1.
A Study Assessing the Association between Antibody Titers and Nutritional Status in Paediatric Population Diagnosed with Measles
Swesh Chandra, Debasis kr Samanta
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 12 months on 1–12-year-old children attending the Pediatric O.P.D. of Department of Pediatrics, Department of Pediatrics, Dr.Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India 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: Majority (70%) of the total subjects had been vaccinated against measles. However, the relationship between age and vaccination status was not found to be statistically significant (p=0.155). No statistically significant difference was observed in the baseline characteristics of vaccinated and unvaccinated group except for mean weight for age Z score which was significantly lower in the unvaccinated group. 41% of the total subjects ≤5 years old had severe wasting (severe acute malnutrition), while 32% had moderate wasting. In children > 5 years, 22% had severe thinness, 11.60% had thinness and only 2 (0.2%) case was overweight. 42.85% of the vaccinated subjects ≤5 years old had severe wasting (severe acute malnutrition), while 34.28% had moderate wasting. A highly statistically significant relationship was observed between BMI Z scores (in subjects aged ≥5yrs) and seropositivity, with higher seropositivity being noted in children with higher BMI z scores. Similarly, a statistically significant relationship was observed between height for age Z scores and seropositivity, with higher seropositivity being noted in children with higher height for age z scores.
Conclusion: Nutritional status of children has an association with measles antibody titres as well GMT of measles specific IgG antibody, with those with better nutritional status having higher measles antibody titres.
2.
Intrauterine Insemination: A Retrospective Review on Determinants of Success
Bhawana Tiwary, Kalpana Singh, Shubhanti Kumari, Huma Nishat
Abstract
Aim: The aim of the present study was to determine the prognostic factors such as female patient’s characteristics and of semen parameters on the pregnancy rate following intrauterine insemination.
Methods: In this retrospective study, we reviewed the medical records of women who underwent IUI at Indira Gandhi Institute of Medical Sciences, Sheikhpura Patna for one year. Records of 100 women who had undergone 100 IUI cycles using sperm from their partners were reviewed. Patients were excluded based on the lack of sufficient treatment data.
Results: A total of 100 IUI cycles were analysed. The overall pregnancy rate per cycle and per couple was 4.6% (15/320) and 16% (16/100) respectively. The average female and male age was 25.5 + 5.30 years and 32.8 ± 4.6 years respectively in the participants with positive IUI result. Both were not statistically significant. Duration of infertility, type of infertility, endometrial thickness, number of follicles, size of follicles, sperm count, sperm motility and single/double IUI did not significantly affect the outcome of IUI. However, logistic regression analysis showed significant relationship between pregnancy occurrence and number of follicles and number of IUI cycles.
Conclusion: The findings of this study showed that age of the couple, duration of infertility, endometrial thickness, size of the follicles, sperm count and sperm motility did not correlate with pregnancy occurrence in an IUI cycle but number of follicles and total IUI cycles correlated with the occurrence of pregnancy.
3.
A Hospital Based Analytical Observational Study Assessing the Risk Factors for Cesarean Delivery in Induced Labor at Term
Priti Kumari, Rashmi Kumari, Archana Jha
Abstract
Aim: The aim of this study was to identify those factors which influence the risk of emergency cesarean delivery in induced labors at term.
Material & Methods: A case–control study was conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India over a period of one year. A total of 150 women were studied, out of which 50 women delivered by emergency caesarean section and 100 women delivered vaginally. The cohort included all women with a live singleton fetus in the cephalic position and induced at term (C37 weeks). Cases were women who delivered by emergency caesarean section and controls were women with a vaginal delivery among the cohort. Informed consent was taken for all patients.
Results: Factors associated with cesarean delivery were analysed. Our study had shown that maternal age C35 years, BMI C30 kg/m2, nulliparity, preinduction Bishops score less than 5, gestational diabetes mellitus, and intrauterine growth restriction are significantly associated with caesarean delivery. The presence of epidural analgesia, gestational hypertension, postterm pregnancy, and premature rupture of membranes was not associated with significant increase in cesarean delivery if labor was induced at term.
Conclusion: A vaginal delivery is the best choice for both mother and child. However, it is better to take those patients with multiple risk factors for elective cesarean section rather than inducing them at term. Women with multiple risk factors for caesarean can be taken up for elective cesarean section rather than inducing them at term.
4.
Observing the Morphology of Foramen Ovale in Dry Adult Human Skull Bones: Morphometric Study
Meeta Sahai, Vinita Sinha, Rajendra Prasad
Abstract
Aim: The aim of the present study was to define anatomical variations in foramen ovale.
Method: The study was carried out on 60 foramen ovale using 30 dry adult human skull bones of unknown sex and the bones were taken from the Anatomy Department, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. Skulls which were fractured at the surrounding of foramen ovale were not included in the study.
Results: Out of 60 foramen ovale, minimum to maximum anteroposterior diameter on left side were 3.2 mm- 8.0 mm and on right side were 3.8 mm-8.2 mm. Average anteroposterior diameter on left side was 5.8±1.420 mm and on right side was 5.6±1.385 mm. Minimum transverse diameter on left side was 2.2 mm and on right side was 2.7 mm. Maximum transverse diameter was 6.3 mm and 5.5 mm on left and right sides respectively. Majority of the foramen were oval shaped and it was seen in 24 sides (left 8, right 16), almond shape was seen in 20 sides (12 left, 8 right), round shape was seen in 12 sides (8 left, 4 right), slit like foramen was seen in 4 sides (2 left, 2 right). Out of 60 foramina, bony spine was observed in 10 followed by 5 bony plates and 1 osseous lamina.
Conclusion: Morphometric and morphological anatomy of foramen ovale is very useful for medical practitioners while handling the cases of trigeminal neuralgia, tumour detection, bony outgrowths that leads to necrosis, ischaemia. The Foramen ovale is important foramina of the skull base.
5.
Determine the Clinical Significance of Immature Reticulocyte Fraction (IRF) and Reticulocyte Maturity Indices in Differential Diagnosis of Anemic Patient: An Observational Study
Md. Imteyaz Alam, Madhu Bharti, Manish Kumar Jha, Poonam Kumari
Abstract
Aim: The aim of the study was to determine clinical significance of immature reticulocyte fraction (IRF) and reticulocyte maturity indices in differential diagnosis of anemic patient.
Methods: The present study was conducted at the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of 1year and 200 cases were included in the study. Total of 100 cases, included 48 male and 52 female (40 cases of Iron deficiency anemia, 35 cases of anemia due to chronic kidney disease and 25 cases of thalassemia trait) were studied.
Results: The table showed statistically significant decrease in values of RBC, Hb with retic count was 0.92±0.006, IRF values were also low (0.090±0.060) so as the RETL, RETM, RETH. In thalassemia trait patient, reticulocyte count was high 2.75±0.055 with IRF values were 0.112±0.090, RET L was 89.1±0.090, RET M 7.6±0.060, RET H was 3.5±0.032 observed. The table showed mean retic count of 1.2 with SD of 0.007, and in IRF mean was 0.090 with SD of 0.120 in 35 patients of anemia due to chronic kidney disease. Retic count was low in IDA compare to thalassemia patient (high- hemolytic), IRF values were low in IDA and in CKD patient compare to thalassemia group and regarding reticulocyte indices, statistically significant difference observed for RET H, RET M and RET L between three groups.
Conclusion: Our study showed that with the use of automated fluorescence analyser providing IRF and reticulocyte maturity indices (LFR, MFR and HFR) was quite very useful in the early detection and for the differential diagnosis of iron deficiency anemia, thalassemia and anemia due to chronic kidney disease.
