International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

NMC Approved

Peer Review Journal

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1. Clinical and Etiological Profile of Acute Febrile Illness Associated with Thrombocytopenia in Pediatric Patients
Hemachandran Jeldi Jesudoss, Kirtika Shrivastava, B Vamshi Krishna, Gouri Rajput
Abstract
Background: Thrombocytopenia frequently presents as a common clinical condition in routine medical practice. Due to the multitude of potential causes, evaluating and treating patients with thrombocytopenia can be challenging. This study aimed to identify the diverse etiological factors and clinical characteristics of fever with thrombocytopenia in children aged 1 month to 12 years admitted to our hospital. Methods: Acute febrile illness lasting for 5 days. Demographic data collection included age, gender, geographical location, and a detailed medical history. The investigations included Complete blood count, peripheral smear study, urine albumin, blood urea, serum creatinine, liver enzymes and serum bilirubin, xray chest depending upon detailed examination on suspicion of tropical infections MP smear, dengue IgM, scrub typhus 20 IgM ELISA, widal test, leptospirosis IgM were performed along with blood culture and urine culture. Results: Distinct etiologies exhibit varying thrombocytopenia severities. Undiagnosed fever has the highest proportion of severe cases (53.12%). Dengue fever consistently presents with moderate or severe thrombocytopenia. Scrub typhus commonly has moderate (42.5%), mild (25.00%), and severe (9.37%) cases. Acute Lymphoblastic Leukemia (ALL) shows only moderate thrombocytopenia in 2 out of 8 cases. Malaria, enteric fever, viral encephalitis, and septicemia demonstrate low thrombocytopenia prevalence. Among 80 children, 77 improved with treatment, 2 were referred for hematological malignancy, and 1 for multiorgan dysfunction. Conclusion: Febrile Thrombocytopenia, a benign illness in children, is characterized by common GI symptoms and is prevalent. Infants with thrombocytopenia often experience shock and an altered level of consciousness. Severe thrombocytopenia correlates with bleeding, primarily presenting as petechiae. Treating the primary condition led to a prompt improvement in platelet count, particularly in non-bleeding cases. Despite encountering platelet counts as low as five thousand cells/cumm, most of the cases improved.

DOI: 10.5281/zenodo.10955936

2. An Observational Study of Correlation between Serum Ferritin Levels and Liver Functions in Multiple Transfused Thalassemia Patients in a Tertiary Care Centre at Jaipur, Rajasthan
Rajveer Singh Yadav, Gaurav Agrawal, Shweta Yadav, Trapta Goyal, Jitendra Kumar Gupta, Nikita Pal, Abhishek Kumar Sharma
Abstract
Background:  Thalassemia is a heterogeneous group of mendelian disorders. Thalassemia itself and complications due to iron overload can damage multiple organ systems. Objective: Aim of our study was to correlate between serum ferritin level & liver functions in multiple blood transfused thalassemia patients. Materials and Method: This was an observational study conducted in the department of pediatrics in a tertiary care hospital, Jaipur, Rajasthan. All those patients who received more than 50 blood transfusions are considered as multiple transfused patients and were included in this study. The Pearson correlation coefficient was applied to observe the correlation between serum ferritin level and liver function tests. A p- value of < 0.05 was considered statically significant. Result:  A total of 50 patients were enrolled in this study. 92% patients were under 15 years of age and male to female ratio was 2.33:1. There was significant correlation between serum ferritin level > 1000ug/L and serum transaminases levels (p value < 0.001) with strongly positive correlation coefficient was SGPT r = +0.622 and SGOT r = + 0.704. The correlation between serum bilirubin level with serum ferritin level <1000ug/L was static but further increase when serum ferritin level more than 1000ug/L a p-value <0.001 and r = +0.784. Conclusion: Patients having abnormal liver functions in thalassemia patients due to iron over-load. Iron over-load in the body, which turn to lead to increased serum ferritin levels in multiple transfused thalassemia patients. High serum ferritin levels is associated with liver functions derangement. Serum ferritin levels should be monitoring routinely in multiple transfused thalassemia patients. Chelation therapy should be started as early as indicated to prevent liver functions derangement.

DOI: 10.5281/zenodo.10955984

3. A Clinical Study on Ulcero-Membranous Lesions of Oral Cavity and Oropharynx
D Rajanikanth, C Arunakumar, T. Swaroop Kanth, Paruchuri Nikhila
Abstract
Introduction: Ulcero-membranous lesions of oral cavity and oropharynx are common ENT complaint we encounter in OPD and also pose effect on health of the patients and so it is important to establish proper diagnosis and to provide appropriate treatment. Aims: To determine the proportion of patients presenting with various clinical features of ulcero-membranous lesions in oral cavity & oropharynx. Materials and Methods: it is a prospective study done in department of ENT over a period of 18 months. Patients with complaints of ulceromembranous lesions attending otorhinolaryngology OPD who are willing to participate in study were considered for study. Results: In present study, most common age group involved were 41-60 years constituting 45.09% and males outnumbered females constituting 65.69%.Most common throat symptom was odynophagia followed by burning sensation, dysphagia and throat pain. Associated ear complaints were present in 14.7% and nose complaints in 5.9%.General symptoms like fever was present in 10.7%,loss of weight was present in 23.5%, general weakness was present in 15.6%,skin lesions were present in 6.9%.Systemic diseases like diabetes was present in 34.3%,hypertension was present in 25.4%,HIV was present in 3.9%.Risk factors like smoking present in 43.1%,alchohol consumption present in14.7%,tobacco chewing present in 17.6%,prior radition exposure present in 0.9%. Most common site affected in present study was tongue 44.1% followed by palate 29.4%, buccal mucosa 15.6%, tonsils 8.8%, lips 7.8%,alveolus 2.9%, RMT 1.9%. Most common etiology found was neoplastic etiologywhich constitute 41.1%, followed by inflammatory etiology 31.3%, infective etiology 20.5% and miscellaneous 6.8%. 52.9% patients were managed conservatively and among patients with neoplastic etiology, 36.2% were treated surgically by oncosurgery team and 10.7% patients were managed with radiotherapy. Conclusion: With increase in habits like smoking and chewing nicotine in any form in adult population there is rise in incidence of malignancies .So high index of suspicion is needed while treating an oral ulcer especially chronic ulcers. Biopsy and histopathological examination are always gold standard to confirm the diagnosis.

DOI: 10.5281/zenodo.10956474

4. Comparison of Steroid and/or Sodium Hyaluronate Injections in Frozen Shoulder: A Prospective, Double-Blind, Randomized, Placebo-Controlled Trial
Lal Bahadur Prasad, Vasudha Gupta, D P Bhushan
Abstract
Background: Limited research has explored the impacts of concurrent administration of corticosteroid (CS) and hyaluronic acid (HA) for adhesive capsulitis (AC) of the shoulder. This study examines the combined effects of simultaneous intra-articular injections of CS compared to injections of CS or HA alone. Methodology: A randomized, placebo-controlled trial was conducted with sixty AC patients. They were assigned to one of four groups: saline, CS, HA, and CS with HA. The primary outcome measure was changes in the Shoulder Pain and Disability Index (SPADI) scores after one month. Secondary measures included alterations in pain, range of motion, muscle strength, and overall satisfaction at various intervals up to six months post-injection. Results: At the one-month mark, SPADI score changes were significantly greater in the CS with HA group (−30.3 ± 11.6) compared to the saline (−4.4 ± 21.1) and HA (−7.8 ± 23.1) groups. The CS with HA group exhibited a larger score change than the CS group (−25.6 ± 11.2). Moreover, regarding pain reduction and range of motion improvement, the CS with HA group demonstrated superior and more rapid effects compared to the saline and HA groups. Additionally, functional scores favored the CS with HA group over the saline and HA groups. Conclusion: In the management of AC, simultaneous CS and HA injections proved more efficacious in enhancing SPADI scores after one month compared to single CS or HA injections.

DOI: 10.5281/zenodo.10956581

5. Alternate Method of Inexpensive Customized Vacuum Assisted Closure Dressing for Infected and Non Healing Wounds
Ankesh Goyal, Abhishek Rathore, Vachan Goyal, Rohan Yadav
Abstract
Background: Open fractures are very commonly encountered in orthopaedics. Type III open fractures proved the most difficult to treat owing to the varied injury patterns, increased morbidity from associated injuries, massive soft tissue damage or loss over the fracture sites, compromised vascularity, wound contamination, and fracture instability and sometimes require secondary procedures like grafting and flaps. Similar is the case with wounds that remain after debridement. These wounds especially over a subcutaneous bone like tibia take a long time to heal due to less availability to soft tissue to bridge the wound margins and presence of infection. Vacuum assisted closure (VAC) dressing is an effective way of treating these kind of wounds which are hard to heal and provide a faster way to heal the infection and provide healthy granulation tissue over which secondary procedure like skin grafting can be done. It reduces the time for wound healing. Conventional VAC dressing is costly and not everyone can afford it. Here we describe an inexpensive method for customised VAC dressing. Methods: 48 patients were included in the study with various size and grade of wounds and treated with customised VAC dressing for various duration depending on the wound size. Results: most of the wounds healed with the application of VAC dressing and could be closed with primary closure. 13 patients required split thickness skin grafting and 2 patients required flap for the closure of the wounds. Conclusion: The customised VAC dressing was as effective as conventional VAC dressing in healing the wounds.

DOI: 10.5281/zenodo.10956852

6. Comparison of Dermatoglyphic Patterns in Bronchial Asthma Patients and Controls in Southern Rajasthan
Kalpana Sharma, Vaishaly Kishore Bharambe, Komi Vyas, Ram Prakash Saini
Abstract
Introduction: Dermatoglyphics is a science that deals with ridge patterns of volar aspect of hands and feet. It may be helpful indicator for screening of asthma in the mass population because both things are related to gene. The objective of the study was to compare the dermatoglyphic angles of palm in bronchial asthma patients and controls. Method: Prints were collected from both hands of 230 patients of bronchial asthma and 230 controls. In these prints angles of palm “atd”, “tad”, and “tda” were studied. Result: In present study there is significant increase in the mean value of ‘atd’ in both hands of patient (p<0.0001). The mean value of ‘atd’ is 42.27 in right hand of patient and 40.26 in controls and the mean value of ‘atd’ is 43.76 in left hand of patient and 41 in controls. Mean value of ‘atd’ is more in right (42.08) and in left (43.14) hand of male patients as compared to right (40.15) and left (41.28) hand of male control.Mean value of ‘atd’ is more in right (43.37) and in left (43.68) hand of female patients as compared to right (40.52) and left (40.68) hand of female control. Conclusion: In the comparison to controls, patients’ right and left hands showed a significant increase in the mean “atd” and “tad” and a decrease in the “tda”.In comparison to male controls, male patients’ right and left hands showed increase in the mean “atd” and “tad” and a decrease in the “tda”. In the comparison of female controls, female patients’ right and left hands showed not significant decrease in the “tad” angle, but decrease in the “tda”angle with significance.

DOI: 10.5281/zenodo.10956915

7. Study to Determine the Prevalence of Urinary Tract Infection and Identify the Causative Organism and their Antibiotic Sensitivity Pattern in Moderate Acute Malnutrition and Severe Acute Malnutrition Children
V. Shivaprakash, Madhu Sannegowda, Gururaja R
Abstract
Background: The purpose of this study was to ascertain the frequency of urinary tract infections in malnourished children, to identify the causal organisms, and to investigate the antibiotic sensitivity pattern of these organisms. Methods: A Hospital-based Cross-sectional Observational Study was carried out on 160 moderately and severely malnourished children admitted to the Paediatrics department of the Nutritional Rehabilitation Centre (NRC), District Hospital Tumkur, over the course of a 12-month period from January 1, 2021, to December 31, 2021. The study was approved by the Institutional Ethics Committee, and participants provided written informed consent. Results: In 45 (28.13%) of the children had severe acute malnutrition, while 115 (71.88%) had moderate acute malnutrition. 25 children (15.63%) were < 3SD, and 135 (84.38%) were < 2SD. The mid-upper arm circumference of 25 children (15.63%) was less than 11.5 cm, whereas the mid-upper arm circumference of 135 children (84.38%) was between 11.5 and 12.5 cm. Of the children, 146 (91.25%) had no oedema, 131 (81.88%) had no visible severe wasting, and 29 (18.13%) had visual severe wasting. The most frequent presenting symptom was fever (42.5%), which was followed by convulsions (26.68%), vomiting (26.78%), and cough (26.78%). Abdominal discomfort (6.88%), diarrhoea (6.88%), urinary bladder soreness (3.75%), increased frequency of micturition (2.5%), and renal angle tenderness (2.5%) were present in fewer than 10% of the cases. In 29 (18.13%) of the children, the urine cultures were positive, and in 131 (81.88%), they were negative. Therefore, 18.13% of the sample had a UTI. Of the 29 children whose urine cultures were positive, E. Coli was found in 15 (51.72%), Klebsiella in 5, (17.24%), Proteus in 4, (13.79%), Pseudomonas in 4, (13.79%), and Acinetobacter in 1 (3.45%). E. Coli was the most often isolated organism. E. coli was completely susceptible to Imipenem, followed by Meropenem (93.3%), Nitrofurantoin (87%), Amikacin (86.6%), Gentamicin (73.3%), Co trimoxazole (26.66%), Cefixime (20%), Co-Amoxiclav (13.33%), Cefotaxime (13.33%), and Ceftriaxone (6.67%). Conclusion: E. coli is the most frequent gram-negative bacilli isolated. Imipenem, Meropenem, Amikacin, Nitrofurantoin, and Gentamicin are the most effective antibacterial medicines against these species. These observations have served as the foundation for the current diagnostic and therapeutic guidelines for clinicians treating children with complex Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM).

