International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

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Peer Review Journal

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1. Clinical and Microbiological Profile of Patients with Acute Bacterial Cholangitis at a Tertiary Care Centre in Northern India
Sumit Yadav, Saksham Seth, Rishabh Gupta, Mukesh Kumar Jain, Gaurav Kumar Gupta, Sandeep Nijhawan
Introduction: The changing antimicrobial sensitivity pattern poses a great therapeutic challenge in the modern era. With the development of antibiotic resistance due to widespread injudicious use of antibiotics, we now have very limited antibiotics against certain pathogens, especially for fatal GI emergencies like acute cholangitis. We conducted a study to assess the microbial profile and the sensitivity pattern to antibiotics in patients who presented with acute bacterial cholangitis. Methods: We enrolled all the patients admitted in our hospital between June 2023 to October 2023, who had acute bacterial cholangitis and were above 18 years of age. They were prospectively analyzed. Patient’s clinical features, etiology, microbial profile and antibiotic sensitivity pattern were analyzed. As soon as patient underwent any procedure all cultures were obtained. Antibiotics were administered after collecting the bile for Culture and Sensitivity. Results: Seventy six patients with acute cholangitis were evaluated. Choledocholithiasis, seen in 43 patients (56.6%) and malignancy seen in 29 patients (38.1%), were the most common factors precipitating acute cholangitis. Bile culture was positive in 62 of 76 patients (81.5%), and blood culture was positive in 23 of 76 (30.2%) patients. E. Coli followed by Klebsiella sps. were the most common organisms that were isolated from the bile culture. The organisms showed multi-drug resistance (MDR) pattern. The most common drugs to which these showed sensitivity were, Meropenem and Tigecycline. Conclusions: With more community acquired pathogens being MDR/XDR, as shown in this study, there is a prompt need to revise the antibiotic policy depending on the local resistance pattern. Acute cholangitis, is a medical emergency and should be treated immediately with broad spectrum antibiotics and Endoscopic/Percutaneous intervention depending on the expertise.

2. Study of Lipid Profile in Hypothyroidism
Dasari Kamalakar, Ade Vittal, Soumya. B, Tanajee Zade
Hypothyroidism is one of the most common forms of thyroid dysfunction resulting from the deficiency of thyroid hormones. Hypothyroidism is the most common of thyroid disorders in India affecting one in ten adults and more so in women than men by 6 to 8 times. Hypothyroidism also affects the lipid metabolism in a significant way. This cross sectional study was conducted in the department of General medicine, to evaluate the lipid profile of hypothyroid patients .30 Clinically and biochemically newly diagnosed hypothyroid patients of both sexes, age 20 to 60 years and 30 normal healthy controls were include in study. Serum lipid profile was estimated in both groups. Total  Cholesterol, Triglycerides, LDL Cholesterol, VLDL was higher in hypothyroid subjects as compared to controls  and it was statistically highly significant. HDL Cholesterol was lower as compared to controls and it was statistically highly significant.

3. Comparison of Continuous Intravenous Infusion of Tramadol and Intramuscular Diclofenac Sodium for Postoperative Analgesia
Rajesh Dinesh, Mohamed Hussain Sait A., Antony K.A.
Background: This study was conducted to compare the efficacy of intramuscular diclofenac sodium with continuous intravenous infusions of tramadol for post-operative pain relief in patients undergoing major surgeries under regional anaesthesia. The side effects of the drugs are also compared. Methods: This was a prospective randomized study conducted among 50 patients who underwent various gynecological, orthopedic, and general surgery at shree krishna hospital, karamsad from 2001 to 2003 ( two years) after obtaining clearance from institutional ethical committee and written informed consent from study participants. Results: Pre-operative values of mean pulse rates were comparable in the 2 groups, i.e. group A and group B. The difference in mean pulse rate between the two groups at 8 hours, 12 hours, 16 hours, 20 hours, and 24 hours was statistically significant. In changes in mean systolic BP at various time intervals, the difference in mean systolic blood pressure between the two groups at 15 minutes, 30 minutes, 4 hours, 6 hours, 12 hours, 20 hours, and 24 hours was statistically significant. In mean respiratory rate per minute at various time intervals, the difference in mean respiratory rates between the two groups at 15 minutes, 30 minutes, 4 hours, 6 hours, 12 hours, 20 hours, and 24 hours was statistically significant. Conclusion: An intravenous bolus followed by an infusion of tramadol has no major advantage over intramuscular diclofenac sodium other than onset of action and ease of achieving the desired degree of analgesia.

4. Taste Dysfunction and Its Relationship to Hba1c Level and Disease Duration in Type 2 Diabetes Mellitus Patients with Autonomic Neuropathy
Vijay Bavkubhai Vala, Rajan Rameshbhai Kakaiya, Ruchita Ashokbhai Jethva, Pradeep Jivanbhai Baraiya
Background and Aim: Type 2 diabetes mellitus (T2DM) affect quality of life very much and causes various complications. Diabetic autonomic neuropathy (DAN) is one of the common complications in diabetes. Thus present study was aimed at determining taste dysfunction in a population of T2DM subjects and its correlation with HbA1c level. Material and Methods: This was an observational cross sectional study which was carried over a period of one year in the department of medicine, Tertiary care institute of India. The 100 patients of T2DM with autonomic neuropathy and 100 healthy controls were taken for the study. Autonomic neuropathy was assessed clinically. Chemical taste test using four solutions of basic tastes (sweet, sour, salty, bitter) were done. Results: There was a significant difference between the 2 groups in terms of HbA1c (%) (p≤0.05), with the median HbA1c (%) being highest in the chemical taste dysfunction: sweet: yes group. Strength of association (Point-Biserial correlation) =0.49. There was a significant difference between the various groups in terms of distribution of chemical taste dysfunction: Sweet (p≤0.05). There was no significant difference between the groups in terms of duration of T2DM (years) (p>0.05). Conclusion: The study found a significant correlation between taste dysfunction and HbA1C level and blood sugar fasting level in type 2 diabetes mellitus patients. Alteration in taste was mainly for sweet. Sour, and bitter did not show any difference in case groups compared to controls.

5. Relationship between Sagittal Abdominal Diameter and Other Anthropometric Obesity Indicators in Adults with a History of Cardiovascular Risk Factors
Pradeep Jivanbhai Baraiya, Ruchita Ashokbhai Jethva, Rajan Rameshbhai Kakaiya, Vijay Bavkubhai Vala
Background and Aim: Obesity has reached epidemic proportions in our country due to modernization. The distribution of body fat plays an important role in complications due to obesity. 11 Because Family History is an independent risk factor for CVD, it has the potential to become a screening tool to identify people, especially asymptomatic young adults, who are at increased CVD risk. Material and Methods: Present cross-sectional; study was conducted at the Department of General Medicine, Tertiary Care Teaching Institute of India for the duration of 1 year. Total 200 patients were included in the study. When compared to BMI, WC and WHR, SAD correlated better with total cholesterol, fasting blood sugar, post prandial blood sugar and HbA1c. Results: BMI had strong positive correlation to Weight, SAD and WC. Men showed high correlation to Weight, BMI, FBS and PPBS, moderate correlation to age, SBP, WC, HC, HbA1C, VLDL, TG. Women showed high correlation to Weight and BMI. Moderate correlation to WC, HC, VLDL, TG, PPBS and HbA1C and low correlation to FBS. All metabolic and anthropometric parameters showed positive correlation with SAD except Height and HDL. Conclusion: Robust correlation exists between sagittal abdominal diameter and cardiovascular risk factors. Sagittal abdominal diameter is comparable to body mass index but it correlates better with metabolic risk profile of an individual than body mass index, waist circumference & waist-to-hip ratio.

6. Study of Influenza Virus Infection at Tertiary Care Center, Ahmedabad
Anokhi Goswami, Mital Vinzuda, Toral Trivedi, Anil Rajput, Sanjay Rathod, Mina Kadam
Background: Influenza viruses belong to Orthomyxoviridae family of viruses. Orthomyxoviridae family viruses are negative-sense ssRNA viruses. Four genera are described; Influenza A, B, C & D. Among this, Influenza type A infects humans and is responsible for all flu pandemics. In 2009, an Influenza pandemic caused by a novel strain of H1N1 resulted in millions of infections in more than 214 countries. Since their introduction in 1968, H3N2 Influenza viruses have undergone extensive genetic and antigenic evolution leading to numerous seasonal epidemics. In the present study, patients categorized as category C under national Influenza guidelines and admitted to hospital were screened for Influenza viruses. The aim of current study was to determine the occurrence of Influenza virus infection, to determine circulating subtype of Influenza virus, to determine whether the age & gender affects susceptibility to Influenza viruses. Method: In present study, rRT-PCR method was used. As per standard guidelines, received samples were processed in the Molecular laboratory of Microbiology Department. Viral RNA was extracted from the sample using automated extraction method (GeneMag Quick Viral DNA/RNA Purification Kit). rRT-PCR reaction mixture was prepared using Tru PCR kit. The instrument used was CFX96/C1000 Touch Thermal Cycler System (BIO RAD). Result: Out of 728 samples received in the laboratory for influenza virus testing, 89 samples were positive for Influenza virus.88 samples were positive for Influenza A virus and 1 for Influenza B virus from total 89 positive samples. The most dominant subtype of Influenza A virus was H3N2 53 (60.22%) followed by H1N1 20 (22.72%) and other subtype 15 (17%).Gender wise distribution of subtype does not show any significant difference. Among 728 samples received, 347 and 381 samples from male & female patients respectively. Detection of influenza virus was found more in age group of 18 – 60 years as compared to other age group. Month wise distribution of H3N2 subtype shows that there was sudden increasing trend of this strain from August 2022 to February 2023. Conclusion: In present study, an influenza A (H3N2) outbreak was confirmed with a co-circulation of A (H1N1) pdm09. Positivity rate of H3N2 is slightly higher among male patients and among age group of 18-60 years. Influenza cases were maximum during winter.

