significantly least mean MGMPI score (36.74±2.40) after 24 h. On comparing the mean difference (baseline and 24 h) of the three groups, significantly (P = 0.01) lowest mean difference was elicited by Propolis group. Conclusion: The herbal toothpaste containing propolis was more effective in reducing plaque accumulation in comparison with the control group. Considering the effect of propolis-containing toothpastes on the reduction of dental plaque accumulation, these can be used as an effective oral hygiene product.

84. Determining the Prevalence of Retinopathy of Prematurity (ROP) in Premature Babies: A Prospective Observational Study
Sangeeta,  Rajesh Tiwary
Abstract
Aim: The aim of the present study was to determine the prevalence of ROP in premature babies in a tertiary care hospital. Material & Methods: It was a prospective study carried out in premature babies referred for ophthalmological examination in Department of Ophthalmology, over a period of one year. 200 babies were enrolled in this study. Babies with GA of <32 weeks at birth and birth weight <1500 gm, babies with gest age>32 weeks or birth weight >1500 gm were included if they were exposed to oxygen therapy for more than >7 days. Results: Out of 200 patients screened for ROP, 60 babies (30%) were found to have ROP of different zones and stages. We found out that total 32% of 200 babies which accounts for 64 babies were very low birth weight. 44% of total babies were low birth weight which accounts for 88 babies. 24% babies were having normal birth weight which accounts for 48 babies. In the present study, 55% were pre term babies and 45% were delivered at full term. In our study 55% of very low birth weight babies, were having ROP which accounts for 33 out of 64 babies. 241.66% of low birth weight babies were having ROP (25 out of 88). Only 3.34% of normal birth weight babies were having ROP. ROP was found in 54 Out of 110 pre term babies. Only 6 babies out of 90 full term babies had ROP. These findings were statistically significant (P less than 0.0001). Conclusion: Retinopathy of Prematurity was most commonly seen in low-birth-weight babies. High rate of premature birth and increasing advancement of healthcare without proper standards resulted in third epidemic. It is essential to screen premature babies and babies with low birth weight. Awareness regarding ROP screening is a key factor for its prevention. There is urgent need of screening guidelines of ROP for developing countries like India.

85. A Hospital Based Prospective Clinical Study to Correlate the Dry Eye and Diabetic Retinopathy with Duration of Diabetes and Blood Urea and Serum Creatinine Level
Sangeeta,  Rajesh Tiwary
Abstract
Aim: The aim of the present study was to correlate the dry eye and diabetic retinopathy with duration of diabetes and blood urea and serum creatinine level. Material & Methods:  A prospective clinical observational study was conducted in department of Ophthalmology for a period of one and half years. A written consent was obtained from the patients before subjecting them for detailed clinical examination. 100 cases of only type 2 diabetes mellitus patients who reported to eye OPD through referral from diabetology OPD and ward, medicine OPD and ward for routine diabetes eye screening were examined. Results: Among 100 patients studied, 65 patients were females and 35 patients were males. The patients diagnosed with diabetes less than 1 year duration were 5%. Majority of population were between 1 to 5 years duration i.e., 60%. 64% had no dry eye symptoms and 36% had dry eye symptoms. 26% of patients had FBS less than 110mg/dl. 74% had FBS more than 110mg/dl. 25 patients had PPBS less than 160 mg/dl. 75 patients had PPBS more than 160 mg/dl. 85 patients had urea level less than 40 mg /dl. 15 patients had urea level more than 40 mg. 90 patients had Creatinine level less than 1 mg/dl.10 patients had Creatinine more than 1 mg/dl. 30 Schirmer test positive patients, 8 patients had 1 to 5 years of diabetes. 10 of them were 6 to 10 years of diabetes. 8 of them were 11 to 20 years of diabetes. The P value of above comparison was significant. 25 TBUT test positive patients, 4 of them were in 1 to 5 years duration of diabetes, 16 of the were in 6 to 10 years duration and 5 of them were in 11 to 20 years duration of diabetes. Conclusion: There was statistically significant positive correlation between the dry eye and duration of diabetes and severity of retinopathy. Hence, all the diabetic patients should be evaluated and screened at the earliest for retinopathy changes and presence of ocular surface disorders and treated accordingly. Early treatment would prevent complications associated with ocular surface disorders and diabetic retinopathy. They should be emphasized upon on need for regular follow up and maintaining a good glycemic control.

86. A Hospital Based Retrospective Assessment of the Clinicopathological Characteristics of Meningiomas at I.G.I.M.S., Patna
Samrendra Kumar Singh, Niraj Kanaujia, Brajesh Kumar
Abstract
Aim: The aim of the present study was to study the clinicopathological characteristics of intracranial meningiomas. Methods: This was a retrospective study conducted in the Departments of Neurosurgery at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The study period was of 4 years, between January 2019 to February 2023. All the patients diagnosed as intracranial meningiomas in our department were included in the study. Results: A total of 200 patients were included in the study. Meningothelial meningioma was most common histological type (40%, 80/200), followed by transitional (20%, 40/200) and psamommatous (10%). The WHO Grade I was seen in 180 (90%) patients, 10 (5%) had Grade II, and 10 (5%) had Grade III tumors. On analyzing cases of recurrence, we noticed a statistically significant relation with Simpson grade of excision. Of 200 patients, 140 (70%) were female and 60 (30%) were male. On the correlation of gender ratio with age, we found that females predominated males in the 4th, 5th, and 6th decade and this predominance is less pronounced in elderly and pediatric patients. Convexity meningioma was the most common subtype of meningioma, followed by parasagittal. We found that higher grade WHO Grade II and III meningiomas are more common in males as opposed to Grade I lesions which are more common in females, and the difference was statistically significant. Conclusion: Meningiomas are benign tumors which are more common in females. The supratentorial location is more common than infratentorial, pediatric meningiomas are aggressive, and recurrence of meningiomas depends on the histological grade and Simpson grade of excision.