6. A Single Center Retrospective Study to Investigate the Effectiveness of Continuous Catheter Drainage in Comparison to Needle Aspiration in the Treatment of Liver Abscesses
Alok Kumar, V.K. Gupta, R.K. Ajai
Abstract
Aim: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses.
Methods: This was a single-center retrospective comparative study conducted at department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India for the duration of 1 year. A total of 60 patients were included in the study, divided into two groups, percutaneous needle aspiration (n=30) and pigtail catheter drainage (n=30).
Results: In presenting study the age group of the patients ranged from the 20-68 years. Highest incidence (60%) was found in 30-39 years age group. In this study 54 patients were male and 6 patients were female. 52 patients were from rural and 8 were from urban population and the incidence of alcohol consumption was 70%. It was observed that fever was present in needle aspiration and catheter drainage 94% and 92% respectively. There was 100% anorexia, pain and tenderness in right upper quadrant and hypochondruim in needle aspiration and catheter drainage respectively. It was observed that leukocytosis was 82% and 100% in needle syringe and catheter drainage. The patients in PCD group showed earlier clinical improvement and 50% decrease in abscess cavity volume as compared to those who underwent PNA. However, there was no significant difference between the duration of hospital stay or the time required for total or near-total resolution of cavity.
Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.
7.
Analyzing the Importance of Mammography and Sonography in Fat Necrosis: Prospective Clinicopathological Study
Mamta Singh, Amar Kumar Singh, Renu Rohatgi, Usha Kumari
Abstract
Aim: The aim of the present study was to analyze the importance of mammography and sonography in fat necrosis.
Methods: A prospective clinicopathological study was conducted on 100 female patients of different age groups from 30 to 60 years. Patients’ information is collected from at Department of Obstetrics and Gynaecology, Nalanda Medical College and Hospital, Patna, Bihar, India for one year.
Results: 100 lesions were identified on mammograms. The predominant mammographic features of the 100 lesions apparent on mammograms were as follows, 25 (25%) radiolucent oil cyst (either with or without curvilinear mural calcification), 14 (14%) round opacity, 15 (15%) asymmetrical opacity or heterogenicity of the subcutaneous tissues 25 (25%) dystrophic calcifications 4 (4%) clustered pleomorphic microcalcifications and 4 (4%) suspicious speculated mass. 100 lesions were identified at sonography. The predominant US features of the 100 lesions apparent on sonograms were as follows 15 (15%) solid appearing masses, 16 (16%) anechoic masses with posterior acoustic enhancement (cyst), 16 (16%) anechoic masses with posterior acoustic shadowing (cyst with mural calcification), 10 (10%) cystic masses with internal echoes 5 (5%) cystic masses with mural nodule and 25 (25%) increased echogenicity of the subcutaneous tissues (small cysts inside this area±). In 13 (13%) masses, no discrete lesion could be identified on sonograms.
Conclusion: In conclusion, there is a wide range of mammographic and ultrasonographic patterns of fat necrosis.
8.
Association of Prolonged AMV with Fluid Balance and Pediatric Index of Mortality 2 (PIM2) Score in Children Admitted to Pediatric Intensive Care Unit (PICU)
Bheemsen Kumar, Sanjay Kumar Nirala, Sanju Kumari, Gopal Shanker Sahni
Abstract
Aim: This study was conducted to determine the association of prolonged AMV with fluid balance and pediatric index of mortality 2 (PIM2) score.
Methods: This prospective observational study was conducted over a period of 12 months in the pediatric intensive care unit (PICU) at SKMCH, Muzaffarpur, Bihar, India. The study enrolled all patients admitted in the PICU of age 29 days to 12 years, who fulfill the inclusion criteria during the 12-month period.
Results: This was a study of 50 participants of which infants (<1 year) were maximum (26, i.e., 52%). Males outnumbered females comprising 58% (29) of the study population. Maximum number of admissions (16) had central nervous system involvement followed by respiratory system involvement. Out of the 50 children admitted in PICU during the study period, 35 (70%) children had prolonged mechanical ventilation. 33 patients had positive fluid balance ≥ 15%. 30 patients who had ≥15% positive fluid balance required prolonged mechanical ventilation. Similarly, 30 patients who had PIM2 score ≥ 5 required prolonged mechanical ventilation. The Pearson chi-square test was applied to test the significance of association between positive fluid balance and prolonged mechanical ventilation. P value was 2:25 × 10−7 which is <0.05 suggesting rejection of null hypothesis and statistically significant association between two variants.
Conclusion: There was a significant association of prolonged AMV with positive fluid balance (>15%) and PIM2 score (>5). By strict maintenance of fluid balance with appropriate intervention, the length of AMV and PICU stay can be decreased.
9.
A Hospital-Based a Single-Blind Parallel Clinical Trial Assessing the Antiplaque Efficacy of Propolis-Based Herbal Toothpaste
Priyata Ranjan, Pratyush Anshuman
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 at Department of Dentistry, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India including 100 dental students (50 females and 50 males) All subjects were given verbal and written information about the study, and after entering the study, they signed a written consent form regarding all information received.
Results: Out of 50 subjects, 25 were males and 25 were females with mean age of 20.82±1.48 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 (46.44±5.07) followed by Dabur (38.42±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.
10.
A Retrospective Observational Clinicopathological Assessment Post-dated Pregnancy
Priti Kumari, Rashmi Kumari, Anupma Sinha
Abstract
Aim: The aim of the present study was to find out the incidence of maternal complications, perinatal mortality and morbidity in post-dated pregnancies.
Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for 11 months. Total 100 patients in the antenatal ward and labour room were selected for the study and they were divided into two groups, Control group with Gestational age 37-40 weeks and Study group with Gestational age >40 weeks.
Results: Maximum number of patients belonged to the age group of 25-30 years both in cases (50%) and control group (50%). The maximum number of patients in the study group (80%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. 64% of the patients in study group were primigravida and in the control group 54% were primigravida. The percentage of LSCS was 32% which was higher than in the control group where it was 14%. Incidence of instrumental delivery was also higher in the study group as compared to control group (10% as compared to 6%). Among the indications for LSCS, the most common indication among the study group was acute foetal distress which includes meconium-stained liquor (10%) followed by cephalopelvic disproportion (8%). In the control group, most common indication was non progress of labour (2%) followed by acute foetal distress (0.5%) and non-reactive CTG (1%).
Conclusion: Post-dated pregnancy remains a clinical dilemma for an obstetrician. The choice is between watchful expectancy for labour to start or induction in post-dated patients. According to our study, post-dated pregnancies are related with higher rate of LSCS and instrumental deliveries.
11.
A Hospital-Based Study Assessing Outcome of Intra-Articular Calcaneal Fractures Managed Surgically with a Plate in Terms of Bohler’s and Gissane’s Angle and AOFAS Score: An Observational Study
Angad Kumar Choudhury, Dilip Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate the functional and radiological outcome of intra-articular calcaneal fractures managed surgically with a plate in terms of bohler’s and gissane’s angle, rate of radiological union and AOFAS score.
Methods: The Prospective study was conducted at department of Orthopaedics Jawahar Lal Nehru medical college and Hospital, Bhagalpur, Bihar, India for the period of one year Jan 2019 to December 2019 and a total of 50 patients with intra-articular calcaneal fractures meeting the inclusion and exclusion criteria were chosen for the study.
