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.

DOI: 10.5281/zenodo.10966651

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.

DOI: 10.5281/zenodo.10966675

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.

DOI: 10.5281/zenodo.10966700

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.

DOI: 10.5281/zenodo.10969806

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.

DOI: 10.5281/zenodo.10969812

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.

DOI: 10.5281/zenodo.10969824

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.

DOI: 10.5281/zenodo.10971169

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.

DOI: 10.5281/zenodo.10971180

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.

DOI: 10.5281/zenodo.10971193

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.

DOI: 10.5281/zenodo.10971203

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.

DOI: 10.5281/zenodo.10971215

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.

DOI: 10.5281/zenodo.10971227

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.

DOI: 10.5281/zenodo.10971245

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.

DOI: 10.5281/zenodo.10971265

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.

DOI: 10.5281/zenodo.10971293

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.

DOI: 10.5281/zenodo.10976341

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.

DOI: 10.5281/zenodo.10976354

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.

DOI: 10.5281/zenodo.10976362

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.

DOI: 10.5281/zenodo.10976367

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.

DOI: 10.5281/zenodo.10976374

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.

DOI: 10.5281/zenodo.10976380

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.

DOI: 10.5281/zenodo.10976390

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.

DOI: 10.5281/zenodo.10976397

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.

DOI: 10.5281/zenodo.10976556

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.

DOI: 10.5281/zenodo.10976575

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.

DOI:10.5281/zenodo.10976588

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.

DOI: 10.5281/zenodo.10976597

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.

DOI: 10.5281/zenodo.10976612

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.

DOI: 10.5281/zenodo.10976618

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.

DOI: 10.5281/zenodo.10976620

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.

DOI: 10.5281/zenodo.10976626

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.

DOI: 10.5281/zenodo.10976640

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.

DOI: 10.5281/zenodo.10976648

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.

DOI: 10.5281/zenodo.10976675

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.

DOI: 10.5281/zenodo.10976683

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.

DOI: 10.5281/zenodo.10976692

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.

DOI: 10.5281/zenodo.10976687

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.

DOI: 10.5281/zenodo.10976668

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.

DOI: 10.5281/zenodo.11353591

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.

DOI: 10.5281/zenodo.11353649

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.

DOI: 10.5281/zenodo.11353728

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.

DOI: 10.5281/zenodo.11353822

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.

DOI: 10.5281/zenodo.11353861

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.

DOI: 10.5281/zenodo.11354024

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.

DOI: 10.5281/zenodo.11354085

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.

DOI: 10.5281/zenodo.11354236

Aim: The aim of the present study was to assess the patient related barriers affecting effective treatment of asthma. Methods: The study was a prospective observational study for a period of one year in the Department of Pharmacology, DMCH, Laheriasarai, Darbhanga, Bihar, India. The study was conducted at outpatient and inpatient department of medicine and paediatrics. 100 patients were included in the study. Results: The average age of the Patients was 38.52±23.77 Yrs. (Range- 6-83), majority of the patients were Male -55% and Females were 45%. 13% patients said that they were bored to take medication. 9% patients said they do not remember to take medication. 22% patients did not use inhaled corticosteroid as they were feeling better. 36% patients did not feel the need to take ICS. 18% patients said that it was wastage of money to use ICS. 2%  patients had concern about side effects. Conclusion: It can be concluded from our study that the most common barrier found were bored to take medication, do not remember to take medication, feeling better, no need to take it, wastage of money concern about side effects.

Aim: The aim of the present study was to assess the radiological outcome following proximal realignment procedure (Campbell procedure) for habitual dislocation of patella. Methods: This was a prospective study conducted on 20 patients with habitual patellar dislocation, who presented to the Department of Orthopaedics, In all cases patellar dislocation was treated by Campbell’s procedure. Results: The sulcus angle pre-operatively and Post-operatively was not statistically significant. The congruence angle pre-operatively and Post-operatively was statistically significant. Conclusion: We concluded that following proximal realignment procedure (Campbell procedure) for habitual dislocation of patella radiological parameters were brought back to normal. There were no significant changes in sulcus angle. Congruence angle was brought back to normal, which was statistically significant (p<0.001).

Aim: The aim of the present study was to compare anthropometric measurements, liver function tests, haemoglobin and plasma glucose levels in individuals with alcohol abuse and normal population. Material & Methods: The study was carried out in the Department of Medicine, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India in between the duration of 24 months. The study included 200 individuals with alcohol abuse recruited from department of General Medicine. A total of 100 patients, age, sex, height and weight matched healthy individuals were taken as controls. Results: Patients with alcohol misuse averaged 43.7 years old, while controls averaged 42.08 years old. This age difference between cases and controls was not statistically significant. About 41% of alcohol abusers were 31-40 years old and 40% were 41-50. About 41% of non-alcoholics were 31-40 years old and 45% 41-50. About 16% of alcohol abusers had hypertension, 2% had dyslipidemia, 1% had intervertebral disc prolapse, 1% had obesity, and 80% had no comorbidity. About 8% of non-alcoholics had hypertension. It was statistically significant that 28% of alcohol abusers had binge drunk. The mean haemoglobin level of alcoholics was 13.6 gm% and of controls was 13.8. Not significantly different. Fasting plasma glucose averaged 85.4 mg/dl for alcoholics and 84.2 mg/dl for non-alcoholics. Not significantly different. Conclusion: Alcohol abusers had higher bilirubin, AST, and ALT levels. Hypertension is more common in alcoholics.

Aim: The aim of the present study was to find out the incidence of maternal complications, perinatal mortality and morbidity in postdated pregnancies. Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology for 22 months. Total 200 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 (45%) and control group (52%). 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. 65% of the patients in study group were primigravida and in the control group 55% were primigravida. The percentage of LSCS was 30% which was higher than in the control group where it was 15%. Incidence of instrumental delivery was also higher in the study group as compared to control group (13% as compared to 7%). Among the indications for LSCS, the most common indication among the study group was acute foetal distress which includes meconium stained liquor followed by cephalopelvic disproportion. In the control group, most common indication was non progress of labour followed by acute foetal distress and non-reactive CTG. Maternal complications like LSCS, PPH and sepsis all were higher in the study group as compared to the control group. 17% of infants in the study group had asphyxia as compared to only 7% in the control group. 15% infants of the study group had to be admitted to the NICU as compared to 10% in the control group. 3% was the percentage of intrauterine deaths in the study group as compared to none in the control group. Conclusion: Postdated pregnancy remains a clinical dilemma for an obstetrician. The choice is between watchful expectancy for labour to start or induction in postdated patients. According to our study, postdated pregnancies are related with higher rate of LSCS and instrumental deliveries.

Aim: The aim of the present study was to assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine bleeding. Material & Methods: This prospective observational study was conducted on 200 patients attended the Department of Obstetrics and Gynecology between the duration of January 2021 to December 2023 and to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding. Results: Majority of the patients belonged to 31-40 years age group. Of the 200 patients, majority, 80 had symptoms for more than 1 year, 72 patients had symptoms for 6 months to 1 year and 48 patients had symptoms for less than 6 months. Majority of the patients presented with menorrhagia. The second commonest was post-menopausal bleeding in 32 cases. There were 30 cases with polymenorrhagia and 26 patients with Hypomenorrhea. Out of 200 patients, 50 had proliferative followed by 44 secretary. Histopathology findings corroborate the hysteroscopically detected cases of hyperplasia, atrophic endometrium and endometritis. Both hysteroscopy and curettage were accurate when an abnormality was diagnosed, giving a specificity of 96.4% and 96.4% respectively and positive predictive value of 94.3% and 95.3% respectively. The ability to diagnose a lesion was more with hysteroscopy i.e. sensitivity in comparison to curettage, (91.9% versus 78.2%) while a negative diagnosis was less wrongly made with hysteroscopy in comparison to diagnostic curettage. Conclusion: Hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value and the results of hysteroscopy are immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with abnormal uterine bleeding for accurate diagnosis and further treatment.

Aim: The aim of the present study was to assess the efficacy of thrombolysis in Acute STEMI patients, with respect to resolution of ST-elevation on treatment with streptokinase and also to predict short term outcome during hospital stay in terms of adverse events and mortality. Methods: This study was done by analysing the ECG of patients with diagnosis of acute ST segment elevation before and after thrombolysis with Streptokinase, admitted to Department of  Cardiology, IGIMS, PATNA, Bihar, India for the period of 2 years. 150 Acute STEMI patients who had received thrombolytic therapy with streptokinase were studied in three groups namely Category A, Category B and Category C based on ST segment resolution after administration of thrombolytic therapy. Results: In the present study, the minimum age of the patient was 30 years, maximum age was 75 years. Maximum numbers of patients in between 40-59 years constitute 55%. Mean age of present study was 52.8±9.6. Male was significantly increased (P<0.000) when compared with female patients. In this study chest pain was the most common mode of presentation, present in 116 (96.66%) patients associated with sweating in 104 (86%) patients, breathlessness seen in 30 (25%) patients. Syncope was seen in 12 (10%) patients and palpitation in 6 (5%) patients. In this study anterior wall Myocardial infarction was not significant compared with inferior wall myocardial infarction. Thrombolysis time of <3 hours, 3-5 hours and more than 5 hours was noted in a, b and c categories patients. B and c categories patients were significantly increased when compared with categories of patients. Conclusion: In this present study we conclude that the efficacy of IV streptokinase for thrombolysis in acute STEMI and patients with no ST segment resolution at 90 minutes following thrombolysis were associated with more frequent adverse events and increased mortality compared to partial and complete resolution group. Percentage of resolution of ST segment following 90 minutes of thrombolysis as a diagnostic test helps in risk stratification of patients.

Aim: The aim of the present study was to compare open versus closed modalities of treatment of breast abscess and to isolate the commonest organism responsible for breast abscess. Methods: A cross sectional prospective study was designed to compare the breast abscess cases (both open and closed) admitted in Department of Surgery, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for a period of 2 years. A total of 200 cases were selected for the study and divided into two groups – open group and closed group. Results: Maximum number of cases i.e. 120 (60%) were observed in the 15-25 yrs of age group followed by patients in 26-35 years of age group (20%). In the present study, pain was present in 100% of patients, 96% patients had swelling and 8 (3%) patients complained of history of fever on presentation. Out of 92 cases operated by open method, 64% cases were lactating mothers, while 36% cases were non-lactating. Abscess on right side was more common (64%) than on the left side (36%). Maximum number of patients 116 (58%) had breast abscess in the upper outer quadrant followed by 50 (25%) cases in the lower outer quadrant, 26 (13%) cases in the upper inner quadrant and 8 (4%) case in the lower inner quadrant. The total number of dressings in the open category was 16.44, whereas in the closed category it was 3.38.  Among the total cases, total recurrence was seen in 20 (10%) cases from which 6 (6%) cases in open group and in 14 (14%) cases in closed group. Conclusion: Dressing in conventional method is painful and causes discomfort to the patient. Primary closure technique has a major drawback of failure but the failure rates are acceptable. The duration of hospital stay and nursing care was less in primary closure technique as compared to open method of treatment.

Aim: The aim of the present study was to find the rate of caesarean deliveries and various indications of the procedure. Methods: The present study was conducted in the Department of Obstetrics and Gynecology conducted this retrospective study on women who underwent LSCS over a period of 14 months.  Out of the 445 deliveries, 200 were delivered by cesarean section. All the mothers who underwent LSCS in this hospital in the designated period were included in this study. Results: The LSCS prevalence was 44.94% in our institution. We have assessed the common indications of LSCS performed in this study population. In our study group, the range of age varies from 18 to 43 years with an average of 27.37±4.21 years, 30% of the women aged between 18-25 years, majority, i.e., 60% belongs to the age group of 26-35 years and only 10% observed in the higher age group. Out of the 200 cases, parity was distributed almost equally in this study group, i.e., 45% were primigravidae, and 55% were multigravida. 5% of the LSCS occurred at <32 weeks of gestation and 25% between 32-36 weeks. The majority of the LSCS were delivered between 37-40 weeks (70%) of gestation. Mode of conception was spontaneous for 97%, and 3% received infertility treatments. Mode of conception was spontaneous for 97%, and 3% received infertility treatments. LSCS was mostly done for ‘previous LSCS’ indication (42%), followed by failure of induction of labor (25%). Fetal distress was an indication in 40 cases (8%), Breech presentation in 6%, PPROM in 5%, CPD in 4%. Other indications such as preeclampsia, placenta previa, unfavorable cervix, multiple gestation, abruptio placenta, LSCS on demand etc., was 1%. Conclusion: Although LSCS indications seen in our institute are the same in most institutions worldwide, efforts should be made to focus on reducing the primary LSCS rates thereby reducing the most common indication of previous LSCS in subsequent pregnancies.