7. Comparing the Clinical Outcome of Hip Arthroplasty Performed Through Smith Peterson (Direct Anterior) Versus Southern Moore (Postero-Lateral) Approach
Darshak Patel, Bharat Dhanani, Mitul Patel, Modi Amul Kaushik Kumar
Background and Aim: Total hip arthroplasty (THA) has become one of the most reliable and patient-requested surgical interventions in all medicine. The procedure can be performed using a variety of surgical approaches, but the posterior approach, direct lateral approach, and direct anterior approach are by far the most common across the globe. Present study done to determine which surgical approach is better for posterior dislocation. This will allow for the development of a standard approach to treating femur fracture necks in elderly patients. Material and Methods: The present analysis is the randomized control trial done in the GMERS, medical college, Sola, Ahmedabad. The study was done for the period of one year. A total of 40 patients were included in the research analysis. Every participant who satisfied the requirements for inclusion was assigned at random to either the posterior lateral approach (PLA) or the anterior approach (DAA) group. The rise and change in CK levels following THA were examined using a little amount of data. Additionally, we assessed preoperative and postoperative joint function using the Harris Hip Scores (HHS) method, and we scored VAS points to assess pain intensity. The position of the femoral prosthesis was measured using the Nakata method. Results: The mean operating time when it was compared between the two groups it was found to be longer in DAA group patients as compared to other group. The difference in the parameters like incision, duration of the hospital stay, intra operative blood loss and mean of the post-operative damage, when compared between the two groups were found to be statistically significant. The hospital length stay was also shorter, the loss of intra operative blood loss was less and there was low intra operative drainage in DAA group patients. Conclusion: Anterior approach was linked to shorter hospital stays, increased functional scores, quicker short-term rehabilitation, and earlier withdrawal of mobility aids like walkers and crutches. Conversely, the posterior technique could result in a shorter surgical duration, comparable long-term function, and no rise in the incidence of problems.

8. Study on Association of Lipid Profile and Hypertension
Puduri Rajendra Prasad, Ch Sandeep Kumar, Srikanth Peddi Reddy
Abnormalities in serum lipid and lipoprotein levels (dyslipidemia) are recognized as major modifiable cardiovascular disease (CVD) risk factors1 and have been identified as independent risk factors for essential hypertension giving rise to the term dyslipidemic hypertension. The objective of this study was to examine the serum lipid patterns of newly diagnosed hypertensive patients attending a tertiary healthcare center. Study included 50 Hypertensive and 50 normal healthy control subjects. Lipid profile was estimated in both groups. Our study  shows that TC-Total cholesterol, TGs-Triglycerides, LDL- Low density lipoprotein, VLDL-Very low density lipoprotein was higher in Hypertensive subjects as compared to normal control subjects and this difference was statistically highly significant. HDL-High density lipoprotein was low in Hypertensive subjects as compared to normal control subjects and this difference was statistically highly significant. Dyslipidemia and hypertension in combination increases the risk of cardiovascular diseases, stroke etc. Hence early detection of dyslipidemia in hypertensive patients and aggressive treatment of both the conditions should be carried out to prevent complications.

9. A Comparative Study of Serum Lipid Profile in Pre-Eclamptic and Healthy Pregnant Women
Lokeshwer Prasad Meena, Alka Meena, Pratibha Chauhan, Sangeeta Meena
Background: Pre-eclampsia is a multisystem disorder that complicates 3%–8% of pregnancies in Western countries and constitutes a major source of morbidity and mortality worldwide. This study aims to evaluate and compare serum lipid profile in pre- eclamptic and healthy pregnant women. Methods: A prospective study was conducted, collecting data on lipid profile in 35 pre- eclamptic and 35 healthy females. Student’s t-test and chi-square test were used for analysis and comparison. The study was conducted from Mar 2021 to Oct 2022. Results: The mean Triglyceride (TG) and Total Cholesterol (TC) levels in Pre- eclampsia cases were higher as compared to controls and this difference is statistically significant (p < 0.001). Importantly, HDL level is significantly less in women who had Pre-eclampsia compared with healthy controls (p< 0.001). The positive linear correlation observed between TG, TC and Systolic & Diastolic Blood Pressure further strengthens the potential interplay of these parameters. Conclusion: Considering the results, of this study correlating with the various other studies, it can be concluded that dyslipidemia is significantly evident in preeclampsia and plays an important role in its pathogenesis. The preventive measures taken to avoid dyslipidemia like dietary control, weight reduction and physical activity and its positive effect on pregnancy need to be further studied.

10. Formulation and Evaluation of Anti-Microbial Agent in Various Dosage Forms by Using Ethnopharmacological Selected Indian Medicinal Plants
Chandrachud Sharma, Yuvraj Singh Sarangdevot
The foundation of the herbal medication business is the ethnomedical values of plants. In order to create herbal medications with minimal side effects, India has contributed its expertise in traditional system medicines (Ayurveda and Siddha). These plants have historically been utilised by tribal communities in India as extracts, powders, or pastes to cure conditions including anti-microbial activity, cough and colds, fever, stomach, kidney, and liver diseases, pain, inflammation, and wounds. The current study focuses on the antibacterial properties of Indian medicinal herbs such Ocimum sanctum, Adhatoda vasica, and Solanum xanthocarpum. Numerous of the long-standing ethnomedicinal applications of these plants are supported by ethnopharmacological investigations. These three ethnomedicinal plants have yielded several phytoconstituents, some of which have exhibited pharmacological activity through in vivo and/or in vitro tests. For herbal medicines to be used safely and effectively, ethnomedical applications that are backed by scientific research are crucial. Using the agar-well diffusion method and various concentrations (30%, 50%, 70%, and 100%), the antibacterial activity of the Solanaceae family plant Solanum xanthocarpum was assessed in vitro against a number of human pathogenic microorganisms, including Escherichia coli, Yersinia pestis, Pseudomonas aeruginosa, and Staphylococcus aureus. In comparison to the control group, chicken flesh that had been washed with AVELE for 90 minutes had higher sensory attribute ratings for juice and tenderness as well as a higher overall sensory quality. This study demonstrates AVELE’s ability to kill L. monocytogenes NCIM 24563 effectively, indicating that it may be utilised as a marinade or rinse for meat preservation. The Lamiaceae family of plants includes the fragrant herb Ocimum sanctum Linn, sometimes known as holy basil. It is a native of the tropics of Asia and Africa. To prepare the leaves for grinding, they were detached from the stem, thoroughly cleaned in clear water, and then dried for seven days. In order to create a uniform powder, dried leaves were ground separately in an electric grinder. The powder produced using the “cold extraction method” was converted into ethanol, hexane, and chloroform extract. Ocimum sanctum leaves’ antibacterial effectiveness suggests that the plant has strong antimicrobial qualities. Additionally, because ocimum is so common in India, it might be suggested as a conveniently accessible source of antibacterial compounds in place of synthetic chemicals.

11. A Study on Etiological and Microbiological Profile of Catheter Related Bloodstream Infection in Paediatric Intensive Care Unit of a Tertiary Care Hospital in Eastern India
Nagesh Nayak M, B Vamshi Krishna, Suneel Kumar G
Background: Central venous catheters are used commonly in Pediatric ICU settings now a days, but their potential complications are also well known. One of the main complications is catheter- related bloodstream infection (CRBSI). The present study (pediatric ICU-based study) aimed at diagnosing such infections and identifying the potential pathogens implicated, in order to provide better patient care and to prevent such infections from occurring in the future. Methods: This study included a group of 350 consecutive patients between age 1-12 years with indwelling central venous catheter, admitted in PICU of Dr B.C. Roy Postgraduate Institute of Paediatric Sciences, Kolkata who had developed clinical manifestations suggesting CRBSI such as fever or chills, unexplained hypotension, and no other localizing sign. after 48hours of catheterization. Results: Among the 350 catheter tips paired with blood cultures, there was no evidence of any bacterial growth among the 106(30.3%) subjects. The remaining 244 (69.7%) catheter tips paired with blood culture showed bacterial growth, of which 223 catheters (63.7%) had only tip colonization with negative blood culture and 21 (6%) catheters were positive for both tip and blood culture with same micro-organism. triple lumen catheters accounted for 47.6% (10/21) of CRBSI while double lumen and single lumen catheters accounted for 33.3% (7/21) and 19% (4/21) respectively. Femoral site catheterization accounted for majority of CRBSI’s (15 out of 21), while jugular and subclavian site accounted for 5 and 1case of CRBSI’s respectively, among the CRBSI patients a total of 9 organisms were isolated, of which most common were Gram positive cocci (GPC) with 57.1% (12 out of 21) followed by Gram-negative organisms with42.9% (9 out of 21). Conclusion: This study concluded that CRBSI are more common with femoral site insertion and gram positive cocci are common in CRBSI.