Results: In our study, patients between the ages group 18 yr and 60yr with a mean age of 33.36yr were included. The majority of the patients in the study were males, with 92% of the study population. In this study, 62% of the patients had right side involvement and 38% of the patients had left side involvement. The most common mode of injury in the study group was falling from height followed by RTA. About 76% of patients had a bohler’s angle between 10
o-20
o and in 24% of patients, it was <10
o in the pre-operative period, with a mean bohler’s angle of 11.75
o. Whereas in the post-operative period, 48% of patients had a bohler’s angle between 200-300 and 52% had it between 300-400, with a mean post-operative bohler’s angle of 29.67
o. The difference between pre-operative and post-operative mean bohler’s angle was statistically significant with a p value <0.01. The difference between pre-operative and post-operative mean Gissane’s angle was statistically significant with a p value <0.01.
Conclusion: We concluded that with proper pre-operative planning, the timing of surgery, intra- operative expertise of the surgeon, and post-operative care, surgical management of intra-articular fracture using a locking plate, gives a better outcome and minimal complications.
12.
Preperitoneal Meshplasty for the Treatment of Incisional Hernias: A Prospective Clinical Evaluation
Dharmendra Kumar
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 100 patients with incisional hernia managed by Preperitoneal mesh repair in Department of General Surgery, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India for the period of 2 years.
Results: In the present study, there were 50 male and 150 females. Most of the patients belonged to 31-50 years age group. 82 (82%) patients had midlines incision causing the incisional hernia. This was followed by Pfannensteil incision in 10 (10%) and paramedian incision in 8 (8%) 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.
13.
A Clinic-Demographic Profile and Assessment of Menstrual Problems of Adolescent Girls Attending Tertiary Care Facility
Tanu Kumari, Sneha Bhushan, Archana Jha
Abstract
Aim: The aim of the present study was to observe the menstrual disorders among adolescent girls and to observe the demographic profile and assess hygiene practices during menstruation.
Material & Methods: This descriptive prospective study was conducted in adolescent girls attending gynaecology outpatient Department of obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for the period of one year. During the study period, 100 girls visiting OPD for menstrual disorders consented for study participation and were enrolled.
Results: Adolescent girls age group ranged from 10-19 years. 56% of girls belonged to age group 14-16 years, with the mean age of 15.5 ±1.3 years. The mean age of menarche was 13.7 ±0.94 years. Majority of girls attained menarche between 12-14 years of age. The inter-menstrual period among majority of girls (72%) was 21-35 days, followed by more than 35 days in 16% and less than 21 days in 12%. The duration of menstruation cycle was 3-5 days in 77% girls, with moderate flow in 68% girls. In menstrual symptoms, almost all girls (94%) experienced abdominal pain/cramps. Backache (43%), body ache (32%) & irritability (27%) were other common symptoms. Sanitary pads were used by 85% girls and remaining girls used both sanitary pads and cloth. Majority of girls (71%) changed their absorbent less than 4 times. 75% girls cleaned their genitalia less than 4 times and 57% used soap & water for the same. The most common presenting complaint was dysmenorrhea (76%) among adolescent girls. Percentage of menorrhagia, irregular menses and polymenorrhoea was almost equal and ranged from 7-9%.
Conclusion: Dysmenorrhoea was the commonest cause of morbidity among adolescent girls, which may affect their mental and social wellbeing. This may also result in significant school absenteeism. Though, use of sterile sanitary pads was seen in majority of the girls, hygiene practices may be further improved with the engagement of health care professionals, teachers, and community groups.
14.
A Hospital Based Cross Sectional Study Assessing APR in Pediatric URTI Patients with Respect to Available Benchmark and to Decide on Interventions Required to Improve the Prescription Behavior
Ram Babu Raman, Asha Kumari, Sushil Kumar
Abstract
Aim: The current study was conducted to assess the APR in pediatric outpatient department (OPD) for URTI patients with respect to available benchmark and to decide on interventions required to improve the prescription behavior.
Material & Methods: This was a cross sectional observational study at conducted in Department of Pharmacology in collaboration with Department of Pediatrics over a period of 10 months, at DMCH, Darbhanga, Bihar. The prescriptions of children diagnosed with upper respiratory tract infections and lower respiratory tract infections (LRTI) were screened. Their demographic profile and details of drugs prescribed were recorded.
Total 100 patients were included in the study.
Results: Out of 100 patients, boys were 40 and girls were 60. Age group 5-7 years had 15, 7-9 years had 20, 9-11 years had 35 and 11- 13 years had 30 children. Antibiotics prescribed in children were co‑amoxiclav in 34, amoxycillin in 30, Ofloxacin in 20 and cefuroxime in 16. The difference was significant (P> 0.05).
Conclusion: URTI was treated using single antimicrobial whereas LRTI was treated with more than one antimicrobials or combination of antimicrobial and antiviral agent. The prescriptions were in accordance with the national treatment guidelines.
15.
Evaluating the Effect of Warm versus Regular Room Temperature Seitz Bath in Perineal Wound Healing: A Retrospective Observational Study
Barun Kumar
Abstract
Aim: The aim of the present study was to compare the effect of warm versus regular room temperature seitz bath.
Methods: This was a clinical retrospectively study conducted in the Department of General Surgery, Lord Buddha Koshi medical College and Hospital, Saharsa, Bihar, India for 18 months after taking the approval of the protocol review committee and institutional ethics committee. Out of 104 patients 60 patients (57.70%) opted for warm water seitz bath (Group A) and others 44 (42.30%) (Group B) opted for regular room temperature seitz bath.
Results: The 60 patients (57.70%) in the study group opted for warm water seitz bath as compared to 44 patients (42.30%) of regular water seitz bath from the second day of surgery onwards. The cases who opted for regular water seitz, were in poor socioeconomic background, due to easy and frequent availability of regular water as compared to warm water. All the 16 cases of episiotomy (26.66%) wounds repaired by gynaecologist opted warm water seitz only.
Conclusion: The progress of wound healing and postoperative comfort in operated perineal surgical wound does not based on type of seitz bath and the antiseptic solution used for sitz bath. But it is found that the frequency of sitz bath and subsequent improvement in the local hygiene definitely give comfort to the patient and speeds up wound healing.
16.
A Prospective Observational Assessment of the Effectiveness of Minimal Antibiotic Therapy and Routine Long Term Post-Operative Therapy in Elective Surgery
Shanker Bharti, Rajesh Narayan
Abstract
Aim: The aim of the present study was to evaluate the effect of three doses prophylactic antibiotic an hour before a surgical intervention with the chosen standard antibiotic with regard to the conventional use of same antibiotic for 5 to 7 days.
Methods: The present prospective observational study was conducted on 100 Patients attending outpatient Department of Surgery, Bhagwan Mahavir institute of medical science, Pawapuri, Nalanda, Bihar, India for the period of 8 months.
Results: The age range of the patients in group I was 18–85 years with mean and standard deviation (SD) of 44.78±15.75 and the age range of the patients in group II was 18–74 years with mean and SD of 40.82±14.66. There was no significant variation between data of the two groups based on age. In group I, 34 (68%) patients were male and 16 (32%) were female. In group II 30 (60%) patients were male and 20 (40%) patients were female. Mean hemoglobin level in group I was 12.06 with SD of ±1.60 and in group II it was found to be 11.70 with SD of ±1.25. Mean serum protein levels found to be in group I was 6.65 with SD of ±0.72 and same in group II was 6.64 with SD of ±0.74. 10 (20%) cases had diabetes in group-I and 8 (16%) cases in group II and addiction was present in 9 (18%) cases in group I and 10 (10%) cases in group II. There was no significant difference between both the groups based on diabetes and addiction. Two groups of cases with 50 cases each were evaluated for post-operative SSI, it was found that in group I, 5 (10%) cases had grade 2 SSI (3 cases on POD 3rd and 2 cases on POD 5th). In group II, 5 (10%) cases had grade 2 SSI (3 cases on POD 3 and 2 cases on POD 5). The p value is 0.90 and was not significant. There was no statistical significant difference between both the groups based on Southhampton grade.