Aim: The aim of the present study was to estimate the prevalence of stress, main stressor, major coping strategy adopted and the relation between stress and academic performance was studied among the first-year undergraduate medical students. Methods: This cross-sectional study was conducted under the Department of Physiology with a convenience sample of 100 first-year undergraduate medical students in ANMMC, Gaya, Bihar, India. Results: Mean PSS score was 18.52 ± 6.14 in male students, 21.18 ± 5.28in female students and 19.16 ± 5.35 in all the students. Mean PSS score was highly significantly more in female students when compared to male students with a p-value of 0.005. The main source of the stressor was academic-related, followed by social-related stressors, teaching and learning related stressors, group activities related stressors, Intra and interpersonal related stressors, drive and desire related stressors in the decreasing order. The majority of the students were using active coping, acceptance, planning, positive reframing and using instrumental support to cope stress. Substance abuse was the least coping strategy employed. In the mild group, not significant negative correlation was seen in between PSS vs. theory and practical marks. A positive, not significant correlation was observed between PSS vs. Viva-voce marks in mild group. Although the negative correlation was observed in between PSS vs. theory, practical and viva-voce marks in moderate and severe stress groups, highly significant negative correlation was observed only in moderate stress group as p< 0.005. Conclusion: Our study revealed a higher prevalence of stress among females. Academic related stressors were major stressors. Majority of students were employing positive coping strategies. A negative correlation was observed between stress and academic performance in theory marks. So, regular counselling to decrease stress might improve the academic performance of the students.

Aim: The aim of the present study was to compare the ease of tracheal intubation between supine and 25° back-up positions when using two video laryngoscopes (VLS). Methods: This randomised controlled study was conducted at ESIC Medical College, Bihta, Patna, Bihar, India for the period of 1 year. Written informed consent was obtained from all the participants to use their data for research and educational purposes. The study was conducted in agreement with the Declaration of Helsinki, 2013 and adherence to the Consolidated Standard of Reporting Trials (CONSORT) guidelines. Results: There were male predominance in all the groups and in group K1 mouth opening was higher. The mean (SD) mIDS was less in the 25° backup position as compared to the supine position by using both the King Vision and the McGrath VLS. The ELM was required in eight and four patients in groups K1 and K2, respectively. In contrast, it was needed in seven and three patients in groups M1 and M2, respectively. 12 and 8 patients required tube rotation in groups K1M1 and K2M2, respectively. Both manoeuvres were used in three patients in group K1 and two in group M1. A total of 68% in group K1 versus 32% in group K2 who required airway manoeuvres, whereas 60% versus 28% of patients needed airway manoeuvres in M1 versus M2 during intubation. Calculating the total number of patients requiring manoeuvres in the 25° back-up and supine positions by using King Vision and McGrath VLS resulted in a risk ratio of 0.48, P < 0.001, 95% CI: 0.305–0.765, and an odds ratio of 0.24 with a 95% CI 0.10 − 0.55. The intubation time was shorter using the 25°back-up position compared to the sniffing position using both the King Vision and the McGrath. Intubation was accomplished on the first attempt in all the groups. Conclusion: The 25° backup position is useful in providing ease of intubation using both the channelled (King Vision) and non-channelled (McGrath) VLS with less requirement of ancillary manoeuvres and shorter intubation time without complications.

Aim: The aim of the present study was to evaluate the risk of GDM in antenatal mothers with previous history of PCOS. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India and including 1950 pregnant women, the medical records of 200 women diagnosed with PCOS were evaluated. Results: A total of 200 women reported a history of PCOS. Women with PCOS before early pregnancy were more likely to be older, had higher prepregnancy BMI, and used assisted reproductive technology compared with women without PCOS. In the adjusted analysis, women with a previous diagnosis of PCOS had a higher risk for GDM than women with no such diagnosis (adjusted OR 1.55, 95% CI: 1.14–2.09). There was also a strong association between PCOS and preterm birth (adjusted OR 1.69, 95% CI: 1.08–2.67). In the stratified analysis using multivariable logistic regression, the adjusted OR for GDM among women with PCOS undergoing assisted reproductive technology was 1.44 (95% CI: 1.03–1.92) and among women with PCOS who conceived spontaneously was 1.60 (1.18–2.15) (Figure 1). Also, the risk of preterm birth was increased in women with PCOS regardless of use of assisted reproductive technology. There was no difference in the incidence of other adverse birth outcomes. Conclusion: Our results suggest that women with PCOS were more likely to develop GDM and experience preterm birth. Future longitudinal studies are needed to better deter- mine the underlying processes of PCOS during gestation and to develop efficient preventive strategies to preclude the adverse effects on both the mother and child.

Aim: The aim of the present study was to assess pain relief and functional outcome in knee osteoarthritis (OA) cases treated by intra-articular injection of platelet-rich plasma (PRP). Methods: All patients attending the Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India 40 to 70 years age group with knee pain included according to the inclusion and exclusion criteria during the study period. The sample size was 70 knees. A detailed clinical history of the patient was elicited. A general physical examination and Local examination of the affected knee was done and basic investigations done. Results: The efficacy was compared in respect to age, sex, body mass index and the grades of osteoarthrosis in the study. It shows that the majority of patients were females. There was a significant improvement in all scores over time compared to the pre-treatment value (p < 0.001). The mean baseline VAS was 7.48, which was found to be significantly reduced at the end of follow upto 3.6 (48.1% reduction in pain). Conclusion: Intra-articular injection of PRP is effective in treating early grade I and II osteoarthrosis knee. The study shows outcome with significant improvement of symptoms in patients with age group between 40 and 60. Our study group didn’t required analgesics following 1 week after injections till follow up of 6 months Complications like infection, stiffness and effusions is nil in this study. Unlike steroids it doesn’t increases the risk of infection in future procedures.

Aim: The aim of the present study was to assess the maternal and fetal outcome in previous caesarean section. Methods: This prospective study was done in the Department of Gynaecology, Netaji Subhas Medical College, Bihta, Patna, India over a period of 12 months. The study has been done on women admitted for safe confinement with previous cesarean section.  During the study period, there were total 12000 admissions. Results: Cesarean section was done for 1800 women, include primary and repeat cesarean section (rate of CS 15%). There were 800 women with history of previous one CS. Elective CS was done for 500 cases. Successful vaginal delivery was conducted for 200 cases and failure of trial among 100 cases. Cesarean section was done for 1800 women, include primary and repeat cesarean section (rate of CS 15%). There were 800 women with history of previous one CS. Elective CS was done for 500 cases. Successful vaginal delivery was conducted for 200 cases and failure of trial among 100 cases. Fetal distress was the major indications for emergency repeat CS (52%), followed by non progress of labour (34%). In elective repeat CS, major indication was CPD (40%), followed by fetal distress (16%). 12% had adhesions followed by 8% with obliterated UV fold. Conclusion: The overall maternal risks are increased in repeat CS, but successful vaginal delivery is possible if women are managed well. They should be counseled about maternal and perinatal risks and benefits of planned vaginal birth after cesarean section and elective repeat CS. Elective repeat CS should preferably be done at 39 completed weeks of gestation to avoid the risk of preterm birth.

Aim: The aim of the present study was to assess the different modalities of diagnosis and treatment in patients with a mass in right iliac fossa Methods: This hospital based prospective study was conducted in Surgery department of Patna Medical College and Hospital Patna, Bihar, India. A total of 100 patients presenting with the complaint of a mass in the right iliac fossa were studied. Results: The most common diagnosis made for the patients with the right iliac fossa mass was appendicular mass (49%) which was diagnosed using ultrasonogram and in 27% of the study subjects ileocaecal TB was diagnosed by means of contrast enhanced CT and for 12% of the patients, it was carcinoma caecum which was diagnosed by using colonoscopy with biopsy and 9% had psoas abscess and 3% had amoeboma. Most of the cases of appendicular mass or abscess drainage and excision were done and for 27% of the patients who were with ileocaecal TB, anti-tuberculosis treatment was given. In patients with psoas abscess, incision and drainage was performed. Right colectomy was done for majority of the patients with Ca caecum and further chemotherapy was given. Conclusion: This study showed that appendicular mass is the commonest pathology in right iliac fossa amongst all and conservative treatment followed by interval appendicectomy is the best mode of treatment. Carcinoma of the colon and ileocaecal tuberculosis was the other two common causes for mass in the right iliac fossa. These cases also carry a good prognosis, if properly diagnosed and treated.

Aim: The aim of the present study was to evaluate clinical presentation and outcome of ectopic gestation in a tertiary care hospital. Methods: This study was conducted in Gauri Devi Institute of Medical Science & Hospital, Durgapur, West Bengal, India in the department of Obstetrics and Gynaecology. We included all the patients who were admitted with ectopic pregnancy for 1 year. Total of 100 patients were included with ectopic pregnancy who were admitted in our hospital. Results: Maximum patients were in the age group of 26-30 (40%) and 31-35 (36%) years. In our study 40 patients (40%) with ectopic pregnancy were primigravida and 60 patients (60%) were multigravidas. In our study majority of women presented with pain abdomen (95%) followed by bleeding/ spotting per vaginum in 51%. Amenorrhea was seen in 22% women. On physical examination forniceal tenderness was seen in 85% of patients, 45% patients had cervical motion tenderness and 40% had both pallor and tachycardia. 25% patients presented with shock. In our study out of 100 patients, 56 (56%) had emergency laparotomy and salphingectomy done, 16 (16%) had medical management with methotrexate, 14 (14%) had laparoscopy and 10 (14%) had expectant management. Conclusion: Ectopic pregnancy is still a major challenge in obstetrical practice because of its bizarre clinical presentation. It can be diagnosed early by keeping a high index of suspicion and personnel training. Despite exhaustive efforts to prevent ectopic pregnancies the numbers are constantly rising due to increased reporting of the cases and improved diagnostic modalities. Delay in referral causes significant morbidity and diminishes the chances of preserving future fertility.

Aim: The aim of the present study was to evaluate whether iron deficiency anemia is associated with acute bronchiolitis Material & Methods: This Cross-Sectional Analytical study was carried out in the Department of Paediatrics, Government Medical College Bettiah, West Champaran, Bihar, India from  Dec 2018 to November 2019. A total number of 200 patients were enrolled in the study and among them, 100 children with bronchiolitis were considered as cases, and 100 healthy children without bronchiolitis were considered as control, who were matched with age. Results: Majority of the patients were in the age group between 13-18 months. The mean age was found 13.087±5.735 months in cases and 15.125±7.963 months in controls. The mean age difference was not significant between the two groups (p>0.05). Male participants (65%) were the predominant group in the study and female participants (35%). Exclusive breastfeeding was found in 39 cases and 64 controls respectively. The differences were statistically significant (p<0.05) between the two groups in the chi-square test. Overcrowding was found in 76 cases and 60 controls respectively. There was a significant difference in Hb (gm/dl) between cases and controls followed by MCV (fl) between cases and controls. The MCH (pg) level was statistically and significantly lower in cases compared to controls; followed by MCHC (g/dl) which was statistically and significantly   lower   in   cases compared to controls. S. Iron (µg/dl) was statistically and significantly lower in cases compared to controls. Transferrin Saturation (%) was statistically and significantly lower in cases compared to controls. RDW-CV (%) was statistically and significantly higher in cases compared to controls. Among the 200 study subjects 80 cases had anemia, followed by 60 controls had anemia. Their difference was statistically significant between the two groups (p<0.05). Conclusion: Iron deficiency anemia has a significant association with bronchiolitis. A larger and more extensive study was recommended.

Aim: The aim of the present study was to evaluate the functional outcome of osteosynthesis of tibial plateau fractures using different surgical techniques after a minimum period of 6 months by using Rasmussen scoring system. Methods: A prospective longitudinal study was conducted in the Department Of Orthopaedics, PMCH, Patna for a period of two years .All patients with proximal tibial fracture in the age group between 20 and 60 years were included as our study subjects. Patients presented with neurovascular injuries were excluded from the study and a total of 100 patients satisfying our inclusion and exclusion criteria were taken as our study subjects. Results: In our study majority of the study patients were in the age group between 30 and 50 years with more males as compared to females. The type of tibial plateau fracture was classified as per Schatzker classification. In the present study it was shown that type II tibial plateau fracture (38%) was the most common type followed by type VI fracture (21%) and type V (15%) and the incidence of type I, and III was 10%, type IV was 6%. In our study for patients with type I tibial plateau fractures closed reduction with cancellous screw fixation was performed for all the patients, among patients with type II fractures open reduction with internal fixation along with elevation plateau and buttress plating was done for majority of the subjects and patients with type II fractures bone grafting was done along with this procedure and a similar type of procedure was performed for patients with type III, IV and V tibial plateau fractures. ORIF with dual plating was performed for majority of the patients with type VI fractures. Conclusion: In the management of tibial plateau fractures, open reduction with internal fixation using plate screws with lesser soft tissue dissection would lead to excellent functional outcome.