87. Evaluation of Desarda’s Technique in Inguinal Hernia
Chandra Mohan Sinha, Hari Shankar Prasad, Sumit Mishra, Kashinath Pandit, Ravi Kant Kumar, Aman
Abstract
Aim: The aim of the present study was to evaluate the treatment of inguinal hernia with this method in terms of various operative and postoperative parameters. Methods: The present study included 200 patients, presented to depart of General  Surgery for elective repair of uncomplicated inguinal hernia, for the period of 2 years. All patients admitted to the surgery department signed a written informed consent. Results: 164 patients (82%) had a right sided hernia while 36 patients (18%) had a left side one. 180 of them (90%) had oblique hernia while 20 patients (10%) had direct one. As regard to the operative time (calculated from skin incision to skin closure), it ranged from 30-70 minutes with a mean of (46.24 ± 12.48). Technical difficulties presented in 28 patients (14%). 12 patients were obese and needed longer time for dissection with an operative time reached 70 minutes, and 12 patients had an unclear anatomy. The overall operative time for these patients was 70 minutes. The surgeons were almost satisfied with the procedure (in 95% of the patients). Surgeons were unsatisfied in 10 cases (5%) earlier in the study as they were not so familiar with the new technique which took longer time than expected (5 minutes). The cremasteric muscle was cut in 15 patients (15%) for better positioning of the external oblique flap. The three nerves (ilio-inguinal, ilio-hypogastric and genital branch of genito-femoral nerve) were identified and preserved in 172 patients (86%). The iliohypogastric nerve was cut in 18 patients (9%), while clear identification of the 3 nerves failed in 10 patients (5%). In the present study, seroma, wound infection and hematoma complications were noted. Conclusion: Desarda’s repair is easy to perform and is good in terms of postoperative pain, return to everyday activity and no foreign body sensation. Desarda technique could be indicated in young cases, infected surgical fields or in the presence of financial limitations or when patients refusing mesh or have a history of mesh rejection in another site.

88. Study to Identify Role of Preoperative Bilirubin Level in Predicting the Severity of Acute Appendicitis
Shashank Gaurav, Saurabh Kumar, P.K. Sachan
Abstract
Aim: The aim of the present study was to identify whether preoperative bilirubin level can predict the severity of the disease. Material & Methods: The study was conducted in the Department of General Surgery, Himalayan Institute of Medical Sciences, Dehradun, India for Eight months on 100 consecutive patients who were clinically diagnosed as acute appendicitis. These patients were evaluated with Alvarado score. In addition, preoperative bilirubin level and liver enzymes were estimated. Ultrasound abdomen was done preoperatively routinely. After surgery histopathology was studied. The parameters which showed statistically significant results for predicting complications were analyzed. Results: In the conducted investigation, the gender distribution revealed that 62 individuals (62%) identified as men, whereas 38 individuals (38%) identified as girls. Among the total of 100 instances, 45 were deemed to be complex in nature. Out of a total of 100 patients, 60 exhibited high levels of bilirubin whereas the other 40 instances had normal bilirubin levels. Among a sample size of 100 cases, it was observed that 40 patients had a total leucocyte count above 11000. Conclusion: Patients diagnosed with appendicitis who have increased levels of bilirubin are at a heightened risk for experiencing complications such as perforation, gangrene, and suppuration.

89. Comparing the Bupivacaine Heavy and 2-Chloroprocaine for Saddle Block in Perianal Day Care Surgeries: Observational Interventional Study
Rishi Kant, Nitin Kumar
Abstract
Aim: The aim of the present study was to compare the bupivacaine heavy and 2-chloroprocaine for saddle block in perianal day care surgeries. Methods: This observational interventional study conducted in the Department of Anesthesiology for 12 months. We included 100 patients in each group. Results: There was a statistically significant difference in the mean time for eligibility to discharge from the hospital between the groups, as shown by a p-value of less than 0.001. Group A exhibited a lower mean time (238.52 ± 22.78 min) in comparison to group B (342.58 ± 16.54 min). The average duration of stay in the Post-Anesthesia Care Unit (PACU) was found to be shorter in group A (65.35±6.64 min) compared to group B (77.23±8.52 min), with a statistically significant p-value of less than 0.001. The mean duration of ambulation differed significantly between group A (mean time: 184.36±20.38 min) and group B (mean time: 272.38±20.60 min), as shown by a p-value of less than 0.001. There was a statistically significant difference in the time required to void between group A (mean time: 222.38±20.48 min) and group B (mean time: 312.28±22.58 min), with a p-value of less than 0.001. There were no discernible disparities between the two groups with regards to demographic characteristics. The incidences of complications seen in our research, including as bradycardia, hypotension, headache, postoperative nausea and vomiting (PONV), and backache, were found to be similar in both groups. Conclusion: The use of saddle block anesthesia with 2-Chloroprocaine demonstrates adequate efficacy in achieving surgical anesthetic for perianal procedures, in comparison to the administration of low dosage hyperbaric Bupivacaine. Moreover, the utilization of 2-Chloroprocaine is associated with favorable outcomes, including faster release from the hospital, shorter duration of stay in the post-anesthesia care unit, and quicker recovery in terms of ambulation and micturition.

90. The Impact of a Combined Intervention Including Nutritional Education and Nutritional Supplements on Alterations in the Nutritional Status of Soon-to-be Married Individuals, with the Objective of Mitigating the Occurrence of Stunting in Neonates: A Comparative Study
Alokkumar Binod Kumar Singh, Rupesh Shinde
Abstract
Aim: The purpose of this study was to determine the effect of a combination of nutritional education and nutritional supplementation on changes in the nutritional status of the prospective bride and groom to prevent stunting in newborns. Methods: The present study included subjects from the three intervention groups was 150 people. The intervention group is group 1: nutrition education intervention (stunting material) +multi micronutrien, group 2: nutrition education (stunting material) IFA (iron folic acid) and group 3: nutrition education (reproductive health material) +IFA. Results: The average BMI value of the three groups on the subject of the bride and groom before the interventions were 21.64±3.16 kg/m2. The mean BMI after intervention was 22.08±3.12 kg/m2 with a difference change of 0.45±0.36 kg/m2. The results of the Wilcoxon test showed that there was a difference in the mean BMI before and after the intervention in all groups (p<0.05), meaning that there was a significant difference in the mean before and after the intervention. The statistical test showed that there was a significant difference in the mean BMI between the three groups (p<0.05). The provision of education and nutritional supplementation since the bride and groom (premarital) until delivery, based on the distribution of outcome variables, showed that of 150 newborns, 19 babies had a body length of <48 cm, namely stunting. And 18 had low birth weight (<2,500 grams). For the variable head circumference, 16 infants had abnormal head circumferences, i.e. <32 cm for male infants and <31 cm for female infants. The distribution of the number of cases at risk of stunting was highest in group 3 and the lowest cases in the group that received intervention in group 1. The average body length of the babies in the three groups was 49.21±1.36 cm. Conclusion: The intervention can change the parameters of the nutritional status of the subject and there is a relationship between weight gain during pregnancy and infant anthropometry.