DOI: 110.5281/zenodo.10956999

8. Dysphonia: Associated with Inhalation Corticosteroids
Younus Majeed Dar, Junaid Nasim Malik, Majidul Islam Masoodi
Abstract
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.10957028

9. Study of Lipid Profile Levels in Patients with Subclinical Hypothyroidism
Shruthi B R, C. Nagasireesha, Vijaya Lakshmi, Garima Agarwal
Abstract
Background: Thyroid dysfunctions invariably lead to disturbances in lipid metabolism and significantly contribute to the development of other cardiovascular risk factors. Despite this, the effects of subclinical hypothyroidism on lipid metabolism remain undetermined. In the present study, we aimed to identify the etiological factors and lipid abnormalities associated with subclinical hypothyroidism. Methods: This hospital-based cross-sectional study was conducted in the outpatient Department. Adult patients meeting the biochemical criteria for subclinical hypothyroidism were included in the study. None of the patients were recruited from routine screening programs. Only diagnosed cases of subclinical hypothyroidism who met the predefined inclusion and exclusion criteria were enrolled. Inclusion criteria included all diagnosed cases of subclinical hypothyroidism with normal levels of T3, T4, and fT4, but with TSH levels greater than 4.5 µIU/mL. Results: The most common cause of subclinical hypothyroidism in our study was autoimmune thyroiditis, as suggested by the presence of thyroid peroxidase antibody, seen in N=32 cases (64%). N=40 cases (80%) were having TSH in the range of 10 to 20. N=6 patients(12%) had TSH between 5 and 10. N=4 cases(8%) were having TSH above 20. N=32 cases (64%) had positive thyroid peroxidase antibodies while 18 (36%) were negative for TPO Ab. There were significant elevations of Total cholesterol, LDL- cholesterol, and serum triglycerides in cases of subclinical hypothyroidism as compared to controls, the levels of triglycerides were also found to be elevated however the values were not significant. Conclusion: Subclinical hypothyroidism patients exhibit lipid abnormalities characterized by notable increases in total cholesterol, LDL levels and alongside alterations in triglycerides. Administration of thyroxine is anticipated to be beneficial in correcting these lipid abnormalities.

DOI: 10.5281/zenodo.10957056

10. Impact of Body Weight on the Outcome of Pregnancy: An Observational Analysis
Shaktisinh Vaghela, Charmi Pawani, Prafulla Kotak
Abstract
Background and Aim: The effect of maternal underweight on obstetric performance is less clear. While some researchers have found increased incidences of preterm delivery, low birth weight and increased perinatal loss in these women, others have reported a protective effect of maternal underweight on certain pregnancy complications and interventions. By performing this study it would be possible to evaluate the association between BMI and its adverse effect on pregnancy outcome. Material and Methods: A total of 500 women with uncomplicated complications were included in the study. With the help of a predesigned questionnaire, basic information including weight and height was collected in the first checkup and BMI calculated accordingly. Patients were divided into 4 groups such as Underweight (<18.5 kg/m 2), Normal (18.5-24.9), Overweight (25-29.9) and Obese (30 and above). Weight gain during each visit was recorded and development of any antenatal complications throughout pregnancy was noted down. Information regarding postnatal complications, gestational age at delivery and also birth weight and Apgar score of the neonate was collected from the case sheets following delivery. Results: The mean age of the subjects in our study was 26 years. Maximum percentage of LGA babies were born to obese women compared to women with normal BMI. Likewise maximum percentage of SGA babies were born to women in the underweight group. There was a significant association between BMI and birth weight. Conclusion: In India, previously the problems during pregnancy were more related to low BMI but with changing lifestyle, obesity is increasing rapidly especially in urban set ups and may become a major health problem in the future.

DOI: 10.5281/zenodo.10961309

11. Knowledge, Attitude and Practice Behaviors Regarding Relationship between Diabetes Mellitus &Periodontitis among General Dental and Medical Practitioners
Piyush Pujara, Milind Joshi, Parth Sakaria
Abstract
Background and Aim: There is a strong link between diabetes mellitus (DM) and an increased risk of periodontal disease. In fact, periodontitis is often considered as the sixth complication of DM. This study aimed to evaluate the understanding, perspectives, and behaviours of medical practitioners who treat diabetes towards diabetes and periodontal disease. Additionally, it explored their willingness to recommend dental treatment to their patients. Material and Methods: A survey was conducted to gather information on the awareness, attitude, and practice of general dental and medical practitioners in Bhuj Town, Gujarat, India, regarding the relationship between Diabetes Mellitus and Periodontitis. The survey utilised a self-administered, structured questionnaire to collect data. Participants were questioned regarding specific periodontal complications, their understanding, and their perspective on the reciprocal connection between diabetes and periodontal disease. Results: In the study, 100 general practitioners took part, with 50 being physicians and the other 50 dentists. Dentists demonstrated a higher level of awareness about the impact of diabetes complications on periodontal health compared to physicians, with a statistically significant difference. Most dentists preferred to refer their patients to physicians for medical evaluation, unlike physicians. They were particularly interested in understanding the connection between diabetes mellitus and periodontal health. Healthcare professionals in the dental field tend to stay informed about the connection between Diabetes Mellitus and Periodontal Health by attending conferences or continuing dental education programmes. On the other hand, medical practitioners tend to rely on professional journals as their primary source of information. Conclusion: Dentists demonstrated a greater understanding and application of the bidirectional relationship between diabetes and periodontitis compared to physicians.

DOI: 10.5281/zenodo.10961350

12. Randomized Trial to Compare Hemorrhoidectomy Performed Using Harmonic Scalpel versus Conventional Electrocautery
Sanchit Jain, Ajay Singh Kalyanwat, Mahesh Kumar Mangal, Dhiraj Daga
Abstract
Introduction: Internal hemorrhoids are classified on the basis of degree of prolapse and manifestation into Grade I-IV. Hemorrhoidectomy is the standard surgical treatment for Grade III and IV hemorrhoids. The study was done to compare hemorrhoidectomy performed using electrocautery with harmonic scalpel. Material and Methods: The study was double blind randomized trial conducted in the Department of General Surgery, Government RDBP Jaipuria Hospital from January, 2023 to September, 2023. Patients with Grade 3 and Grade 4 hemorrhoids above 18 years of age were randomly divided into two groups to undergo Milligan Morgan hemorrhoidectomy using either electrocautery or harmonic scalpel. Intraoperative and postoperative variables were evaluated in both groups. Result: There were 30 patients in each group. There was no significant difference in the two groups with regard to grade of hemorrhoids, sex or age. Significant difference in groups was noted in terms of intraoperative and postoperative bleeding and average postoperative pain score with result being better in harmonic scalpel group. Conclusion: Hemorrhoidectomy performed using harmonic scalpel is a safe and effective treatment for Grade III and Grade IV hemorrhoids. Harmonic use reduces the operative time, the postoperative blood loss and most importantly, postoperative pain in comparison to conventional electrocautery based hemorrhoidectomy.

DOI: 10.5281/zenodo.10961402

13. Assessing Prevalence of SNHL in Type 2 Diabetes Patients and to Find the Effect of Duration and Control of Diabetes on Hearing Loss
Priyanshu Shekhar, Namira Azmi, Shudhanshu Shekhar Prasad, Satyendra Sharma
Abstract
Aim: The aim of the present study was to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss. Methods: The present analytical cross-sectional study was conducted in Department of ENT for period of two years . The present study was conducted on 100 type 2 diabetes patients and age and gender matched 100 non- diabetic controls in the age group of <50 years. Results: In the present study, 65% were females and 35% were male. The mean age of patients was 43.17, mean fasting blood sugar was 131.49±28.52, mean PP blood sugar was 170.20±40.25 and mean HbA1c was 7.43±0.49. Mean age of patients was 36.54, mean fasting blood sugar was 109.01±3.14, mean post-prandial blood sugar was 124.56±9.81 and mean HbA1c was 6.006±0.222. The result showed that only 26 patients had normal hearing and 74 patients had SNHL whereas 14 patients in this group had minimal hearing, 20 had mild SNHL, 48 had moderate, 5 had severe SNHL and 13 patients had profound SNHL. 70 patients had DPOAE refer whereas 30 patients had DPOAE pass. Wave V grossly delayed in DM group as compared to non-DM with all frequencies (i.e. 70, 80 and 90) whereas interpeak latencies of wave I-V at 70 db frequency is almost equal in DM and non-DM group but it increase with increase in frequencies (i.e. 80 and 90 db). Conclusion: This study concluded that the diabetics are at definite risk of developing auditory dysfunction, therefore it is recommended that all newly diagnosed diabetic patients should undergo a complete audiological evaluation at the time of diagnosis and a regular half yearly or yearly follow up is warranted for early detection of damage to auditory functions. Although factors other than diabetes contribute to hearing loss, early glycemic control for type 2 diabetic patients may reduce the incidence rate of this disease.

DOI: 10.5281/zenodo.10961429

14. Study on Anosmia and Ageusia in COVID -19 Patients
Dweethi Jayaprakash, M. Raneeth Kumar, T. Keerti Santoshi, Jadhav Rajkumar
Abstract
Initially, acute loss of smell (anosmia) and taste (ageusia) was not considered important symptoms for coronavirus disease 2019 (COVID-19). Evidence has demonstrated that an abrupt absence of smell and taste has been observed even when other general symptoms of COVID-19 infection are not present. This may act as another gateway to the early identification of patients with COVID-19. In this study, we aim to describe the features of loss of smell (anosmia) and loss of taste (ageusia) in COVID-19 patients. This retrospective study was done in year to assess the features of loss of smell and taste sensations in Covid 19 infected subjects. 80 subjects participated in this study. Questions regarding features of loss of smell and taste sensations in covid 19 patients were asked with help of Google forms. 47.5 % had Loss of smell , 31.25 % had loss of taste . 21.25 % had Loss of both smell and taste. In conclusion, anosmia and ageusia seem to be part of important symptoms and clues for the diagnosis of COVID-19, particularly in the early stage of the disease.

DOI: 10.5281/zenodo.10961466

15. Detection of ATP Amount with Quantitative Biosensors
Arshnoor Kaur, Chetna, Baljeet Singh, Sachin Dhull, Pulkit Deswal, Pranav Bhati
Abstract
Lack of appropriate biosensors for precise local real-time measurement of extracellular ATP content in the pericellular space from individual cells under healthy and pathological settings has until now prevented a thorough understanding of the role of ATP as an extracellular signal. The relationships between neurons and glia as well as the transmission of purinergic neurotransmission to no muscular cells are discussed. Both the ontogeny and phylogeny of purinergic signaling are considered to demonstrate the ancient and pervasive nature of purinergic neurotransmission. We describe here how to immobilize firefly luciferase (Fluc) coupled with green fluorescent protein (GFP) on the plasma membrane of HEK 293 cells to create a straightforward, sensitive, and dependable dual-function biosensor for the local real-time measurement of extracellular ATP concentration in the pericellular space in living cells.

DOI: 10.5281/zenodo.10961570

16. Clinical Correlation of Cardiac Function and Troponin-I & CPK MB in Dengue Fever in Children
Sangeeta Dudve, Jyotsna Mishra, Sardar Vikram Singh Bais, Gunvant Singh Eske
Abstract
Background: Dengue virus infection in children is a major health problem in many parts of the world. Its manifestations range from mild fever to severe and life-threatening disease. Although cardiac involvement has been reported in DVI. Objectives: We conducted this study to analyze association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever. Methods: This was a prospective observational study in which 100 paediatric patients who were hospitalized and diagnosed to be having Dengue fever were included. All patients were stratified into either of the 3 groups- Dengue without warning signs, Dengue with warning signs and severe Dengue. A detailed history and thorough clinical examination were done for all patients. Cardiac function was assessed by ECG, 2D Echo, CPK-MB and Troponin-I. Results: Dengue with and without warning signs was seen in 42.3% and 40% cases respectively whereas severe dengue was seen in 17% cases. Majority of patients were male. Mean duration of fever was 6 to 9 days.  Among serological profile of dengue patients 36.9% were positive for IgM, 34.2% were positive for Ns1Ag and 28.9% positive for IgM+NS1. Among total dengue patients in this study, 21 (58.3%) had ECG changes, the majority of which belonged to the dengue with warning signs group. A significant correlation was noted between the cardiac markers, ECG and 2D ECHO findings with the severity of dengue (P<0.05). Conclusion: Cardiac markers (CPK-MB and Troponin-I) have significant correlation between Dengue without warning signs, Dengue with warning signs and severe Dengue.