12. Prevalence of Chronic Rhinosinusitis in Chronic Obstructive Pulmonary Disorder Patients: Outcome of an Observational Case-Control Study
Viqar Khursheed Mir, Younus Majeed Dar, Mir Sajad Qadri
Background: Studies have persistently demonstrated that lower and upper airway diseases often coexist however the available data is limited. Aim: we aimed to evaluate the prevalence of chronic rhinosinusitis in chronic obstructive pulmonary disorder patients at a tertiary care hospital in northern India. Methods: In the present prospective case-control study, we recruited cases with COPD and according to Gold criteria visiting both OPD and admitted in the IPD block of GMC Srinagar age, gender and district of residence matched subjects as controls for the evaluation of CRS. Results: we recruited 200 cases and control each. The mean age (±SD) was 64.4 (±12.1) years. Males showed an over  representation than females (ratio 2.4:1). CRS was present in 14.5% of COPD cases compared to controls (8.0%). We observed nearly two-fold risk for developing CRS in patients with COPD (OR=1.97 95% CI:1.06 – 3.83). Unlike anosmia, we also observed a significant association of nasal discharge obstruction, posterior nasal drip and facial pain anosmia with the risk of COPD (p<0.005). However, we did not find any correlation of symptoms based of LK scoring between cases controls (p>0.05). Conclusion:  We observed that COPD and CRS can frequently co-exist. The presence of CRS should be assessed in COPD patients, especially in those with severe diseases. Further research is needed understand the overlapping pathophysiological mechanisms underneath COPD and CRS.

13. Histopathological Study of Spectrum of Benign and Malignant Lesions of Intestine
Smita Hilalpure, Shubhangi N Jibhkate Bawankule, Vijay Mulay, Richa Lath, Aniruddha Jibhkate
Background: The small and large intestines account for the majority of gastrointestinal (GI) tract length and are common sites of primary and metastatic tumors. There is a large variation in the distribution of this neoplasm, all over the world. It is a leading cause of death in the developed world, emphasizing the importance of proper documentation of histopathologically diagnosed gastrointestinal neoplasm. The study aims to comprehensively investigate the spectrum of benign and malignant lesions across all age groups in the intestine, evaluate suspected patients through histopathology, examine the prevalence within our institution, and provide site-wise distribution information. Methods: This prospective study was carried out over two years and includes 99 cases of surgically resected and biopsy specimens of the intestine having suspected benign and malignant lesions. Poorly fixed/unfixed specimens and inadequate biopsies were excluded. The diagnosis, typing, and staging of tumors were done following the latest guidelines. Results: Of the total 99 intestinal neoplastic lesions large intestine was most commonly affected (82%) while Anal Canal was least commonly affected (2%). The majority of tumors were epithelial in origin (95%). Only 12% of cases showed metastasis to regional lymph nodes or a distant site. Conclusion: Histopathological evaluation of resected intestine is important in determining the cause, extent of disease, further adjuvant therapy, and prognosis of disease, and thus improving patient survival.

14. A Prospective Clinical Study on Gastric Perforation
Venkata Ramesh Kalluri, Gopalam Padmajarani, P. Himabindu, U. Jagadeeshwar
Aims: A prospective clinical study was carried out on gastric perforation to study its incidence, etiology and outcome. Materials and Methods: It is a prospective study in 100 cases of gastric perforation which have been admitted in department of General surgery. The present study done to analyse the etiological factors, incidence & outcome of gastric perforation. The provisional diagnosis was established by clinical features & radiological evidence in the emergency department & the definitive diagnosis was made during surgery. Results: Higher incidence was observed among 41 – 60year age group individuals and among male sex. Most of the subjects belongs to low socioeconomic status (95%) and resides in rural areas. (66%). Alcohol consumption (34%), cigarette smoking (24%), regular use of NSAIDs (86%) and past history of PUD (81%) are significant risk factors for gastric perforation. Abdominal pain (100%) was found to be a constant complaint among gastric perforation followed by abdominal distension (76%) and vomiting. (75%) Examination findings such as abdominal tenderness (97%) is consistent with the gastric perforation. Most (87%) of the subjects presented within 12hours of onset of symptoms. Mostly antrum (85%) was involved in perforation. Regarding the size of perforation, most of the subjects were between 0.5 – 1cm (77%). Diagnosis was made based on radiologic findings in chest and abdominal radiography, with pneumoperitoneum in most (90%) of the subjects. Most of the cases had Graham’s patch repair (86%) and a few had distal gastric resection (14%) with gastrojejunostomy. Conclusion: Different types of post-operative complications were observed in significant percentage of subjects. PUD was the most leading etiology causing gastric perforation in the present study, followed by chronic gastritis and malignancy. Overall, 14% subjects had expired following treatment, in the present study.

15. Top of Form Measurement of Biomarkers in Squamous Cell Carcinoma of Head and Neck Region: Pre vs. Post Treatment Analysis
Nishant Shrivastava, Shriram Gautam, Shikha Shrivastava
Introduction: Head and neck cancer ranks as the most common cancer in men and both sexes in India. However, due to extensive loco-regional involvement, poor patient general condition, or comorbidities, curative treatment often becomes unfeasible. The aim of this study was to assess serum biomarker levels in patients with head and neck squamous cell carcinoma (HNSCC) before and after treatment. Methodology: This research was conducted at a tertiary care hospital in India. The study included 56 newly diagnosed HNSCC patients and 45 age- and sex-matched healthy individuals. Chi-square and t-tests were employed to explore associations and comparisons between the case and control groups, respectively. Results: The subjects were divided into three groups: group A consisted of pretreatment cases, group B comprised post-treatment cases, and group C served as controls. There was a significant difference between group A and group B, suggesting notable changes in glucose levels before and after treatment. Furthermore, significant differences were observed between cases before treatment and controls concerning creatinine, ALT, albumin, total protein, and TBIL levels. Conclusion: The study revealed highly significant differences between case and control groups, particularly in terms of LDL, protein, and calcium levels. These findings underscore the importance of assessing serum magnesium levels in HNSCC patients before and after treatment to understand their implications on disease progression and management.

16. A Hospital-Based Study to Assess the Clinic-Etiologic Spectrum of Right Iliac Fossa Lesions: An Observational Study
Ashutosh Kumar Singh, Lalan Kumar, Rajesh Narayan
Aim: The aim of the present study was to assess the clinical profile and various causes of right iliac fossa lesions. Methods: A hospital based prospective study was done with 50 patients to evaluate right iliac fossa lesions – its clinical profile and it‘s Management at department of General surgery. Duration of the study was 2 years. Results: The most common disease in our study was appendicular mass (42%) followed by appendicular abscess (28%), iliopsoas abscess (12%), Ileocaecal tuberculosis (6%) and carcinoma cecum (6%). There was 1 case each of right undescended testis with malignant change, right ectopic kidney and Non-Hodgkin‘s lymphoma of ileum, each of these cases accounting for 2% of the total cases in our study. The highest number of cases (46%) was in the 21–30 years age group. The youngest patient was 14 years old and oldest was 75 years old. There were 30 male and 20 female patients in our study. It was observed that there was preponderance of male patients. 17 patients gave history of nausea and vomiting. 17 patients gave history of fever, it was usually mild degree and intermittent. Loss of appetite was present in all the patients (100%) of appendicular mass. Diarrhoea was seen in 1 patient. One patient presented with the mass per abdomen as one of his complaint. Conclusion: Diseases presenting as a mass in the right iliac fossa were normal, in the age range of 20 to 40 years. In males, the average occurrence tends to be greater. Pressure in the right iliac fossa, fever, vomiting and lack of weight were the most common presentation symptoms. Abdominal tuberculosis is a significant health issue in our nation and, due to varying appearances of patients with ambiguous abdominal pain and non-specific medical symptoms, poses a diagnosis difficulty and obstacle.

17. Observational Research to Evaluate the Use of C-Reactive Protein in Deciding Duration of Antibiotics Therapy in Neonatal Bacterial Infection
Prem Kumar, Nand Kishor Singh, Akhilesh Kumar
Aim: The aim of the present study was to assess the role of C-reactive protein in deciding duration of antibiotics therapy in neonatal bacterial infection. Methods: The present study was conducted in the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India and 50 patients were included in the study. The duration of study was about two years. Results: Clinical features of infected neonates were 39 (78%) born by vaginal delivery 3 (6%) had history of maternal fever, 6 (12%) had history of PROM, 20 (40%) refusal of feeds, 16 (32%) lethargy, 10 (20%) poor cry, 10 (20%)   Tachypnea,   6 (12%)   jaundice,   7 (14%) conjunctivitis, 6 (12%) vomiting, 3 (6%) excessive cry, 2 (4%) pyoderma, 2 (4%) abdominal distension, 2 (4%) hypothermia, 1 (2%) fever, 2 (4%) diarrhea, 2 (4%) umbilical sepsis in the study. Study of organism observed in 21 (42%). In the gram negative 16 (32%) neonates: 6 had klebsiella, 4 had E Coli, 4 had pseudomonas, 2 had acinetobacter.  The neonates had gram positive bacilli – 3 staphylococcus aureus, 1 Coagulase Negative Staphylococci (CoNS), 1 had Haemolytic streptococci. CRP guided distribution of treatment, relapse rate in two groups and correlation with blood culture. In group A (23) had CRP value was <6 -duration of therapy was <3 days and No. bacilli, No relapse was observed. In group B CRP value was >6 in 32 neonates, 2 patients treated for 5 days, 14 patients for 7 days and 11 patients for 11 days. Blood culture was positive for 12 neonates with 7 days therapy, for 10 neonates with 11 days duration therapy and no relapse was observed. Overall duration of treatment for <7 days observed in group I were 23, and group II were 2 and total number were 25. Duration of > 7 days therapy observed in group 1 was 14 and group 2 was 11 and total number was 25. Conclusion: The role of CRP is significant in deciding the duration of antibiotics therapy in neonates. It is safer as compared to other, but still further study is required for other marker because CRP cannot influence gestation age infections, non-infectious confounders.