91. Blood Group and Haemoglobin Levels in Rural Populations: A Hospital-Based Correlation Study
Suchita Kumari, Rohan Kumar, Mritunjay Kumar Azad, Abha Prasad
Abstract
Aim: The aim of the present study was to assess the association between blood groups and blood hemoglobin levels in rural population of Bihar region. Methods: The study was done after obtaining  in the Department of Physiology. A total number of 100 subjects were recruited for the study. The subjects were recruited from the common rural population in and around in the Bihar region. Apparently healthy males and females of the age group 18–45 years were included in the study. Results: In the present study, there were 65 male and 35 females. B +ve was the most common followed by O +ve blood group. O −ve was the least of all blood groups and we did not have any AB−ve blood group subjects in our study population. The mean value of all the blood groups in our selected population falls in the normal range, except for O−ve blood group. There were no significant differences in the hemoglobin values among the blood groups except between A+ve and O+ve blood groups. Total 32 adults are anemic, while remaining 68 adults are non-anaemic. In the present study, 19 female and 13 male were found to be anemic. In our study we found that adults with blood group B (15%) are more prone for anemia, followed by O (10%), blood group A (5%) and AB (2%). There was a significantly high value of hemoglobin occurring in the O+ve individuals (hemoglobin values of 15–16.5 g/dL) as compared to the A+ve individuals though the absolute values and mean values of the hemoglobin fall in the normal range only. Conclusion: Through this study, quantitative information regarding the mean values and differences in blood hemoglobin levels among the ABO blood groups obtained, the blood groups prone to anemia could be determined.

92. Assessment of Airborne Infection Control Practices and Adherence to National Airborne Infection Control Guidelines: An Observational Study
Alok Kumar Binod Kumar Singh, Rupesh Shinde
Abstract
Aim: The objective of the current study was to assess the health facilities for airborne infection control practices and adherence to the National airborne infection control guidelines. Methods: A cross‑sectional study was conducted in Department of Community Medicine, 100 health‑care facilities.  A checklist was developed based on the NAIC guidelines, which dealt with three main domains of infection control‑administrative control, environmental control, and personal respiratory protection measures. Results: Most of the facilities had infection control committees 72 (72%). Annual infection control trainings were held for staff in 38 (38%) facilities, but 40 (40%) of facilities were familiar with NAIC guidelines. Counselling on cough etiquette/hygiene practices in registration/ waiting areas was practiced in 10 (10%) institutions. Cross ventilation was present in OPDs in 55 (55%) institutions. Fast‑tracking of respiratory symptomatic in OPD was practiced in 18 (18%) institutions. Segregation of respiratory symptomatic was practiced in 18 (18%) of the facilities. The provision of providing masks to respiratory symptomatic was present in 28 (28%) of institutions. Sputum was disposed of properly in 87 (87%) institutions. N95 masks were available in high‑risk settings in 14 (14%) health facilities. Conclusion: There exist deficiencies in adherence to all components of NAIC guidelines including administrative, environmental, and use of personal protective equipment in both government and private hospitals in the state.

93. Assessing Accuracy of Hysteroscopy in the Diagnosis of the Cause of Bleeding in Women with Abnormal Uterine Bleeding: An Observational Study
Nilam Bharti, Ranjana Kumari, Girija Kumari, Sweta Rani
Abstract
Aim: The aim of the present study was to assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine bleeding. Material & Methods: This prospective observational study was conducted on 100 patients attended the Department of Obstetrics and Gynecology between the duration of 1 year and to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding. Results: Majority of the patients belonged to 31-40 years age group. Of the 120 patients, majority, 43 had symptoms for more than 1 year, 34 patients had symptoms for 6 months to 1 year and 23 patients had symptoms for less than 6 months. Majority of the patients presented with menorrhagia. The second commonest was post-menopausal bleeding in 16 cases. There were 15 cases with polymenorrhagia and 13 patients with Hypomenorrhea. Out of 100 patients, 26 had proliferative followed by 23 secretary. Histopathology findings corroborate the Hystereoscopically detected cases of hyperplasia, atrophic endometrium and endometritis. Both hysteroscopy and curettage were accurate when an abnormality was diagnosed, giving a specificity of 96.4% and 96.4% respectively and positive predictive value of 95.2% and 94.4% respectively (Table 6). The ability to diagnose a lesion was more with hysteroscopy i.e. sensitivity in comparison to curettage, (90.9% versus 77.4%) while a negative diagnosis was less wrongly made with hysteroscopy in comparison to diagnostic curettage. Conclusion: Hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value and the results of hysteroscopy are immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with abnormal uterine bleeding for accurate diagnosis and further treatment.

94. Evaluation of the Preperitoneal Mesh Method for the Treatment of Incisional Hernias in a Prospective Clinical Study
Satyendra Kumar, Mritunjay Kumar, Rajesh Narayan
Abstract
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 200 patients with incisional hernia managed by Preperitoneal mesh repair in Department of General Surgery during the period of 1 year. Results: In the present study, there were 60 male and 140 females. Most of the patients belonged to 31-50 years age group. 144 (72%) patients had midlines incision causing the incisional hernia. This was followed by Pfannensteil incision in 20 (10%) and paramedian incision in 12 (6%) patients. Major wound infection was encountered in 16 patients (8%) but the mesh was not removed in any of the cases. Only 20 patients had seroma formation. There were no postoperative complications in 82% of cases. Conclusion:  Preperitoneal meshplasty found to be efficient method of incisional hernia repair with less post- operative complications.