DOI: 10.5281/zenodo.10961649

17. A Descriptive Study on Stress Levels in Mothers of admitted Neonates in NICU in a Tertiary Care Centre, Jaipur
Nikita Pal, Kaushal Singh Baghel, Trapta Goyal, Abhishek Kumar Sharma, Rajveer Singh Yadav, Gunjan Agarwal
Abstract
Background: Hospitalization of a neonate is quite stressful for parents specially mothers. Aims & Objectives: To assess the stress levels in mothers of admitted newborn in NICU and to identify demographical and obstetric profile of mother and clinical profile of newborn that affects the stress level. Methodology: This cross- sectional study was carried out between September 2022 and august 2023 in a tertiary care hospital. A validated scale, The Parental Stressor Scale (PSS): NICU questionnaire was used to measure the stress among 125 mothers of admitted newborns. The stress scores were quantified using Likert scale. Results: The mean stress scores for the subscales sight and sounds of unit, looks and behaviour, parental role alteration and staff behaviour and communication   were 1.98±0.766, 2.99±0.577, 2.94±1.011, 1.40±0.562 respectively. Stress was significantly higher in mothers who were younger, illiterate, primigravida, had LSCS, with previous NICU exposure and those with pregnancy complications. Mothers of newborn admitted within 24 hours of birth, with lower gestational ages, female gender, lesser birth weights, those requiring oxygen and ventilator support have higher stress scores. Conclusions: NICU mothers are under moderate stress and an appropriate interventional programme targeted towards specific stressors is required to alleviate their stress.

DOI: 10.5281/zenodo.10961730

18. To Study the Factors Affecting Quality of Life in Children Suffering From Haemophilia
Jyotsna Mishra, Sardar Vikram Singh Bais, Sangeeta Dudve, Gunvant Singh Eske
Abstract
Introduction: Congenital hemophilia predominantly affects males and is characterized by mutations in clotting factor genes located on the X chromosome. This study aims to evaluate the quality of life (QoL) of pediatric patients with hemophilia. Materials and Methods: A cross-sectional comparative analysis was conducted involving 78 children with hemophilia treated at an Indian Hospital. A questionnaire encompassing demographic and socioeconomic information, along with a separate questionnaire focusing on quality of life, was utilized to gather data from the studied cases and their accompanying parents. Results: The majority of patients experienced joint bleeding, yet most expressed satisfaction with their QoL. A significant portion of patients were able to complete homework, engage in daily activities, and move around freely. However, many patients reported difficulties and annoyances affecting their lifestyle, with some experiencing emotional challenges but not depression directly related to hemophilia. Despite these challenges, most children enjoyed school, had friends, made future plans, and were not apprehensive about their future. Although most patients could engage in muscle activities, some felt discomfort about visiting the hospital. Conclusion: Hemophilia profoundly influences the health-related quality of life (HRQoL) in the studied cohort. Disease severity, bleeding frequency, joint bleeding occurrences, financial constraints, and therapeutic interventions collectively impact hemophilia-related HRQoL. Routine hemophilia management should include psychological assessments and caregiver support, integrating outcome measures that assess both HRQoL and caregiver burden.

DOI: 10.5281/zenodo.10961851

19. Surgical Outcomes of Indolent Oral Verrucous Carcinoma Patients and Their Long Term Follow Up
Vijaya Lakshmi V V, Paramesh Shivanna, Rakesh S Ramesh
Abstract
Background and Objectives: Oral verrucous carcinomas are uncommon tumours and they have favourable outcomes. They have a long latency period. This study was conducted to evaluate the surgical outcomes of oral verrucous carcinoma patients in a tertiary cancer hospital in South India. Methods: This retrospective  study was conducted in biopsy proven oral verrucous carcinoma patients who underwent treatment at the surgical oncology department of a tertiary care center in south India, from January 2014  to December 2020. The patients were followed up until December 2023. Results: 133 patients underwent surgery for oral carcinoma during the study period. Of these, 8 patients had oral verrucous  cancer. The mean age of presentation was 55.3 years. Buccal mucosa was the most common subsite affected, seen in 6 patients. Three patients had pT1, four patients had pT2, and one patient had pT3. Reexcision was done in two patients. None of our patients had recurrence in the follow up period. Conclusion: Verrucous carcinoma is characterised by inherently favourable prognosis. It displays local aggressive behavior and uncommon regional or distant metastasis. Surgical excision with adequate margin is the most effective and standard treatment. There should be special emphasis on close follow up in view of high recurrence.

DOI: 10.5281/zenodo.10961906

20. A Study of Posterior Reversible Encephalopathy Syndrome in Severe Preeclampsia and Eclampsia
C. P. Padmini, Malloba Sumana, K.A. Sameera, M. Vaishnavi Reddy, D. Swapna
Abstract
Introduction: Posterior reversible encephalopathy syndrome is a clinical and radiological syndrome which develops in patients with severe preeclampsia and eclampsia. Posterior reversible encephalopathy syndrome is commonly manifested as headache, visual disturbances, altered consciousness and seizures typically in patient with new onset hypertension. Aims and Objectives: To determine incidence and maternal outcome of PRES in severe pre-eclampsia and eclampsia patients. Materials and Methods: A prospective study was done in patients with severe preeclampia and eclampsia and developed PRES in a tertiary care center during year April 2022 to April 2023 at  RIMS Adilabad. Patients demographics, gestational data, outcome were studied. CT Brain was done for all this patients, patients presenting in antenatal period CT Brain was done after delivery. Results: Out of 280 severe preeclampsia and 84 eclampsia patients admitted during this period. Out of which 18 patients developed PRES. Out of these 12 were primigravida. The diagnosis was common in age group < 25 years. Of these 18 cases, 14 patients presented with multiple seizure episodes, 11 cases were controlled with mgso4 only, remaining 7 cases controlled with mgso4 and phenytoin. It is most commonly seen in gestation age >36 weeks and its incidence is mostly seen in postpartum eclampsia. Perinatal mortality was seen in 5 patients. No maternal deaths were seen during this period. Conclusion: Timely identification and prompt initiation of medical intervention in patients with PRES can minimize the potential for adverse outcome. Prognosis of patients with PRES was favorable.

DOI: 10.5281/zenodo.10961977

21. A Study to Evaluate the Reasons and the Risk Factors for Postoperative ICU Admissions: An Observational Study
Uma Shankar Kumar, Prashant Kumar Gupta
Abstract
Aim: The aim of the present study was to evaluate the reasons and the risk factors for postoperative ICU admissions in a tertiary care hospital in Bihar region. Methods: This case-control study was conducted at Department of Anesthesiology and Critical Care for the period of 12 months. A total of 100 patients were included in our study and 50 patients as cases and 100 patients as controls. Cases were defined as the patients who required postoperative ICU admission within 24 h after surgery during the study period. Controls were the patients who did not require ICU admission following a surgical procedure during the same study period. Results: Among cases, 45 (90%) patients had GA followed by 4 regional blocks/neuraxial blocks and one sedation only. Among controls, 85 (85%) patients had GA followed by 7 cases of regional, 6 neuraxial block and two sedation only. 38 (76%) of cases were known hypertensive vs. 40 (40%) in controls. 35 (70%) of cases were diabetic vs 46 (46%) among controls. 11 (22%) of cases had respiratory diseases vs. 43 (43%) in controls. 14 (28%) of the patients among cases were ventilated in ICU. The most common reasons for ICU admission among cases was for neuro-observation 18 (36%) cases followed by requirement for cardiovascular monitoring 14 (28%), sepsis 10 (20%), intraoperative cardiac events 3 (6%), prolonged surgery 2 (4%), intraoperative arrest 1 (2%), Diabetic ketoacidosis 1 (2%) and increased Oxygen requirement postoperatively 1 (2%). In univariate analysis, the risk factors for ICU admission included age, ASA class, hypertension, DM, IHD, respiratory disease, renal dysfunction, neurological abnormality. We then constructed a final multivariate logistic regression; we found ASA and presence of neurological disease or abnormality as risk factors for postoperative ICU admission. Conclusion: In conclusion, ASA class and perioperative neurological abnormalities are most significantly associated with ICU admission in the postoperative period.

DOI: 10.5281/zenodo.10962020

22. An Observational Study to Assess the Lipid Profile of Decompensated Chronic Liver Disease: A Hospital-Based Assessment
Ujjwal Kumar, Rahul Kumar
Abstract
Aim: The aim of the present study was to assess the lipid profile of Decompensated chronic liver disease. Methods: This observational study was carried out amongst 50 Decompensated chronic liver disease patients that fulfils the inclusion and exclusion criteria and attended the gastroenterology OPD of IGIMS, Patna, Bihar, India. Results: 43 (86%) were male and 7 (14%) were female. The age range was from 16 to 76. The average age of the patients in the study was 48.72±12.58 yrs. 34% of the patients were between 40 and 50 years of age. 91.67 % of the patients were alcoholic. Abdominal distension and ascites were most common presenting complaints. Pallor was present in 32 (64%) cases. Splenomegaly was present in 24 (48%) patients of Decompensated chronic liver disease. Renal dysfunction was present in 18 (36%) cases. Icterus was present in 12 (24%) cases. 33 (66%) of the patients had decreased platelet count. The comparisons between lipid profile of Decompensated chronic liver disease patients and healthy controls was significant (p<0.05). Conclusion: Lipid abnormalities are commonly seen in patients with Decompensated chronic liver disease and screening for the same is essential for intervention with appropriate treatment to prevent adverse cardiovascular events. The levels of serum total cholesterol, TG, LDL and HDL in patients with Decompensated chronic liver disease are related to the advancement in Decompensated chronic liver disease. It helps in diagnosis of severity of liver disease and also acts as a good prognostic sign.

DOI: DOI: 10.5281/zenodo.10962040

23. A Hospital-Based Study to Evaluate the Clinical Profile of Dengue Patients: An Observational Study
Shivendu, Chandan Kumar, Rupesh Kumar Roy
Abstract
Aim: The aim of the present study was to study clinical spectrum of dengue patients admitted in a tertiary care hospital in Bihar. Methods: The present study was conducted in the Department of General Medicine for the period of 1 year. A total of 200 hospitalized patients (Age >15 years) diagnosed as dengue were enrolled in our study. Results: A total of 200 hospitalized patients (Age >15 years) diagnosed as dengue were enrolled in our study out of which 150 patients were males (75%) and 50 patients were females (25%). Mean age of presentation was 39.51 years (19-68 years). Maximum number of cases was found in age group 30-40 years (37%) followed by 23% in 41-50 years age group. Out of 200 cases with distribution in antigenic presentation, 56% patients were NS1 positive, IgM positive in 29% of cases, NS1 & IgM positive in 11% patients and IgG positive in 3% of cases which indicated secondary cases and 2 cases with all NS1, IgM, IgG for Dengue positive. In our series in clinical manifestations, all cases (100%) presented with fever, myalgia(75%), headache(50%), rashes in 15% cases others clinical features are nausea, pain abdomen(20%) loose motion(15%), puritus etc. None of our patient have visual complains. Retro-orbital pain was noted in 5 patients (5%). Bleeding manifestations in any form was seen in 40% cases. In spectrum of bleeding manifestations bleeding in skin manifestations like Purpura or Petechia predominates (26%). Gasto-intestinal bleeding like malena (21%) and hematemesis in 2% cases and other bleeding features like epixtasis in 6% cases, Gum bleeding in 3%, Hematuria in 1%, and Ophthalmic bleeding like sub conjunctival hemorrhage, intra-vitreal hemorrhage in 8% cases. The commonest organ involvement is Liver (hepatopathy) in 52% cases. Conclusion: With the rise in incidence in dengue fever, there is necessity to understand dengue fever, now more than ever, and this study brings out the intricacies of symptomatology, platelet counts relation with bleeding, complications and antigen antibody variation with regard to dengue.