Aim: The aim of the present study was to compare the use of monopolar electrocautery and ultrasonic dissection of gall bladder in laparoscopic cholecystectomy in terms of intra-operative and post-operative parameters. Material & Methods: A prospective randomized controlled trial within the duration of 2 years undertaken in Department of General Surgery,  It included 200 patients undergoing laparoscopic cholecystectomy. Results: The mean±SD of age (years) in group A was 40.65±7.43 and while in group B was 42.28±9.71. There was no significant difference between the groups in terms of age (years). There was no significant difference between the various groups in terms of distribution of age. The majority of the patients in both the groups were females. In group B (harmonic scalpel) 70% were females and 30% were males while, in group A (electrocautery) 76% were females and 24% were males. The p value for sex distribution was found to be statistically insignificant. The mean±SD of operative time (minutes) in the group A was 50.20±11.88 while in group B was 39.21±11.21. There was a significant difference between the 2 groups in terms of operative time (minutes). The mean±SD of number of times lens cleaning done in group A was 3.16±1.35and in group B was 2.06±0.88. There was a significant difference between the 2 groups in terms of number of times lens cleaning done. 7% of the participants in the group A had gall bladder perforation while 24% of the patients in group B had gall bladder perforation. There was a significant difference between the various groups in terms of distribution of gall bladder perforation. 7% of the participants in group A had biliary leak. There was no significant difference between the various groups in terms of distribution of biliary leak. None of the participants in either of the groups had Common bile duct and bowel injury. 5% of the participants in the group A and group B had drain (output nature: bile). There was no significant difference between the various groups in terms of distribution of drain output/nature. The mean±SD of duration of hospital stay (days) in the group A was 1.20±0.74 while in group B was 1.06±0.22. Hence, there was no significant difference between the groups in terms of duration of hospital stay (days). Conclusion: Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.

Aim: The aim of the present study was to identify factors associated with mental health status among students residing in girls’ hostels of Bihar region. Methods: A descriptive cross- sectional survey was done among students residing in girls’ hostels of Bihar region for the period of 2 years. Five hostels were chosen at random (lottery method) from a list provided by the girl’s hostel association. 200 students were included in the study. Results: The mean age of respondents was 20.24±2.58 years, almost all of them were Hindu (90%), the majority of the respondents were studying for bachelor’s (75%) and about 15% of them were preparing for their bachelor studies. The mean DASS score for depression was 10.38±7.86. 96 (48%) fall into normal range. Similarly, the mean score for anxiety was 13.61±8.33 and only 44 (22%) were under the normal range. likewise, the mean score for stress was 13.79±8.54, 84 (42%) fall under the normal range according to the severity scale classification of DASS. The study found that more than half of the respondents were not disturbed by their roommate (55%). More than three-fourths of the participants reported that no one in their family had died in the past two years (78%). More than three-fifth of respondents did not face any sort of abuse in their life (65%). More than three fourth felt homesick while living away from home (78%). The majority of respondents were supported by others in their time of need (80%). Conclusion: The depression, anxiety, and stress are all harmful to individuals and society. Suicidal thoughts, personality changes, relationship and marriage troubles, dropping out of college, and other negative outcomes are some of the effects. Our findings revealed an alarming level of depression, anxiety, and stress among female dormitory students.

Aim: The aim of the study was to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Methods: The observational study was carried out in the Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for the period of 2 years. Total 200 Children upto 5 years aged, admitted in Nutritional Rehabilitation Centre of Department of Paediatrics, were include in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: Majority of children with SAM were having co-morbidity in the form of Anaemia (90%), Diarrhoea (64%) followed by pneumonia (30%), Rickets (27%), Tuberculosis (16%), Otitis media (16%), UTI (10%), Celiac (8%), Hypothyroidism (5%), & HIV (3%). 140 (70%) SAM children presented with diarrhea out of which Hyponatremia was in 100 cases & Hypernatremia was in 5 cases. No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.07). Potassium levels of children with diarrheal & non diarrheal children with SAM. Serum Potassium levels of 200 SAM children were analysed. It was found that 45 SAM children were having hypokalemia. Hypokalemia was found in 30 diarrheal cases & 15 in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.025) between Diarrheal & Non diarrheal cases. Conclusion: We concluded that dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions. Hence, we recommend that due care is to be given for management of dyselectrolytemia in complicated SAM children.

Aim: The aim of the present study was to assess the relationship Between Body Mass Index and Outcomes in Acute Myocardial Infarction. Methods: The present study was conducted in the Department of Medicine, Ford hospital and research centre Pvt. Ltd, Patna, Bihar, India. Informed consent were not required for this study because NIS data are de-identified and publicly available. 200 estimated weighted admissions with AMI were identified. We identified hospitalizations for AMI with the International Classification of Diseases, Tenth Revision (ICD-10). Results: The difference in comorbidities between different groups; most of our cohort had hypertension, with the highest percentage in patients with BMI > 40 kg/m2. Diabetes mellitus was also highest in patients with BMI > 40 kg/m2 with an incremental increase in percentage with elevated BMI. The presence of chronic kidney disease was higher at both extremes of BMI groups. Heart failure as a comorbidity was notably higher in lower BMI groups. Similarly, atrial fibrillation history was higher in those with BMI < 25 kg/m2. Stroke and transient ischemic attacks were higher in both BMI groups below 25 kg/m2. Charleston comorbidity index was higher in both BMI groups below 25 kg/m2. Ventricular fibrillation was more likely in BMI groups (25 – 29 and > 40 kg/m2). PCI was performed most commonly in the BMI 30 – 40 kg/m2 group. CABG was performed but mostly in BMI > 20 – 29 kg/m2 and BMI 30 – 40 kg/m2 groups. Systemic thrombolysis was only administered in 1.8% of hospitalizations and more commonly in the lowest BMI group < 20 kg/m2. Conclusion: The current analysis of a nationally representative sample demonstrated the clinical implications of BMI in patients with AMI. Patients with a BMI of 30 – 40 kg/m2 had more favorable LOS, inpatient complications, and in-hospital mortality when compared to those with ideal body weight. Hence, this supports and expands on the concept of the “obesity paradox”.

Aim: The aim of the present study was to compare the diagnostic performances of Ultrasound (graded compression Sonography) and unenhanced focused CT in patients suspected of having acute appendicitis. Methods: In this retrospective study, an analysis of 50 consecutive patients who presented in the Department of Radio-Diagnosis, JLNMCH, Bhagalpur, Bihar, India from  January 2022 to December 2022 with acute appendicitis was done. Results: Out of these patients, 23 patients had appendicectomies- 25 as emergency and appendicitis was confirmed by microscopic examination of the surgical specimen. Appendicectomy was not performed in 27 patients. Among these patients, 10 had an alternate diagnosis. 50 patients (35 males and 15 females) aged 7 – 68 years (mean age 29.8 years) clinically suspected with acute appendicitis underwent USG and CT. Of the 28 cases in which USG was negative for appendicitis, 10 cases had alternative diagnosis. The remaining 18 cases were reported as normal, of which 3 had appendicitis, and 1 case had alternate diagnosis (epiploicappendagitis). CT detected all case of acute appendicitis. Of the 26 cases in whom CT was negative for appendicitis, 8 cases had alternate diagnosis by CT. The remaining 18 cases were reported as normal of which 3 had alternate diagnosis (1 pelvic inflammatory disease, 1 inguinal hernia, and 1 duodenal perforation peritonitis). CT had a sensitivity of 100%, specificity of 96.96% and accuracy of 98.34% for the diagnosis of acute appendicitis. Conclusion: This study showed that both unenhanced focused CT and sonography are accurate imaging modalities in patients with suspected appendicitis. The choice of type of study to perform is likely to depend on the available resources and personnel at various institutions and the clinical features. However, CT was found to be superior to US in evaluating patients suspected of having acute appendicitis.

Aim: A comparative analysis of autonomic function testing throughout several trimesters of pregnancy. Material and Methods: This cross-sectional research comprised 120 pregnant women from the outpatient Physiology Department of SKMCH, Muzaffarpur, Bihar, India. All 40 first-, second-, and third-trimester women were informed about the surgery and gave written permission. Autonomic function tests were performed on all 120 pregnant women at the ANC clinic throughout each trimester. The window-based cardiac autonomic neuropathy analyzer CAN WIN performed cardiovascular sympathetic and parasympathetic tests with interpretation. Results: It found no statistically significant differences in age and height between I-Trimester (40) Women’s, II-Trimester, and III-Trimester Women’s. (p>0.05). However, the mean weight difference between IIIrd trimester and non-pregnant and IIIrd trimester and IInd trimester was statistically significant. Women in all three groups had mild sympathetic dysfunction. Females in group I exhibited normal parasympathetic function, mild to moderate parasympathetic dysfunction, and moderate sympathetic dysfunction. Women in group II had mild parasympathetic and moderate sympathetic dysfunction. Women in group III had moderate parasympathetic and sympathetic dysfunction. Conclusion:  Changing sympathetic and para-sympathetic activities in various trimesters show that the body adapts to the developing foetus, resulting in appropriate pregnancy outcomes.

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 Radiodiagnosis, Indira Gandhi Institute of Medical science, Patna, Bihar. Breast lesions were detected by clinical breast examination, mammography and ultrasound. A total of 100 breast lesions were examined by histological methodology. Results: A total of 100 breast lesions were examined by histological method, revealing the presence of 48 invasive cancers, and 52 benign lesions. The mean age of the patient was 58 years, ranging from 32 to 80 years. Most of the patients belonged to 50-59 years. The histological types of cancer in patients were: invasive ductal, invasive lobular, mixed (ductal/lobular) tubular, medullary, mucinous. Mammography was false negative in 46 out of 52 invasive cancers; ultrasound was false negative  in 38 out of 48 cancers. Mammography was false negative in 45 out of 51 patients without cancer; ultrasound was false negative in 37 out of 49 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.

Aim: The aim of the present study was to evaluate hemodynamic effects of regional anaesthesia in preeclamptic females. Methods: The observational study was conducted in the Department of Anaesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya , Bihar, India from march 2019 to February 2020. Study population comprised of 100 normotensive ASA grade II parturients planned for LSCS and 100 ASA grade III preeclamptic parturients planned for LSCS. Results: Mean age in normotensive group was 25.35±4.36 years and in pre- eclamptic group mean age was 24.16±3.07 years. The mean weight at the time of caesarean section was 72.8±6.34 kgs in the preeclamptic group and 74.66±7.53 kgs in preeclamptic. The mean gestational age at the time of caesarean section was 39.14±0.54 weeks in preeclamptic women and 39.07±0.77 weeks in normotensive. Majority of the study participants were nulliparous women in both the group (55% in normotensive group v/s 68% in pre- eclamptic group) while nearly 43% of the participants in the normotensive group and 27% in pre-eclamptic group were primipara. Both groups were comparable in term of mean age, weight, gestational age and parity comparison (p<0.05). All the non-preeclamptic parturients were ASA II while, all parturients in the preeclamptic group were ASA III, and this difference was statistically significant between both groups; (p< 0.001). The incidence of hypotension in non-preeclamptic parturients (93%) was significantly higher and that of preeclamptic parturients (15%). Similarly, bradycardia was also more commonly observed in normotensive group (32%) compared to pre-eclamptic group (2%). 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.

Aim: Comparative study of cryotherapy and electrocautery as therapeutic options for cervical erosion. Material and Methods: This was a prospective study carried out in 100 patients attending Department of Obstetrics & Gynaecology Jawaharlal Nehru medical college & Hospital, Bhagalpur, Bihar, India, for cervical erosion. Patient were allocated in two groups. Group A patients underwent electrocautary and Group B underwent cryotherapy. 50 patients were randomly allocated in each group. Female of reproductive age group and only inflammatory changes in pap smear were included in this study. Results: Majority of the patients presented with vaginal discharge (group A 16 and group B 9). Pelvic pain was a complaint in 5 patients in group A and 4 patients in group B. Menstural complaints included dysmenorrhoea, irregular menses, postcoital and intermenstural spotting and oligomenorrhoea. They were 4 in group A and 2 in group B. multiple complaints means patients presented with more than one from above complaints. Most common complaint intra operative is discomfort. 7 patients of group A experienced discomfort while 4 patients of group B experienced discomfort. Backache was experienced by one patient of cryotherapy group and one patient of electrocautary group experienced bleeding. Both groups were compared by T test, p value >0.05 so the difference is not statistically significant. Most common immediate postoperative complaint was pelvic pain. Three Cryotherapy patients experienced pelvic pain. Two electrocautary patients experienced discomfort and one patient experienced bleeding after procedure. Conclusion: Though in short term follow up electrocautry seems to be better than cryocautry. But if seen in long term follow up both are equally good.