18. A Hospital-Based Assessment of the Spectrum of Renal and Perinephric Space Infection: An Observational Study
Lalan Kumar, Ashutosh Kumar Singh, Rajesh Narayan
Aim: The aim of the present study was assess the spectrum of renal and perinephric space infection among urology patients. Methods: The present study was conducted in the Department of General Surgery for the period of 24 months. 200 patients were included in the study. Suspected patients were clinically evaluated and investigated using ultrasound scan of the abdomen. Results: Out of 200 patients, 130 (65%) males and 70 (35%) females suffered from renal and perirenal space infections in the age group of 10-70 years. Majority were young in the age group of 21-30 years. At the time of presentation, the commonest symptom was fever (96%) followed by flank pain (43%) weakness and lethargy (73%). The average duration of symptoms was 23 days (range 7-60 days). On clinical examination, all patients were febrile (range 99- 103° F) with marked costovertebral tenderness in 90%. It was seen that 96 (48%) patients had renal abscess, 84 (42%) perinephric abscess and 20 (10%) emphysematous pyelonephritis. The predisposing factors were diabetes mellitus (36%), ureteric calculi (32%) and renal calculi (24%) in these patients. 120 patients were treated with antibiotics only and 40 patients were treated with antibiotics+ PCD. In 8 patients, there was drainage of pus and debris. Conclusion: Renal and perinephric space infection continues to be a serious urological problem with high mortality rate. A high index of suspicion, prompt diagnosis, appropriate antibiotics and surgical intervention may be effective in reducing mortality.

19. A Prospective Single Center Study Assessing Clinical Profile of Tetanus in Children: An Observational Study
Sunil Kumar Singh, Anil Kumar
Aim: The aim of the present study was to assess the clinical profile of tetanus in children admitted in tertiary care hospital. Methods: A prospective single centre observational study carried out over a period of 24 months by Pediatrics Department,  All eligible patients as per inclusion and exclusion criteria were selected for the study. 50 patients were included in the study. Results: Gender wise distribution shows that 62% were male. Epidemiological distribution showed that 34 (68%) of patients were from rural area. Socioeconomic distribution shows that 33 (66%) patients were from lower socioeconomic status. Among non-neonatal tetanus, 20 (40%) were traumatic and 8 (16%) were otogenic while others were idiopathic. Among non-neonatal cases mortality was 17 cases with commonest mortality in the age group. Among non-neonatal cases the mortality was commonly seen in traumatic cases. 78% were not immunized and 20% were partially immunized. The most common complication seen was Hyperpyrexia in 13 (26%), followed by Pneumonia in 11 (22%) cases, Thrombophlebitis and Bedsore in 7 each (14%) cases septicaemia was seen in 4 (8%) cases. Conclusion: Tetanus is more common in rural population. This may be due to illiteracy, poor socio economic status, poor awareness of immunization programme, fear of complication due to vaccination, superstition. Mortality is decreased as the incubation period and period of onset increased. Mortality is increased with temperature and grade of tetanus increased.

20. Role of PEDIS Scoring in Predicting Complications of Diabetic Foot: An Observational Study
Ahsan Ulla, Purnendu Paul, Swapan Choudhury
Aim: The aim of the present study was to evaluate the usefulness of PEDIS scoring in identifying the severity of diabetic foot ulcer and its management. Methods: This was a hospital based prospective observational study conducted in the Department of General Surgery, Jagannath Gupta Institute of Medical Sciences & Hospital, Budge Budge, Kolkata, West Bengal, India. Patients who came to the hospital with Diabetic foot ulcers below the level of malleolus including both outpatients and inpatients were taken into this study after getting consent. This study was conducted for 1 year. Totally 100 patients were included in the study and followed up for 6 months. Results: Out of 100, 75 (75%) were males and 25 (25%) were females. White blood cell counts were found to be elevated in 30 (30%) patients. The cut-off value for high WBC was considered to be more than 11,000/mm3. Cut-off value taken for high random blood sugar was 140 mg/dl. About 65 (65%) patients were having abnormally elevated random blood sugar. 10 (10%) patients were found to have osteomyelitis and they were tested positive for probe to bone test. Patients with score of less than 7 managed with debridement showed good results at the end. Patients with score more than 4 with high random blood sugar and elevated white cell count being showed delayed healing. We predicted the complications of the diabetic foot based on the PEDIS scoring with factors like uncontrolled blood glucose level, grossly increased white blood cell count, additional co-morbidities and previous history of surgery in the same foot. All of the factors and management of diabetic foot ulcer showed p value of less than 0.05 except the conservative management. Conclusion: The present study concluded that PEDIS scoring helps in predicting complications in diabetic foot ulcer and its management.

21. An Observational Study to Evaluate Mammographic and Sonographic Findings in Breast Cancer Screening at Tertiary Care Centre
Sandeep Kumar, Madhukar Dayal, Rajeev Ranjan
Aim: The aim of the present study was to assess the mammographic and sonographic findings in breast cancer screening. Methods: The present study was conducted in the Department of Radiology. Breast lesions were detected by clinical breast examination, mammography and ultrasound. A total of 200 breast lesions were examined by histological methodology. Results: A total of 200 breast lesions were examined by histological method, revealing the presence of 96 invasive cancers, and 104 benign lesions. The mean age of the patient was 58 years, ranging from 31 to 78 years. Most of the patients belonged to 50-59 years. The histological types of cancer in 96 patients were: invasive ductal, invasive lobular, mixed (ductal/lobular) tubular, medullary, mucinous. Mammography was false negative in 44 out of 96 invasive cancers; ultrasound was false negative in 26 out of 96 cancers. Mammography was false negative in 30 out of 104 patients without cancer; ultrasound was false negative in 14 out of 104 patients without cancer. Conclusion: Breast ultrasound is more accurate than mammography in symptomatic women 45 years or younger, mammography has progressive improvement in sensitivity in women 60 years or older. The accuracy of mammograms increased as women’s breasts became fattier and less dense. In young women and women with dense breasts, ultrasound appears superior to mammography, and may be an appropriate initial imaging test in those women.

22. A Hospital Based Study to Evaluate the Correlation of Ultrasound with X-Ray for Determining the Amount of Aspirated Effusion and Evaluate Pleural Effusion
Saumitra Barthwal, Isha Saini, Amisha Patel
Aim: The aim of the present study was to evaluate the correlation of ultrasound with chest radiographs for determining the amount of aspirated effusion and evaluate pleural effusion. Methods: The present study was conducted at SGRRIMHS and Shri Mahant Indiresh Hospital, Dehradun, India from June 2022-Oct 2023.  The source of data for this study includes total 50 patients referred to the department of Radio- Diagnosis and Imaging for chest radiography and ultrasonography from OPD/IPD/ED of SGRRIMHS and Shri Mahant Indiresh Hospital, Dehradun, India. Results: In this prospective study 50 patients were included, out of which 31 (62%) were male and 19 (38%) were female, the average age of patient were 37.3 years. In this study we included only those patients who underwent both x-ray as well as USG to identify pleural effusion. Results from USG showed 25 (50%) males and 9 (18%) females had pleural effusion in right lung whereas 10 (20%) females and 6 (12%) males had pleural effusion in left lung. In x-ray images 20 (40%) males and 9 (18%) females showed pleural effusion in right lung and 11 (22%) female, 10 (20%) males had effusion in their left lung. For right lung minimum volume of fluid was 36.4 ml and maximum volume was 340 mL whereas the average volume was 93.98 mL. In left lung minimum 36.4 ml of fluid was detected and maximum recorded volume was 220.2 mL and average volume recorded was 60.1 mL.  Average volume of effusion in male was 35.50 mL in left lung and 120.40 mL in right lung. In female average effusion in right lung was 102.90 mL and in left lung was 64.36 mL. Conclusion: USG is some distance superior than simple X-Ray in locating of minimal pleural & also for quantification of pleural effusion. Furthermore, interventions like pleural faucet can also done. USG can locate low amount of fluid presence even less than 3 ml, while X- ray fails to help diagnose such low quantity of fluid.