95. Outcome Assessment of Surgical Management of Both Bones Forearm Fracture with Locking Compression Plate: An Observational Study
Aditya Kumar, Rakesh Kumar
Abstract
Aim: The objective of the study was to evaluate the functional outcome of both bone forearm fractures with locking compression plate. Methods: This prospective study was conducted in the Department of Orthopaedics for the period of 1 year. A total of 50 patients were included in our study. The study was conducted after obtaining written informed consent from the patient and patient attenders and patients who met the inclusion and exclusion criteria were studied. Results: Our study population age ranged from 18 to 60 years, 18 years being the youngest patient and 60 years our oldest patient. Mean age of our study population was 31.3 years. Majority of the patients belonged to 21-30 and 51-60 years age group (24%). There were 60% male and 40% females. About 56% of the participants (n = 28) had a fracture on the left side and 44% of the participants (n = 22) had a fracture on the right side. About 15 participants (30%) had a mid-diaphysis fracture, 5 participants (10%) had a fracture at the upper one-third, and the remaining 30 patients (60%) had a lower one-third fracture of the radius and ulna. The majority of the fractures were transverse 30 (60%), 13 (26%) were short oblique type, 5 (10%) were comminuted type, and 2 (4%) was segmental fracture type. About 15 participants (30%) had a mid-diaphysis fracture, 5 participants (10%) had a fracture at the upper one-third, and the remaining 30 patients (60%) had a lower one-third fracture of the radius and ulna. The majority of the fractures were transverse 30 (60%), 13 (26%) were short oblique type, 5 (10%) were comminuted type, and 2 (4%) was segmental fracture type. A road traffic accident was a common cause of injury in the study population constituting 21 (42%), followed by fall while playing in 13 (26%), self-falls in 11 (22%), and fall from height in 5 (10%). Conclusion: The incidence of both bone fractures is more in this modern era and if it is treated conservatively the results are poor and so require a stable fixation to achieve fracture union with good functional outcome. Hence ORIF with LCP is a safe and effective option in the fixation of both bone forearm.

96. A Study to Assess the Clinical Profile of Patients with Acute Kidney Injury Following Acute Gastroenteritis: A Prospective Study
Vijay Gadhia, Darshankumar Parmar, Sanket G. Makwana
Abstract
Aim: The aim of the present study was to assess the clinical profile of patients with acute kidney injury following acute gastroenteritis. Methods: The Present study was conducted in patients who were diagnosed to have AKI following acute gastroenteritis. Study was prospective, observational type. Study was conducted in Department of General Medicine for the period of one year. Total 100 patients of AGE with AKI were considered for this study. Results: Most common age group in this study was age group of 61–70 years (30%), followed by age group of 51–60 years (26%). Mean age of study patients was 54.6 ± 12.8 years. Male patients (65%) were more than female patients (35%). According to clinical presentation most common symptom was loose stools (100%), followed by fever (78%) and vomiting (66%). Other complaints were shortness of breath (20%) and altered sensorium (16%). AKI was staged for severity according to the KDIGO criteria2. At the time of diagnosis most patients were in stage 1 (60%), while 30% and 10% were in stage 2 and 3 respectively. Conclusion: Acute kidney injury in patients with acute gastroenteritis had good prognosis if detected earlier. Early recognition of AKI is essential to ensure prompt and appropriate management, and to avoid progression to deadlier stages of the disease.

97. A Hospital Based Observational Cross Section Study of Pulmonary Hypertension in Patients with Chronic Kidney Disease
Gopal Prasad, Kumar Abhinav, Sujay Ranjan
Abstract
Aim: The aim of the present study was to assess the occurrence of pulmonary arterial hypertension in chronic kidney disease and to study the risk factors for development of pulmonary arterial hypertension (PH) in these patients. Methods: This was an observational cross sectional study conducted on 200 patients of CKD (based on KDIGO 2012 criteria) attending Medicine OPD or admitted to the Nephrology wards in Patna Medical College and Hospital, Patna, Bihar, India for one year. Results: Pulmonary hypertension was found in 120 patients (60%) of the study population. No significant association was seen between age, BMI, presence of diabetes and s.uric acid with presence of  PH. Significant association was seen with systolic and diastolic blood pressure with PH. Significant association was also seen with severity of CKD & PH. Presence of hemodialysis and dialysis duration were significantly associated with PH. Of 120 patients with PH, 45 patients (37.50%) had mild PH, 65 patients (54.16%) had moderate PH and 10 patients (8.34%) had severe PH. Conclusion: We concluded that pulmonary arterial hypertension is significantly associated in patients of CKD and increase in severity of PAH occurs with deterioration of renal function in CKD cases. Anemia, duration of dialysis, hypertension, hyperparathyroidism, AV fistula, increased calcium phosphate product and left ventricular failure are risk factors for development of PAH.

98. A Retrospective Study Assessing Clinic-Epidemiological and Risk Profile of Ectopic Pregnancies
Suchandra, Renu Jha, Kumudini Jha
Abstract
Aim: The purpose of this study was to appraise all the cases of ectopic pregnancy managed at a tertiary care centre and to determine the incidence, risk factors, clinical presentation, management and morbidity associated with ectopic pregnancy. Methods: This retrospective study was conducted at Department of Obstetrics and Gynaecology for one year. The case records of patients diagnosed with EP were retrieved from the medical records department. Total 200 patients were reported. Results: About 78% of the women were in the age group of 21-30 years. About 79% of patients in the study belonged to low socioeconomic status. Ectopic pregnancies were more common among multigravida (78%). In present study, tubal surgeries (sterilisation and tubal recanalisation) were found in 30% followed by previous abortion (18%). 28% of patients had no identifiable risk factors. 90% of patients had amenorrhoea, 96% of patients presented with pain abdomen, 35% of patients had bleeding per vaginum. 13.7% of patients presented with features of shock. 50% of patients had anaemia due to hemoperitoneum. 26% of patients had abdominal distention. Abdominal tenderness was present 80% of the patients. Cervical movement tenderness was present in 46% and forniceal tenderness in 68% of patients. Adnexal mass was palpable in 13%. Among tubal ectopic pregnancies majority of cases were ampullary pregnancies (62%) followed by isthmus (22%), fimbrial (13%) and cornual (3%).31% of patients had more than one litre of blood loss. 20% underwent laparoscopic salpingectomy. Among laparotomy, salpingectomy was done in 60%, partial salpingectomy in 16% and partial ovariotomy in 4%. Conclusion: Ectopic pregnancy is still a major challenge in gynaecological practice. Early diagnosis and early referrals are the key to successful management. It is better to over diagnose an ectopic pregnancy especially in a rural setup. Most cases present late, making tubal conservation treatment inapplicable.