Aim: The objective of this study was to compare the clinical profile of P. falciparum, P. vivax and mixed infections of malaria. Methods: This retrospective observational study included malaria patients who were admitted to Department of General Medicine, Jannayak Karpoori Thakur Medical College and Hospital Madhepura,, Bihar, India for 12 months. Inpatient retrieved and scrutinized on the basis of the patient’s demographic profile, clinical findings, investigations, treatment, and complications during this 12- month period. Results:  The subjects consisted of 60 P. vivax and 40 P. falciparum cases. The P. vivax cases consisted of 45 males and 15 females while P. falciparum cases consisted of 18 males and 22 females. Fever was the most common presentation in all 100 patients both falciparum and vivax infected patients. This was followed by chills and rigors were present in 80 patients, 45 of patients with falciparum and 35 of the patients infected with vivax. Nausea and vomiting were another common complaint was observed in 70 of total patients, more in falciparum 40 than vivax 30. Other less common symptom were, easy fatiguability observed in 30 patients and cough was present in 20 patients. All these manifestations were most commonly observed in falciparum than vivax. Altered sensorium was observed only in falciparum 12 patients. Patients who had mixed infection presented with almost all symptoms like fever with chills and rigors, easy fatigability, vomiting, cough and altered sensorium. Bivariate relationship between clinical features and complications of P. vivax and P. falciparum malaria showed no statistical significant difference. Conclusion: We concluded that P. vivax Mono infection tends to have as similar course and complications as compared to malaria due to P. falciparum mono infection.

Aim: To assess the effectiveness of a single injection vs triple injections utilizing a costoclavicular method for performing infraclavicular brachial plexus block during forearm and hand surgery. Materials and Methods: This study was conducted in the Department of Anesthesia, Patna Medical College and Hospital, Patna, Bihar, India for 12 months. Seventy patients scheduled for surgery of the forearm and hand, were enrolled in the study. Hemodynamic variables (BP, HR, and SPO2) were evaluated. All the patients were kept nil per oral 8 hours prior to surgery. The patients were randomly assigned to either the single injection group (S group, n = 35) or the triple injection group (T group, n = 35) using a random integer set generator. The ratio of allocation was 1:1. A researcher who was not involved in performing the block generated the randomization set and enrolled the participants. Results: A skin puncture was performed once in both groups, except for 1 case in the T group, where 2 skin punctures were performed due to an out-of-plane injection in 1 cord. The performance time of the T group and S group was similar. The block onset time of the T group was not significantly different from that of the S group. However, the rate of blockage of all 4 nerves was significantly higher in the T group than in the S group. The proportion of patients with complete sensory block and complete motor block at each evaluation time up to 30 minutes after the block was similar in both groups, except for the patients with the radial nerve block at 15 minutes, those with the musculocutaneous nerve block at 20 minutes, and those with the median nerve at 25 and 30 minutes. No vascular or pleural punctures occurred during the procedures. Other complications were ptosis (1 case), and paresthesia (2 cases) in the S group and nausea (1 case), and hoarseness (2 cases) in the T group. Complete recovery of sensory and motor function was confirmed in all patients. No neurologic complications were reported at the 1-week follow-up. Conclusion: In conclusion, the Triple injection of CC approach increased the consistency of US-guided infraclavicular BPB in terms of the rate of blocking all 4 nerves without increasing the procedure time, despite administration of the same volume (25 mL) of LA.

Aim:  The present study was conducted to assess the APR in paediatric outpatient department (OPD) for URTI patients with respect to available benchmark and to decide on interventions required to improve the prescription behaviour. Material & Methods: This was a retrospective study in the Department of Pharmacology, Anugrah Narayan Magadh Medical College and Hospital Gaya, Bihar, India from September 2019 to July 2021. 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 200 patients were included in the study. Results: Out of 200 patients, boys were 90 and girls were 110. Age group 5-7 years had 32, 7-9 years had 38, 9-11 years had 72 and 11- 13 years had 58 children. Antibiotics prescribed in children were co-amoxiclav in 70, amoxycillin in 58, Ofloxacin in 42 and cefuroxime in 30. 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.

Aim: The aim of the present investigation was to assess the diagnostic accuracy of FNAC, on parotid gland swellings, in order to determine its usefulness in the planning of parotid gland surgery. Methods: The present study was conducted in the Department of Pathology, DMCH, Darbhanga, Bihar, India and 100 patients were included in the study for the period of 2 years. All patients underwent FNAC under US guidance following clinical examination. In order to obtain homogeneous and comparable data, only FNAC performed in the Institute were considered. All details regarding demographic and clinical data, including age, sex, previous surgery, timing of symptoms, cytological and histological results, site and volume of the lesions, involvement of histological sample margins and relapses were saved in an electronic database. Results: FNAC samples were obtained in 100 cases. FNAC results were “non-diagnostic” in 22 cases (22%), “inflammatory/ benign lesion” in 70 (70%), “malignant neoplasm” in 8 (8%). In the present study, pleomorphic adenoma was in 45 patients (56.25%) and Warthin’s tumour in 20(25%). Adenocarcinoma (2.14%) was the most common malignancy, followed by Mucoepidermoid carcinoma (2.5%) and squamous cell carcinoma (2.14%).The most common histopathological diagnosis was “benign lesion”, that occurred in 70 patients (87.5%). FNAC showed a sensitivity of 81% and a specificity of 99%. Accuracy for malignancy was 97%, accuracy for a benign lesion was 83%, overall diagnostic accuracy was 97%. Conclusion: Our study suggests that preoperative FNAC plays a useful role in the accurate diagnosis of parotid tumors. It is a safe and effective diagnostic modality for the treatment of patients with parotid tumors. Fine needle aspiration cytology is a reliable, cost-effective, well tolerated and an easy procedure to perform.

Aim: To investigate sensorineural hearing loss in infants after acute bacterial meningitis. Material and Methods: It was a retrospective study conducted in Department of Pediatrics, NMCH, Jamuhar, Sasaram, Bihar, India 10 months. Fifty infants with ABM were enrolled in the study with written informed consent from parents. Details were recorded in a pre-decided proforma. Including age, gender and detailed history followed by complete physical examination. Lumber puncture was performed in all the children for CSF examination. Diagnosis of ABM was considered when CSF examination showed polymorphonuclear pleocytosis, low sugar and high protein for age and /or CSF culture positive for bacterial growth. Results: 22(44%) had abnormal imaging (USG/CT/MRI) of Brain. Hydrocephalus being the most common abnormal finding was seen in 11 cases. 13(26%) out of 50 children developed SNHL following acute bacterial meningitis. SNHL was bilateral in 7(14%) and unilateral in 6(12%) cases. SNHL was mild in 3patient, moderate in 5 patients, severe in 4 patients and only 1 patient had profound hearing loss. Patient with high value for Mean ± SD for Total nucleated cells in CSF for group I was 1675.4 ± 2318.6 while for group II it was 444.57±360.3. CSF Total Neutrophil count had more incidence of SNHL. (P value 0.003). Mean ± SD for Protein (mg/dl) in CSF for group I was 415.2 ± 484.1 while for group II it was 204.1 ± 210.3. Patient with higher value for CSF protein had more SNHL. (P value 0.036). Mean ± SD for Sugar (mg/dl) in CSF for group I was 25.5± 15.8 while for group II it was 40.3 ± 15.9. Patient with low value for CSF sugar have more SNHL. Among 9 cases with CSF sugar less than 20, 5 developed SNHL, which was statistically significant (P value 0.03). Risk of developing SNHL is higher in patient who have CSF sugar less than 20. Conclusions: The present study throws light on the occurrence of sensorineural hearing loss following acute bacterial meningitis. SHNL, which if left untreated may lead to serious handicap affecting the linguistic performance and overall development of the child. Hence our study emphasizes the need for complete audiological evaluation of a child recovered from meningitis. BERA is a helpful tool for screening the sensorineural hearing loss especially in the young children and infants in whom other conventional methods may not be of much use.

Aim: The aim of the present study was to assess the importance of influence of exercise on diabetics and hypertensive patients. Methods: The study was a retrospective study, all the patients attending the Department of Physiology of Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India for two years , 200 patients having both hypertension and diabetes were selected including both males and females of age group 35-50 years. Results: Among 200 study population, 117 (58.5%) males and 83 (41.5%) females are categorized following age groups from 35-50 years. In this study of 200 diabetic patients, 100 patients were regularly doing exercises, in that 65 (65%) had a controlled diabetic status and 35 (35%) were not under control; 100 patients were not doing exercises regularly, in that 35 (35%) had a controlled diabetic status and 65 (65%) were not under control. P value <0.001 showed statistically significant. In this study of 200 hypertensive patients, 100 patients were regularly doing exercises, in that 62 (62%) had a controlled hypertensive status and 38 (38%) were not under control; 100 patients were not doing exercises regularly, in that 38 (38%) had a controlled hypertensive status and 62 (62%) were not under control. P value <0.001 showed statistically significant. Conclusion: The study found that known cases of type 2 diabetic mellitus and hypertension are benefitted by regularly doing exercise when compared with not doing exercise. The various studies suggest that T2DM patients and hypertension require reinforcement of DM education including dietary management through health-care providers, health facilities, etc.) to encourage them to understand the disease management better, for more appropriate self-care and better quality of life.

Aim: To investigate the seroprevalence of Hepatitis B virus infection among pregnant women receiving treatment at a tertiary hospital in Bihar. Material and Methods: This study was conducted in the Department of Microbiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India from Jan 2018 to December 2018. Every pregnant woman coming for antenatal care at the study location was screened for Hepatitis B virus according to national guidelines. All pregnant women were evaluated for serum HBsAg using ELISA (Merilisa kit) and Rapid immunographic test. (Reckon Kit). This retrospective study was conducted to determine the seroprevalence of the HBsAg. Result: Total 4131 antenatal women were screened for Hepatitis B Surface Antigen. A total of 21 cases were found to have HBsAg positive out of 4131 who underwent testing, indicating a prevalence rate of 0.50%. Such low prevalence is suggestive of increased awareness of people towards vaccination and routine antenatal screening. The mean age of HBsAg positive pregnant women was 26.23 years. Four subjects (19%) were from rural area while 17 (81%) were residing in urban area. None of these antenatal women had HBV-HCV or HBV-HIV co-infection. Most common age group with HBV infection was 25 – 30 years, with 21 subjects indicating a prevalence rate of 0.50%. Conclusion: The risk of chronic infection in Hepatitis B is more if the infection is acquired in early age. The risk of chronicity is >90% in newborn. Neonates who acquire infection from their mother during pregnancy have higher chances of becoming chronic carrier. Such babies develop chronic liver disease at a younger age and represent the most important reservoir of infection in the community.

Aim: The aim of the present study was to compare anterior chamber parameters in angle closure glaucoma spectrum with normal individuals with Scheimpflug imaging. Methods: The Present study was prospective, comparative, randomized study, carried out in the Department of Ophthalmology, IGIMS, Patna, Bihar, India. Study duration was of 1 year. In present study sample size was 40 eyes in each group. Results: In present study patients were from age group between 51 – 60 years in both the groups i.e. 18 in group A (Angle closure glaucoma spectrum eyes) and 20 in group B (eyes of normal individual) followed by 40 – 50 years 14 in group A and 16 in group B. 40% were male and 60% were females. In present study primary angle closure suspects eyes were most common (60%), followed by PACG (20%) and primary angle closure (15%). In present study anterior chamber parameters in both the groups were more in group B (eyes of normal individual) than in group A (Angle closure glaucoma spectrum eyes). Also ACV/AL, ACV/KERATOMETRY, ACV/WTW, ACV/LT were more in group B(eyes of normal individual) than group A(Angle closure glaucoma spectrum eyes) and this difference was statistically significant. All anterior chamber parameters were more in PAC eyes than in PACS eyes and this difference was statistically significant in all parameters (p value <0.05) except in ACV/AL and in ACV/WTW. Conclusion: In present study all anterior chamber parameters were more in normal eyes compared to angle closure glaucoma spectrum and mean difference was significant. Scheimpflug imaging can be a very useful tool in differentiating angle closure glaucoma spectrum from normal individuals, but, it cannot differentiate between the patients within the spectrum like primary angle closure suspect versus primary angle closure versus primary angle closure glaucoma.

Aim: To evaluate the functional result of femur interlock nailing in adult patients with shaft femur fractures. Materials and Methods: This was a retrospective study conducted in the Department of orthopaedics SKMCH, Bihar, India. This is a study includes 40 cases of diaphyseal fractures of femur shaft treated with closed interlocking intramedullary nailing. The inclusion criteria was all Patients of age above 18 years with diaphyseal fractures of femur (Both closed & Grade 1 compound) and both males and females. We excluded the patients of age less than 18 years and Pathological fractures. The most common mechanism of injury is road traffic accident. Maximum numbers of patients in this study are of young reproductive group and mean age is 30.44 years. In the present study it is seen that femoral shaft fractures are more common in males than females. Results: Most of our patients were of the younger age group, 26(66.6%) patients between 18- 30 yrs., the average age being 30.44 years, which correlate the fact that younger population is at increased risk of femoral fractures. In our series the level of fracture is dominated by middle 24 (60%) patients followed by 12 (30%) distal 1/3rd junction fractures and 4 (10%) proximal 1/3rd junction. The mean duration of hospital stay in our study was 16 days average. Intra operatively reduction was achieved by closed means in 34(85%) cases and 6(15%) needed open reduction due to late operation interval. The reduction of the fractures were good in 34(95%) of patients and acceptable in 4(10%)  In our study no patient was permitted to weight bear fully on affected limb before 6 weeks,  Final outcome was excellent in 35 out of 40 patients 87.5%, good in 3 patients 7.5%, fair in one patient 2.5% and poor in 1 patient 2.5%. Conclusion: Interlocking techniques lead to fewer complications of nonunion/malunion, lesser soft tissue dissection, and earlier fracture healing and lesser chances of infection. It provides the advantages of early ambulation, lower rates of infection, delayed union, nonunion and malunion compared to other treatment modalities. Early mobilization of the patient helps in healing of the fracture and prevents joint stiffness.