Conclusion: A minimal dose antibiotic prophylaxis is equally efficient and has added advantage of reducing the duration of hospital stay and cost of medicines for the patients. Hence minimal dose antibiotic is better than a routine long term antibiotics therapy.
17.
A Hospital Based Comparative Assessment of Two Different Antibiotic Prophylaxis Regimes in Patients Undergoing for Elective Caesarean Section
Rashmi Kumari, Priti Kumari, Anupma Sinha
Abstract
Aim: The objectives of the study were to audit and implement the use of prophylactic antibiotics in women undergoing elective caesarean section.
Methods: This comparative, prospective, hospital-based study was conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for the period of 12 months.
Results: Mean age was 24.6±3.7 years in group A & 23.7±3.2 years in group B. BMI at the time of admission was 27.3±6.4 kg/m² & 28.2± 5.5 kg/m² in group A & B respectively. Mean duration of surgery was 43.7±7.3 min in group A & 46.4±5.5 in group B. Average blood loss in both groups was comparable. Mean days of hospitalisation was 4.8±3.7 days & 5.7±2.9 days in group A & B respectively. History of previous laparotomy like LSCS, ectopic surgery, etc. was present in 70 & 64 patients from group A & B respectively. Most common indication for elective LSCS was previous LSCS followed (40 % and 38.34%) by primi with CPD (23.34% v/s 21.66%). In the group A prophylactic antibiotic prophylaxis was given to 24 women (40%) and was not given to 36 women (60%). In group B, out of 60 women of this 54 (90%) of women received prophylactic antibiotic before elective LSCS. Out of 24 women who received antibiotic in group A, 41.66% received antibiotic within 1 hour and 14 cases (58.34%) received more than 1 hour before procedure. Out of 54 women in group A, 45 (83.34%) women received antibiotic within 1 hour, 8 received more than 1 hour (14.81%). In the group A, majority of the women received amoxicillin clavulanic 1.2 gm IV /Inj cefotaxime based on the policy formulated based on the antibiogram of the hospital.
Conclusion: This study showed single dose antibiotic prophylaxis is as effective as conventional multi dose antibiotic therapy. It is cost effective, antibiotic resistance of microorganisms can be prevented, reduces patient side effects, nursing staff work.
18.
Efficacy of Electroconvulsive Therapy (ECT) in Psychiatric Patients
Pranaw Kumar, Nilesh B. Shah
Abstract
Aim: The aim of the present study was to evaluate the efficacy 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 Total of 144 patients 74 (51.39%) patients was of Schizophrenia, 45 (31.25%) patients was of MDD, 19 (13.19%) patients was of BMD in Mania, 6 (4.17%) patients was of OCD and PANSS scale, HAM-D 17 item scale, YMRS scale, Y-BOCS scale was applied respectively before the start of ECT (Baseline score) and End score was taken after one week of last ECT. Change of 51.53 Mean point (PANSS), 13.78 Mean point (HAM-D 17 item), 28.52 Mean point(YMRS) and 2.83 Mean point (Y-BOCS) occurred during the course of ECT.
Conclusion: The present Prospective cohort study was conducted in a tertiary care hospital to study the efficacy 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. In the study we find Change of 51.53 Mean point(PANSS) occurred during the course of ECT in Schizophrenia group, Change of 13.78 Mean point (HAM-D 17 item) occurred in MDD group, Change of 28.52 Mean point (YMRS) occurred in BMD in Mania group and only Change of 2.83 Mean point occurred in OCD group. Indicating good acute response to the ECT in Schizophrenia (51.53 Mean point PANSS), MDD (13.78 Mean point HRSD 17 items), BMD in Mania (28.53 Mean point YMRS) and poor response in OCD (2.83 Mean point Y-BOCS) symptoms.
19.
An Observational Assessment of the Unnatural Female Fatalities and Association of the Role of Socioeconomic Circumstances and Violence
Rohan Kumar, Suchita Kumari, Hasnain Hussain, Alok Pritam
Abstract
Aim: The aim of the present study was to investigate unnatural female fatalities, causes of unnatural deaths and the role of socioeconomic circumstances and violence against women.
Methods: A retrospective study was conducted in the Department of Forensic Medicine and toxicology in association with Sadar Hospital, Saharsa for the period of one year. Total 100 cases of unnatural deaths referred for autopsy were evaluated in the present study. Only female’s cases of children’s and adolescents with the age group of 5 to 20 years were enrolled in the present study. The approval of the institutional ethics committee was taken before starting the study.
Results: Majority of the participants belonged to 5-10 years (50%) followed by 10-15 years (30%). 49% cases had accidental deaths followed by 23% suicide. 30% road accidents, 15% drowning, 12% poisoning were the leading causes.
Conclusion: Majority of the victims of ‘unnatural deaths belonged to the lower socioeconomic category. Suggestions relating to road safety, decreasing the stress of the modern mechanical life-style, educating the public in general and regarding. The availability, use and storage of poisonous substances in particular have been put forward, while highlighting the social evil of dowry system prevailing in India.
20.
Role of Modified Biophysical Profile and Doppler Ultrasonography Studies in Predicting Perinatal Outcome in High-Risk Pregnancies: A Comparative Study
Geeta Rani, Sachin Kr Singh
Abstract
Aim: The aim of the present study was to compare MBPP and umbilical artery Doppler flow in high-risk pregnant women in prediction of perinatal outcome in high-risk pregnancies.
Material & Methods: A prospective observational and comparative study was done on 100 high-risk pregnant women over 12 months. Antenatal women with singleton pregnancy who delivered within 48 hours of performing MBPP and Doppler USG, with presence of ≥1 high-risk factor like pre-eclampsia/gestational HTN, BOH, post-dated pregnancy, FGR, GDM, maternal heart disease, anaemia, hypothyroidism and IHCP were included in the study. MBPP (NST and AFI) and umbilical artery Doppler was performed. Perinatal outcome was measured in terms of stillbirth/IUD, LBW, Apgar <7 at 5 minutes, admission to NICU, neonatal death within 48 hours of delivery, MSL and neonatal seizures within 24-48 hours.
Results: Out of 140 Patients included in our study 84 new born had adverse perinatal outcome. Umbilical artery Doppler velocimetry and MCA was done in all 140 study participants. The three categories of neonatal outcomes were healthy baby, IUGR, and neonatal death. 56 of the 70 patients with normal MBPP (70%) delivered healthy babies. 65 (72.22%) patients delivered healthy neonates. APGAR score was more than 7 in 70 (87.5%) and less than 7 in 10 cases, when Doppler studies was normal while APGAR was more than 7 in 82 patients (91.11%) and less than 7 in 8 patients when Doppler studies was abnormal this was statistically significant. It was seen that MBPP had a sensitivity of 90.60%, specificity 57.93%, PPV 61.06%, NPV 89.08% while that of Umbilical artery Doppler was 88.32%, 53.37%, 55.75% and 87.23% respectively.
Conclusion: MBPP is a better predictor of perinatal outcome compared to umbilical artery Doppler USG in high-risk pregnant women. MBPP should be done in all high-risk pregnancies even if Doppler is normal. Both the tests must be performed in all high-risk pregnancies to improve perinatal outcome.