DOI: 10.5281/zenodo.10962052

24. A Hospital-Based Study Destemming the Clinical Implication of Serum Uric Acid, Serum Calcium, Serum Creatinine and Serum Electrolytes in Patients with Kidney Stone
Amit Ranjan, Mukesh Jaysawal, Khursheed Alam
Abstract
Aim: The aim of the present study was to assess the clinical significance of serum uric acid, serum calcium, serum creatinine and serum electrolytes in patients with kidney stone. Methods: The present study was conducted in the Department of Surgery and 200 patients were included in the study. The patients were divided into two groups according to serum UA levels: the UA-high group with hyperuricemia (serum UA ≥ 7.0 mg/dL) or the UA-low group with normal UA levels (serum UA < 7.0 mg/dL) groups. Results: Patient background was significantly different between the UA stone patients and the patients with Coax/CaP stones in age, sex, body mass index, HTN, DM, CVD, hemoglobin, serum Alb, serum UA, hyperuricemia, triglyceride, and stage 3 CKD. The UA-low group comprised 50 control subjects and pair-matched 25 patients with UA stones. There were no statistically significant differences in background between UA stone patients and control subjects.  The UA-high group comprised 10 patients with UA stones and 20 pair-matched control subjects. There were no statistically significant differences in background between UA stone patients and control subjects. The UA-low group comprised pair-matched 20 patients with CaOx/CaP and 20 patients with UA stones. There were no statistically significant differences in background between UA stone patients and CaOx/CaP patients.  The UA-high group comprised 10 patients with CaOx/CaP and pair-matched 10 patients with UA stones. There were no statistically significant differences in background between UA stone patients and control subjects. Conclusion: Patients with UA stones had significantly worse renal function than controls and CaOx/CaP patients regardless of hyperuricemia. Urolithiasis (CaOx/CaP and UA stone) and hyperuricemia had an association with impaired renal function. Our findings encourage clinicians to initiate intensive treatment and education approaches in patients with urolithiasis and/or hyperuricemia in order to prevent the progression of renal impairment.

DOI: 10.5281/zenodo.10962187

25. A Cross Sectional Assessment of the Distribution and Antimicrobial Susceptibility Patterns of Lower Respiratory Tract Infections
Ravi Kumar, Stuti Kumari, Pradeep Kumar Tiwary, Bijoy Kumar
Abstract
Aim: The aim of the present study was to assess the distribution and antimicrobial susceptibility patterns of lower respiratory tract infections in the medical and surgical intensive care units of Nalanda Medical College and Hospital, Patna, Bihar, India. Methods: This was a retrospective study conducted at Department of Anaesthesia & Intensive Care, for the period of 12 months. However, this study was restricted only to the medical and surgical ICUs. Total number of patients (medical and surgical admissions) seen at our Institute during the study period was 1200; out of whom, 200 patients required intensive care. One hundred patients were enrolled for the study after considering the inclusion and exclusion criteria. Results: A total of 100 patients were included in the study, out of which 70 (70%) were males. Amongst different age groups, maximum patients were above 60 y (30%) and the least were between 18–30 y (12%). The underlying major medical conditions of the LRTI were diabetes mellitus (30%), respiratory pathology (20%), nephrological pathology (18%) and malignancy (14%). The bacteria were isolated predominantly from the tracheal aspirate (85%), compared to broncho–alveolar lavage (15%) with a statistically significant difference between them. Out of all the isolated organisms, A. baumannii (n = 30; 30%), P. aeruginosa (n = 24; 24%) and Klebsiella (n = 22; 22%) were the most positive isolates, S. aureus and Enterococcus were equal (n = 4; 4%). In the gram–negative isolates, A. baumannii was most susceptible to colistin (93.34%) followed by minocycline (80%) and amikacin (66.66%). With regard to P. aeruginosa, it was observed that only around half of the isolates were susceptible to doripenem (62.5%) and it was also observed that most of the isolates were resistant to all the commonly used antibiotics. In the gram–positive isolates, S. aureus was equally susceptible to linezolid (75%) and vancomycin (75%); and 100% of the isolates of Enterococcus were susceptible to vancomycin. Conclusion: Gram–negative pathogens were predominantly responsible for lower respiratory tract infections. Moreover, antimicrobial resistance rate was high with the most commonly used antibiotics and also to higher antibiotics such as carbapenems.

DOI: 10.5281/zenodo.10962290

26. Enhanced Recovery after Surgery Protocol Compliance Impact on Recovery after Cesarean Section in Primi Patients as Compared to Conventional Care
Hetal Kanabar, Dinesh C. Babariya, Dipti Desai, Anshuman Shastri, Kanvee M. Vania
Abstract
Background and Aim: Enhanced recovery after surgery (ERAS) is an evidence-based, multi-disciplinary approach throughout preoperative, intraoperative and postoperative period. The ultimate goal of ERAS is to enhance recovery, to improve the maternal and neonatal outcome and reducing perioperative complications. Material and Methods: This is a prospective, randomized study involving 92 patients 46 in each group. In Group A ERAS protocols were applied and in Group B conventional care was given. Data evaluation was done by VAS (visual analog scale) score at 6-hour, comparison of CRP level at 24 hour and length of hospital stay. Results: Post-operative pain was significantly less in ERAS group (p value 0.00008). There was no change in post op CRP level at 24 hours in both groups (p value 0.11). There was decreased duration of hospital stay in ERAS group (p value 0.000000042). Post-operative complications like nausea- vomiting and severe pain was significantly (p value0.0076 and .015 respectively) less in ERAS group while there was no change in postoperative headache and wound infection rate (p value 0.62 and 0.557 respectively). Conclusion: We discovered that ERAS protocols significantly reduces hospital stay and decreases post-operative pain. ERAS protocols can be used to make tertiary hospital more efficient and speedier. ERAS protocol significantly improves overall patient satisfaction and reduces perioperative complications.

DOI: 10.5281/zenodo.10962356

27. A Retrospective Cross-Sectional Evaluation of the Predictors of Difficulty in Laparoscopic Cholecystectomy
Aditya Veer Vikram, Amit Kumar Bimal, Pratibha Kumari
Abstract
Aim: The aim of the present study was to identify predictors for difficult Laparoscopic cholecystectomy. Methods: A retrospective cross-sectional review of surgical records was done for all patients who underwent laparoscopic cholecystectomy on an elective basis at Department of General surgery, Lord Buddha Kosi Medical College & Hospital, Saharsa, Bihar, India for the period of 2 years. A total of 250 patients who underwent laparoscopic cholecystectomy (50 patients with difficult and 200 patients without difficult LC) were studied during the study period. Results: The majority of patients were female. The median age was 48 years. When we assessed different preoperative and intraoperative variables in two groups (difficult LC and non-difficult LC), we found differences based upon age, gender, past history of acute cholecystitis, gallbladder wall thickness, fibrotic gallbladder, and adhesion at the triangle of Calot (P < 0.05). However, We did not observe significant differences in other variables (P > 0.005). We had also evaluated different factors associated with difficult LC. In logistic regression analysis, on multivariate analysis gender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4–5 mm), fibrotic gallbladder, and adhesion at the triangle of Calot were significantly associated with an increased risk of difficult laparoscopic cholecystectomy (P < 0.05). Conclusion: Gender (male), past history of acute cholecystitis, gallbladder wall thickness ( 4–5 mm), fibrotic gallbladder, and adhesion at Calot’s triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.

DOI: 10.5281/zenodo.

28. A Hospital-Based Assessment of the Outcome of Pulmonary Thromboendarterectomy
Madhav Kumar, Tushar Kumar, Namita Mishra, Aandrei Jivendera Jha, Devi Shetty
Abstract
Aim: The aim of the present study was to assess the one-year outcome of Pulmonary Thromboendarterectomy surgery. Methods: The present study was conducted in newly diagnosed consecutive patients with CTEPH from a period ranging from May 2011 to May 2014. 90 patients were selected in the study. Results: Of the 90 subjects who qualified for inclusion in the study, there were 63 males (70%) and 27 females (30%). The majority of the patients were in the 21 – 50 years group, with almost equal numbers in the 21 – 35 year and 36-50-year age group. Two third of the patients were admitted with NYHA Class 3 (66.67%). Patients recorded with NYHA Class 2 were 27.78%, while patients recorded with NYHA Class 4 were only 5.56%. No patient was recorded with NYHA Class 1. Cough was also a common symptom, being present in 70 patients (77.77%). Haemoptysis was also a fairly common symptom, being present in 39 patients (43.33% of patients), at some point in their history. Only 4 (4.44%) of the patients were diabetic. Functional status according to the Karnofsky Performance Status score in 90 patients at late follow‐up after pulmonary endarterectomy and in 70% of the patients, the Karnofsky Performance Status score was 80% or higher (i.e., “able to carry on normal activity”). Conclusion: Success of PTE has now been confirmed. It remains the primary treatment for CTEPH.  Longer life expectancy is expected in these patients. PTE is safe and effective operative procedure. PTE is successful, curative alternative to lung transplant. Compared to lung transplant, PTE offers lower surgical mortality rate, better long term survival and fewer chronic complication.

DOI: 10.5281/zenodo.

29. A Hospital-Based Study to Explore the Impact of Pursuing Tissue Diagnosis by Endoscopic Ultrasound (EUS) Guided Biopsy for Primary Diagnosisin Patients with Pancreatic Cancers
Sanjay Kumar, Ravikant Kumar, Lajpat Agarwal, Mamta Kumari, Manish Mandal
Abstract
Aim: The aim of the present study was to explore the impact of pursuing tissue diagnosis by endoscopic ultrasound (EUS)  guided biopsy for primary diagnosis in patients with Pancreatic ductal adenocarcinoma. Methods: The present study was conducted at Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India in patients who were diagnosed and/or treated with PC at our high-volume tertiary  center  were prospectively included in a patient database. 50 patients were included in the study. Results: Median age at diagnosis was 66 years. A majority of patients were male (56%; n = 28); had a good performance status and initially presented with synchronous metastatic disease. Most patients were treated with single-agent gemcitabine or gemcitabine-containing combination chemotherapy, followed by 5-FU-based regimens. We calculated TTI as time from first imaging study showing a suspicion of advanced PC and administration of the first cycle initiation was 29 days (range: 1–124 days), with a 75th and 90th percentile of 43 and 60 days, respectively. Prior to the conduct of our study, we assumed that a TTIinterval of more than 21 days represents a “treatment delay”. Applying this strict definition, a delay in treatment initiation was found in 30 patients (60%). Treatment delay was significantly more frequent in patients who initially presented with synchronous metastatic disease than in patients who relapsed after surgery in curative intent. Conclusion: EUS biopsy significantly impacts time between suspicion and treatment of PDAC. This may be exacerbated by clinical practices increasingly favoring neo-adjuvant therapy that necessitates biopsy-proven disease. Time to treatment may also be impacted by access to tertiary centers and racial disparities.

DOI: 10.5281/zenodo.

30. Determining the Prevalence of Systemic Diseases in Patients with Periodontal Disease: a Case Control Study
Divya Kumari, Pranav Prakash
Abstract
Aim: The aim of the present study was to determine whether there is a significant difference in the prevalence of systemic diseases in patients with periodontal disease and patients without periodontal disease. Methods: This case-control, epidemiological study was carried out in the Department of Dentistry. The study was conducted for period of one year. Among these patients, 200 patients with periodontal disease (cases) and 100 patients without periodontal disease (controls) were included in the study. Results: Prevalence of systemic diseases in cases was 51% i.e. 102 patients have systemic disease among 200. In periodontal patients, highest prevalence is in 50- 59 age group (78.57%) and other age groups in decreasing order was; >60 (55.88%), 40- 49 (548.14%), 30- 39 (40%) and 18- 29 (20%). In controls, prevalence was 18% i.e. 18 patients have systemic diseases among 100, which is considerably less than cases group. Highest prevalence is in 50- 59 age group (33.33%) and other age groups in decreasing order is; 40- 49 (30%), 18- 29 (17.39%), 30- 39 (13.15%) and >60 (0%). Among cases, 65 patients are beginning destructive periodontal disease, 60 patients are Established destructive periodontal disease, and 75 patients are in Terminal disease. Patients with periodontal diseases (cases) had higher prevalence of hypertension, diabetes, CVS disorders. There were 10 males and 8 females in controls. Conclusion: Due to the high frequency of medical conditions, thorough evaluation of patients medical history should be a mandatory first step in the diagnosis and management of dental diseases. Dental practitioners may also contribute their expertise in assessing risk for several systemic conditions. The fact that the oral diagnostic samples (saliva, crevicular blood) can be readily obtained non-invasively, and at potentially lower costs, may offer important advantages to some traditional medical testing.

DOI: 10.5281/zenodo.

31. A Retrospective Study to Evaluate the Role of Diffusion MRI in Differentiating Pediatric Posterior Fossa Tumors
Shruti chaubey, Priyanka Raj, Sanjeev Suman, V.S. Prasad
Abstract
Aim: The aim of the present study was to evaluate the role of diffusion MRI in differentiating pediatric posterior fossa tumors. Methods: This study was a retrospective study and conducted in the Department of Radiodiagnosis. The inclusion criteria were pediatric patients less than 20 years of age with posterior fossa tumor who had performed MRI and DWI/ADC prior to any treatment. The study period was of one year. During the study period, there were 100 patients with posterior fossa tumors. Results: There were 52% male as compared to females. 70% had high grade tumor and 30% had low grade tumor. In high grade tumor, 25 had medulloblastoma and in low grade tumor, 15 had Pilocytic astrocytoma. The ADC ratio cut-off level for differentiation medulloblastoma from ependymoma, medulloblastoma from ATRT, medulloblastoma from pilocytic astrocytoma and medulloblastoma from diffuse midline glioma were noted. The ADC ratio of medulloblastoma was significantly lower than ependymoma, pilocytic astrocytoma and DIPG. The ADC cut-off ratio of ≤ 1.115 allowed discrimination medulloblastoma from other posterior fossa tumors with sensitivity, specificity, PPV and NPV of 94.6%, 82%, 68.4% and 96.8%, respectively. Conclusion: In Conclusion, diffusion MRI has a significant role in diagnosis of various types of pediatric posterior fossa tumors. ADC ratio can be used to differentiate medulloblastoma from other posterior fossa tumor in pediatric patients with good level of diagnostic performance.