Aim: The aim of the present study was to find out the prevalence of refractive errors in school going children, its different types and visual outcome after correction of refractive errors. Methods: The present study was conducted at Department of Ophthalmology, NMCH, Patna, Bihar, India and 2000 school going children in the age group of 10 to 15 years from secondary schools for the period of 2 years. Results: In the present study age distribution of study subjects showed out of 3000 students, majority was of age 12 years (19%). Out of 2000 students screened, 960 (48%) were females and 1040 (52%) were males. Out of the total 320 cases of refractive errors, 12.5% were old cases while 87.5% were newly diagnosed cases. Overall a significantly high prevalence of refractive errors was reported in cases of 13, 14 and 15 years as compared to younger children. Mean age of cases with refractive error was significantly higher as compared to cases without refractive errors (12.85 vs 11.79 years; p<0.01). Prevalence of refractive error was significantly higher among females as compared to males. The result showed relatively better visual acuity was reported in right eye (p<0.05). It was observed that 97.50% of eyes improved visual acuity at 6/6, 2.18% improved at 6/9 and 0.15% improved to 6/36 and 6/60 only. Conclusion: We found that every sixth school going adolescent children is suffering from refractive error. Majority of them were new cases who were unaware of their refractive error indicating a hidden problem of serious dimensions. So screening of school children can play an important part in detecting these hidden cases suffering from refractive errors. Visual impairment from uncorrected refractive errors can have immediate and long-term consequences in children which can be reflected on school performances. Screening of the children for vision at the time of school admission and periodical eye examination of the children is recommended for early rectification of impaired vision.

Aim: Comparative examination of the biochemical profile of complications in individuals presenting with acute febrile illness. Material and Methods: This hospital-based retrospective study was conducted in the Department of Medicine at JNKTMCH, Madhepura, Bihar, India for 12 months. Patients age more than 13 yrs. who presented with complaints of fever with complications admitted to emergency department or general wards ICU, and were ready to give consent are enrolled for study. Patients whose complaints and lab profile do not match with acute fibril illness were excluded, thorough details of history Details of history and results of a were taken and enter was made on standard sheet. Results: Complication presentation was more of from lower and middle socio  economic class (43% and 46%) ache (85.9%), headache (77.4%), vomiting (73.4%), abdominal pain (50%), high colored urine (34.2%), breathlessness (32.1%), and loose motion (25.1%) and altered Sensorium (8.8%). Most of patients were associated with generalized body ache 86.9% followed by headache (78.9%) and dyspnea (32%), some of the patients reported symptoms which were associated with high chances of complications like dark colored urine (P=0.00), loose stools (P=0.002), body rash (P=0.0036), dyspnea (P=0.002), seizures (P=0.019) and altered Sensorium (P=0.001). Shock (71.9%) followed by liver involvement (66.7%) were the commonest complication of dengue fever while derangement in hematological indices were (65 %) that CNS (29.4%) respiratory 15%, l it was renal failure (14.9%) were the main complication of malaria. Multi organ involvement of 3 or more commonest finding 119(43 .75%) after that followed by 2 organs in 63(22.18%). In terms of outcomes Dengue had mortality was 12 (5.8 %), malaria 8(7.6%), enteric 2(5.6%), Hepatitis E 2(50%), hypovolemic or hemorrhagic shock and bleeding manifestation was main mortality causes in dengue,   acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) in malaria fulminant hepatic failure and disseminated intravascular coagulopathy were the causes for mortality in hepatitis E. Conclusion: This study presents a comparative analysis of the biochemical clinical profile of infectious diseases that occur after the monsoon and in early winter. It aims to enhance physicians’ understanding of the complication profile and outcomes associated with these diseases. The findings of this study can play a significant role in reducing mortality and morbidity by facilitating early referral to a tertiary centre and prompt management of the disease and its potential complications.

Aim: The aim of the present study was to compare the hyperbaric bupivacaine 0.5% and hyperbaric 0.5%+Fentanyl 20 micrograms in spinal anesthesia for elective lower abdominal and lower limb surgery. Methods: A retrospective study was conducted in Shree Narayan Medical Institute and Hospital, Saharsa, Bihar period of 12 months and 100 patients were included in the study. Results: The groups were comparable with respect to age, weight, gender ratio and ASA status of patients. There was a significant difference in postoperative mean HR between two groups. SBP was observed win both groups with values being comparable at corresponding study stages except at 60 minutes and the difference was significant (p value<0.05).  A similar trend of DBP was observed win both groups with values being comparable at corresponding study stages except at 60 minutes and the difference was significant (p value<0.05). Postoperative DBP was comparable between two groups. The mean time of onset of sensory blockade in Group A was 134.4 ±14.9 seconds and group B was 137.5 ± 13.5 seconds. The mean time of onset of motor blockade group A was 228.7 ± 20.5 seconds and the meantime of the onset of the motor blockade in Group B was 229.5 seconds. In this study out of 100 patients the visual analogue score at 3 hours was 0.6 in group A and 0.1 in Group B. At 6 hours postoperatively VAS was 4 in group A and 1.7 in group B. At 24 hours VAS was 4.0 in group A and 2.6 in Group B. Conclusion: The addition of 20ug of fentanyl to 0.5% hyperbaric bupivacaine in spinal anesthesia, prolongs the duration of sensory and motor blockade, increase the duration and quality of postoperative analgesia 12 – 24 hours without causing any gross hemodynamic disturbances or adverse effects. Based on the above facts we conclude the addition of fentanyl has many advantages and can be recommended with all spinal anesthesia techniques.

Aim: To investigate the use of a low dosage of hyperbaric bupivacaine and fentanyl for spinal anesthesia during cesarean surgery. Material and Methods: A prospective randomized, double-blind study was conducted in the Department of Anesthesia, PMCH, Patna, Bihar, India for one year.  Patients of ASA grade I and II within age group of 18 to 35 years of undergoing elective caesarean section after obtaining informed written consent from the patients.  The study population was randomly divided into three groups group A, group B and group C. All the patients were assessed for onset and duration of sensory and motor block, maximum level of sensory block, haemodynamic stability, APGAR score and side effects like nausea, vomiting, respiratory depression, shivering, pruritus, etc. if any. Results: Duration of sensory block was significantly longer in group C (202.13±7.52 min) than group A (126.13±6.59 min) and group B (171.76±7.846 min) (p <0.05).(Table2) Onset of motor block was 4.16±0.5888 min in group A, 5.39±0.7205 in group B and 5.57±0.5474 in group C respectively, the difference being statistically significant (p < 0.05). In Group A, duration of motor block was 161.73±12.74 minutes, in Group B 121.36±8.56 minutes. and in Group C138.76±7.51 minutes. The difference was statistically significant (p < 0.05). Haemodynamic parameters (PR and MAP) were comparable throughout the surgery in all the 3 groups (p > 0.05). Quality of intraoperative analgesia was excellent in all the patients of group B and group C. In Group-A it was excellent in 83.3%; good in 16.67% The difference in the three groups is statistically significant (p=0.0097) . Hypotension was seen in 40%, 20% and 33.3% of patients in Group A, B AND C respectively. Conclusion: Combination of fentanyl with bupivacaine for spinal anaesthesia can be safely employed for patients who undergo caesarean section without significant haemodynamic changes, excellent quality of intraoperative analgesia with good maternal satisfaction and foetal well being.

Aim: The aim of the study was to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH). Methods: This was a retrospective study conducted in the Department of Medicine, Katihar Medical College and Hospital, Katihar, Bihar India for 18 months. A total of 50 patients were recruited in this study. Results: The mean ± SD age, BMI, and WC were 42.28±12.48 years, 26.49±4.82 kg/m2, and 94.12±19.81 CM. No significant age, BMI, or WC difference existed between men and women. Central obesity affected 84%, 80%, and 85.71% of men and females, respectively, with no significant difference. Diabetes was prevalent in 30%, 53.34%, and 20% of men and females. Males and females had 34%, 20%, and 42.85% anti-TPO antibodies. Eleven (18.97%) individuals advanced to OH (defined as TSH ≥10 IU/L) at one-year follow-up. The advancement rate was considerably greater in the anti-TPO positive group compared to the negative group (p<0.023). Conclusion: The first risk stratification may identify SCH patients at highest risk for OH, which requires therapy.

Aim: To investigate the refractive alterations and recurrence of pterygium after pterygium removal using the bare sclera method and conjunctival limbal autografting. Material and Methods: This study was conducted in the Department of Ophthalmology, DMCH, Darbhanga, Bihar, India for one year. Sixty eyes of sixty patients with a primary pterygium were enrolled in the study. All patients underwent a complete ophthalmological examination, including slit lamp examination and keratometry. Pterygium was graded according to its encroachment on cornea: Pterygium < 2mm was Grade 1, Pterygium 2-4 mm was Grade 2 and Pterygium > 4 mm was Grade 3 Pterygium. Each patient was randomly assigned to Group A (pterygium excision with bare sclera technique with cauterisation) and Group B (Pterygium excision with conjunctival limbal autografting secured with sutures). Group A patients underwent pterygium excision in which the tenon’s and subepithelial fibrovascular tissue was carefully and completely dissection. The sclera was left bare. Group B patients underwent pterygium excision with conjunctival autografting. Results: The results of this study are as follows :34 of the 60 patients (56.67%) enrolled in the study belonged to the age group of 40-49. 45 patients out of the 60 were female (75%) while 25% were males. The male to female ratio was 1:3. 43 patients (71.67%) out of 60 did outdoor work. it was seen recurrence was higher in Group A (Pterygium excision with Bare sclera technique with cauterisation) than in Group B (Pterygium excision with Conjunctival Limbal Autografting secured with sutures) and was highly statistically significant (P < 0.01). Conclusion: Pterygium leads to significant astigmatism which affects the vision of the patient. In our study, pterygium excision itself significantly reduces astigmatism and improves the visual acuity. But the type of surgery performed does not seem to have effect on improvement in the visual acuity and the amount of decrease in postoperative astigmatism.

Aim: To investigate the computed tomography findings and clinical features of intraabdominal ruptured liver abscess. Material and Methods: This study was conducted in the Department of Radio-diagnosis, Madhubani Medical College and Hospital, Madhubani, Bihar, India from March 2022 to Jan 2023. This is а retrospective observational study of patients with intrааbdominаl ruptured liver abscess. All diagnosed cases of ruptured liver abscess based on radiology аnd laparoscopic investigation were included in the study. Details of demographics, clinical features, Computed Tomography were recorded. Results: The mean time intervаl between the onset of fever and CT was 8.3 dаys (rаnge, 1-30 dаys). The meаn size of the liver abscess was 8.4 cm (range, 4.0-14 cm). А single аbscess wаs found in 11 pаtients, аnd multiple аbscesses were seen in 21 pаtients. Unilobаr involvement wаs seen in 29 pаtients, with the right lobe аffected more commonly (68.8%, 22 of 32). The аbscesses were completely liquefied in 25 pаtients аnd gаs in the аbscess cаvity in 7 pаtients. Free intrаperitoneаl fluid wаs seen in аll pаtients. Conclusion: А ruptured hepаtic аbscess is more life-threаtening thаn аn unruptured one. А rаpid аnd аccurаte diаgnosis аnd prompt surgicаl intervention аre essentiаl. Most of the cаses hаd аn аcute presentаtion аnd the right lobe is commonly аffected. Pаin in the abdomen wаs the most common symptom which presented in most cаses. Computed Tomogrаphy is аn ideаl tool for diagnosing hepatic аbscesses аnd its complicаtions.

Aim: The aim of this study was to assess the level of thyroid dysfunction in patients with type 2 diabetes mellitus and to identify the association of thyroid dysfunction with diabetic complications. Methods: This retrospective study was conducted in the Department of Medicine, Mata Gujari Memorial Medical College, Kishanganj, Bihar, India from October 2018 to September 2019. A total of 200 participants were included in this study. Results: The mean duration of diabetes was 6.34 ± 2.42 years and the mean glycosylated hemoglobin was 9.3 ± 2.66% among the study population. There were male predominance and the maximum number of diabetic patients included in this study was in the age group of 41-70 years. A majority of study subjects (>80%) had normal TSH, free T3 and free T4 values. Both types of thyroid dysfunction (hypothyroidism & hyperthyroidism) were more common in females as compared to males and mostly involved 41-50 years of age. Conclusion: The prevalence of thyroid dysfunction was 18% among patients with type 2 diabetes mellitus in this study. Hypothyroidism was more common among the study subjects than hyperthyroidism. There was no correlation of thyroid dysfunction with diabetic complications.