21.
An Observational Study Assessing Association between Measles Antibody Titres with Nutritional Status in Children
Sanjay Kumar Nirala, Bheemsen Kumar, Gopal Shankar Sahni
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 one year 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 (66.66%) of the whole sample population has received vaccination for measles. Nevertheless, the statistical analysis did not reveal a significant association between age and vaccination status (p=0.160). There were no statistically significant differences identified in the baseline parameters between the vaccinated and unvaccinated groups, with the exception of 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, 13.33% displayed thinness, and a mere 0.6% were classified as overweight, with just two cases falling into this category. A significant proportion of the vaccinated individuals aged five years or less, namely 43%, exhibited severe wasting, often known as severe acute malnutrition. Additionally, 35% of the participants had moderate wasting. A strong and statistically significant correlation was found between BMI Z scores in individuals aged 5 years and older and seropositivity. The data revealed that children with higher BMI Z scores had a greater likelihood of being seropositive. In a similar vein, a statistically significant correlation was found between height for age Z scores and seropositivity. Specifically, it was shown that children with greater height for age z scores exhibited higher levels of seropositivity.
Conclusion: The nutritional status of children exhibits a correlation with both measles antibody titres and the geometric mean titre (GMT) of measles-specific IgG antibodies. Specifically, children with improved nutritional status tend to have greater levels of measles antibody titres.
22.
A Study of the Efficacy of Oral Colchicine in the Treatment of Oral Submucous Fibrosis
Lakshmi Unnikrishnan, Siddharth Kumar
Abstract
Background & Objectives: Oral submucous fibrosis (OSF) is characterized by abnormal deposition of collagen and is considered to be a potentially malignant disorder by World Health Organization (WHO). It is a precancerous disorder and transforms into malignancy in 1.5 – 15% of all cases. It manifests with wide variety of symptoms like restriction in mouth opening, ulceration, xerostomia and burning sensation. Since it greatly interfere with the quality of life of the patients, proper treatment with primary focus on relieving the symptoms of OSF is necessary. The management of OSF has been a subject of controversy and no definite and widely accepted treatment is available. The aim of this study is to assess the efficacy of oral colchicine in the treatment of OSF.
Methods: 60 patients presenting with OSF between December 2020 and May 2022 were included in the study. A detailed history was recorded. A thorough ENT and general examinations were performed. After investigating the patients for their Liver Function Tests and COVID-19 Rapid Antigen Testing, these patients were assessed for their mouth opening using vernier calipers and Visual Analogue Scale (VAS) was used to assess the burning sensation sensed by the patient and recorded. Then these patients were given oral colchicine therapy. The patients were followed up for a period of 6 months. They were reassessed and the results were recorded.
Results: Majority of the patients were of less than 40 years, with a male predominance among those presenting with OSF. In this study, gutka was the substance mostly abused. Significant improvement in mouth opening and symptomatic relief from burning sensation in buccal mucosa was seen with oral colchicine therapy.
Interpretation & Conclusion: Patients presenting with OSF need appropriate treatment. In our study, we found that early interventions gave better results. Oral colchicine could be a major leap in the treatment of OSF.
23.
Hospital Based Assessment of Vitamin D Serum Levels in Indian Children with Chronic Musculoskeletal Pain with and Without Hypermobility: A Comparative Study
Mani Shankar, Babli Kumari, Rajnish Kumar, Avinash Kumar Sahay
Abstract
Aim: The aim of the present study was to compare vitamin D serum levels in Indian children with chronic musculoskeletal pain with and without hypermobility.
Methods: A cross-sectional study was conducted in the Department of Paediatrics, for six months. Total 100 children were diagnosed with chronic musculoskeletal pain were included in this study. The subjects were divided into two groups, with or without hypermobility.
Results: There were a total of 100 kids, with a mean age of 7.43 2.48 years old (58 females and 42 boys). The most common age range was 3-7 years old (73.6%). 45 (or 90%) of the youngsters tested positive for vitamin D insufficiency in the lab. The data was also compared between the hypermobile and non-hypermobile groups. When compared to children without hypermobility, those that suffer from musculoskeletal discomfort are younger and have a lower body mass index. When compared to children with hypermobility, those without hypermobility had lower vitamin D levels and a greater rate of vitamin D insufficiency. There was a change, but it wasn’t enough to warrant statistical significance.
Conclusion: There was no statistically significant difference in vitamin D deficit between children with and without hypermobility, despite the high frequency of vitamin D deficiency among children and adolescents with chronic musculoskeletal pain.
24.
Effectiveness of Locking Compression Plates for Treating Diaphyseal Fractures of Children’s Femurs: An Observational Study
Angad Kumar Choudhury, Dilip Kumar Singh
Abstract
Aim: The aim of the present study was to evaluate the functional outcome of paediatric femur diaphyseal fracture treated with locking compression plate.
Material & Methods: The clinical, radiological and functional results of Submuscular plating were evaluated in 70 patients operated in between the duration of 2 years 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, 49 were males, and 21 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 11.49 (2.08) years. Right side fractures 40 (57.14%) were more compared to left side fractures 30 (42.86%). For types of fractures, 25 (35.71%) fractures were transverse, 18 (25.72%) fractures were comminuted, 21 (30%) fractures were oblique, and 6 (8.57%) fractures were spiral. Considering the mode of injury, road traffic accident accounted for 60%, other injuries like fall during playing sports were seen in 15.71%, fall from height accounted for 8.57%. The functional outcomes were evaluated and 64 (91.42%) were excellent, 5 (7.14%) were satisfactory and 1 (1.42%) were poor.
Conclusion: The submuscular plating technique for diaphyseal long bone fractures is considered a dependable treatment option when well-planned and implemented.
25.
A Randomized Clinical Interventional Research to Study the Effects of Play Therapy on Reducing Behavioral Problems, Attention Deficit and Hyperactivity in Children
Sanjay Kumar Nirala, Bheemsen Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to examine effect of play therapy on ADHD children.
Methods: In the present study by using randomized sampling Department of Pediatrics, for 12 months and the samples were fifth and sixth graders (average age of 11 years) selected based on the inclusion criteria through purposeful sampling. They were randomly divided into experimental and control groups (16 individuals each) and then the experimental group underwent eight 90- min-sessions of play therapy with the cooperation of the school’s psychological counseling officials.
Results: The post-test mean score of ADHD symptoms was lower than that of the pre-test. This variable of behavioral problems has also obtained a lower average in the post-test test in different components (anxiety and depression, aggression, social incompatibility, antisocial behaviors, attention deficit disorder). In Kolmogorov-Smirnov test, the significance level of the variables should be more than 0.5 0 to be able to express the normal distribution of the variables, therefore, based on the obtained results the values of the significance level of the variables are more than 0.05, so it was concluded that the variables are in a normal state for the analysis of covariance. Levin’s test values are insignificant. In other words, the null hypothesis for the equality of the variances of the two groups was confirmed.
Conclusion: The findings of the present study indicate that educational Play therapy demonstrates efficacy in mitigating behavioral issues and attention deficit and hyperactivity symptoms among children diagnosed with ADHD. This therapeutic approach facilitates socialization skills development, enabling affected children to integrate into society as productive and well-adjusted individuals.
26.
Determining the Role of Second Trimester Umbilical Artery Doppler in Predicting Adverse Pregnancy Outcomes in a Low-Risk Population: An Observational Study
Geeta Rani, Sachin Kr Singh
Abstract
Aim: The aim of the present study was to determine the utility of second trimester umbilical artery Doppler velocimetry in the prediction of adverse perinatal outcomes (intrauterine growth restriction (IUGR), low birth weight (LBW) and stillbirth).