DOI: 10.5281/zenodo.

32. Evaluation of Iron Deficiency Anaemia in Children and its Association with Acute Bronchiolitis: an Observational Study
Monika, Naseem Ahmad, Alka Singh
Abstract
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, NMCH, Patna, Bihar, India for the period of 1 year .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: Anemia caused by a lack of iron has been shown to have a substantial correlation with bronchiolitis. The recommendation was made for a larger and more comprehensive research.

DOI: 10.5281/zenodo.

33. Assessing Efficacy and Safety of Olopatadine 0.1% Ophthalmic Solution and Bepotastine 1.5% Ophthalmic Solution in Patients with Vernal Keratoconjunctivitis
Naveen Kumar, Asha Kumari, Kanchan Kumari
Abstract
Aim: The purpose of the present study was intended to compare the effectiveness and safety of olopatadine 0.1% ophthalmic drops and bepotastine besilate 1.5% ophthalmic drops with BD administration to relieve the symptoms of VKC in a tertiary care hospital in Bihar region. Methods: The study was done in the Department of Pharmacology,  DMCH, Laheriasarai, Darbhanga, Bihar, India for duration of 10 months. By simple randomization (odd/even number) method, registered patients were grouped into A and B. Group A and Group B were given olopatadine 0.1% ophthalmic drops and bepotastine besilate 1.5% ophthalmic drops, respectively, administered one drop in the affected eye twice daily for 6 weeks. Results: The itching scores among the treatment groups with all follow-ups compared with baseline are not statistically significant. The mean ocular discomfort scores during each visit. At the 1st, 2nd, and 3rd follow-up, there is statistical significance in ocular discomfort scores with Group B. In Group B, during the 2nd, 3rd, and 4th follow-ups, there is statistical significance in watering scores (P < 0.05). Conclusion: In this study, based on the evaluation of therapeutic performance, bepotastine eye drops proved quicker relief of symptoms and signs compared to olopatadine eye drops but was not statistically significant which would prove beneficial for the patients.

DOI: 10.5281/zenodo.

34. A Study to Determine the Pattern of Cervical Pap smear Cytology and its Correlation with Clinical Findings
Shipra Singh, Sunil Kumar, Richa Sharma, Poonam Kumari
Abstract
Aim: The present study is intended to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital and to correlate it with clinical findings. Methods: The prospective study was carried out at Department of Pathology , Darbhanga Medical College and Hospital, Darbhanga, Bihar, India during for the period of one year and total 500 patients were screened. The patients were in the age range of 18-70 years, having complaints like watery vaginal discharge, bleeding per vaginal, intermenstrual bleeding, post-coital bleeding, something coming out per vagina, foul smelling discharge and itching in private parts. Results: The maximum number of cases was in the age group 30-39 years constituting 34% of the total cases followed by age group less than 20-29 yrs. The oldest case was of age 65 years. Minimum percentage (2%) of cases were under 60-69 age group. The maximum number of cases was in the age group 30-39 years constituting 34% of the total cases followed by age group 20-29 yrs. The oldest case was of age 65 years. Minimum percentage (2%) of cases were under 60-69 age group. Vaginal discharge was the commonest chief complaint followed by lower abdominal pain. Total 46% showed inflammatory lesion, 1% showed atrophy, 0.2% showed ASCUS, 0.2% showed LSIL, 0.2% showed HSIL, 2% showed SCC, 10% showed metaplasia. Cytological findings broadly classified into unsatisfactory smears, normal and abnormal smears. There were 350 (70%) abnormal Pap smears (benign cellular changes of inflammation as well as Epithelial Cell Abnormalities (ECA), with 20% normal cases and 10% unsatisfactory samples. Inadequate smear are reported unsatisfactory. They did not show adequate number of well visualized and preserved squamous cells either less in number or observed by inflammatory cells or blood. Conclusion: This study emphasized the importance of Pap smears screening for early detection of premalignant and malignant lesions of cervix.

DOI: 10.5281/zenodo.

35. An Observational Study to Correlate Cytological Finding in Thyroid Lesions
Sunil Kumar, Richa Sharma, Shipra Singh, Poonam Kumari
Abstract
Aim: The aim of the present study was to correlate cytological finding in thyroid lesions. Methods: This observational Prospective study was conducted in the Department of Pathology Darbhanga Medical College and Hospital, Darbhanga, Bihar, India in collaboration with Department of Surgery and Radiology. A total of 100 patients with thyroid lesions were subjected to fine needle aspiration cytology during a period of 1 year. Results: Majority of the patients referred for FNAC thyroid were females constituting 80 (80%) of the total 100 patients, and 20 male cases (20%). Age of the patients ranged from 10 years to75 years with a median age of 39 years. The maximum incidence of thyroid lesions was noted in the 31 to 40 years age group in which there were 30 cases (30%). This was followed by the 21 to 30 years of age group and 41 to 50 years of age group with an incidence of 28% (28 cases) and 24% (24 cases). Smears with large quantity of colloid and several groups (generally six or more) of normal appearing follicular cells with or without the presence of histiocytes. The benign lesions include colloid nodule, nodule goiter, thyroiditis and thyroid cysts. The aspirations which contained groups of cells with malignant features were considered diagnostic of primary thyroid cancer (papillary, medullary or anaplastic subtypes) or disease metastatic to thyroid. Histopathologic evaluation was advised because the criteria of malignancy in these lesions are based on evidence of capsular or vascular invasion. Fine needle aspiration cytology of thyroid sensitivity was 88% and specificity was 100%. Conclusion: Fine needle aspiration cytology of thyroid is simple diagnostic tool with sensitivity 88% and specificity 100%. It has certain limitations but it gives guidelines to clinicians about further management of various thyroid lesions.

DOI: 10.5281/zenodo.

36. A Cross-Sectional Analytical Evaluation of the Role of Fetal Epicardial Fat Thickness as a Marker and Use it in Pregnancies to Screen for Gestational Diabetes Mellitus
Pradeep Kumar Nayak, Kshitish Kumar, Archana Verma
Abstract
Aim: The aim of the present study was to evaluate the role of fetal epicardial fat thickness as a marker and use it in pregnancies to screen for gestational diabetes mellitus. Methods: A cross-sectional analytical study was conducted at Department of Radiology  Katihar Medical College and Hospital, Katihar, Bihar, India. Pregnant patients at 24 + 0/6 to 28 + 0/6 weeks of gestation who were scheduled for a 75 g oral glucose tolerance test (OGTT) according to the American Diabetes Association criteria (fasting ≥ 92 mg/dL, 1 hour ≥ 180 mg/dL, or 2 hours ≥ 153 mg/dL) were included in the study. During the study period, 50 cases of GDM and 50 non-GDM patients were identified after the application of inclusion and exclusion criteria. Results: The mean gestational age of cases (26.24 ±1.32 weeks) were matched with that of controls (26.56 ±1.28 weeks). The mean fetal EFT in mothers with GDM was significantly higher, i.e., 0.16 ±0.03 cm than in mothers without GDM, i.e., 0.13 ±0.02 cm (p < 0.001). The 2 hours OGTT results of cases had an average value of 180.22 ±9.81 mg/dL and controls had an average 2 hours OGTT value of 128.72 ±16.32 mg/dL. The receiver operating characteristic (ROC) curve plotted from values calculated from our results showed high sensitivity (i.e., 95.65% and specificity (i.e., 90%) of fetal EFT as a predictor for GDM. Conclusion: In conclusion, EFT is a reliable marker for GDM. Measure- ment of EFT is reproducible, does not require any additional training, and does not adds to scan time.

DOI: 10.5281/zenodo.

37. An Evaluation of Post-Operative Pain Management in Elective Laparotomies in a Tertiary Care Facility: An Observational Study
Saumya Sinha, Om Prakash, Krishna Gopal, Vivek Ranjan
Abstract
Aim: The aim of the present study was to analyse of post-operative pain management in elective laparotomies in a tertiary care centre in Bihar region. Methods: This study was conducted in the Department of General Surgery and Anesthesiology. The present study was conducted for period of 18 months. A sample size of 100 patients fulfilling eligibility criteria was taken for the study. Results: The patients who underwent elective laparotomies were aged between 22 and 74. (34%) 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 which included 24 (24%) patients followed by open cholecystectomy (for carcinoma gall bladder and other indications) which included 8 (8%) patients. Most common was general anaesthesia with transverse plane block which was used in 42 (42%) patients, followed by general anaesthesia with quadratus lumborum block which was used in 18 (18%) patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine in 55 patients followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural in 38 patients. 7 (7%) patients were on transdermal patch on post-operative day 2 and 1 patients were on diclofenac patch and 5 patients were on fentanyl patch. Conclusion: Multimodal analgesia was used in most of the patients for management of post -operative pain 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.

38. An Observational Study Assessing the Promising Outcomes of Proximal Fibular Osteotomy in Treatment of Medial Compartment Knee Osteoarthritis
Vibhash Chandra, Praveen, Ranjeet Kumar, Bhaskar Bej, Jalandhar Mehra
Abstract
Aim: The purpose of this prospective study was to prove the promising outcomes of proximal fibular osteotomy in treatment of medial compartment knee osteoarthritis. Material & Methods:  A prospective observational study including 50 patients in Department of Orthopaedics for the period of 2 years. The following clinical parameters were used: VAS, KSS, KFS. The following radiological parameters were used: MJS, LJS, HKA Angle. post-operative physiotherapy protocol was followed. Discharge was planned based on patients comfort and mobility, that was usually on day 4 or 5. They were followed up at 6 weeks, 3 months, 6 months, 9 months and 12 months. Results: In the present study, most of the patients belonged to 50-60 years age group. In the present study, there were 19 males and 31 females, with male to female ratio 2:3 approximately. The mean age of patients was 52.78 year (age range = 40-70 years). In this study patients included who has BMI>30 and most of patients lie in between 25 to 29.9 BMI i.e. most of them fall in overweight category. Osteochondral defect was found in all cases with various grade, 26 (52%) knees with grade 1, 15 (30%) knees with grade 2, 8 (16%) knees with grade 3 and 1 (2%) cases with grade 4. Average visual Analogue scale (VAS) score significantly decreased from 8.20 pre-operatively to 3.256 in 1 year of follow up. Knee society score improved from 45.25 pre-operatively to 71.77 in 12 month of follow up. Knee function score improved pre-operatively 49.50 to 75.55 in 12 month of follow up. Medial joint space increased from 1.62 pre-operatively to 3.56 in 12 month of follow up. Lateral joint space decreased from 6.68 pre-operatively to 5.38 in 12 months follow up. The correction of alignment Hip knee ankle angle (HKA) after PFO were seen after 12 months. Conclusion: Proximal fibular osteotomy [PFO] is a simple, safe and affordable surgery to reduce pain and improve joint function and the medial compartment space in medial compartment osteoarthritis of knee joint. It may be a promising alternative surgery in most developing countries because of their financial and healthcare delivery limitations that may be used as an alternative surgery for patients of osteoarthritis knee who cannot undergo.

DOI: 10.5281/zenodo.

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

DOI: 10.5281/zenodo.

40. Assessing the Role of Mothers in Prevention of Nutritional Anemia in the Early Childhood: An Observational Study
Priya Verma, Jiteshwar Prasad Mandal
Abstract
Aim: The aim of the present study was to analyze the risk factors and vital role of mothers in prevention of nutritional anemia in the early childhood. Methods: This study was carried out at Department in Pediatrics ,Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India and 200 children aged 6 months–2 years admitted at the hospital during the study period of 1 year were included. Results: Majority of the mothers were aware that neural development of child could be affected by anemia. Maternal knowledge regarding cow’s milk was poor and had a faulty belief that it increases iron absorption, whereas 16% were unaware of the relationship between cow’s milk and anemia. Many mothers believed anemia to occur only in children on vegetarian diet. Around 75% mothers recognized green leaves and 70% women recognized jaggery to be enriched with iron. Although 78% identified vitamin C containing fruits, many were not aware of its vital role in increasing the iron absorption. Mothers of children with more than one sibling had a relatively greater incidence of “poor” knowledge unlike mothers of children with single or no sibling. This implies that those with “poor” knowledge were also unaware of the importance of birth spacing. Conclusion: It is necessary to provide age-appropriate foods at the right time. There is a direct relationship between the lack of education in mothers and the occurrence of anemia in infants. Enhancing the physicians’ knowledge and understanding of maternal health will contribute to the achievement of a nation without anemia.