Aim: The aim of the present study was to determine the prevalence of gestational thrombocytopenia and anemia among pregnant women. Methods: This was a cross-sectional study from 100 pregnant women attending the outpatient department and wards of Department of Obstetrics and Gynaecology Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. Results: In this study, the maximum number of pregnant women belonged to age 31-40 years. The mean age of the study participants were 25.55 (±3.67) years. Most of the study subjects lived in a rural residence. Among the study subjects, maximum were housewives and illiterates. Most of the women came for first antenatal check-up in 2^nd trimester. The prevalence of anaemia in this study was found in 65 (65%) pregnant women, the remaining 35 (35%) women had Hb level in the normal range. Among the 65 anaemic pregnant women in this study the prevalence of anaemia was mild in 33 patients, 22 moderate, and 10 severe anaemia. The prevalence of thrombocytopenia in this study was found in 20 women (20%), the remaining 80 (80%) women had a platelet count in the normal range. Among the 20 thrombocytopenic pregnant women in this study 12 women was mild, 5 were moderate, and 3 were severe. Women of age group 31-40 years had higher prevalence of anaemia and thrombocytopenia  than other age groups; whereas, women with employment had lower prevalence anemia and thrombocytopenia but the difference was not statistically significant. Conclusion: Thrombocytopenia and anemia are the crucial problems among pregnant women. The pregnant women in the present study were from a rural residence and illiterates and housewives. Hence Thrombocytopenia and anemia are a serious alarm for both mother and the baby and needs to be dealt on priority basis.

Aim: The aim of the present study was to assess the prevalence and factors associated with anemia in pregnancy at tertiary health care center in Bihar region. Methods: The present study was a retrospective carried in the Department of Obstetrics and Gynecology, Netaji Subhas Medical College and Hospital, Bihta, Bihar, India for 10 months. Study population was ANC patients attending OPD of OBGY department. In our study, out of 390 patients, 200 patients were anemic according to hemoglobin concentration. Results: Prevalence of anemia in our study was 52.63%. Mean age of the patients was 25.65± 3.4 years. Majority of the patients had mild anemia (52%). Moderate anemia was seen in 30% patients and severe anemia was observed in 18% of the patients.  Most commonly observed clinical feature in our study was fatigue (93%) followed by dizziness (90%). Shortness of breath was complained by 75% patients. Pale skin was seen in 72% patients. Other clinical features were rapid /irregular heartbeat (62%) and chest pain (44%). Most commonly observed risk factor was vegetarian diet (92%). Obstetric factors like birth interval less than 2 years were seen in 90% patients. No consumption or inadequate consumption of IFA tablets contributed anemia in 90% patients. Worm infestation and H/O malaria was seen in 73% and 55% patients respectively. Other risk factors observed were less consumption of fruits (44%) and lower socioeconomic status (30%). Most commonly observed type of anemia was iron deficiency anemia (92%) followed by megaloblastic anemia (5%). Dimorphic anemia was seen in 3% patients. Conclusion: Most commonly observed risk factor for development of anemia in pregnant patients was vegetarian, birth interval less than 2 years no consumption or inadequate consumption of IFA tablets, Worm infestation and H/O malaria.

Aim: Utilizing computed tomography for the diagnosis of acute appendicitis. Material and Methods: This study was conducted in the Department of Radiology, Katihar Medical college and Hospital, Katihar, Bihar, India for 10 months. Retrospective study conducted on patients with right lower quadrant or right flank pain. Fifteen patients from patients with right lower quadrant pain or right flank pain. Results: The study included 15 patients complaining of right iliac fossa pain, only 4 patients (26.66 %) were with normal CT findings and patients (73.33%) were with abnormal CT findings. Regarding sex distribution, 9 patients (60%) were males, while 6patients (40%) were females. The age of the patients ranged between 15-54 years with a mean age of 34 years with the range of 39 year. The most frequently involved age group was from 22-23 years in females and from 22-29 in males. Among the 11 patients who have appendicitis or its complication: 5 patients (45.45 %) had Acute Appendicitis. 1 patient (9.09%) had chronic Appendicitis. 3 patients(27.27%) had Perforated Appendics. 2 patients (18.18%) had Appendicular abscess. Conclusion: MSCT signs of appendicitis include increase in appendix thickness more than 6 mm in diameter, inability of the appendix filling with oral contrast medium or air up to its tip, and wall enhancement with intravenous contrast medium. Presence of an appendicolith, surrounding inflammatory changes and cecal apical changes are helpful signs in diagnosing acute appendicitis. MSCT also is useful in diagnosing complications of appendicitis e.g. appendiceal perforation, phlegmon or an abscess formation, hepatic abscess, and Pylos phlebitis. To conclude MSCT is helpful for accurate and prompt diagnosis in suspected cases of appendicitis &its complications and conditions that mimic appendicitis.

Aim: Investigate the variables that influence the adherence to treatment in people with diabetes mellitus. Material and Methods: A retrospective study was done in the Department of general medicine, Netaji subhas medical college and hospital, Bihta, Patna, Bihar, India, for one year, on 491 diabetes patients. All diabetes patients (both Type 1 and type 2) having age more than 18 years and who were on diabetes medication were included. Diabetes patients having age <18 years and suffering from serious complication and require hospitalization were excluded from the present study. A detailed questionnaire consisting of 25 questions which included demographic details and the questions on the reasons for the treatment interruption were given to all the patients visiting to study center. Patients responded yes or no to each of the following questions: do you have financial problem, do you have no one to accompany you for visit, is diabetes medicine available in your area, do you find sufficient time to come for visit, are you busy in family obligation, is your medication lead to side effects, are you aware about the consequences of missing the doses, do you find it good to take long life medications. Results: Mean age, weight, height and BMI of study cohort was 49.65±10.12 years, 67.97±12.08kgs, 163.75±8.08cm and 25.35±4.06kg/m2 respectively. Majority of the patients were males 336 (68.4%). Of the 491 patients, majority were T2DM patients 483 (98.4%) followed by T1DM 8 (1.6%). Only 78 (15.9%) patients had family history of diabetes. Majority of the patients were illiterate 110 (24%) followed by 104 (21.2%) patients who were graduate. Majority of the patients were married 479 (97.6%), were businessman 121 (24.6%) and had monthly income between 5001 to15000 rupees 108 (22%). Majority of the patients were on oral antidiabetic medications 361 (73.5%) followed by Ayurvedic plus Oral Antidiabetic medication 91 (18.5%). Only, 22 (4.5%) patients were on insulins. In present study majority of the patients were off the treatment since 1-5 months 387 (78.8%) followed by 59 (12%) patients who were off the treatment since 6-10 months. Conclusion: To conclude it is very important to identify the patients with poor adherence in order to improve the factors responsible. By improving the risk factors for the poor adherence on individual basis better outcome can be obtained in terms of better glycemic control among the diabetes patients.

Aim: The aim of the present was to assess the level of self-care activities and quality of life among individuals with type 2 diabetes mellitus (T2DM) in rural areas of Bihar. Methods: A community-based cross-sectional survey was conducted by the Department of Community Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India in the rural area for individuals clinically diagnosed with T2DM for more than 6 months. A total of 200 participants were analyzed who were clinically diagnosed with diabetes for more than 6 months. We excluded people who had co-morbidities like cancers, mental illness, or any diseases that were debilitating in nature, as we expected those conditions to affect our outcome variables. The study period from Feb 2021 to Nov 2021. Results: The participants were almost equal with respect to gender, the majority of the participants 66% belonged to the age group between 41-60 years, 31% of them had education up to high school level and the majority 52.6% of the participants reported their diabetes duration as more than 5 years. But 55% of the participants were living with hypertension as a comorbidity. On analysis of the BMI, one-third of the participants were either overweight or obese, majority of the participants had stage 2 hypertension. Of the study population, almost half (47%) of the participants had glycemic levels well above 125 mg/dl. The WHO quality of life BREF scale responses were analyzed. The mean score of overall quality of life was calculated to 62.68±15.45, and it was also observed that the mean score of physical quality of life was lowest among all the domains of quality of life, at 56.04±7.73. On analyzing the total quality of life 17% of participants reported having poor overall quality of life. Conclusion: In conclusion, this survey study sheds light on the practices and quality of life among individuals with T2DM. The findings reveal that while there are areas of concern, such as poor physical activity, foot care, and blood glucose monitoring practices, participants demonstrated better adherence to diet and medications. Importantly, despite these challenges, the quality of life among the participants was reported as good. These results emphasize the need for targeted interventions and education programs to promote healthy lifestyle practices and further enhance the overall well-being of individuals living with T2DM.

Aim: The aim was to estimate the prevalence and correlates of sexual dysfunction in alcohol-dependent patients and to explore the association between sexual dysfunction and various alcohol-related variables. Methods: This retrospective study was conducted in the de-addiction center of the department of psychiatry in Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for 7 months. The study sample consisted of two groups, recruited through convenience sampling: 100 in-patients with an ICD-10 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) diagnosis of alcohol dependence and 50 controls enrolled from medical wards admitted for management of transient febrile illness. Results: Men with alcohol dependence were different from controls with regard to socio-demographic data of age, domicile, religion, and family type. They were older than controls. The majority of the controls were from rural, joint, Islamic families compared to cases. There were no differences between them in education, occupation, and socio-economic status (SES). 77% of the patients in the case group initiated drinking alcohol before 25 years of age, with 32% of them started before 18 years of age. However, only 10% developed dependence before 25 years of age. 70% of patients were having nicotine use compared to 26% in controls with significant difference. 3/4th of the patients in the case group had a family history of alcohol use, with half of them amounting to dependence. The prominent SD among men with alcohol dependence was low desire followed by premature ejaculation. Low sexual desire was reported by 16% and premature ejaculation by 10%. Every aspect of sexual functioning was disturbed in men with alcohol dependence. 12% reported more than one sexual dysfunction. Premature ejaculation was a prominent type of dysfunction among controls. Conclusion: The study highlights the global nature of sexual dysfunction in men with alcohol dependence. It emphasizes the need for clinicians to routinely assess the sexual problems in their alcohol drinking patients, especially those with liver disease.

Today traumatic dental injury (TDI) is one of major health problem in children. Reasons behind this are numerous like it usually take place at an early age of growth and development, due to frequent involvement of multidisciplinary approach in its treatment. The aim of this study were to determine the prevalence of TDI among the school children aged 12 and 15 years and to assess the relation among associated factors such as overbite, overjet, age and  gender. Methodology: A cross- sectional survey using modified Ellis classification of dental traumatic injuries was conducted on randomly selected 3993 children of age 12 and 15 years old to assess the dental trauma. Results :The prevalence of TDIs were more common in  15-year-olds (11.6%) than in 12-year-olds (10.7%) children, but the difference was not statistically significant (p = 0.065). Similarly, TDIs were more common among boys (14.6%) than girls (9.4%); this difference was statistically significant ( < 0.024). Conclusion: The prevalence of TDIs is significantly more and summons the public health attention.

Aim: To assess the lipid profiles in people diagnosed with Type 2 Diabetes Mellitus. Materials and Methods: This study was conducted in the department of Department of  Medicine, PMCH,  Patna, Bihar, India from January 2018 to December 2018. The subjects who were enrolled in this study were diabetic patients. A total of 160 diabetic patients (80 males and 80 females) with a history of diabetes for 10 years and 160 healthy controls (80 males and 80 females) were randomly selected and they were examined for dyslipidaemia. Serum total cholesterol was determined by an enzymatic (CHOD-PAP) colorimetric method and triglycerides were determined by an enzymatic (GPO-PAP) method. HDL-Cholesterol was estimated by a precipitant method and LDL-Cholesterol by was estimated by using Friedewald’s formula as has been shown below: LDL-C = TC – HDL-C – (TG/5). Results: The results showed that the mean HDL-C con- centration was non significantly lower in the female diabetics as compared to that in the male diabetics. However, it was on par when it was compared with the controls. The results showed that the frequency of high TC was higher in the diabetic group (10% Vs 1%). The control group had a borderline higher frequency of low HDL-C than that in the diabetic group. The mean TG was highly significant and LDL-C was significant among the lipid profile of the male/female diabetics, whereas TC and LDL-C were significant among the lipid profile of the male/female control groups. The correlation studies showed a negative correlation of FBG with HDL-C and a positive correlation of FBG with TC, TG and LDL-C. Conclusion: The diabetic patients had a higher prevalence of high serum cholesterol, high triacylglycerol and high LDL-C than the controls, indicating that diabetic patients were more prone to cardiovascular diseases.