Material & Methods: One hundred low-risk nulliparous women with viable singleton pregnancies who met the inclusion criteria had umbilical artery Doppler assessment between 22 and 26 weeks gestation. RI≤ 0.76, PI≤ 1.36 and SD ≤ 4.52 were considered as normal. Each participant was monitored till delivery to assess outcome. Diagnostic performance of the Doppler indices for the prediction of adverse pregnancy outcomes were determined.
Results: The mean age of the participants was 31.19 ± 4.46 years and the mean gestational age at recruitment was 24.58 ± 1.42 weeks. Average systolic blood pressure at screening was 110.5±10.6 mmHg and the average diastolic blood pressure was 69.3±8.2 mmHg. Average birth weight of the babies was 3.02 ± 0.58 kg, 2/100 babies (2%) weighed >4kg at birth while 19/100 babies (19%) had low birth weight. At least one adverse pregnancy outcome occurred in 40/100 (40%) women. Of the 40 women, 8 (20%) had preeclampsia, 7 (17.5%) had pregnancy induced hypertension without proteinuria, 13 (26%) had intrauterine growth restriction, 20 (50%) had low birth weight fetuses, and there were 2 (5%) still-births. For any adverse pregnancy outcomes, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of abnormal umbilical Doppler parameters were 16.4%, 94.0%, 62.6% and 61.9% respectively. For stillbirth, the sensitivity, specificity, PPV and NPV of abnormal Doppler indices were 67.7%, 90.6%, 16.4% and 99.1% respectively. For IUGR the sensitivity and specificity of PI were 0.0% and 88.4% respectively, while PI had 13.0% sensitivity and specificity of 90.6% for LBW. For stillbirth, the sensitivity and specificity of PI were 66.4% and 91.7%.
Conclusion: Late second trimester umbilical artery Doppler velocimetry has a limited role in this low risk population for prediction of adverse pregnancy outcomes. The role of umbilical artery Doppler velocimetry in the prediction of adverse outcomes in high-risk pregnant women may be worthwhile.
27.
Assessing Bacterial Etiology in the Course of Disease and Their Drug Sensitivity Pattern in Patients Diagnosed with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Ashraf Azam, Vinyanand Jha
Abstract
Aim: The study was carried out to find out the bacterial etiology in the course of disease and their drug sensitivity pattern.
Methods: All hospitalized patients diagnosed with AECOPD admitted in the Department of Medicine, for the period of 2 years were evaluated. The individual bacterial isolates and their sensitive pattern to various antibiotics were also recorded in all one hundred 200 patients. The study was carried out COPD was diagnosed according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines.
Results: Out of 200 patients, clinically diagnosed as AECOPD, 75% were males and 25% were females. 40% patients were in the age group 56-65 years followed by 66-75 (26%) age group. Out of a total 200 cases, 96 (48%) were positive for pathogenic bacteria and 104 (52%) were non-pathogenic. Among total 48 pathogenic microbial, 62% were Gram-negative bacteria and 38% were Gram-positive bacteria. Out of 96 pathogenic bacteria, K. pneumoniae was the commonest (36.45%) followed by P. aeruginosa (20.84%), S. aureus (15.62%), S. pneumoniae (10.41%), S. pyogenes (8.33%). Among antibiotics, Amikacin was found highest sensitive followed by Azithromycin (62.5%), Amoxy Clavulanic acid (62.5%), Ciprofloxacin (58.33%) and Gentamycin (52.08%). However, Levofloxacin and Co-trimoxazole were found to be highly resistant 66.66% and 60.41% respectively among the drugs used in culture and sensitivity of 96 isolated pathogenic bacteria.
Conclusion: Repeated exacerbation and hospital admission leads to a major impact on the quality of life of patients with COPD. Antibiogram helps in screening resistant pathogens and prescribing right treatment protocol.
28.
A Hospital Based Observational Study Analyzing the Vaginal Birth with Previous Caesarean Section and its Outcome
Vidya Paul, Seema
Abstract
Aim: The aim of the present study was to analyze the vaginal birth with previous caesarean section and its outcome.
Methods: This prospective controlled clinical study. 370 women who had undergone previous caesarean section. Out of them, 220 women (67.56%) fulfilled our criteria and were included in the study. A control group (n = 155) was matched from women without previous caesarean section.
Results: In the study group, 200 out of 250 women were delivered vaginally, giving a VBAC success rate of 80%. The remaining 50 women (20%) were delivered by repeat caesarean section, mainly due to intrapartum fetal distress. Of the women who successfully delivered vaginally, 148 (74%) were admitted during the first stage of labour and 52 women (26%) in the second stage versus 80 (80%) and 20 (20%) respectively in the control group. There were no significant differences between the study group and control group in terms of age, parity, gestational age or obstetric and medical history. Oxytocin was used to augment labour in 20 cases (10%) but there was no uterine rupture recorded in these cases. Overall there were 2 cases (1%) of uterine dehiscence and 1 case (0.5%) of uterine rupture among the VBAC group. There were no maternal deaths and only 1 stillbirth after the case of uterine rupture. There was no significant difference between the groups in Apgar scores; 6% of neonates in the VBAC trial group had Apgar score < 6 compared with 5% in the control group (P > 0.05). We found 4 neonates (2%) weighed > 3500 g but < 4000 g in the VBAC group.
Conclusion: Based on the findings presented, it can be inferred that in certain instances when individuals have had one previous lower segment caesarean section and are now experiencing spontaneous active labour, a vaginal delivery attempt may provide a considerable percentage of success without any notable escalation in the likelihood of adverse outcomes for both the mother and the foetus. The length of labour experienced by these ladies was comparable to that of typical births.
29.
A Hospital-Based Study to Assess Acute Disseminated Encephalomylitis in Children: An Observational Study
Shashi Prabha, Anshuman
Abstract
Aim: The aim of the present study was to assess acute disseminated encephalomyelitis in children.
Methods: This was a prospective hospital based clinical study conducted by the Department of Pediatrics, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India over a period of one year. Total 50 patients were included in the study.
Results: Age distribution of study sample has been analyzed. It showed maximum prevalence in 5- 9-year age group (50%) with 30% in 0-4 year & 20 % in 10-14 years age group. Male predominates in the study 60% with female being 40%. Seizures were documented to occur in highest number of cases (66%). Next fever (60%) & altered sensorium (58%) followed. Encephalopathy was observed in 86%, followed by motor deficit in 68% & autonomic involvement in 40%. T1 hypointensity/isointensity was observed in 52%, T2 hyper intensity in 76%, FLAIRS changes in 72% cases. It was observed that the cases with severe presentation had lower proportion of recovery & higher proportion of mortality which was found to be statistically significant.
Conclusion: ADEM is a rare autoimmune demyelinating disorder that mainly affects the CNS and is characterized by an acute inflammatory response targeting the myelin sheath surrounding fibers in the brain and spinal cord. The early recognition and accurate diagnosis of ADEM facilitate timely management and minimize neurological damage.
30.
Dermoscopic Assessment of Topical Steroid-Dependent Damaged Face: An Observational Study
Birendra Prasad
Abstract
Aim: This study was undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS.
Methods: The present study was conducted in the Department of Skin and VD, and 200 cases were included in the study. Patients (18 years or above) with clinical symptoms and signs suggestive of TSDF (redness, itching, acne, burning, swelling, photosensitivity, pigmentation and atrophy) and with history of application of TCS on the face for a period of more than one month were included in the study after obtaining written informed consent. Institutional Ethics Committee approval was obtained before the commencement of the study.