23. A Prospective Single Centre Clinical Trial Assessing Alcaftadine (0.25%) with Olopatadine (0.2%) in Allergic Conjunctivitis
Sujata Kumari, Gautam Garg, Naveen Kumar, Sunil Kumar
Aim: The aim of the present study was to compare the alcaftadine (0.25%) with olopatadine (0.2%) in allergic conjunctivitis. Methods: This was a prospective, observer masked, single centre clinical trial conducted in the Department of Ophthalmology for the period of one year.adhered to the principles of the declaration of Helsinki. Informed consent was obtained from all the participants. 200 patients were enrolled in the study. Results: 100 patients received alcaftadine 0.25 % eye drop and 100 patients received olopatadine 0.2 % eye drop. Mean age of alcaftadine 0.25 % treated group was 26 ± 5.65 years and that of olopatadine 0.2 % treated group was 26.4 ± 6.84 years. Number of males in alcaftadine treated group and olopatadine treated group are 80 and 76 respectively and number of females are 20 and 24 respectively. In alcaftadine 0.25 % treated group, at the time of presentation, mild, moderate, moderately severe and severe cases were 52 (52%), 42 (42%), 6 (6%) and 0 respectively. Similarly, in olopatadine 0.2 % treated group, at the time of presentation, mild, moderate, moderately severe and severe cases were 78 (78%), 15 (15%), 7 (7%) and 0 respectively. Mean severity scores at presentation in both alcaftadine and olopatadine group were comparable with no significant difference (p- value = 0.154, statistically not significant). Both the drugs showed downward shift in mean severity score which was greater in alcaftadine treated group than in olopatadine treated group. Mean reduction in severity score was higher in alcaftadine treated group at both 1 week and 2 weeks post treatment and the difference were statistically significant. Conclusion: In our study, alcaftadine 0.25 % eye drops showed higher efficacy than olopatadine 0.2 % eye drops in relieving ocular signs and symptoms at both 1 week and 2 weeks follow up. Both drugs were found to be safe and well tolerated. Further research is required to understand the basic factors and reasons responsible for these differences in efficacy between the two treatment arms.

24. A Hospital Based 1-Year Prospective Study to Estimate Prevalence and Severity of DR in Recently Diagnosed Type 2 DM Patients
Rajnee Sinha, Madhulika Sinha, Rajeshwar Rao, Gyan Bhaskar
Aim: The aim of the present study was to estimate prevalence and severity of DR  in recently diagnosed type 2 DM patients. Material & Methods: A study was conducted in the Department of Ophthalmology for 1 year. This observational, prospective study was conducted in patients who visited the diabetic clinic and recently diagnosed (less than 3 months from first diagnosis) for type 2 DM. In present study total 100 patients were evaluated for diabetic retinopathy. Results: In present study total 100 patients were evaluated for diabetic retinopathy. Most of patients were from 61-70 years (25%), followed by 51-60 years (22%) and 41-50 years (20%) age group. Male patients (58%) were more than female patients (42%). We noted 10% prevalence of diabetic retinopathy in study patients. Prevalence was more in males (66.66%) as compared to females (33.33%). In present study diabetic retinopathy was noted in 15 patients, divided as mild nonproliferative diabetic retinopathy (66.66%), Moderate nonproliferative diabetic retinopathy (20%), Severe nonproliferative diabetic retinopathy (6.66%) and proliferative diabetic retinopathy (PDR) (6.66%). Macular edema was noted in 4 patients. 60% of them had mild macular edema while 20% each had moderate and severe macular edema. Conclusion: Screening for diabetic retinopathy is important for newly diagnosed diabetic patients. A systematic screening program in the community is needed for early detection and to reduce blindness in diabetic patients.

25. A Hospital-Based Study to Evaluate the Safety and Efficacy of Retrograde Intrarenal Surgery (RIRS) in the Treatment of Kidney Stones
Sajal Kumar
Aim: The aim of the present study was to evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones greater than 2 cm. Methods: The present study was conducted in the Department of General Surgery. A total of 100 patients admitted to our clinic and underwent RIRS for the period of 2 years was reviewed retrospectively. Results: The size, location, and number of the stone(s); age; gender of the patient; prior history of open surgery or ESWL; degree of hydronephrosis were compared. The result showed statistically significant differences in prior history of surgery, localization of the stone and mean stone size. The mean hospital stay was 1.56±0.8 days and the mean duration of surgery was 102.28±32.24 minutes. Conclusion: Currently, PCNL is the gold standard treatment for kidney stones greater than 2 cm. However, single or multi-session RIRS may provide successful results in stones greater than 2 cm. Therefore, RIRS with a holmium laser may be an alternative to PCNL in selected patients with large- sized renal stones.

26. Difference between Partial Pressure of Venous to Arterial Carbon Dioxide as a Mortality Indicator in Septic Shock Patients After Early Goal Directed Therapy: A Prospective Observational Study
Uzma Raihan, Saurav Shekhar, Vivek Ranjan, Ajit Kumar, Ranjeet Rana De
Aim: The aim of the present study was to evaluate if partial pressure of CO2 measured from a superior central vein sample is a prognostic index (ICU length of stay, SOFA score, 28th mortality rate) just after early goal- directed therapy (EGDT). Methods: The present study was conducted at Department of Trauma and Emergency .The study population consisted of adult (≥18 years) septic patients admitted to the intensive care unit after EGTD that persisted with shock (need for vasopressors). During a 6-month period, a total of 100 patients were analyzed. Results: Survivors showed a significant reduction in SOFA score during 3 days follow-up. The admission Pv–aCO2 showed no difference with regard to any possible outcome when categorized in normal and abnormal. Admission Pv–aCO2, ScvO2 and arterial lactate values showed low specificity and sensitivity to predict mortality. Normal or abnormal Pv–aCO2 values in each time did not show statistical difference for 28th mortality, ICU mortality and SOFA scores. Patients with normal ScvO2 values but with enlarged Pv–aCO2 showed higher SOFA score values during follow-up. Conclusion: This study showed that the admission Pv–aCO2 after EGDT is not associated with worse outcomes. The possible physiologic explanation is that blood flow was restored for most patients. In the future, studies with larger numbers of patients may demonstrate that Pv–aCO2 could be a useful complementary perfusion clinical parameter and help identify patients who remain inadequately managed when the hemodynamic optimization has been reached.

27. An Epidemiological Study to Determine the Prevalence of Depression and Disability among Alcohol Dependent Patients
Vinod Verma, Pradeep Kumar, Chandan Kumar Sah, Ajeet Kumar
Aim: The aim of the present study was to assess the prevalence of depression and disability among alcohol dependent patients. Methods: The present study was a cross sectional observational study. It was conducted in psychiatry department of Uma Nath Singh Autonomous State Medical College, Jaunpur, Uttar Pradesh, India from December 2022 to November 2023 and the complete project was done in accordance with the permission granted by Uma Nath Singh Autonomous State Medical College, Jaunpur, Uttar Pradesh, India ethical Committee. Sample size of 100 patients was taken by consecutive sampling. Results: All of the patients were Males (100%). Majority of the subjects were married (81%) and studied up to secondary education (41%), belonged to Hindu religion (78%), low socioeconomic status (65%). Most common occupation was semiskilled (53%) and unskilled (31%). In terms of severity, Moderate (32%) and very severe depression (20%) was more common. Disability was assessed using WHO DAS 2.0 Scale. Among the individual domains, life activities (30%), which include both household and work activities was most affected, followed by participation in the society (20%). In terms of severity, most of the patients had moderate (40%) to severe (38%) disability. Conclusion: AUDs, depression, and their co-occurrence impose a tremendous burden on individuals, families and communities. Three fourths of the patients with alcohol dependence syndrome are suffering from depression. Alcohol dependence is also associated with greater levels of disability, irrespective of the presence or absence of depression. Further research in disability assessment of alcohol users can help in formulating preventive early intervention strategies for specific disabilities. Alcohol control policies need to shift focus from economic issues to the social issues associated with alcohol use.

28. A Retrospective Functional Outcome Assessment of Diaphyseal Fractures of Both Bones of Forearm in Adults after Fixation with Dynamic Compression Plate
Shashank Kumar, Rahul Harish
Aim: The aim of the present study was to analyse the functional outcome of diaphyseal fractures of both bones of forearm in adults after fixation with dynamic compression plate at a tertiary care center. Methods: The present study was retrospective, case record-based study, conducted in Department of Orthopaedics for the period of 2 years. 50 cases satisfying study criteria were considered for study. Cases operated for management of diaphyseal forearm fractures treated by open reduction and internal fixation with dynamic compression plate was considered for this study. Results: The age of these patients ranged from 18-60 years, had mean age of 36.04 ± 8.84 years. 72% were male and 28% were females. In present study right sided injuries (64%) were common, common mode of injury was RTA (66%). Majority of the fractures were seen in the middle 1/3rd (46%), were simple fractures (52%) and closed (86%). Majority of fractures were healed in less than 4 months (72%), followed by 4-6 months (20%). Mean time required for fracture union was 16.34 ± 3.78 weeks. Postoperative complications such as Superficial Infections (4%) and radioulnar synostosis (4%) were noted in two patients each. Using the Anderson scoring system, at 6 months follow-up, 84% patients had excellent results, 12% patients had satisfactory results and 2 (4%) patients had unsatisfactory result (radioulnar synostosis). Conclusion: Open reduction and internal fixation with dynamic compression plate had excellent functional outcome in the majority of patients, maintain rotational stability and length and early mobilization of elbow and wrist joint and had minimum complications.