Aim: The aim of the present study was to assess the anatomical study on types of calcaneal articular facet and squatting facet with emphasis on anatomical co-relation of squatting facet with different angles at the neck of Talus. Methods: The present study was conducted in the Department of Anatomy, Patna Medical College, Patna, Bihar, India for seven months, and on 100 (right-52, left-48) dry talus irrespective of sex from Department of Anatomy. Articular surface of talus on inferior surface is studied for various types of their incidence. Angle at the neck i.e angle of inclination and deviation were measured with the help of Goniometer. Results: Type II articular facets were highest in its incidence in our study with no difference in right and left side viz. 24 patients and 20 patients respectively. Second highest being Type III articular facet on talus without any difference on right and left side viz. 18 patients and 14 patients respectively. Type IV and Type V were least types of articular facet. Lateral squatting facet was found in 22 patients of the bones on right side in 18 patients on left side, showing no significant difference. The mean highly significant incidence of angle of inclination on right side was 124 and on left side 112. Angle of deviation mean we found was 26.5 on right side and 25.4 on left side. We found no significant difference between angle on right and left side of talus. There was no significant co relation between angle of deviation and presence or absence of lateral squatting facet p value >0.05. With angle of inclination we found there is significant co relation between angle of inclination and squatting facet with p value 0.007. Conclusion: Differences in the articular facets on inferior surface of tali is attributed to the significance related to safety of joint i.e. presence of three facets make the joint more stable. Modification on neck of tali leading to formation of squatting facet reflects life style, habitual activities and postural adaptation of population. Occurrence of squatting facet is not only because of postural adaptation like squatting position due to extreme dorsiflexion, but also attributed to climbing, prolonged standing and pes cavus in the individuals.

Aim: To evaluate the functional result of older patients with unstable comminute intertrochanteric fractures treated with primary bipolar hemiarthroplasty. Material and Methods:  This was an interventional retrospective randomized control trial study was conducted in the Department of Orthopedics, Patna medical college and Hospital, Patna, Bihar, India for one year. Data collected from patients presenting with unstable intertrochanteric fractures satisfying inclusion and exclusion criteria who are treated with Cemented Bipolar Hemiarthroplasty. Patient with age group >60 years of either sexes who are able to walk before injury and Intertrochanteric fracture classified as unstable fracture according to Boyd and Griffin classification (type II, III, IV) were included in this study. Polytrauma patients, Patient <60 years of age, Compound intertrochanteric fractures, Patients medically unfit for surgery and Patients with immunocompromised status were excluded from the study. Results: Thirty-one patients were enrolled in this study of them 26 sustained fractures after fall from a standing height, while 5 patients sustained road traffic accidents. The average age at surgery was 73.84 years (range, 65-90 years). There were 13 men and 18 women. The mean operative time was 100±10 minutes. There were two cases of superficial infection and one death. Conclusion: Intertrochanteric fractures of femur are very common among old age patients; females being more commonly affected. The most common mode of injury is domestic fall. According to our results, we believe that Cemented Bipolar Hemiarthroplasty is of choice in freely mobile elderly patients above sixty years of age with an intertrochanteric femoral fracture. In elderly patients with intertrochanteric fractures of the femur treated with hemiarthroplasty gave early mobilization, early return to pre injury level, superior the quality of life and gave a long-term solution.

Aim: The aim of the present study was to estimate prevalence and severity of DR and in recently diagnosed type 2 DM patients. Material & Methods: A study was conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India from February 2017 to January 2018. 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 no proliferative diabetic retinopathy (66.66%), Moderate no proliferative diabetic retinopathy (20%), Severe no proliferative diabetic retinopathy (6.66%) and proliferative diabetic retinopathy (PDR) (6.66%). Macular oedema was noted in 4 patients. 60% of them had mild macular oedema while 20% each had moderate and severe macular oedema. 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.

Aim: The aim of the present study was to assess the effect of Attachable intra oral wound dressing tape on post extraction dental socket. Methods: The study was conducted as a prospective, randomized, controlled, and single-blind clinical trial in the Department of Dentistry, NMCH, Jamuhar, Sasaram, Bihar, India. The study took place over a period of  year. The approval includes a unique registration number and adherence to the instructions outlined in the Declaration of Helsinki. A total of 58 teeth in 58 patients were enrolled in this study. Results: The patients included 31 with (49.2%) percent females, and 27 with (42.9%) percent males and a mean age of 30 years (range, 15-65). Most teeth were located in the mandible (74.6%, n= 47) and (17.5%, n =11) in maxilla. The demographic distribution regarding the age, sex, and jaw at a Mean ± SD (30.30±11.210).Based on postoperative assessments, the data show great percent (65.5%, n= 19) of normal bleeding grade in a study group with a p value of 0.001 so result showed statistically significant difference in the study group when compared with the control group regarding the post dental extraction bleeding. Regarding the incidence of alveolar osteotis after 4 days post dental extraction, the result show 5 cases of alveolar osteotis in control group with (17.2%) percent, and 2 cases of alveolar osteitis in study group (6.9%) with a statistically significant difference in the decrease of alveolar ostietis incidence in study group with a p value = 0.000. Conclusion: Ora-aid is a dental product that can be used after a dental procedure to safeguard the blood clot in the dental socket and prevent it from being dislodged within the initial 5-6 hours following the tooth extraction.

Background: The rising number of primary Caesarean sections has led to increased consideration of delivery mode in subsequent pregnancies. The increasing prevalence of Caesarean sections contributes to a rise in multiple repeat procedures, which are linked to increased risks for both maternal and foetal complications. Methods: A retrospective study was conducted over 12 months at Department of Obstetrics and Gynaecology, Katihar Medical College and Hospital, Katihar, Bihar, India. Data on previous Caesarean sections were collected, and clinical findings during the current pregnancies were recorded. Results: During the study period, 942 women with a history of previous Caesarean section were admitted. Among them, 530 cases underwent elective repeat Caesarean section, while a trial of labour after Caesarean section was planned for 412 cases. Successful vaginal delivery was achieved in 311 cases, while 96 cases required repeat emergency Caesarean section due to failed labour trials. Maternal morbidity, such as adhesions, was observed in 11.25% of cases, and obliteration of the utero-vesical fold in 7.92%. Maternal mortality occurred in 0.15% of cases. Perinatal morbidity and mortality rates were 3.32% and 3.96%, respectively. Conclusions: Given the increasing prevalence of women with previous Caesarean sections, it is crucial to provide informed counselling during attempts at vaginal delivery in well-equipped hospitals. Efforts to reduce primary Caesarean sections are warranted to mitigate complications in subsequent pregnancies.

Aim: The aim of the present study was to compare complications and mortality in AMI patients with diabetes and without diabetes. Material & Methods: A comparative observational study was carried out at Department of pathology and Cardiology, PMCH, Patna, Bihar, India for the duration of 12 months. Study population was adult patients admitted with Acute myocardial Infarction. 50 diabetic AMI and 50 non-diabetic AMI were studied in the study for post AMI complication and mortality. Results: Group-1 consists of 50 cases (35 males and 15 females) and group- 2 consists of 50 cases (40 males and 10 females). Most of the patients in both group diabetic and nondiabetic belonged to age group 45 – 54. The mean random blood sugar in diabetes group in male and female were 236.6±94.82 and 246.64±84.26 respectively. Maximum number of cases of Stable angina belonged to Non-Diabetic group (64%) and unstable angina and MI belonged to Diabetic group (26% and 18%) respectively. There was a significant association between types of AMI among the diabetic and the non-diabetic groups (P<0.001). Among the diabetic patients total 40 (80%) patients had complications. In the non-diabetic patients’ complications were observed in 30 (60%). Pump failure was most common complication followed by sinus tachycardia in diabetic patients. Among the non-diabetic patients, sinus tachycardia was most commonly observed followed by bradycardia. There was a significant association between diabetes and complications (p<0.05). Conclusion: The present study concluded that Post MI complications and Mortality is significantly more among diabetics compared to among non-diabetics.

Aim: The aim of the present study was to predict the effect of hemodialysis on the psychological state of patients and the development of these patients according to response to the hemodialysis. Methods: A study was conducted at ESICMCH, Bihta, Patna, Bihar, India and 200 subjects were included in the study. Patients were selected who were available at the time of interview. A verbal permission was taken from these patients and/or their relatives. A questionnaire was prepared and included a general history, family diseases, drug regimen, and socioeconomic condition. Duration of study from October 2022 to November 2023. Results: Above sixty years represent more than thirty percent, the male was more than sixty five percent. More than fifty percent was married and about forty percent was not educated, five % had earned a university degree, and 1% was postgraduates, with regard to occupation, more than twenty percent was without a job. More than half of the patient was make dialysis less than a year and most of the total sample was perform the dialysis two times a week. In regard to kidney disease, the glomerular renal disease were found to be a main cause of end stage of the disease (39.5%), followed by Diabetic Nephropathy (DN) 31% which contributed to about third of the cases, hypertension 18.5% and rest other. Obstructive neuropathy were about 2%, renal stones about 4% of the sample. Conclusion: The most regarded reason of (ESRD) was the glomerulonephritis and diabetic nephropathy was the second one. Most of patients are uneducated which may play a role in incidence of ESRD.

Aim: The aim of the present study was to determine baseline Widal titers of Salmonella agglutinins among healthy people in Ranchi, Jharkhand (India). Methods: The study was carried out in the Serology section of Dept of Microbiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India for a period of 12 months. Volunteers of both the sexes of 18-50 years of age group of different community of Ranchi who live here for more than 5 years and coming to our microbiology and biochemistry department for different routine test were included. 300 patients were selected in the study. Results: There were equal number of male and females. People of 18-50 years of age group were included. Among them maximum no. of people were from 21-30 years age- group and minimum no. of people were from 18-20 yrs. 20% were illiterate and 42.33% had tap water form municipal as source of water. 52.67% had food born disease awareness. Among 300 samples under the study, 170 had positive (i.e. ≥ 20) end titer value and 130 had negative (i.e. <20) end titer value. Among 150 females 86 i.e. 57.33% were found to be positive (≥ 20) for the end titer value and 64 i.e. 42.67% were found to be negative (<20) for the end titer values. Among 150 males 84 i.e. 56% were found to be positive (≥ 20) for the end titer values and 66 i.e. 44% were found to be negative (< 20) for the end titer values. Conclusion: Widal test is an accessible, cheap and simple test which has diagnostic significance in endemic areas.  Judicious interpretation of the test is made based on the agglutinin levels prevalent in the normal population of the region at a particular time period.

Aim:To investigate the process of estimating age based on digital X-ray images of the shoulder joint. Material and Methods: The present study was conducted was conducted in Department of FMT, Gouri Devi Institute of Medical Science and Hospital, Durgapur, West Bengal, India for one year. This study was carried out on total 200 subjects between the age group of 14 years to 20 years.  Written and informed consent for X-ray were taken from all subjects. Performa and Information sheet used in English and Hindi language. Information of address, education, disease, any habit, age, sex, physical development, nutritional status, work, handedness, diet, family size, socio-economic condition was taken from the subjects. Documentary proof of birth certificate, school leaving certificate, Ration card, election ID, Aadhar card, school ID, hospital record and Driving license verified. Subject for age estimation, MLC and cases referred by CMO from Casualty. Results: This study was conducted at Department of forensic medicine. This study was carried out on 200 participants who belong to the age group of 14-20 years attending the Forensic Medicine. Thus in our study, of the total 200 participants, 100, i.e. 50% were males and 100, i.e. 50% were females. In the present study total numbers of female candidates are 15 and 66.6 percentage of candidates which show complete fusion; in age groups of 17 to 18 years and total numbers of male candidates are 7 and 85.71 percentage of candidates which completed (i.e. stage 3) fusion in age groups of 18 to 19 years according to their respective diets. As is evident from the above tables, no significant effect of the diet of an individual is seen on the fusion of Head of Humerus As is evident from the tables, no significant effect of the Socio-Economic class is seen on the fusion of Head of humerus with respective age in both males and females. Conclusions: In females, the ossification center of shoulder joint occurs earlier than males by one year as seen above. The complete fusion of centers of shoulder joint occurs one to two years later in the population of Bihar than south Indian population and most of the remaining parts of India, centers of shoulder joint fuse at approximately the same as other parts of INDIA. There is no association of vegetarian and non-vegetarian diet on the fusion of epiphyseal centers, in both male and females.

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, Government medical College and Hospital, Madhepura, Bihar, India   from September 2021 to August 2022 were evaluated. The individual bacterial isolates and their sensitive pattern to various antibiotics were also recorded in 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.  45% patients were in the age group 56-65 years followed by 66-75 (22%) age group. Out of a total 200 cases, 80 (40%) were positive for pathogenic bacteria and 120 (60%) were non-pathogenic. Among total 46 pathogenic microbial, 64% were Gram-negative bacteria and 36% were Gram-positive bacteria. Out of 46 pathogenic bacteria, K. pneumoniae was the commonest (35.55%) followed by P. aeruginosa (22.22%), S. aureus (15.55%), S. pneumoniae (11.11%), S. pyogenes (6.66%). Among antibiotics, Amikacin was found highest sensitive followed by Azithromycin (68.68%), Amoxy Clavulanic acid (66.66%), Ciprofloxacin (62.22%) and Gentamycin (55.55%). Levofloxacin and Co-trimoxazole were found to be highly resistant 68.88% and 62.22% respectively among the drugs used in culture and sensitivity of 45 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.