99. Analysis of Electrolyte Abnormalities in Children with Diarrhoea in Relation to Their Type of Feeding: An Observational Study
Kumar Arpit, Rizwan Akhtar, Alka Singh
Abstract
Aim: This study was mainly aimed at analysing electrolyte abnormalities in children with diarrhoea in relation to their type of feeding. Material & Methods: This cross-sectional observational study was conducted in Department of Pediatrics over a period of 2 years. Total of 200 children presenting to pediatric unit with acute diarrhoea under five years of age were selected. Results: The mean age of the study participants was 25.05±18.12 months. The median age of the study participant was 18.12 (interquartile range=9.0-36.5) months. The minimum age was 1.1 months and the maximum age was 60 months. Majority of the children belongs to the age category of less than one year which was 48%. Out of 200 children, 60% were males and 40% were females. In electrolyte imbalance, majority of the participants had hyperkalemia which was 30% followed by 20% had hyponatremia, 15% had hypokalemia, 10% had hypernatremia and 1% had chloride level more than 108 mmol/l. Sodium levels, potassium levels and chloride levels were equally distributed in both the groups with the p value of more than 0.05. Conclusion: With the exception of hypokalaemia, our investigation did not identify a statistically significant correlation between electrolyte abnormalities in pediatric diarrhoea and the manner of feeding. However, it is important to note that the need for exclusive breastfeeding and the continuation of breastfeeding for a period beyond two years continue to have a protective effect against the occurrence of acute diarrhoea in children.

100. Comparative Assessment of Dexmedetomidine-Fentanyl and Dexmedetomidine-Pentazocine for Monitored Anesthesia Care during Tympanoplasty Surgery: A Randomized Clinical Study
Krishna Kumar
Abstract
Aim: The purpose of the study was to compare Dexmedetomidine- Pentazocine and Dexmedetomidine-Fentanyl in terms of VAS, RSS and Haemodynamic parameters. Methods: A prospective, randomized controlled study was undertaken in  Department of Anesthesiology for the period of two years. This study was approved by institutional research and ethical committee. Informed consent was taken from the participants before the procedure. The patients were randomly assigned into two groups, DF and DP with 50 participants in each groups. Results: The demographic data in terms of age and sex were compared in both groups and not significant statistically. Changes in Haemodynamic parameters (Diastolic Blood Pressure, Systolic Blood Pressure, Heart Rate, Respiratory Rate, and SPO2) were recorded and compared between both groups. The Haemodynamic parameters are highly significant statistically. Haemodynamic parameters of group DF were stable than group DP. Intra-operative mean Ramsay Sedation Score (RSS) in group DF was 2.7138±0.4723 while group DP was 2.348±0.5232. Group DP required more sedation than DF and was highly significant statistically. The VAS score was higher in group D-F with statistically insignificant difference from 10 minutes onwards throughout the entire duration of surgery. In group D-P, patients required more rescue dose of analgesic (Pentazocine) than group D-F. The more satisfactory results were noted on Dex-Fentanyl than Pentazocine. Conclusion: We concluded that, Dexmedetomidine-Fentanyl is a better combination than the Dexmedetomidine-Pentazocine for Monitored anesthesia care in Tympanoplasty surgery.

101. A Retrospective Study to Assess the Outcome of Single-Stage Continent Reconstruction of Composite Pericommissural Defects using a Combination of Pacman-Style Free Radial Forearm Flaps and Modified Elastic Musculomucosal Flaps: An Observational Study
Setubandhu Tiwary, C. M. Narayan
Abstract
Aim: The aim of the present study was to evaluate the efficacy and the outcomes of Single-Stage Continent Reconstruction of Composite Pericommissural Defects Using a Combination of Pacman-Style Free Radial Forearm Flaps and Modified Elastic Musculomucosal Flaps. Methods: This retrospective cohort study was conducted in the Department of Surgery for the period of 1 year. 50 patients underwent this type of reconstruction using a combination of PFRFF and OEMMF for the CPECPC defects. Results: Of the 52 patients, 40 were male and 10 were female. Ages of the patients were in the range of 35 to 52 years with an average age of 41.7 years. The CPECPC defects included 20% of the lateral upper lip and up to 36% of the lateral lower lip defects. The average score obtained at the end of the follow-up period was 11.7 (p=0.038) using the institutional assessment scoring system which evaluated both the overall aesthesis and function of the neocommissure and modiolus. 96% of cases (48 out of 50 patients) started regaining continence of the oral cavity as early as third post-operative week. All the cases had regained complete oral continence with re-establishment of all functions of the lip at the 6-month post-operative period. Conclusion: The combination of oblique elastic musculomucosal flap and Pacman-style free radial forearm flap for the reconstruction of composite commissure and pericommissure defects may be a useful addendum from the point of re-establishing the aesthesis and continence in the reconstructed lips.