Results: Females (75%) constituted the majority as compared to males. Most of the patients belonged to the age group of 18–30 years (55%) with a mean age of 34.6 ± 8.2 years. Duration of TCS application ranged less than one year and 1-10 years was 45% patients each. 160 (80%) patients had received some form of formal education, while 40 (20%) patients were illiterate. Presenting complaints of the patients were redness in 150 (75%), itching in 140 (70%), pigmentation in 110 (55%), burning in 124 (62%) and acne in 80 (40%) patients. Clinical findings noted in the patients were erythema in 170 (85%), hyperpigmentation in 170 (85%), and hypertrichosis in 120 (60%) followed by telangiectasia in 100 (50%) and wrinkles in 70 (35%). Polygonal and Y-shaped vessels, though, are categorized under linear vessels with branches, the term Y-shaped vessel was used when only one lateral branch was visible and polygonal vessel was used if multiple branches forming a network were seen. Comparison of dermoscopy findings with their corresponding clinical finding revealed that red diffuse areas, vessels, brown globules, white structureless areas, desquamation, hypertrichosis and white hair were observed in a statistically higher proportion of cases dermoscopically.
Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.
31.
A Study to Ascertain the Early Outcomes Associated with the Surgical Intervention for Congenital Supravalvular Aortic Stenosis (SVAS): An Observational Study
Sanjay Kumar Nirala, Bheemsen Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to evaluate the early results of the surgical management of congenital supravalvular aortic stenosis (SVAS).
Material & Methods: This single-center descriptive cross-sectional study was conducted at Department of pediatrics for the duration of 2 years infants and children aged one month to 15 years with a diagnosis of congenital aortic stenosis, who had undergone surgery were included. Children who had aortic valve stenosis due to acquired causes, such as rheumatic heart diseases, were excluded from the study. In the present study, 100 children with congenital aortic valve stenosis who had undergone open heart surgery were included.
Results: The mean ± standard deviation of the current age of the studied patients was 9.31±1.46 years. The minimum age of the patients was 1 month and the maximum was 15 years. 55 patients (55%) were male and 45 patients (45%) were female. The average weight of the patients was 28.24 ± 20.36 kg. The majority of patients had isolated valvular stenosis (46%), followed by isolated subvalvular stenosis. Combined conditions were fewer compared to the isolated conditions. In patients who had valvular aortic stenosis, commissurotomy was performed in 28 patients, Benthal surgery in 4 patients, and Aortic Valve Replacement (AVR) in 14 cases. Web resection surgery + myomectomy was performed in patients who had only subvalvular stenosis. Only those who had supravalvular stenosis underwent aortoplasty. In patients who had ventricular outflow tract stenosis only at the valvular level, the majority of patients (83.34%) had severe aortic valve stenosis before surgery. Immediately after surgery 55.55% of the patients showed no valvular stenosis; unfortunately, three patients died in the operating room.
Conclusion: The overall success rate of surgery in aortic valve stenosis was acceptable. As different surgical methods implemented in aortic valve stenosis have their own specific pros and cons, regular pediatrician visits are necessary to map-out any possible future complications.
32.
Prevalence of Depression among Patients with Chronic Illnesses: A Cross-Sectional Study
Rajesh R Patel, Amit Vaghela, Devendra Chaudhari, Kinnari P. Trivedi
Abstract
Background: Chronic illnesses have been frequently associated with a range of psychological disturbances. Depression, a leading contributor to global disability, often co-exists with chronic medical conditions. Yet, the prevalence of depression among individuals with chronic illnesses remains poorly quantified in various settings.
Objective: To determine the prevalence of depression among patients with chronic illnesses.
Methods: A cross-sectional study was conducted involving 300 patients diagnosed with chronic illnesses, recruited from a tertiary care hospital. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Sociodemographic data and the nature of the chronic illness were also captured
Results: Out of the 300 patients, 36.7% (n=110) were found to exhibit signs of depression. The prevalence of depression varied significantly across different types of chronic illnesses, with all major categories (Diabetes, Cardiovascular, Respiratory Disorders, and Others) showing a significant association with depression (all with p-values < 0.05). Additionally, the severity of depression, as assessed using the PHQ-9, ranged from minimal to severe among the patient cohort.
Conclusion: Depression is prevalent among patients with chronic illnesses. Regular screening for depression in these patients can aid in timely diagnosis and intervention, improving the overall quality of life and medical outcomes. Healthcare providers should be vigilant to the potential coexistence of depression in patients presenting with chronic medical conditions.
33.
Understanding the Prevalence of Residual Neuromuscular Blockade in the Post Anaesthesia Care Unit: A Cross-Sectional Analysis
Swati Nuna Jain, Nidhi V. Sardhara, Pratikkumar Jain
Abstract
Background: Residual neuromuscular blockade (RNMB) can lead to significant postoperative complications. Despite its clinical importance, the prevalence and associated risk factors for RNMB in the post-anesthesia care unit (PACU) are often under-recognized.
Objective: To evaluate the prevalence of RNMB in the PACU among a sample of 300 patients and identify its associated clinical and procedural risk factors.
Methods: This cross-sectional study was carried out over a three-month period in a tertiary hospital setting. Inclusion criteria involved adult patients who were administered non-depolarizing neuromuscular blocking agents (NMBAs) during their surgeries. RNMB was assessed using a train-of-four (TOF) ratio, with values less than 0.9 at PACU admission indicative of RNMB. Data collection encompassed patient demographics, surgical details, NMBA dosing, and intraoperative neuromuscular monitoring.
Results: Of the 300 studied patients, 15% (n=45) demonstrated RNMB upon PACU entry. Notable risk factors for RNMB included extended surgical duration, larger NMBA dosages, and absence of intraoperative neuromuscular monitoring. Those with RNMB had a significantly prolonged PACU stay and heightened episodes of respiratory complications.
Conclusion: The presence of RNMB in the PACU is a tangible concern, with a prevalence of 15% in our sample. Emphasizing intraoperative neuromuscular monitoring and adopting careful NMBA administration can potentially reduce its incidence, enhancing postoperative patient safety.
34.
A Study of Multiorgan Dysfunction in Patients with Plasmodium Falciparum Malaria
Hiteshkumar Kanzariya, Divyesh Sherasiya, Chirag Adroja, Jalpa Bhadja Dhoriyani
Abstract
Background: Malaria is a global problem, creating a menacing health problem worldwide. Nearly all serious illnesses and deaths from malaria are caused by p.falciparum malaria.
Aims & Objective: This study aimed to study the to study the multiorgan dysfunction in plasmodium falciparum malaria.
Methods: A prospective study was conducted on patients, who were admitted at our Medical College Hospital to the Medicine ward and ICU under Medicine Department. The study was carried out on 108 patients admitted during the period of two years.
Results: In present study out of 108 PF malaria cases 67.6% had multiorgan failure and 32.4% had single organ failure. In total cases of plasmodium falciparum cases 66.7% were male and 33.3% were female. Hepatomegaly was found in 34.3%, splenomegaly in 46.3% and 21.3% had hepatosplenomegaly, rest of the patients reported with associated illness.
Conclusion: Fever with chills and rigors are the most common presenting symptom noted in all cases. Multiorgan dysfunction is more common than single organ dysfunction.
35.