DOI: 10.5281/zenodo.

41. A Cross-Sectional Study Assessing Knowledge, Attitude, and Practice towards Breast Cancer and Breast Cancer Screening among Women
Rashmi Singh, Sujit Kumar
Abstract
Aim: The aim of the present study was to assess the knowledge, attitudes, and practices surrounding breast cancer awareness and screening among women. Methods: This was a descriptive, cross-sectional study, conducted in the Department of Community Medicine.200 Eligible women were included in this study.  Results: The mean age was (36, standard deviation (SD): 13.7) years, and the ages of more than half of them 120 (60%) are from 18-30 years. 84 (42%) of them were illiterate and 72 (36%) had primary education. Regarding their marital status, the majority of them 116 (58%) was married. Additionally, 144 (72%) were housewives. About the participants’ knowledge about breast cancer, the majority of them 120 (60%) agreed that breast cancer is the most common cancer among females, and 120 (60%) said that breast cancer is a curable disease. Moreover, nipple discharge was the most commonly chosen symptom by the participants 88 (44%), and smoking was the most commonly selected risk factor for breast cancer 104 (52%). Furthermore, 104 (52%) of the participants did not know the methods of breast cancer diagnosis. The overall score of the participants’ revealed that more than half of them had poor knowledge about breast cancer, poor knowledge about breast cancer was significantly associated with low educational status, however it was not associated with the occupation of the participants. In this study, it was also observed that 70% of the study participants had positive attitude toward breast cancer screening. Despite having good knowledge and attitude toward breast cancer screening, the practice levels were still seen to be very low among study participants. Conclusion: The majority of the respondents think about breast self-examination as an important issue but they have poor practice. Thus, we recommend more health campaigns and educational sessions in such facilities.

DOI: 10.5281/zenodo.

42. A Study Assessing Association between Pap smear and Cervical Biopsy in A Woman with Unhealthy Cervix
Aneeta Kumari, Puja Sinha
Abstract
Aim:  The aim of the present study was to assess the Pap Smear and Cervical Biopsy in a woman with unhealthy cervix attending tertiary care centre. Material & Methods: This study included 200 married women aged 20-65 years attending Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar, India over the duration of 18 months. Results: In this study, 42% women belong to age group 31-40 years. 31% women belong to 41-50 years of age. 16% women belong to 20-30 years of age, 11% women belong to 51-60 years of age. In this study 40% women were para 3, 30% women were para 4, 16% women were para 5, 5% women were para 2, 3% women were para 6 and 2% women were primipara. In this study population, white discharge was the most common chief complaint (49%), followed by lower abdominal pain in 24%, low back ache in 12%, postcoital bleeding in 9% and postmenopausal bleeding seen in 6%. In this study, association of Pap smear with histopathology was found to be statistically significant (p value <0.001). Conclusion:  PAP smear can be used as screening test for detecting premalignant lesions of cervix. Cervix biopsy has got better specificity than Pap smear, so all symptomatic women should be subjected to cervix biopsy to detect carcinoma at early stage.

DOI: 10.5281/zenodo.

43. Maternal and Perinatal Outcome of Elderly Pregnancy and its Correlation with First Trimester Hba1c and Serum Vitamin D Level
Purita Kumari, Rajeev Kumar Khetan, Pratima
Abstract
Aim: The aim of the present study was to assess the maternal and perinatal outcome of elderly pregnancy and its correlation with first trimester Hba1c and serum vitamin D level. Methods: An observational cross-section study including 200 pregnant women of more than 35 years in age, in their first trimester, divided into two equal groups. First group consisted of 100 women with established diagnosis of gestational diabetes and the second group with proved normal blood glucose levels. We assessed vitamin D level in serum, fasting blood glucose, serum insulin and glycosylated hemoglobin (HbA1c) levels and we depicted the insulin sensitivity using the Quantitative insulin sensitivity check index (Quicki). The results were collected and statistically correlated. Results: The fasting plasma glucose level was significantly lower in controls compared to those with gestational diabetes. 38% of cases with gestational diabetes gave history of GDM in previous pregnancies which was also statistically significant (p-value = 0.0001), also family history of type 2 DM seemed more likely in this same group. The majority of the controls and women with GDM suffered from Vitamin D insufficiency rather than deficiency where the mean 25 OHD levels were 45.60 ± 6.08 and 46.24 ± 10.22 respectively. The fasting insulin levels were significantly higher in the group with GDM with a mean of 18.52 ±6.34 compared to 8.90 ± 2.54 in the control group. A significant inverse correlation was found between the HbA1C levels and Vitamin D where the higher the levels of Vitamin D, the lower the HbA1c levels indicating a good glycemic control in women with gestational diabetes. As regards the Vitamin D levels, they negatively correlated with the fasting blood glucose levels, the fasting serum insulin levels and the HbA1c levels, in the whole study population including both groups; women with GDM and controls. Conclusion: In our study, there was high prevalence of vitamin D insufficiency and deficiency. Considering this we suggest routine testing of all pregnant women, and treatment of women who are found to be vitamin D deficient.

DOI: 10.5281/zenodo.

44. Assessing Rectal Misoprostol versus Intravenous Oxytocin in Reducing Intra and Postoperative Bleeding during Elective Cesarean Section: A Comparative Clinical Study
Kiran Bharati, Bhuvneshwar Kumar, Sudha Bharati
Abstract
Aim: The aim of the present study was to compare the efficacy and safety of 400mcg misoprostol per rectum preoperatively versus intravenous oxytocin in reducing intra operative and post-operative bleeding in elective caesarean section. Methods: The present study included 200 women and take place in the Department of Obstetrics & Gynaecology, Government Medical College Bettiah, West Champaran, Bihar, India who were elective cases for cesarean section. Detailed history of all the patients were taken according to the performa and complete examination and all necessary investigations was done. After having met all the inclusion and exclusion criteria and obtaining written consent. Results: The mean age of misoprostol and Oxytocin Group was 23.87 and 21.95 years respectively. We found no significant difference as the p value was 0.854. Multiparous and primiparous women were 55% and 45% respectively in Misoprostol group; 65% and 35% in Oxytocin group. In Misoprostol group the most common side effect was shivering accounts for 23% patients followed by fever accounts for 7% patients. In Oxytocin group nausea and vomiting were the commonest side effect account for 6% patients each. While analyzing we found statistically insignificant difference for side effects in both groups as the p value was <0.001. Mean blood loss level for Misoprostol and Oxytocin group was 187.12 and 181.09 ml respectively. The difference in blood loss was statistically insignificant between the two groups as the p value was 0.316. The difference in mean Hb level before and after 24 hrs of delivery was insignificant as the p value was >0.05. Conclusion: The present study indicated that in the context of active management of 3rd grade labour, Misoprostol has comparable effectiveness to oxytocin (10IU IV in 500ml RL) in the prevention of early postpartum haemorrhage However, misoprostol was associated with higher incidence of shivering and pyrexia but no other serious adverse effects occurred.

DOI: 10.5281/zenodo.

45. Evaluation of Prophylactic Antibiotics in Women Undergoing Elective Caesarean Section: a Comparative Study
Mamta Singh, Amar Kumar Singh, Rajrani Chaudhary, Renu Rohatgi
Abstract
Aim: The objectives of the study were to audit and implement the use of prophylactic antibiotics in women undergoing elective caesarean section. Methods: This comparative, prospective, hospital-based study was conducted in the department of Gynaecology and Obstetrics, for the period of Jan 2020 to Dec 2022. Results: Mean age was 25.5±3.9 years in group A & 24.6±3.4 years in group B. BMI at the time of admission was 26.4±6.3 kg/m² & 27.3± 5.6 kg/m² in group A & B respectively. Mean duration of surgery was 42.8±7.3 min in group A & 45.5±5.5 in group B. Average blood loss in both groups was comparable. Mean days of hospitalisation was 4.8±3.7 days & 5.7±2.9 days in group A & B respectively.  Most common indication for elective LSCS was previous LSCS followed by primi with CPD. In the group A prophylactic antibiotic prophylaxis was given to 45 women (45%) and was not given to 55 women (55%). In group B, out of 100 women of this 90 (90%) of women received prophylactic antibiotic before elective LSCS. Out of 24 women who received antibiotic in group A, 10 received antibiotic within 1 hour and 12 cases received more than 1 hour before procedure. Out of 90 women in group B, 45 women received antibiotic within 1 hour, 5 received more than 1 hour. In the group A, majority of the women received amoxicillin clavulunic 1.2 gm IV /Inj cefotaxime based on the policy formulated based on the antibiogram of the hospital. Conclusion: This study showed single dose antibiotic prophylaxis is as effective as conventional multi dose antibiotic therapy. It is cost effective, antibiotic resistance of microorganisms can be prevented, reduces patient side effects, nursing staff work.

DOI: 10.5281/zenodo.

46. A Hospital-Based Study Assessing Clinic-Etiologic Profile and Management in Incisional Hernia
Abhishek Sinha, Abhishek Kumar, Puja Kumari
Abstract
Aim: The aim of the present study was to assess the risk factors, clinical presentation and management in incisional hernia. Methods: The present study was conducted in the Department of General Surgery, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India and patients having incisional hernia were included in our study by applying the following inclusion and exclusion criteria. The study was conducted over a period of 1 yr and a total of 50 cases were taken for study. Results: The study showed that incisional hernia is more common in females than in males. Most of the patients belonged to 21-60 years. The study showed that all the patients (100%) presented with swelling in the abdomen. In the present study, 44% had obesity and 24% had anemia. 24% patients had associated pain in the swelling. In this study 70% of patients presented with infra umbilical swelling, 16% presented with supra umbilical swelling, 8% with right iliac fossa swelling and 6% with right lumbar swelling. 46% of the patients presented with incisional hernia within a year of the previous surgery. 22% of patients presented between 1 to 2 years. 30% underwent elective surgery and 70% underwent emergency surgery. In the study 7 patients had surgical site infection and 7 patients had seroma formation. 5 patients had respiratory tract infection. Almost half of the patients in the study group were followed up for complications, including recurrence. 10 patients were followed up for up to one year duration. Conclusion: Incisional hernia is more common in females, especially the multiparous. Incisional hernia is more common in patients who underwent previous surgery on an emergency basis. Cough impulse was present in all the cases and the swelling reduced on lying supine. Seroma formation and surgical site infection were the common complications in the post-operative period. No recurrence was seen in the follow up of the patients.

DOI: 10.5281/zenodo.

47. A Comparative Assessment of the Outcome after out-of-Hospital Cardiac Arrest in Patients with Ischaemic and Non-Ischaemic Heart Disease
Mukesh Shandilya, Chandrabhanu Chandan
Abstract
Aim: The aim of the present study was to investigate all-cause mortality, cardiac death, and return to work among patients admitted after OHCA with IHD and non-IHD. Methods: Patients with OHCA were consecutively enrolled in the study at admission at the Department of Cardiology, IGIMS, PATNA, Bihar, India. 150 patients were included in the study. We included patients admitted after OHCA including patients with return of spontaneous circulation (ROSC) prior to admission. Results: Patients in the IHD group were significantly older than patients in the non-IHD group (median age 67 years vs. 58 years) and were more often males (83% vs. 64%). In addition, a significantly larger pro-portion of IHD patients had ventricular tachycardia or ventricular fibrillation as the initial arrest rhythm and were more likely to take medication for heart disease compared with non-IHD patients. Of the patients with IHD, 57 patients (57%) underwent percutaneous coronary intervention. Conclusion: Cardiac death was the predominant cause of death. Most working patients returned to work within five years with a median time until return to work of six months. There was no statistically significant difference in all-cause mortality, cardiac death, and return to work between patients with IHD and patients with non-IHD, but a trend toward a higher mortality in patients with non-IHD driven by non-cardiac causes was found, which may indicate that IHD is a favourable cause of cardiac arrest.

DOI: 10.5281/zenodo.

48. To Evaluate the Therapeutic Safety and Efficacy of Surgery and to Offer Further Information on Cases of Phakic Eyes with Extended Intervals Between the Development of Malignant Glaucoma and Surgery
Amar Kumar, Tripti Thakur, M. S. Ali
Abstract
Aim: The objectives of this work were to evaluate the therapeutic safety and efficacy of surgery and to offer further information on cases of phakic eyes with extended intervals between the development of malignant glaucoma and surgery. Methods: at the current study, which was carried out at the Department of Ophthalmology at the Indira Gandhi Institute of Medical Sciences in Patna, Bihar, India for one year, the participants were consecutive patients who had undergone core vitrectomy-phacoemulsification-intraocular lens (IOL) implantation-capsulo-hyaloidotomy at least one month after the commencement of malignant glaucoma surgical procedures. Results: This retrospective study examined 10 malignant glaucoma patients who underwent core vitrectomy, phacoemulsification, IOL implantation, and capsulohyaloidotomy. All eyes exhibited primary angle-closure glaucoma (PACG);7 (70%) developed it after trabeculectomy. The average onset-to-surgery time was 6.8 months. IOP, number of IOP-lowering drugs, and ACD differed pre- and post-op (P=0.046, 0.004, and 0.005). Complete, qualified, and anatomical success occurred in 38.5%, 77%, and 100% of eyes. Conclusion: The procedure of core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is a safe and successful treatment for long-term phakic malignant glaucoma.