Aim: The aim of the present study was to evaluate the efficacy of autologous PRP vs steroid injection in the treatment of chronic recalcitrant lateral epicondylitis. Methods: The present study was conducted in the Department Orthopedics, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India for five months.50 patients with signs and symptoms of chronic lateral epicondylitis not responding to conservative management like oral medication, tennis elbow belt, physiotherapy, aged between 18 and 60 years were randomized into PRP and steroid injection group based on a computer-generated block randomization chart. Results: There was no statistically significant difference in the age distribution between the two groups. There was a statistically significant difference between the PRP and CS group at 2 weeks (p < 0.00), 6 weeks (p < 0.00), and 6 months (p < 0.00). At all other follow-up points, there was no statistically significant difference between the two subgroups with respect to the VAS, DASH, and Nirschl scores. Conclusion: Platelet-rich plasma is the better treatment option to treat tennis elbow as there was no recurrence of symptoms or any associated complication till 6 months. The strength of this study lies in the fact that all the patients recruited had a chronic recalcitrant tennis elbow; they were prospectively assessed and randomized. Although the results show good efficacy of PRP compared with steroid, further validation by more subject recruitment is required. The study found to have significant improvement in terms of pain and functional outcome as assessed by VAS score, Nirschl score, and DASH score.

Aim: The aim of the present study was to evaluate the sonographic findings in children with dengue fever (DF) and to determine its role in predicting the severity of the disease. Material & Methods: The retrospective study was done in the Upgraded Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India  from  November  2013 to October 2014 Serological test NS 1antigen, Dengue IgM and IgG Antibody tests were performed. 70 patients were found serologically positive for dengue, were referred for Ultrasound scanning of the abdomen and thorax. Results: Out of 70 cases 42 were male and 28 were female. Out of 70 cases 4 cases were less than 1 year old, 20 aged 1-5 year, 22 aged 6-10 year and 24 cases were in more than 10-year age group. Out of 70 confirmed cases, 50 cases were classified in mild dengue group and 20 cases were in severe dengue fever group. All cases had fever. About 34 (48.57%) cases had vomiting, 40 (57.14%) had pain abdomen, 45 (64.28%) had Petechiae, 37 (52.85%) had melena. 32 (45.71%) had hepatomegaly, 18 (25.71%) had splenomegaly and 21 (30%) had hypotension. Gall bladder wall oedema, ascites, pleural effusion, hepatomegaly, splenomegaly and perinephric oedema were present in 55 (78.57%), 40 (57.14%), 36 (51.42%), 42 (60%), 22 (32.42%) and 11 (15.71%) in all dengue fever group while 20 (100%), 20 (100%), 17 (85%), 12 (60%), 8 (40%), and 9 (45%) in severe dengue group respectively. Conclusion: Sonographic features of thickened GB wall, pleural effusion (bilateral or right side), ascites, hepatomegaly and splenomegaly should strongly favour the diagnosis of dengue fever in patients presenting with fever and associated symptoms, particularly during an epidemic. The degree of thrombocytopenia showed a significant direct relationship to abnormal ultrasound features.

Aim: The aim of the present study was to assess the role of magnesium sulphate and it’s timing of administration on the survival and short-term neurologic outcome (such as seizure, tone, reflex and death) of neonate with severe perinatal asphyxia. Methods: The study was conducted in Department of Pediatrics, JLNMCH, Bhagalpur, Bihar, India for one year, and all neonates admitted into both inborn and out born units of the SCBU with APGAR score < 6 at 5minutes or those referred from other health facilities with history of inability to establish spontaneous respiration (cry) at birth were enrolled after informed consent from the parents/caregivers. A total of 706 neonates were admitted and out of these neonates 136 (19.3%) had SPNA. Results: Among those with SPNA 84 (61.8%) were male and 52 (38.2%) were female neonates, giving a M: F of 1.6:1. Majority 125 (91.9%) were delivered in health facility and 53 (29.0%) of them had no signs of hypoxic ischemic encephalopathy at presentation. Respiratory distress as evidenced by tachypnea (respiratory rate > 60) was the most common 73(53.7%) presenting symptom. Outcome showed that 104(76.5%) were treated and discharged while 32(23.5%) died. About equal number of mothers delivered term 70 (51.5) and preterm 66 (48.5%) babies. Most 114 (83.8%) mothers were booked and 55 (40.4%) of them were primiparous, 50 (36.8%) multiparous and 31 (22.8) grand multiparous. Majority of mothers received postpartum magnesium sulphate. There was statistically significant association between birth weight (0.001) and HIE (0.009) with outcome. However, admission heart rate, Spo2, BCS and gestational age were not significantly associated with outcome. Conclusion: The findings of this study further strengthen the role of magnesium sulphate in improvement of short term neurologic outcome in asphyxiated neonates but there was no statistically significant difference in mortality with timing of administration of first dose of magnesium sulphate.

Aim: The aim of the present study was to analyses aqueduct velocity parameters by phase contrast MRI CSF flowmetry in Idiopathic Normal pressure hydrocephalus patients (NPH). Methods: The present study was conducted at Department of Radiodiagnosis, Shri Ramkrishna Institute of Medical Sciences, Durgapur, West Bengal, India. Total no of 60 participants age range was between 38 to 88  were enrolled into the study. Duration of study for one year. Results: 58.3% population was >60 years, 26.7% population group was in between 51-60 years and 15% population was < 50 years age. Overall gender distribution in case group (n=30) 25 was male and 5 was female and in control group(n=30) 22 was male and 8 was female. Gait Disturbances was present in 86.7%, Dementia was present in 73.3% and Urinary Incontinence was present in 70% in Case Population. Ventriculomegaly was present in 93.3%, Symmetrical trans ependymal edema was present in 90%, Sulcus effacement was present in 90%, Corpus callosal thinning   was in 83.3%, Corpus callosal angle was between 50 -80 degree in 83.3% and Flow Void at cerebral aqueduct was present in 62.2%. Conclusion: MRI CSF flowmetry using phase contrast method is an advanced imaging parameter which can non- invasively and reliably detect NPH. Also, it can be used to follow the response to treatment following shunting and can act as a prognostic marker.

Aim: To determine the prevalence and identify the risk factors of nocturnal enuresis among school-going children in Darbhanga, Bihar. Material and Methods: This retrospective study was conducted in the Department of Community Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India from January 2018 November 2018. School going child in the age group of 5 to 15 years and Child and parents ready to participate in the study and responded to the questionnaire were included in this study. A predefined questionnaire, prepared in English and translated to local languages, Hindi, was handed over to all the children attending the selected schools. Children were asked to hand over the questionnaire to their parents and return with the filled questionnaire. The questionnaire was prepared to obtain the information related to the socio-demographic factors of the family, information related to child’s age, sex and other factors, frequency of enuresis and information related the risk factors. Results: So, the response rate was 83.63%. Out of that 657 were from Hindi medium schools and 773 were from English medium schools. The response rate from English medium schools (87.64%) was better than the response rate from Hindi Medium schools (79.35%). The overall prevalence of nocturnal enuresis was 11.4 %. The maximum prevalence was found in the age group of 8-9 years (22.96%). The prevalence of nocturnal enuresis in the age group of 7 -8, was 18.92%. There was only one child suffering from nocturnal enuresis in the age group of 13-14, whereas no child complained of it above the age of 14 years. The differences in the prevalence rates in these age groups were statistically significant. (χ²7= 77.65, p = 4.15 x 10^-14). The prevalence of nocturnal enuresis in boys (14.34%) was significantly more than the prevalence in girls (8.31%). The odds ratio was 1.85 (95% confidence interval-1.32-2.59). The prevalence of nocturnal enuresis was more in Hindi medium school as compared with English medium school. Table 4 shows the association of nocturnal enuresis with various socio-demographic and other factors. It shows that the nocturnal enuresis was significantly associated with socio-economic status, stress, poor school performance, sleep pattern (hard to awaken), family history, burning micturition, not going to toilet before bed. But it was not associated with maternal or paternal education, birth order, type of family. A total of 102 (62.58%) children’s parent felt that it was an abnormal condition and consulted any doctor. Remaining 61 parents felt that the nocturnal enuresis or bedwetting is a common and normal phenomenon. Conclusion: Nevertheless, the study has concluded that the prevalence of nocturnal enuresis is 11.40% in school going children and it is associated with age, sex, stress, family history, burning micturition, hyperactive child, poor school performance, sleep pattern (hard to awake) avoidance of going to micturate before sleep etc.

Aim: To determine the significance of maternal serum ferritin as a prognostic indicator for intrauterine growth restriction. Material and Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India from April 2019 to March 2020. 326 antenatal women visiting the antenatal clinic were enrolled in the study on the 25^th week. Exclusion criteria were BMI <18, placental abnormalities like velamentous insertion, antepartum haemorrhage, multiple pregnancies, patients with acute infection, positive CRP, raised TLC count, congenital malformation, and foetuses with chromosomal or genetic syndrome. Gestational age was defined as completed weeks from the onset of the last menstrual period, if there was a mismatch between the dates and USG reports by more than two weeks then the ultrasonographic dating (first trimester) was considered for calculating gestational age. Results: Patients were divided into three groups depending on the serum ferritin value. The above data shows that the maximum percentage of growth-restricted babies is seen in the subgroup of women having a mean serum ferritin value of >20 ng/ml during pregnancy. The data above depict that women with mean serum ferritin above 20 ng/ml, were 6.26 times more likely to have asymmetrically growth-restricted babies and 4.47 times more likely to have symmetrically growth-restricted babies when compared to women with serum ferritin value less than <20 ng/ml. The analysis was statistically significant P<0.0001 for asymmetrical growth restriction as an outcome and P<0.05 for symmetrical growth restriction as an outcome). Serum ferritin value at 20.2 ng/ml was associated with the highest Yuden’s index which means that it can be taken as a cut-off for screening antenatal patients for development of fetal growth restriction with 61.5% sensitivity and 80.1% specificity. Conclusions: In our study, a negative correlation was found between the value of serum ferritin and neonatal birth weight. In the future, a large randomized control trial is needed to find an association between maternal serum ferritin and IUGR.

Aim: To compare the effectiveness of Epley’s technique in combination with medical therapy vs medical therapy alone in the treatment of individuals with benign paroxysmal positional vertigo (BPPV) in the Bihar area. Material and Methods: A retrospective study  was conducted in the Department of ENT, Nalanda Medical College & Hospital,Patna, Bihar, India from April 2020 to March 2021.  Non-probability methods used in sample selection and patients split into two categories. Group A (Epley only) 47 patients, Group B (Epley’s + beta histine) 47 patients.  Both adult patients with vertigo complaints as the only short-lived symptom for less than one minute diagnosed with the Dix-Hall picking maneuver were included. Patients of vertigo for more than one minute and other ear effects, such as hearing loss, tinnitus and aural fullness have been removed. Also omitted were patients with Meniere’s disease and acute peripheral vestibulopathy. Results: The research involved a total of 94 patients. The majority of the women were women in group A (Epley’s only) while 27 (57.45 %) were women and 20 (42.53 %) were men in group B. The age of the patients is between 16 and 65 years, with an average of 35 years. The majority of patients in Group A were aged between 26 and 35 years 36 percent while the highest number of patients (27 percent) in Group B was aged between 46 and 55 years. Epley has been shown to be more efficiently and efficiently administering benign paroxysmal vertigo in the dosage of 48 mg betahistine per day at two separate doses (78.7 % efficiency in Group B Vs 61.7 % in Group A, when only Epley has been used alone). Conclusion: In conclusion, Epley’s maneuver with betahistine is more successful than Epley’s maneuver alone to handle benign paroxysmal positions. However, we are recommending additional randomized control trials for large populations of various organizations.

Aim: The aim of the present study was to find out the modifiable risk factors which are responsible for the non- adherence among the diabetes population. Methods: The present research was a retrospective  study that was conducted on two hundred diabetic patients who had attended the Department of Medicine, JLNMCH, Bhagalpur, Bihar, India, for a period of 12 months. Results: Average age, weight, height, and BMI were 48.62±10.12 years, 64.96±12.08 kgs, 164.76±8.08 cm, and 25.35±4.06kg/m2. The patients were 140 (70% male). Of 200 patients, 196 (98%) had T2DM, whereas 4 (2% had T1DM). Only 30 (15%) individuals have diabetes in their families. Eighty (40%) were illiterate, whereas 56 (28%) were graduates. 196 patients (98% married) were married. Patients were mostly on oral antidiabetic medicines 150 (75%) and Ayurvedic plus oral 40 (20%). Only 10 (5%) patients used insulin. In this research, 160 (80%) patients were off therapy for 1-5 months, followed by 24 (12%) for 6-10 months. The most prevalent reason for treatment cessation was long-term medicine (75%), followed by not knowing the repercussions of skipping doses (68%), drug side effects (65%), and financial issues (58%). Conclusion: It is very important to identify the patients with poor adherence in order to improve the factors responsible. By improving the risk factors for the poor adherence on individual basis better outcome can be obtained in terms of better glycemic control among the diabetes patients.