A Study to Assess the Clinical Profile and Spectrum of Functional Disability of Patients of Cerebral Palsy
Manish Ranjan, Arvind Kumar Yadav, Kripa Nath Mishra
Aim: The aim of the present study was to assess the clinical profile of patients of cerebral palsy and to assess the spectrum of functional disability. Methods: The present study was done in the pediatric department of Darbhanga Medical College and Hospital. The present study is the observational study conducted for a period of one year. A total of 100 patients diagnosed with cerebral palsy attending the OPD of the pediatric department were included in the study. All the patients belonged to the age group of upto 12 years. Results: In the present study, most of the participants belonged to 2-5 years of age and 60% were male. According to nutritional status, majority of the patients belonged to grade III. Among them, 48% were generalized tonic-clonic seizures, myoclonic seizure (30%), febrile seizure (6%), refractory seizure (8%) and status epilepticus (8%). GMFCS score 5 was seen in 28% (mostly quadriplegic), followed by GMFCS level 1, 22% (mostly hemiplegic), others mostly diplegic in level 3 (20%), level 2 and 4 (15%). Conclusion: In present study, children between 2 to 5 years with male preponderance were mainly noted. Diplegic CP patients were most common and equally distributed between GMFCS 2 to 4. Perinatal factors (asphyxia) were main etiological risk factor. Multidisciplinary CP clinic also provide more satisfaction thus compliance for rehabilitation.

30. A Hospital Based Study to Assess the Clinical Profile Patients Diagnosed with Chronic Suppurative Otitis Media
Manish Kumar, Md. Tausiful Haque, Birendra Kumar
Aim: The aim of the present study was to find out the magnitude of Chronic Suppurative Otitis Media. Methods: The study was conducted on 200 cases of clinically diagnosed chronic suppurative otitis media in the age group 20-50 years, attending Out Patient Department (OPD) of Ear, Nose and Throat (ENT) The study was conducted for duration of 12 months. Results: In the present study, 100 were unilateral cases with safe variety and 44 had cases with unsafe variety. Ear discharge was the most common complaint followed by ear itching then decreased hearing and ear pain and lastly tinnitus. Conclusion: There is an urgent need in bringing awareness among the patients regarding the disease and its possible complications if left untreated. And also we are emphasizing to improve the health care facilities being available to the patients – both in the form of treatment and also in the form of awareness of preventive measures.

31. MR Spectroscopy and Post-Operative Histopathology in Diagnosis of Intra-Cranial Space Occupying Lesions – A Comparative Study
Gaurav Batra, Biju Bhadran, Girish K.M., Pooja Batra
Aim: The aim of the present study was to assess the various MR Spectroscopy findings in Intra-cranial space occupying lesions that help to make a clinical diagnosis and effectiveness of MR Spectroscopy in diagnosing Intra-cranial space occupying lesions and its accuracy as confirmed by post-operative histopathological findings. Methods: The present study was conducted in the Department of Neurosurgery, Government TD Medical College, Alappuzha, Kerala. 18 months after Institutional Ethics Committee approval. Data was collected for a period of 12 months and analysis was done at the end of 12 months. All patients admitted with intra-cranial space occupying lesion and undergoing surgery under Department of Neurosurgery, Government TD Medical College, Alappuzha, Kerala and who were willing to participate in the study. Results: It was observed that out of the total 50 cases participated in the study, most of the cases i.e. 9 (18%) each, belong to the age group of 31-40 years and 51-60 years, followed by 8 (16%) each in age group of 41-50 years and 61-70 years. Out of total 50 cases participated in the study, 32 (64%) were males and 18 (36%) were females, with male to female ratio 1.8:1. Most common diagnosis among the participated cases was Glioma in 17 (34%) cases followed by meningioma in 11 (22%) cases, abscess in 3 (6%) cases and metastasis, pituitary tumour, lymphoma, pineal tumour each in 2 (4%) cases. After Histopathological examination, most common finding observed was Glioma in 17 (34%) cases followed by meningioma in 11 (22%) cases. Conclusion: The present study has shown MRS can differentiate neoplastic from the non-neoplastic intracranial lesions, as well as diagnose various lesions based on metabolite ratios and spectrum, helps in better tissue characterization improving the accuracy and confidence level of neurosurgeons in their diagnosis.

32. Dysphonia: Associated with Inhalation Corticosteroids
Younus Majeed Dar, Junaid Nasim Malik, Majidul Islam Masoodi
Inhaled corticosteroid (ICS) therapy has emerged as a cornerstone in the pharmacological management of asthma, exerting potent anti-inflammatory effects within the respiratory tract. Despite its efficacy, the occurrence of dysphonia, characterized by alterations in voice quality, represents a prevalent local adverse event associated with ICS administration, affecting a substantial proportion of patients, with reported incidence rates ranging from 5% to 58%.The precise pathophysiological mechanisms underlying dysphonia secondary to ICS therapy remain incompletely elucidated. However, it is hypothesized that dysphonia may be attributed to the deposition of active corticosteroid particles within the oropharyngeal region during inhalation. Subsequent local effects, such as myopathy or mucosal irritation in the laryngopharynx, are postulated to contribute to the development of dysphonia. In the clinical evaluation of dysphonia, a comprehensive assessment must incorporate considerations of concurrent ICS use, given its potential role as a contributing factor. In order to mitigate this adverse effect, several pragmatic strategies have been proposed. These include the judicious utilization of the lowest effective dosage of ICS, the implementation of spacer devices during medication administration to optimize drug delivery to the lower airways while minimizing oropharyngeal deposition, and adherence to post-inhalation hygiene practices, such as gargling, mouth rinsing, and facial washing, aimed at mitigating local corticosteroid accumulation. Regular maintenance of spacer devices through meticulous cleaning procedures is also advocated to prevent the accumulation of medication residues.

33. A Clinical Study to Evaluate the Effect of Glutamine Supplementation on Infection and Clinical Outcomes among Burn Patients
Uma Shankar Kumar, Anupama Priyadarshini, Parmod Kumar Sinha
Aim: The aim of the present study was to evaluate the effect of glutamine supplementation on infection and clinical outcomes among burn patients. Methods: The study was carried out during the duration of 2 years in the ICU.  200 burn patients were enrolled, 18-50 yrs. of age, of both sexes, total burn surface area of 20% -60%, expected length of stay in ICU > 48 h, admission within 72 h of burn injury and with any sort of thermal injury like flame burns, scald burn and contact burns. Results: 200 patients were enrolled in the study and allocated into two groups of 50 patients in each group. Patients’ demographic data and burn were comparable between the groups with insignificant differences. As regard wound culture, there was a significant reduction of positive wound cultures in the glutamine group on day 5 (p < 0.001), there were 16 patients in group I and 40 patients in group II with +ve wound culture. However, there was a statistically significant drop in Gram -ve bacteremia in group I than in group II (p < 0.001), whereas there was no statistically significant difference between the two groups in respect to gram +ve bacteremia. There was a significant decrease in WBC count in group I than in group II on day five and day 10 (p = 0.003 and 0.002). According to blood cultures, there was significantly increased bacteremia in group II than group I at day 5 (p < 0.005), with a statistically significant drop in gram -ve bacteremia in the glutamine group than the control group (1 vs. 8 patients, p < 0.026), whereas there was no statistically significant difference among the groups as regards gram +ve bacteremia (0 vs 2 patients, p < 0.440). There was a significant decrease in the SOFA score in the glutamine group than the control group on day 5 (p < 0.001). The mean ICU stay was statistically significant shorter in group I than group II. Conclusion: The present results proved that IV glutamine supplementation in adult burn patients can reduce the impact of infectious morbidity and improve the clinical outcome.

34. A Hospital Based Observational Study to Assess the Association of Dengue Serology with Variations in RBC Parameters
Manish Kumar Jha, Poonam Kumari, Madhu Bharti
Aim: The aim of the present study was to assess the association of dengue serology with variations in RBC parameters. Methods: The present study was conducted in the Department of Pathology. Out of 200 total study populations, 100 were dengue positive and 100 were dengue negative. Results: Multiple logistic regression showed thrombocytopenia, leukopenia (ORA = 0.999; p < 0.001), glucose level, aspartate aminotransferase and monocytosis as significant parameters in the NS1-only positive group. Similarly, thrombocytopenia, glucose level and aspartate aminotransferase were significant in IgM-only positive patients. Moreover, thrombocytopenia, leukopenia, glucose, aspartate aminotransferase and lymphopenia were independent predictors in both NS1 + IgM positive groups. Conclusion: The study found that certain hematological and biochemical parameters can predict the outcome of dengue infection, which can assist physicians in the diagnosis and proper patient management. Parameters, such as thrombocytopenia, AST, hyperglycemia, and leukopenia with monocytosis (in the NS1-only phase); thrombocytopenia, elevated AST, and high blood glucose (in the IgM-only phase); and thrombocytopenia, elevated AST, high blood glucose, and leukopenia with lymphopenia (in the dual-positive/both NS1 + IgM phase), can provide insight into dengue positivity and help with patient management.