DOI: 10.5281/zenodo.

49. A Hospital Based Prospective Observational Assessment of Gynaecological Disorders in Geriatric Women
Ankita Kumari, Swati
Abstract
Aim: The aim of the present study was to assess gynaecological disorders in geriatric women regarding their frequency, diagnosis and management. Methods: It was a prospective observational study done over one year period in the Department of Obstetrics and Gynaecology, PMCH, Patna, Bihar, India. All elderly women admitted in our institution aged 60 years and above were included in the study. In our study there were 200 patients aged 60 years and above amongst total admission of 2840 in the Gynaecology ward. The incidence of hospital admission of geriatric female patient came out to be 7.04%. Results: 104 (52%) were in the age group of 60-65 years, 50 (25%) in the age group of 66-70 years, 30 (15%) in the age group of 71-75 years and 10 (5%) were more than 75 years. The most common presenting complaint was postmenopausal bleeding in 84 patients (42%), followed by pain and abdominal distention in 76 patients (38%). 60 patients (30%) complained of something coming out of introitus, 32 patients (16%) reported discharge per vaginum and 16 patients (8%) had urinary complaints. Malignancy was the most frequent diagnosis with 110 (55%) patients having malignant disease followed by uterovaginal prolapse, ovarian cyst and urinary complaints. Of the total malignancies, ovarian cancer constituted 47.27% (n=52) followed by cervical cancer 31.81% (n=35) endometrial carcinoma 12.72% (n=14), vulval cancer 5.45% (n=6) and vaginal cancer 2.72% (n=3). 48 patients of ovarian cancer, exploratory laparotomy proceed total abdominal hysterectomy with bilateral salpingo oopherectomy with infracolic omentectomy with surgical staging of tumour was done. Conclusion: Pelvic organ prolapse and genital malignancy are the major gynaecological causes of hospital admissions in the patients above 60 years. Post-menopausal bleeding is the commonest complaint. Ovarian and endometrial cancer is showing a rising trend in this age group. Though cervical cancer was the second most common malignancy in this group, most of these patients presented at advanced stage and hence was inoperable.

DOI: 10.5281/zenodo.

50. A Clinic-Demographic Profile and Outcome Assessment of Ectopic Gestation: an Observational Study
Saba Ghaffari, Khatibur Rahman
Abstract
Aim: The aim of the present study was to assess the progress of labor in all ANCs with previous LSCS consenting for vaginal delivery using partogram and to note the feto-maternal outcome. Methods: A retrospective observational study was conducted at department of obstetrics and Gynaecology, Gauri Devi Institute of Medical Science & Hospital, Durgapur, West Bengal, India for the duration of 12 months in 50 patients with previous LSCS for trial of labor who fulfilled the inclusion criteria. Detailed history regarding age, parity, duration of pregnancy and labour pain was taken from every patient. Results: Our study included a total of 50 patients with average age 25.05 years with minimum age of a patient being 19 years while the maximum age was 33 years. Majority of the women belonged to 18-24 years. In present study 40 out of 50 patients delivered at the gestational age of 37-40 weeks (80%). Out of these the patients who underwent repeat LSCS were 30 (60%) and those who delivered vaginally were 15 (30%). Out of 30 patients who undergone repeat LSCS, 4 patients had scar dehiscence, 6 patients were taken for LSCS due to non-progression of labor and 20 patients had fetal distress. Conclusion: The partogram was able to reduce feto-maternal complications and help in early detection of deviation from normal labor thus guiding in timely intervention. The subjects who crossed alert line in partogram were taken for LSCS thus indicating higher efficacy of partogram. With the use of partogram maternal complications in patients with previous LSCS like obstructed labor, prolonged labor, scar dehiscence and scar rupture and other complications like PPH, cervical tears/vaginal lacerations etc. can be prevented.

DOI: 10.5281/zenodo.

51. A Study to Evaluate the Clinical Spectrum and Outcomes of the Patient with Inguinal Hernia
Murari Kumar, Kunal Kumar
Abstract
Aim: The aim of the present study was to evaluate the clinical presentation, management and outcomes of the patient with inguinal hernia. Methods: The present study was conducted in the Department of General Surgery, Patna Medical College and Hospital Patna, Bihar, India. 50 patients were included in the study. Results: Most of the patients belonged to 21-40 years and there were male predominance. In this study we found that a higher incidence of inguinal hernia on right side 60%, 30% hernia left sided and 8% were bilateral congenital inguinal hernia. In this study, 84% cases had indirect inguinal hernia and 16% cases had direct inguinal hernia. 56% had bowel content. In this study, hernioplasty (58%) was the common operative procedure used to manage the cases followed by herniorrhaphy (28%), stoppa’s procedure (6%), reduction with herniorrhaphy (4%) and resection and anastomosis with hernioplasty (4%). In this study, post-operative complications were very minimal i.e. wound infections (4%), groin pain (4%), hematoma (2%), scrotal swelling (2%) and recurrence (2%). Conclusion: The incidence of inguinal hernia was most common in the age group of 21-40 years. The hernioplasty (58%) was the preferable surgical option in the management of hernia. Increasing awareness in general population may help in detect at earlier stage and will reduce the disease morbidity.

DOI: 10.5281/zenodo.

52. Evaluating Clinical Profile and Outcome of Chronic Ectopic Pregnancy in Tertiary Care Hospital
Naaz Ahmed, Vinita Sahay
Abstract
Aim: The aim of the present study was to assess the clinical profile and outcome of chronic ectopic pregnancy in tertiary care hospital. Methods: This prospective observational study was undertaken in the Department of Obstetrics & Gynecology, Netaji Subhas Medical College, Bihta, Patna, India on pregnant women with persistent chronic ectopic pregnancy . During the study period of one year, 9940 patients were delivered to the institute. 85 patients were diagnosed with ectopic pregnancy. Hence, the incidence of ectopic pregnancy was 0.85% in our study. Only 10 patients were diagnosed in chronic ectopic frequency (CEP). Results: 30% cases were aged ≤ 30 years while rest of the cases was aged more than 30 years. The mean age was 34.56 ± 5.0 years. 40% (4 cases) were nullipara, 60% (6 cases) were primipara and none of cases were multipara. Our center being tertiary center, 40% (4 cases) were referred from other centers while 60% (6 cases) were diagnosed at our hospital. Majority of the patients 60% (6 cases) presented at 6 to 8 weeks of gestation followed by 40% (4 cases) at less than 6weeks of gestation. Amenorrhea and pain abdomen was the most common complaint seen in 100% (7 cases) followed by Vaginal Bleeding/Spotting (60%) and Fainting Attack (30%). 80% cases were positive UTP. All of the patients were positive in Culdo/Paracentesis. The beta-HCG levels of more than 5000mIU/ml was observed in 10% (1 case), beta-HCG of less than 1500mIU/ml was in 60% (6 cases, and beta-HCG in the range of 3000-5000 mIU/ml was in 30% (3 cases). All of the patients had hemoglobin range of 7-10 gm/dl. Conclusion: Chronic ectopic pregnancy is rare and is often misdiagnosed preoperatively. Chronic ectopic pregnancy should be the provisional diagnosis in a young multiparous woman with AUB and/or abdominal pain, if the ultrasound shows the presence of a heterogeneous mass in the POD and/or adnexa, with no internal vascularity on CD.

DOI: 10.5281/zenodo.

53. A Study Assessing Functional Outcome of Management of Proximal Humeral Fractures with Philos Plate fixation
Rakesh Kumar Pal, Anand Kumar, Arun Kumar
Abstract
Aim: The aim of the present study was assess the functional outcome of management of proximal humeral fractures with Philos plate fixation. Methods: This was a prospective cohort study conducted in 50 patients with fractures of the proximal humerus at Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India. The indications of operative treatment were based on Neer’s classification of proximal humerus fractures. Results: In the present study, maximum numbers of patients were in their 5th decade of life, with a mean age of 53.47 years. There was a male preponderance, accounting for 60% of the patients. The majority of patients (26 cases) sustained injury due to road traffic accidents, followed by fall on an outstretched hand (18 cases) and assaults (6 cases). There were 25 (50%) patients with two-part, 18 (36%) patients with three-part, and 7 (14%) patients with four-part fractures. The final outcome of the procedure was graded as excellent, good, moderate, and poor depending upon the scores of 86-100, 71-85, 56-70, and 0-55, respectively. As per parameters of the Constant scoring system, the overall results were assessed to be excellent in 25 patients, good in eight patients, and moderate in ten patients. Six patients had poor functional results. No intraoperative or immediate postoperative complications in the form of neurovascular injuries/complications related to general anaesthesia were observed in the present study. Out of the six cases of four-part fracture dislocations, AVN of the humeral head was observed in two patients. One of these two patients had AVN of the head along with nonunion of the fragment with the shaft.

Conclusion: The present study indicated that it is a promising implant and provides a good functional outcome in proximal humerus fractures. Along with providing a buttressing effect laterally, it can also provide inferomedial support by locking screws, which prevent varus displacement of proximal fragment in the presence of medial comminution.

DOI: 10.5281/zenodo.

54. Assessment of Microbiology and Antimicrobial Spectrum in Patients with of Surgical Site Infection
Sunil Kumar, Ravi Kumar, Shashi Kishore, Sanjay Nag
Abstract
Aim: The aim of the present study was to evaluate the antimicrobial susceptibility pattern of microorganisms involved in the pathogenesis of surgical site infection. Methods: The study was a cross-sectional study which was carried in the Department of Microbiology, ANMMC, Gaya, Bihar, India for the period of one year. Total 190 patients with SSIs either sex or any age, who had surgical wound pus, discharge, or signs of sepsis were include in this study. Patients with cellulitis and suture abscess were excluded from this study. Out of 190 samples, 100 samples were culture positive (52.63%). Results: Among 100 positive samples 58 (58%) were males. Maximum no. of culture positive samples in age 20-30 years (30%) followed by 30-40 (21%) and then followed by 40-50 (14%) of age group respectively. Out of 100 culture positive samples S.aureus (23%) was the most common pathogen isolated followed by Escherichia coli. (21%), Citrobacter spp. (16%) and Pseudomonas aeruginosa (11%) respectively. Among gram negative bacilli, E.coli was most sensitive to Imipenem followed by Amikacin and Piperacillin Tazobactam whereas for Citrobacter spp., Imipenem followed by Gentamicin, Ciprofloxacin was the drug of choice then for Klebsiella spp., Imipene followed by Gentamicin, Amikacin was the drug of choice. Among gram positive organism, S.aureus showed maximum antibiotic sensitivity to Linezolid followed by Vancomycin, Amikacin whereas CONS was sensitive to Linezolid followed by Vancomycin, and Gentamicin. Conclusion: The present study concluded that the increasing resistance to antimicrobials increases the risk of morbidity and mortality; therefore, there is urgent need of implementation of measures to restrict the health care associated infection. Rational use of antimicrobials, proper hygiene, and strict asepsis should be applied in all health care.

DOI: 10.5281/zenodo.

55. Assessment of the Prevalence and Risk Factors of Hearing Loss using Measurements of Otoacoustic Emission (OAE) in Newborns Admitted to NICU at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar
Rajesh Kumar Sah, Saba Ekta, Bankey Behari Singh
Abstract
Aim: The aim of the present study was to assess the prevalence of hearing loss using measurements of otoacoustic emission (OAE) in newborns admitted to NICU in department of pediatrics, Anugrah Narayan Magadh Medical College and hospital, Gaya Bihar (ANMMCH, Gaya,Bihar) and to determine the risk factors predictive of hearing impairment in these newborns. Methods: This was a hospital-based prospective observational study carried out among the neonates admitted to NICU at ANMMCH, Gaya Bihar. Parents or guardians were counselled regarding the OAE screening test. A total of 200 neonates were included. Results: Out of a total of 200 study participants, there were 34 (17%) patients who were referred after the initial screening. Out of which there were 24 (12%) patients who had hearing loss at 4 weeks after rescreening. In the present study among the total participants (200), the majority were males. A majority of the participants had a weight range between 1.5 to 2.0 kg, followed by 1.0 to 1.5 kg. Out of all the participants, 110 (55%) had a normal vaginal delivery, and 90 (45%) had LSCS. Among the newborns, 50 (25%) had a history of assisted ventilation, and 10 (5%) of them had hearing loss. Additionally, 50 newborns (25%) had a history of ototoxic medications, and 10 (5%) of them had hearing loss. Out of 14 (7%) patients who had a history of neonatal jaundice requiring exchange transfusion, 4 (2%) had hearing loss. Conclusion: According to our study, the rate of hearing problems among high-risk newborns admitted to the neonatal intensive care unit (NICU) was 12%. We found preterm and low birth weight babies, perinatal asphyxia, culture-positive sepsis, and male gender as risk factors for hearing loss in the newborn period. It’s the need of the hour to address these risk factors in preventing hearing impairment among neonates admitted to NICU and Successful implementation of universal newborn hearing screening should be the goal of every nation. It is important to establish good practices and promote teamwork among healthcare professionals in order to prevent risk factors that may cause hearing loss.