102. A Hospital Based Assessment of ST Elevation Myocardial Infarction of Inferior Wall and Right Ventricle in Rheumatic Mitral Stenosis Due to Thrombus at Right Coronary Sinus
Abu Huraira, Rajneesh Kumar, Brajesh Kumar, Prattay Guha Sarkar
Abstract
Aim: The aim of the present study was to evaluate ST elevation myocardial infarction of inferior wall and right ventricle in rheumatic mitral stenosis due to thrombus at right coronary sinus. Methods: The present study was conducted in the Department of Cardiology, Acute MI was diagnosed by the presence of at least 2 of the following criteria: electrocardiographic changes, significant rises in myocardial bound creatine kinase fraction, and typical chest pain. Inferior wall MI was diagnosed by electrocardiography, echocardiography and coronary angiography. In patients with non-ST elevation MI, echocardiography and coronary angiographic findings were used for determination of the diagnosis of inferior wall MI. There were total 200 patients included in the present study. Results: There were no differences in age, sex and other frequencies of underlying diseases among the 3 groups. There were no differences in the modality of intervention, severity of coronary artery disease. 147 (73.50%) patients had the culprit lesion in the right coronary artery and 53 (26.50%) patients had the culprit lesion in the left circumflex artery. Patients whose culprit lesion in the left circumflex artery had an increased frequency of more severe MR than those with the culprit lesion in the right coronary artery, but this difference did not reach statistical significance. There were no significant differences in annular area within the 3 groups. However, patients with mild or moderate MR had larger tenting area than those without MR. Conclusion: In the acute phase of inferior wall MI, MR was associated with LV systolic dysfunction with tethering. Therefore, it can be suggested that reduced closing force as a consequence of LV systolic dysfunction in the presence of leaflet tethering would play a more pivotal role in the development of MR in the acute phase of inferior MI, whereas increased tethering forces through a combination of annular dilation and geometric remodeling of the LV would be more important contributor in the chronic phase.

103. Study to Determine the Effect of Phototherapy on Serum Magnesium Level in Term Neonates with Hyperbilirubinemia: An Observational Study
Rupesh Kumar, Juli, Akhilesh Kumar
Abstract
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 200 eligible neonates admitted in the Department of Neonatology, receiving phototherapy for the period of one year.  informed consent was obtained from the parents of the selected neonates. This study included 200 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 200 full‑term neonates with jaundice who received phototherapy for treating neonatal indirect hyperbilirubinemia, comprising 130 (65%) males, and 70 (35%) females, with the mean gestational age of 37 ± 0.8 weeks and mean postnatal age of 5.4 ± 1.3 days. There were 68 (34%) neonates delivered by normal vaginal delivery and 132 (66%) neonates delivered by cesarean section. Mean birth weight was 3.2 kg. Subjects have a mean intrauterine age of 38.45 weeks and a jaundice onset age of 3.67 days. The mean difference of jaundice onset age, intrauterine age, admission weight and mother’s age were not significant. Serum total magnesium level in single and double phototherapy decreases after treatment, but this decrease is significant only in the double phototherapy group (P = 0.032). In the intensive group, this parameter has slightly increased, which is not statistically significant (P = 0.575). The serum total magnesium level and its changes were reported in three groups before and after phototherapy. The serum magnesium level in new borns before treatment was normal in all three treatment groups. The status of each patient showed that single, double, and intensive phototherapy groups have magnesium content of more than 2.2 mg/dl, respectively. 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.

104. Assessment of the Functional Outcome of Osteosynthesis of Tibial Plateau Fractures using Different Surgical Techniques
Abhinav Kumar, Abhishek Anand, Swati Singh, Puja Sinha
Abstract
Aim: The aim of the present study was to evaluate the functional outcome of osteosynthesis of tibial plateau fractures using different surgical techniques after a minimum period of 6 months by using Rasmussen scoring system. Methods: A prospective longitudinal study was conducted for a period of one year at department of Orthopedics. All patients with proximal tibial fracture in the age group between 20 and 60 years were included as our study subjects. Patients presented with neurovascular injuries were excluded from the study and a total of 50 patients satisfying our inclusion and exclusion criteria were taken as our study subjects. Results: In our study majority of the study patients were in the age group between 30 and 50 years with more males as compared to females. The type of tibial plateau fracture was classified as per Schatzker classification. In the present study it is shown that type II tibial plateau fracture (40%) was the most common type followed by type VI fracture (22%) and type V (14%) and the incidence of type I, III and IV was 8%. In our study for patients with type I tibial plateau fractures closed reduction with cancellous screw fixation was performed for all the patients, among patients with type II fractures open reduction with internal fixation along with elevation plateau and buttress plating was done for majority of the subjects and for 7  patients with type II fractures bone grafting was done along with this procedure and a similar type of procedure was performed for patients with type III, IV and V tibial plateau fractures. ORIF with dual plating was performed for majority of the patients with type VI fractures. Conclusion: In the management of tibial plateau fractures, open reduction with internal fixation using plate screws with lesser soft tissue dissection would lead to excellent functional outcome.

105. A Study to Explore the Extent of Coagulation Profile and its Correlation with the Severity of TBI
Sandeep Yadav, Madhu Priya
Abstract
Aim: The aim of the present study was to explore the extent of coagulation profile derangements, its correlation with the severity of TBI, and clinical outcome. Methods: The study was performed on patients with isolated head injury in department of General Surgery for one year . A total of 100 patients in the age group of 20 to 70 years were studied. Results: Majority of the patients belonged to the age group 41-50 years followed by 51-60 years. 80% were male and 20% were females in the present study. Road traffic accident was the primary (75%) mode of injury. In patients with MHI, 64% of the study population had coagulopathy while 48% of the patients with SHI were found to have coagulation abnormalities. The patients with SHI were divided into two groups. The first group included 40 patients and had GOS 1 or GOS 2. The second group included 8 patients and had GOS 5. p-Value for DIC score was < 0.001 and is statistically significant. p-Value in both PT and APTT was < 0.05 and was significant. However, it was not significant for D-dimer, fibrinogen, and platelet counts. In patients with MHI, p-value in case of DIC score, platelet count, APTT, and D-dimer was < 0.001 and was highly significant. p-Value in PT was < 0.05 and found to be statistically significant, however, it was not significant for fibrinogen. Conclusion: The patients of isolated head injury are at high risk of developing coagulation abnormalities. Coagulopathy is directly associated with the severity of TBI, GCS, and is independently associated with poor outcome. DIC score is a useful parameter in the prediction of prognosis of head injury patients. The timely intervention in such patients can help improve prognosis. The analysis of coagulation parameters are useful predictors of outcome and can be used to explain the relatives about prognosis and course of the patient during the hospital stay.