35. A Hospital-Based Assessment of the Role of the Serum Trace Elements Levels (Zinc and Copper) In Obese and Non-Obese Type 2 Diabetic Patients: An Observational Study
Kavita Priyadarshani, Suman Kumar Singh, Madhu Sinha
Aim: The aim of the present study was to assess the role of the serum trace elements levels (Zinc and Copper) in obese and non-obese groups. Methods: The present study was carried out in the Department of Biochemistry and 200 patients of type 2 diabetes mellitus attending Medicine OPD were recruited into the study. Informed about the details of the study and the written consent was obtained from all the participants of the study. Results: The mean and SD of BMI and Waist-Hip ratio in non-obese group was (24.86 ± 0.88) and (0.88 ± 0.12) which was lower than that of the Obese group (26.43 ± 2.68) and (0.92 ± 0.08). BMI and waist-hip ratio were significantly higher (P < 0.05) in obese group than those of the non-obese group. The mean and SD of Fasting Glucose, Total Cholesterol, Triglycerides, LDL and Copper levels in Obese group was higher than non-obese group, whereas mean and SD of HDL-cholesterol and Zinc levels is lower in Obese group when compared to those of the non-obese group). In addition, LDL and Copper levels in Obese group were significantly higher (P<0.05) whereas HDL-Cholesterol and Zinc levels were significantly lower than those of the non-obese group.  Correlation analysis in the diabetic Obese and Non-Obese group was done between trace elements, BMI, Waist-Hip ratio, Fasting Glucose and lipid profile. Statistically significant positive correlation was observed between Zinc and LDL, Copper and HDL levels whereas significant negative correlation was observed between Zinc and Cholesterol, Copper and LDL levels in non-obese group. The levels of Zinc have significant negative correlation with Cholesterol and Triglyceride levels whereas significant positive correlation was observed between copper levels and BMI in Obese group. Conclusion: Deficiency of Serum Zinc is inversely related to body weight and Body Mass Index (BMI) and directly related to high copper levels. Dietary supplementation with Controlled weight reduction should be considered with extreme care and also the therapeutic replacement of zinc with chelating excess copper may prove beneficial in delaying the further progress of diabetic complications.

36. Estimation and Association of Serum Uric Acid in Type-2 Diabetes Mellitus
Shanta Kumari, Harshwardhan, Rajiva Kumar Singh
Aim: The present study aimed to know whether serum Uric acid level can be used as predictor and prognostic marker of type 2 diabetes mellitus in Patna Bihar. Methods: The present study was conducted in the Department of Physiology. 100 patients were included in the study. Results: Individuals in the higher uric acid quartiles were more likely to be older, overweight and obese and have high total cholesterol levels. We observed an inverse association between serum uric acid levels and diabetes mellitus in both the age- sex-adjusted and the multivariable-adjusted models. In a supplementary analysis where we examined the association between uric acid and diabetes mellitus defined in addition to fasting glucose as raised HbA1C (levels > 6.5%), compared to quartile 1 (referent) the multivariable adjusted odds ratio (95% CI) of diabetes in quartile 2 was 0.61 (0.42–0.89), quartile 3 was 0.50 (0.38–0.65), and in quartile 4 was 0.61 (0.45–0.83); P trend ≥0.004. Conclusion: The present concluded that that higher serum uric acid levels are inversely associated with diabetes mellitus in both men and women.

37. Assessment of Post Operative Pain Management in Open Suprapubic Cystolithotomy for Bladder Stone: An Observational Study
Amit Ranjan, Mukesh Jaysawal, Khursheed Alam
Aim: The aim of the present study was to record the drug used for postoperative pain in suprapubic cystolithotomy and to determine the effectiveness of multimodal analgesics used. Material & Methods: A prospective observational study for a period of 12 months in 100 patients who underwent suprapubic cystolithotomy from the department of general surgery. Results: A total of 100 patients were included among which 40 were female and 60 were the male patients. The patients who underwent suprapubic cystolithotomy were aged between 20 and 70.40 patients were in the age group of 40-50 years. The 20 different types of surgeries were recorded. The most common surgery performed in our study was open appendectomy followed by open cholecystectomy. Four different types of anaesthesia were used. Most common was general anaesthesia with transverse plane block followed by general anaesthesia with quadratus lumborum block. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural. By the second day 52 patients were shifted to oral analgesics most common drug used was the combination of aceclofenac, paracetamol and serratiopeptidase. NRS score was recorded for all the 100 patients on postoperative days 1, 2 and 3. Severity of pain gradually reduced from post -operative days 1-3 with the use of various analgesics. Conclusion: Combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

38. Comparative Assessment of Analgesia and Sensory Blockade in Patients Undergoing MRM
Stuti Kumari, Ravi Kumar, Akhilesh Kumar Singh, Bijoy Kumar
Aim: We aimed to compare the techniques in terms of analgesia and sensory blockade in patients undergoing modified radical mastectomy (MRM). Methods: The present study was conducted in the Department of Anaesthesia & Intensive Care, for 1 year. The study adheres to CONSORT guidelines. 100 American Society of Anesthesiologists (ASA) I/II patients between the age group 20 and 60 years, who were scheduled to undergo unilateral MRM under general anaesthesia, were screened. Out of these, 50 patients were allocated in one of the two groups. Results: Morphine consumption within 24 h postoperative period in group I was 6.50 ±1.30 mg and in group II was 8.65 ±0.75mg. The difference was highly significant between the two groups (P < 0.001). The intraoperative fentanyl consumption (μg/kg) was more in group II (1.56 ±0.480), compared to the other group: 1.5 ±0.570 Conclusion: Injection of drugs deep to erector spinae muscle provides more cranio‑caudal blockade of posterior and lateral chest wall than superficial group.

39. A Hospital-Based Survey of Distribution of Hepatitis a in Clinically Suspected Cases of Acute Viral Hepatitis: An Observational Study
Aradhana Bharati, Samir Alam, Archana, Vijay kumar
Aim: The aim of the present study was to assess the seroprevalence of Hepatitis A cases and profile of clinically suspected cases of acute viral hepatitis at a tertiary hospital. Methods: The present study was prospective and observational study conducted in the Department of Microbiology, PMCH, Patna, Bihar, India for the period of one year.  In present study, serum of 200 cases of suspected hepatitis was tested. Results: Suspected hepatitis cases were most commonly observed in 15 – 30 years of age group (45%) followed by 31 to 45 years of age group (30%) and less than 15 years (18%). Suspected hepatitis cases were most commonly observed in female (53%) population as compared to male (47%). The most common clinical features amongst cases of hepatitis was fever (98%) followed by malaise (97%), abdominal pain (88%), Yellow discoloration of urine (24%) and loss of appetite (14%). Anti HAV test (IgM) was reactive most commonly in less than 15 years of age group followed by 15 to 30 years and 31-45 years. Amongst HAV positive cases there was slightly higher number of female cases as compared to male cases. Mean Total Bilirubin, SGOT/AST, SGPT, ALP and A/G ratio amongst hepatitis A cases was 2.86± 2.46, 113 ± 28.73, 308 ± 152, 1365 ± 596 and 0.68 ± 0.24 respectively. Conclusion: HAV infections are prevalent infections among clinically suspected acute viral hepatitis patients and remain a major health problem in developing countries. Reduced incidence of HAV infection in respective age group indicates the role of improved sanitary measures and public education.

40. Comparative Assessment of Hemodynamic Changes Due to Subarachnoid Blockade in Preeclamptic and Normotensive Healthy Parturients
Mahesh Kumar, Amit Kumar
Aim: The aim of the present study was to compare hemodynamic effects of regional anaesthesia in preeclamptic females and healthy parturients. Methods: The observational study was conducted in the Department of Anaesthesiology & Critical Care, Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India. Study duration was of 24 months. Study population comprised of 50 normotensive ASA grade II parturients planned for LSCS and 50 ASA grade III preeclamptic parturients planned for LSCS. Results: Both groups were comparable in term of mean age, weight, gestational age and parity comparison (p<0.05). The incidence of hypotension in non-preeclamptic parturients (92%) was significantly higher and that of preeclamptic parturients (14%). Similarly, bradycardia was also more commonly observed in normotensive group (30%) compared to pre-eclamptic group (2%). Mean lowest SBP, DBP and MAP measured among the preeclamptic patients were consistently higher (128.66±6.54 mm Hg, 84.16±6.02 mm Hg and 96.62±5.65 mm Hg respectively) than the corresponding values among the healthy parturients (93.67±4.56 mm Hg, 55.46±6.24 mm Hg and 68.16±5.25 mm Hg respectively). Need of mepehentermine was also significantly higher in normotensive women (9.31±4.16 mg) compare to pre-eclamptic group (1.38±3.32 mg). (p value <0.001) Mean duration of procedure in both normotensive group (58.62±8.32 min) and pre-eclamptic group (58.32±6.44 min) was comparable between both groups. No statistically significant difference was noted for neonatal weight and APGAR score between two groups (p>0.05). Conclusion: Subarachnoid blockade is associated with better perioperative hemodynamic stability and lower risk of hypotension and vasopressor requirements in preeclamptic women compared to the rates of healthy subjects. Subarachnoid block can be safely practiced in patients with preeclampsia undergoing caesarean section. The benefit of rapid, dense and reliable subarachnoid block over epidural anaesthesia should be considered for preeclamptics undergoing caesarean section.