A Narrative Review on Formulation and Quality Attribute Considerations for Chewable Tablets
Monika, Pragi, Varun Kumar, Amit Kumar, Deepak Garg, Preeti, Ashok Kumar
Abstract
Recent advancements in novel drug delivery systems aim to improve the safety and therapeutic effectiveness of drug molecules by formulating a convenient or easy-to-administer dosage form. Patients with swallowing issues include those who are young, old, bedridden, crippled, and mentally ill. Oral administration is the most appropriate route for drug delivery because it has the highest compliance, especially in paediatrics and geriatrics. It has been cited as the most effective and secures way to administer medications. Chewable dosage forms include tablets, delicate pills, and gums. “Chewable squares” is a lengthy item in the drug specialist’s toolbox. The purpose of the chewable tablet is to provide a unit dosage that may be given to toddlers, teenagers, or the elderly who could also have difficulty swallowing a whole pill. The benefits of chewable tablet formulations include stability, palatability, precise dosing, portability, and ease of delivery. Taste masking of bitter drug candidates can be done by the aid of sweeteners, flavoring agents and by utilizing taste masking techniques. Chewable tablets can be formulated by the use of tableting methods: dry granulation, wet granulation and direct compression.
36. Study of Sublingual Misoprostol and Oral Misoprostol for Induction of Labor at Term- An Open Label Randomized Prospective Study
Zainab Ayazahmed Kharodiya, Lunat Ayaz Ismail, Shamimah Ayazahmed Kharodia
Abstract
Background: Misoprostol, an oral prostaglandin compound, is being increasingly used for induction of labor by vaginal, oral and sublingual route, though unlicensed for this use. This study was undertaken to compare the efficacy of sublingual misoprostol to oral misoprostol in induction of labor at term.
Materials and Methods: This prospective study was done from 1
st December 2020 to 15
th September 2021. Study included total 160 patients admitted to Tata Main Hospital for induction of labor at 37-42 weeks of gestation, who were randomized into two groups of 80 women each as Group A (Oral misoprostol) and Group B (Sublingual misoprostol). Age, pre- and post- induction Bishop score, maternal side effects, dose requirement induction to delivery interval, mode of delivery, 3
rd stage complication, incidence of tachysystole/ hyperstimulation/ hypertonus, gain in Bishop Score ≥6, success rate were all recorded.
Results: The mean number of doses of misoprostol was significantly lower in the sublingual group (p=<0.001). Mean induction interval was significantly lower in Sublingual group when compared to the Oral group. Significantly faster gain in Bishop score was observed in Sublingual group. Success rate was similar n both groups.
Conclusion: Although the Sublingual route of misoprostol led to a faster improvement of Bishop score, overall success rate of induction by both the routes of misoprostol was comparable.
37.
Analysis of Methods of Screening of Cervical Cancer – Liquid Base Cytology Versus Conventional Pap Smear
Shanti Snehlata, Sadhana Kumari, Reena Sinha, Usha Kumari
Abstract
Background: Cervical cancer continues to be the most common genital cancer among females in India. The universal application of PAP smears in western countries has led to drastic decline in invasive cervical cancer. In developing countries like India its incidence is still high due to lack of effective screening Programs. In this study the efficacy of LBC was compared with CPS for screening of cervical cancer.
Aims & Objectives: The aims and objectives of our study is to evaluate the sensitivity and specificity of conventional Pap smear versus LBC for Screening of Cervical cancer and find out a better option.
Material and Method: The study was done in the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital Patna from May 2022 to April 2023(one year). Total 200 women were included in the study. Samples collected were divided into two parts by split sample technique. Cervical biopsy was done with abnormal cells in either conventional Pap smear or LBC samples and results were compared and analyzed.
Result: Liquid Base Cytology was found to be more sensitive than CPS (79% Vs 66.5% ) with similar specificity (98.25% Vs 97.5%). Samples were satisfactory in 94% in LBC Versus 92% in CPS.
Conclusion: Liquid base cytology has higher sensitivity with similar specificity in comparison to CPS in the screening of cervical cancer. LBC can be used as a better option in the screening of cervical cancer.
38.
Study of Renal Doppler Ultrasonography in Cases of Chronic Kidney Disease at IGIMS, Patna with the Influence of Demographic Data
Sumity Singh, Sanjay Kumar Suman, Manisha Kumari, Samiullah Hassan
Abstract
Introduction: CKD (Chronic kidney disease) universally is considered as a major disease affecting public health and critically raises the burden on health care system. Timely diagnosis and management of CKD is very vital to holdup the advancement of disease. Doppler renal ultrasonography (US) possibly plays a significant role in defining CKD and its advancement to end stage renal disease (ESRD).
Material and Methods: This study was a hospital based cross-sectional observational study performed on 50 CKD patients hospitalized or attending IGIMS, Patna. After 8-12 hours fasting, blood, Doppler US reports and demographic profile were collected. The collected data from all the participants was analysed using “SPSS Statistics Base 22 software” and p value <0.05 was considered statistically significant.
Results: Our research observed significant difference in mean of pulsatility index (PI) and renal resistive index (RRI) from left interlobular arteries and both sides of main renal artery. PI from right interlobular arteries was also significantly different from control group although difference in mean RRI was statistically non-significant. The significant positive correlation of RRI with age and negative correlation with eGFR (glomerular filtration rate) was observed.
Conclusion: Our study concludes that a suspected or diagnosed CKD patient must be examined by Doppler US to confirm or assess the renal prognosis. The better clinical application and understanding of Doppler US data can be made by simultaneously assessing the comprehensive variables which can influence the data.
39.
Paravertebral Block In Percutaneous Nephrolithotomy
Chetankumar Tikar, Pradeep Jain, Sandesh Parab, Priyank Kothari
Abstract
Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCNL). In this study we have compared two groups of PCNL surgery comprising 125 patients each, one with TPVB and one without TPVB. TPVB is effective modality in controlling early postoperative pain after PCNL surgery. However there is no effect in late postoperative pain control after PCNL surgery with TPVB.
40.
Correlation between Clinical Presentation, Surgical Interventions, and Pathological Findings in Patients with Pancreatic Lesions: A Cross-Sectional Assessment
Pratikkumar N. Parker, Jigisha R. Bhoya, Ankur N Sarvaiya, Pradeep V. Mistry
Abstract
Introduction: Pancreatic lesions, an encompassing term for various pancreatic abnormalities, can range from benign cystic lesions to aggressive malignancies. The complexity surrounding the pancreas’s location and the non-specificity of early symptoms often results in delayed diagnosis, potentially worsening patient prognosis.
Objectives: To assess the relationship between the clinical symptoms, the resulting surgical interventions, and the eventual pathological diagnosis in 300 patients with pancreatic lesions.
Methods: In this cross-sectional assessment, 300 patients diagnosed with pancreatic lesions for the period of two years were studied. Data extracted included clinical presentations, type of surgical intervention (if any), and the definitive pathological diagnosis. Statistical analysis using chi-square tests and multivariate regression was performed to ascertain correlations.
Results: Of the 300 patients, 26.7% presented with jaundice, 40% with abdominal pain, and 33.4% with other symptoms. Surgical intervention was undertaken in 60% of patients undergoing the Whipple procedure. A significant correlation was observed between patients presenting with weight loss and pancreatic adenocarcinoma. The likelihood of undergoing surgery was highest for those with jaundice. Pathological findings post-surgery aligned with preoperative clinical suspicion in 66.7% of cases, with adenocarcinoma being the most common pathological outcome.
Conclusions: There exists a notable correlation between specific clinical presentations, the need for surgical interventions, and the pathological findings in patients with pancreatic lesions. Understanding these correlations can significantly influence clinical decision-making processes, potentially leading to more precise surgical interventions and better patient outcomes.