106. An Observational Study to Investigate the Head and Neck Mucormycosis in Patients with Prior COVID-19 Infection
Puja Priyadarshini, Satyendra Kumar Jha, Pranava Dutta Verma
Abstract
Aim: The aim of the present study was to investigate the head and neck mucormycosis in patients with prior COVID-19 infection. Methods: This cross-sectional study was conducted in the Department of Plastic Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India, We obtained the information by examining the data of patients who visited Hospital  with head and neck mucormycosis infection that occurred during or after the course of Covid-19 infection for the period of one year. Among all 50 patients were included. Results: 30 (60) were men and 20 (40) were women, with a mean age of 56±12.6 years. 21 patients died due to mucormycosis, with a mean age of 60.0 ± 12.0 years (P-value=0.065), and those who survived had a mean age of 52.4 ± 12.0 years. The correlation of the clinical symptoms with the recurrence of mucormycosis and the outcome of the cases showed statistically significant differences in the outcome of patients with positive visual symptoms and orbital bone involvement. Conclusion: The COVID-19 pandemic has caused an increase in the occurrence of mucormycosis, a fungal infection. This global health challenge has also led to a rise in secondary illnesses, including mucormycosis. Specifically, Rhino-orbito-cerebral mucormycosis (ROCM) in the head and neck area has been found to have a high mortality rate and can cause severe damage to the eyes, bones, and surrounding tissues. This investigation has established a clear connection between mucormycosis and visual impairment, involvement of the ethmoidal bone, and orbital involvement, all of which contribute to a higher mortality rate. Diagnosing mucormycosis in COVID-19 patients is challenging due to the absence of specific clinical features and reliable diagnostic tests.

107. Assessing Utility and Efficacy of Bleeding Care Unit (BCU) in the Management of Upper GI Bleeding
Manish Kumar Bhaskar
Abstract
Aim: The aim of the present study was to study the utility and efficacy of bleeding care unit (BCU) in the management of upper GI bleeding. Methods: The present study was conducted in the Department of Gastroenterology for one year and collected the data of all upper GI bleeding patients admitted in bleeding care unit. A total of 200 patients were admitted with UGI bleed. The data collected for both the groups of patients included the history, examination, laboratory investigations, and different outcomes. Results: Of the 200 patients studied, 50 belonged to pre-BCU group and 150 patients were admitted in BCU. 20 and 60 patients had comorbid illnesses in both groups respectively. Maximum patients had esophageal variceal bleed. The length of days and time to endoscopy were found to be significant. The mean (SD) time from admission to EGD improved after implementation of BCU and pathways from 21.3 (7.4) to 9.42 (9.9) hours. Conclusion: We found that BCP implementation in UGI bleeding management was useful if practiced over longer time period.

108. Lipocalin2 and Other Inflammatory and Angiogenic Variables in the Vitreous of Diabetic Macular Edema and Proliferative Retinopathy
Santosh Kumar Sethi, Satyanarayan Mallik, Soumya Ranjan, Suroma Joysmine Marandi, Sarita Panda
Abstract
Study participants had either diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR), and researchers looked for angiogenic and inflammatory factors in their vitreous. The study included 30 diabetics; 22 of them had PDR and 8 had DME. The procedure for collecting samples did not include diluting anything. “Thirteen individuals without vitreomacular interface pathology (n = 3), including four with full-thickness macular hole (FTMH), four with vitreomacular traction syndrome (VMT), and five with idiopathic epiretinal membrane (iERM), were also included in the sample pool. Cytometric flow analysis was used to measure the concentrations of several cytokines and growth factors, including IL1b, IL6, IL8, IL27, TNFα, ICAM-1, VCAM, MCP-1, VEGFA, and LCN2.  Patients with PDR had elevated median concentrations of the following biomarkers compared to controls: LCN2, IL6, IL8, IL1b, IL27, ICAM-1, VCAM-1, MCP-1, TNFa, and VEGFA. On a related note, the median levels of IL6, IL8, IL27, ICAM-1, VCAM-1, TNFa, and VEGFA were all greater in DME patients compared to controls. The median LCN2 concentration in the diabetes patients was 6,822 pg/ml (IR = 3,645 pg/mL), which is quite a difference compared to the control group’s 3,697 pg/ml (IR = 3,456 pg/mL). Further, the median LCN2 levels were 5,896 pg/ml in the PDR group and 7,445 pg/ml in the DME group, with IR = 7,9601 and 3,719, respectively (p = 0.03).” For both PDR and DME, our findings point to the involvement of many inflammatory and angiogenic mechanisms in their pathogenesis. Since elevated vitreous LCN2 levels may correlate with the onset of PDR in individuals with DME, this protein may be an appropriate target for therapy. To provide further evidence, additional long-term study is necessary.

109. Prevalence of Road Traffic Injuries and Associated Risk Factors: A Community Based Cross Sectional Study
Madhu Priya, Sandeep Yadav
Abstract
Aim: The aim of the present study was to estimate the prevalence of road traffic injuries (RTIs) and  associated risk factors among residents of Bihta, Patna. Material & Methods: This was a cross-sectional study conducted among 500 study subjects selected from urban and rural field practice area of the Department of Community Medicine, NSMCH, Bihta, Patna. Data was collected by personal interview using a pre-designed, pre-tested structured questionnaire. Result is presented in percentages and association was tested using logistic regression analysis. Results: In the present study, the overall prevalence of RTI was found to be 4%. The prevalence of RTI was higher amongst males compared to females. RTI was also significantly higher among participants in the age group of 18-30 years and among people who were unelmployed. In the final multi-variate analysis, people belonging to age group of 18-30 years and >50 years, unemployed, married and having graduation degree were found to be significantly associated with RTIs. Conclusion: Our present study found a high prevalence of RTIs with risk factors like young age group, male gender, alcohol consumption and driving in rural areas. A constant increase in the number of motor vehicles, rampant encroachment of roads, unscientific construction of subways and under passes at highways, extremely high speed driving at the highways, ignorance regarding wearing helmets among riders of two wheelers, nasty tendency of violating traffic rules, anarchic traffic systems and population explosion have greatly contributed to rapid increase in road traffic accidents and thus RTI injury cases. Hence, preventing the occurrence of such injuries can greatly reduce fatalities.