41. A Study to Analyze the Postoperative Period PTE
Madhav Kumar, Aandrei Jivendra Jha, Namita Mishra, Tushar Kumar, Devi Shetty
Aim: The aim of the present study was to analyze the efficacy, safety, morbidity and survival associated in the postoperative period. Methods: The present study was conducted in the Department of Cardiac surgery, Narayana Institute of cardiac sciences, Bangalore, India and a total of 90 consecutive patients undergoing PTE were included. All the data were collected prospectively. Results: Mean age of the patient was 42.08 years with male preponderance. Only 54 patients gave previous history of deep venous thrombosis. Signs of right ventricular failure like edema, jaundice, ascites and raised jugular venous pressure were present. Out of 90 patients, 18 were tested positive for antiphospholipid antibody, and 3 were having protein C/S deficiency. These abnormalities were observed predominantly in the younger age group (<35 years). The mean preoperative mPAP was 41.97±8.26 mmHg; mean cardiac index was 1.98±0.22 L/min/m2 and mean pulmonary vascular resistance was 418.39±95.88 dynes/sec/cm. In this regard, our study showed significant reduction in PAP, pulmonary vascular resistance and corresponding improvement in cardiac index. The mean ICU stay of patients who survived was 11.25 days. The mortality rate in our study was 11.11% (10 patients) of which two patients had significant pulmonary hemorrhage in the immediate postoperative period. In our study we encountered two cases of pulmonary hemorrhage. Conclusion: Pulmonary endarterectomy is an effective and potentially curative surgical treatment for patients with severe chronic thromboembolic pulmonary hypertension. The mean ICU stay of patients who survived was 11.25 days. The mortality rate in our study was 11.11% (10 patients) of which two patients had significant pulmonary hemorrhage in the immediate postoperative period. In our study we encountered two cases of pulmonary hemorrhage.

42. Comparing Post-Op Analgesic Efficacy of the Pulmonary Recruitment MANOEUVRE and Intraperitoneal Hydrocortisone in Laparoscopic Surgeries
Amandeep Kaur
Aim: The objective of the current study was to examine the hypothesis that the pulmonary recruitment maneuver provides a greater reduction in postoperative pain compared to intraperitoneal hydrocortisone instillation in patients who had undergone laparoscopic cholecystectomy surgery. Methods: In the Department of Anesthesiology, the current investigation was carried out. The sample consisted of 150 patients, including 50 patients in each group.  This study included patients classified as American Society of Anesthesiologists (ASA) physical status I and II, ranging in age from 20 to 55 years. These patients were scheduled to have diagnostic laparoscopic cholecystectomy operations as part of gall bladder disease. Results: The demographic profile baseline values of haemodynamic variables and surgery time were similar throughout the study groups, and there was no statistically significant distinction observed among the three groups. Both the hydrocortisone and pulmonary recruitment groups showed a statistically significant difference compared to the control group in terms of total analgesic use 24 hours after surgery, with a P value of 0.001. Additionally, there was a substantial decrease in the initial request for analgesia in both the hydrocortisone and pulmonary recruitment groups compared to the control group, as indicated by a P value of less than 0.001. There was no notable disparity in the overall intake of analgesics between the two intervention groups. The frequency of postoperative nausea and vomiting was found to be similar among the patients in all three groups. Conclusion: The utilization of both intraperitoneal hydrocortisone administration and the pulmonary recruitment procedure has demonstrated efficacy in alleviating postoperative pain subsequent to laparoscopic surgery.

43. A Cross-Sectional Study to Examine the Factors That Influence Breastfeeding Initiation in Women with Infants Younger Than One Year of Age
Monika, Manoj Kumar Ram, Alka Singh
Aim: The aim of the present study was to assess timely initiation of breastfeeding and associated factors among mothers of children less than 12 months old. Methods: The present study was conducted at department of Pediatrics, NMCH, Patna, Bihar, India and mothers who have a child less than 12 months of age were included in the study. Total 1000 mothers were included in the study. Results: In this study, 500 mothers had infants less than 12 months participated in this study making the response rate 98%. The mean age of mothers that participated in this study was 24.96 with the standard deviation of (±0.970). About 700 (70) of respondents were Hindus in their religious affiliation. About 400 (40%) of mothers completed primary school and 750 (75%) of them were housewives. Around 520 (52%), and 480 (48%) of them were females and males respectively. About 900 (90%) of the study participants had exposure to mass media and the majority of respondents. The highest majority, 850 (95) of respondents had received antenatal care (ANC). About 800 (88.88%) of participants started their antenatal care before fifth month of gestation. Majority, 520 (57.77%) had four antennal visits. 586 (65.12%) of the study participants had gotten counseling on breast feeding. 500 (55.55%) were receiving counseling on timely initiation of breastfeeding. 800 (80%) respondents delivered at health institutions and 440 (88%) of them were assisted by health professionals. 860 (86%) of the mothers had spontaneous vaginal delivery. About 34% mothers did not give breast milk within 1 hour after delivery to their infants because of maternal illness. The Bivariate logistic regression analysis yielded that sex of the child, place of delivery for the current child, mode of delivery, exposure to media and family type were statistically associated. Conclusion: Mothers reported an 80% prevalence of timely commencement of breast feeding. Male infant, nuclear family, spontaneous vaginal birth, and ANC advice on timely breastfeeding initiation were associated with early breastfeeding.

44. A Placebo Control Double Blind Randomized Clinical Evaluation of the Effect of Metformin on Breast Fibrocystic Disease
Neha Gupta, Sujit Kumar Sah, Shubham Kumar, Asrita Gvvbs, Rinku Kumari, Pradeep Jaiswal, Pawan Kumar Jha
Aim: The aim of the present study was to evaluate the effects of metformin on Fibrocystic changes of breast changes. Methods: This was a placebo control double blind randomized clinical trial in the Department of General Surgery. Among women of age group 18 to 40 years with FCD who were visited to Surgery OPD with presenting complaint of breast lump and cyclic mastalgia or breast pain for at least one week during every monthly for six months were selected. Results: The mean age of participants in metformin, vitamin E and control groups was 30.4 ±3.91, 30±3.17 and 30.2±2.92 years respectively that based on variance analysis there was not a significant difference between the three groups (p-value >0.05). Based on analysis variance, the mean of the number of cysts, cyst size, tenderness and breast pain at the basal had no significant difference between the groups, but they had a significant difference between the groups at the end of the study (p < 0.05). The frequency of cyst location at the basal was not different between the groups, but at the end of the study, in situation when there were unilateral in metformin, vitamin E and control groups showed there is a meaningful difference between the groups after the intervention (p < 0.5). Conclusion: The present study showed that metformin is effective to relief the clinical symptoms and imaging items of FCC. Although, more high quality researches are needed in different ethnic populations to confirm these results.

45. A Hospital-Based Study to Assess Normal Anatomical Variations in Paranasal Sinuses using CT
Pradeep Kumar, Priyanka Raj, Sanjeev Suman, V.S. Prasad
Aim: The aim of the present study was to assess normal anatomical variations in paranasal sinuses using CT. Methods: The present study was conducted in the Department of Radiodiagnosis for the period of 12 months. 100 patients were included in the study. Results: In the present study, maximum patients belonged to 31-40 years followed by 20-30 years. There were 65% male as compared to females. According to anatomical variation, 32% were single and 68% were multiple. According to CT detected anatomical variation, 85% had Deviated nasal septum followed by 51% Concha bullosa and 47% prominent bulla ethmoidalis. Conclusion: According to the results, nasal septal deviation was the most common anatomic variation. Haller cell and pneumatised septum are the rarest ones noted in our study. Also, there was a strong correlation between the unilateral Concha bullosa and contra lateral septal deviation, which was evident based on the studies.

46. A Hospital Based Retrospective Observational Assessment of Mesh Related Infections
Amit Kumar Bimal, Aditya Veer Vikram, Pratibha Kumari
Aim: The aim of this study was to analysis of mesh related infections in Bihar region. Methods: A retrospective observational study was conducted in the department of General Surgery for 2 years and 100 patients were included in the study. Results: Mesh infection was more common in males. Among 100 patients, 82 were males and 18 female patients. Majority of the patients were in the age group 40-50 followed by 50-60 age groups. The time of presentation after surgery was more after 5 months and 40% had co-morbidities. Antibiotic has used according to the protocol of our hospital; it was followed in 96 patients in the first surgery i.e., hernia repair surgery. Parenteral cephalosporin was used in 96 patients and amoxicillin- clavulanic acid in 4 patients. Antibiotic has repeated if the procedure was beyond 2 hours. After postoperative day 2, patients were switched over to oral antibiotics for three days. Likewise, during the second admission, i.e., when the patient was admitted with mesh infection, 96 patients were given cephalosporin, and 4 patients were given Piperacillin tazobactam. Polypropylene mesh was used in 85 patients, and the composite mesh was used in 15 patients who underwent IPOM. Conclusion: Most of the patients took more than 5 months to report infection. Comorbidities were present in 40% patients and risk for complications after hernia repair is increased among patients with comorbid conditions. So, the proper selection of the patient, ensuring good control of comorbid medical conditions will prevent mesh infections.

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