110. A Hospital Based Study to Assess the Importance of Influence of Exercise on Diabetics and Hypertensive Patients
Abha Prasad, Mritunjay Kumar Azad, Malti Kumari
Abstract
Aim: The aim of the present study was to assess the importance of influence of exercise on diabetics and hypertensive patients. Methods: The study was a cross-sectional study, all the patients attending the medicine Out Patient Department  for 15 months. It is a cross sectional study, 200 patients having both hypertension and diabetes were selected including both males and females of age group 35-50 years. Results: Among 200 study population, 117 (58.5%) males and 83 (41.5%) females are categorized following age groups from 35-50 years. In this study of 200 diabetic patients, 100 patients were regularly doing exercises, in that 65 (65%) had a controlled diabetic status and 35 (35%) were not under control; 100 patients were not doing exercises regularly, in that 35 (35%) had a controlled diabetic status and 65 (65%) were not under control. P value <0.001 showed statistically significant. In this study of 200 hypertensive patients, 100 patients were regularly doing exercises, in that 62 (62%) had a controlled hypertensive status and 38 (38%) were not under control; 100 patients were not doing exercises regularly, in that 38 (38%) had a controlled hypertensive status and 62 (62%) were not under control. P value <0.001 showed statistically significant. Conclusion: The study found that known cases of type 2 diabetic mellitus and hypertension are benefitted by regularly doing exercise when compared with not doing exercise. The various studies suggest that T2DM patients and hypertension require reinforcement of DM education including dietary management through health-care providers, health facilities, etc.) to encourage them to understand the disease management better, for more appropriate self-care and better quality of life.

111. A Hospital-Based Assessment of the Prevalence of Bacterial Meningitis in Children with Apparent Febrile Seizure
Ruby Kumari, Chandan Kumar, Kishore Kumar Sinha, Satish Kumar
Abstract
Aim: The aim of the present study was to determine the frequency of meningitis in children with FS( febrile Seizure )and related risk factors. Methods: This cross-sectional study was performed on 550 patients aged 6 months to 6 years who had first attack of seizure with fever in the Pediatric Ward of Jawaharlal Nehru medical College and Hospital, Bhagalpur, Bihar, India from December 2021 to September 2022.Patients were divided into 2 groups. Those with simple febrile  seizure with one tonic colonic seizure attack for less than 15 minutes. Those cases who had multiple attacks or seizures lasting more than 15 minutes, or had focal seizures were categorized as complex FS. Results: Of those 300 patients were male (54.54%) and 250 were female (45.45%). In children who had not undergone an LP, meningitis could be excluded according to clinical status. The majority of patients with meningitis and all patients with bacterial meningitis were in the age group less than 18 months old. The majority of patients with meningitis had presented with their first attack of FS (45 cases, 90%) when compared with patients with a normal LP (44%) and this was statistically significant (p<0.001). 17 patients with meningitis (34%) and 180 patients with a normal LP (36%) were been pretreated with antibiotics before admission and this was not statistically significant. According to logistic regression analysis, independent variables for predicting meningitis were neurological deficits, postictal drowsiness, body temperature, level of Hb, and WBC. Postictal drowsiness (p=0.001), neurologic deficit (p=0.000), and body temperature ≥38.5oC (p=0.032) were among the clinical signs, which were statistically significant predicting factors for meningitis. Laboratory tests including white blood count (WBC) ≥15000 mm3 (p=0.002), and hemoglobin (Hb) <10.5 gr/dl (p=0.010) also had statistical significance in predicting meningitis. Conclusion: In conclusion, our findings suggested that the frequency of bacterial meningitis in children who presented with febrile  seizure (FS) is not high. Meningitis is more common in patients less than 18 months old with febrile  seizure (FS); however, complex features of seizures, first attack of FS or impaired consciousness seem to be significant risk factors for meningitis and an LP should be in mind in this situation.

112. A Hospital Based Study Evaluating the Outcomes of Total Hip Arthroplasty Patients
Sanjeet Kumar, Rajeev Kumar Rajak
Abstract
Aim: The aim of the present study was to compare the harries hip score as a patient self-report and a physician-assessed instrument in evaluating the outcomes of total hip arthroplasty patients. Methods: This study is based on a cohort of 50 patients with 50 primary THAs who were a minimum of 1-year post surgery in the Department of Orthopedics, Government medical college West Champaran, Bettiah, Bihar, India. Results: There were 16 men and 34 women, with a mean age of 69 years. 21 patients had done post-graduated study and 60% had unilateral hip involvement. The mean HHS by self-report questionnaire was 76.0 ± 19.0; the surgeon-assessed HHS was 78.7 ±18.7. The WOMAC scores at clinical follow-up were pain, 2.3 ± 3.1; stiffness, 1.8 ± 1.7; and physical function, 15.3 ± 12.3. The SF36 scores at clinical follow-up were general health, 74.9 ±17.6; physical function, 47.8 ± 28.1; role physical, 55.5 ± 41.4; and bodily pain, 64.6 ± 26.4. The Pearson correlation for the 3 WOMAC scales ranged from 0.90 to 0.96 (P<.0001); for the 8 SF36 scales, the range was 0.78 to 0.97 (P<.0001). The highest Pearson correlation coefficient was noted for the self-report HHS and physician-assessed HHS at 0.99 (P<.0001). The n statistics evaluate the level of agreement between the 2 methods of administration that exists beyond chance. Values >0.75 indicate excellent agreement and are considered sufficient for most instruments in which group level comparisons are being considered. The values for the n statistic for each item of the HHS ranged between 0.79 and 1.00 (P<.0001). Conclusion: The performance of a patient self-report HHS is comparable to that of a physician-administered HHS. Because a self-report format offers several advantages over a physician-administered format, greater consideration should be given to its use in evaluating the outcomes of THA.

 

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