DOI: 10.5281/zenodo.

56. Determining the Effect of Pharmacological and Non-Pharmacological Approach in Relieving Preoperative Anxiety in Adult Patients Undergoing Laparoscopic Abdominal Surgeries
Rishabh Ravi, Md. Kaisar Alam, Sujata Rani, Vishwanath Ankad
Abstract
Aim: The aim of the present study was to compare the physical intervention hand-holding with conversation and the common pharmacological drug midazolam in relieving preoperative anxiety in adult patients undergoing laparoscopic abdominal surgeries. Methods: The present study was conducted at ESIC Medical College, Bihta, Patna, Bihar, India and patients undergoing laparoscopic cholecystectomy or appendectomy under general anaesthesia were recruited. 150 patients, undergoing laparoscopic cholecystectomies and laparoscopic appendectomies were recruited in three groups. Results: There were females in all the groups except group M where males were predominant. Majority of the patients belonged to ASA I grade. The HR and APAIS scores were significantly different in the three groups after intervention but MBP was not significantly different in all the three groups. On pair-wise comparison, there was a significant difference in the HR between groups HCM and HC. However, the HR in group M did not significantly differ from HR in groups HCM and HC, as seen in the post-hoc analysis. The APAIS score showed a significant difference between the three groups with group HCM showing the lowest anxiety scores, followed by group HC and group M showing the highest anxiety scores. Conclusion: The study found that hand-holding and conversation, when included with midazolam, effectively reduced anxiety in preoperative settings. While hand-holding with conversation alone is effective, only midazolam as premedication for anxiolysis is inferior.

DOI: 10.5281/zenodo.

57. Comparative Assessment of the Efficacy and Safety of Two Different Doses of Intravaginal Misoprostol for Induction of Labor
Tanu Sharma, Abhishek Ranjan, Minu Sharan
Abstract
Aim: The aim of the present study was to compare the efficacy and safety of 25 mcg intravaginal misoprostol vs 50 mcg misoprostol for induction of labor. Methods: This study was conducted in the Department of Obstetrics and Gynecology at Patna Medical College and Hospital, Patna, Bihar, India. This study group consisted of 200 cases of low-risk singleton pregnancies attending the antenatal clinic of Patna Medical College and Hospital, Patna, Bihar, India, or admitted to the antenatal ward. Results: Maximum cases from both groups were in the age group 20 to 25 years. Most cases are booked cases in both groups accounting for 82 and 79% in both groups respectively. Most cases in 25 mcg group were term pregnancies (65%) and in 50 mcg group postdated pregnancies (54%).Oxytocin augmentation need in both groups was similar. Vaginal deliveries are more with 25 mcg (74%) when compared to 50 mcg (51%). Cesarean section rate is more with 50 mcg (39%). In the present study, it was seen that the induction delivery interval with 50 mcg misoprostol was less than 12 hours in 62 cases (62%) and, in 25 mcg, it was in 33 cases (33%). Most cases in 50 mcg group delivered vaginally within 12 hrs with single dose.  Majority of failed induction were due to failure to progress. In 50 mcg group the total number of failed induction were 39 out of 100 patients giving an incidence of 39%. Majority of failed induction were due to fetal distress. There was 26% incidence of side-effects in 50 mcg misoprostol group and 14% of incidence in 25 mcg group. Tachysystole and hyperstimulation were found only in 50 mcg group. Conclusion: Local application of misoprostol tablet in the posterior fornix is more convenient and easier procedure. Misoprostol offers benefits of reduced cost, temperature stability when compared to other prostaglandin preparation. Change in Bishop’s score is good with both the groups, 50 mcg is proved to be a better cervical ripening agent statistically. Induction delivery interval is significantly less with 50 mcg group (9.45 hrs) in comparison to 25 mcg group (14.5 hours).

DOI: 10.5281/zenodo.

58. Assessment of Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia and its Association with Duration of Phototherapy
Amresh Kumar Sahu, Shyam Bahadur Prasad, Anil Kumar
Abstract
Aim: The aim of the present study wads to assess the prevalence of hypocalcemia in neonates with unconjugated hyperbilirubinemia receiving phototherapy and to observe association of hypocalcemia with duration of phototherapy. Material & Methods: A prospective observational study conducted over a period of Jan 2019 to December  2019 among 200 neonates (both term and preterm) in the Department of Paediatrics, Government Medical College Bettiah, West Champaran, Bihar, India. Results: The mean age of preterm and term neonates was 118.12±42.78 and 122.28±41.19. There were more males as compared to females in preterm and term neonates. Mean birth weight of preterm and term in this study were 2723.17±246.44 grams and 3132.78±370.90 grams respectively. 10 term neonates experienced hypocalcemia at 12 hours after starting of phototherapy. Similarly, 20 term neonates had hypocalcemia 48 hours after starting of phototherapy. None of the preterm neonates enrolled in the study experienced hypocalcemia after starting of phototherapy. It was observed that occurrence of hypocalcemia was not significantly associated with the duration of phototherapy. On comparing the 0 hours calcium level with subsequent hours, the mean difference in total serum calcium levels in both term, and preterm babies were found to be statistically significant and the difference was seen to be more significant in term babies. Correlation analysis of a duration of phototherapy with hypocalcemia showed a negative but insignificant correlation with a coefficient (r of −0.045 and a p=0.95). Conclusion: A reduction in the serum calcium with increased duration of phototherapy, however, it does not fall to the level where treatment is required. Hence it is not recommended to monitor serum calcium levels in neonates receiving phototherapy.

DOI: 10.5281/zenodo.

59. A Study to Address the Promising Outcomes of Proximal Fibular Osteotomy in Treatment of Medial Compartment Knee Osteoarthritis
Angad Kumar Choudhury, Maseeh Azam
Abstract
Aim: The purpose of this prospective study was to prove the promising outcomes of proximal fibular osteotomy in treatment of medial compartment knee osteoarthritis. Material & Methods:  A prospective observational study including 50 patients in Department of Orthopaedics, Jawahar lal Nehru medical College and Hospital, Bhagalpur, Bihar, India for the period of 2 years. The following clinical parameters were used: VAS, KSS, KFS. The following radiological parameters were used: MJS, LJS, HKA Angle. post-operative physiotherapy protocol was followed. Discharge was planned based on patients comfort and mobility that was usually on day 4 or 5. They were followed up at 6 weeks, 3 months, 6 months, 9 months and 12 months. Results: In the present study, most of the patients belonged to 50-60 years age group. In the present study, there were 19 males and 31 females, with male to female ratio 2:3 approximately. The mean age of patients was 52.78 year (age range = 40-70 years). In this study patients included who has BMI>30 and most of patients lie in between 25 to 29.9 BMI i.e. most of them fall in overweight category. Osteochondral defect was found in all cases with various grade, 26 (52%) knees with grade 1, 15 (30%) knees with grade 2, 8 (16%) knees with grade 3 and 1 (2%) cases with grade 4. Average visual Analogue scale (VAS) score significantly decreased from 8.20 pre-operatively to 3.256 in 1 year of follow up. Knee society score improved from 45.25 pre-operatively to 71.77 in 12 month of follow up. Knee function score improved pre-operatively 49.50 to 75.55 in 12 month of follow up. Medial joint space increased from 1.62 pre-operatively to 3.56 in 12 month of follow up. Lateral joint space decreased from 6.68 pre-operatively to 5.38 in 12 months follow up. The correction of alignment Hip knee ankle angle (HKA) after PFO were seen after 12 months. Conclusion: Proximal fibular osteotomy [PFO] is a simple, safe and affordable surgery to reduce pain and improve joint function and the medial compartment space in medial compartment osteoarthritis of knee joint. It may be a promising alternative surgery in most developing countries because of their financial and healthcare delivery limitations that may be used as an alternative surgery for patients of osteoarthritis knee who cannot undergo.

DOI: 10.5281/zenodo.

60. Assessment of Nutritional Awareness among Mothers and Iron Deficiency Anemia in Infants
Amit Kumar, Vibhas Ranjan
Abstract
Aim: The aim of the present study was to analyze the risk factors and vital role of mothers in prevention of nutritional anemia in the early childhood. Methods: This study was carried out in the Department of Pediatrics, DMCH, Darbhanga, Bihar, India and children aged 6 months–2 years admitted at the hospital during the study period were included. Any child with chronic disorders such as hemoglobinopathies, hemolytic anemia, and treated for anemia and those on any immunosuppressants such as steroids and biologics were excluded as an indirect measure to eliminate anemia of chronic disease. The study protocol was approved by the Hospital Ethics and Scientific Committee. An informed written consent was obtained from the mothers of these children. A total of 200 participants were included. Results: Majority of the mothers were aware that neural development of child could be affected by anemia. Maternal knowledge regarding cow’s milk was poor and had a faulty belief that it increases iron absorption, whereas 16% were unaware of the relationship between cow’s milk and anemia. Many mothers believed anemia to occur only in children on vegetarian diet. Around 75% mothers recognized green leaves and 70% women reconized jaggery to be enriched with iron. Although 78% identified vitamin C containing fruits, many were not aware of its vital role in increasing the iron absorption. Mothers of children with more than one sibling had a relatively greater incidence of “poor” knowledge unlike mothers of children with single or no sibling. This implies that those with “poor” knowledge were also unaware of the importance of birth spacing. Conclusion: Recognizing the causative factors plays an essential role in preventing iron deficiency anemia (IDA). Exclusive breastfeeding must be promoted, along with avoiding excessive cow’s milk intake. Intervening at the right period with age-appropriate foods becomes a necessity. Maternal illiteracy has a positive correlation with anemia in infants. Improving maternal awareness by the physicians will pave the road toward a nation free from anemia.

DOI: 10.5281/zenodo.

61. A Descriptive Assessment of the Knowledge of Glaucoma among Patients Visiting Tertiary Care Facility
Ragini, Shalini Sheoraj
Abstract
Aim: The aim of the present study was to assess the knowledge of glaucoma among patients of selected health facilities in Bihar state. Methods: The study was carried out in two selected health facilities in Bihar State and 200 participants were included in the study. Results: A total of 200 subjects responded correctly to the questionnaire of which 120 (60%) were females and majority of them were aged 21-30 years (20%) followed by 51-60 years (16%). Above half 187 (51%) of them had tertiary education while only 10 (5%) were illiterate. Greater than half of the participants 120 (60%) were married, 64 (32%) yet to marry. Interestingly, a good number of the participants 76 (38%) were self-employed and public servants comprise of 40 (20%). Majority lived in urban area 130 (65%). The common symptoms of glaucoma known were painless vision loss (25%), sudden vision loss (25%) while a substantial number 92 (46%) could not identify any symptoms. About the risk for glaucoma, the major predisposing factor was hereditary (20%) followed by cataract 16 (8%) while steroid (0.5%) was the least. Although, more than half (52.5%) do not know the risk factors of glaucoma. The most common treatment option identified by the respondents was surgery 50 (25%) followed by eye drop 36 (18%). The use of eye drops and surgery combine was 8 (4%) while laser and spectacles were the least treatment option (1.5%). Conclusion: In conclusion, the level of knowledge of glaucoma was fairly low and one of the most important and effective actions for early detection of glaucoma and its management may be raising public awareness and knowledge levels regarding the disease. These findings suggest that there is a need for health education in Ondo state population to increase their level of awareness and knowledge of glaucoma. Inadequate knowledge in the general population may be an important cause for failure to detect glaucoma early and may result in blindness from the disease.

DOI: 10.5281/zenodo.

62. Outcome Assessment of Paediatric Femur Diaphyseal Fracture Treated with Locking Compression Plate
Binay Kumar, Anshu Anand, Ajoy Kumar Manav
Abstract
Aim: The aim of the present study was to evaluate the functional and radiological outcomes of paediatric femur diaphyseal fracture treated with locking compression plate. Material & Methods: The clinical, radiological and functional results of Submuscular plating were evaluated in 70 patients operated in between the duration of 3 years for fracture shaft humerus, shaft of femur and shaft of tibia. All the surgeries were carried out by a single surgical team at Department of Orthopaedics, PMCH, Patna, Bihar, India. Results: Among the study group, 49 were males, and 21 were females. There was a male preponderance. The youngest age among patients was six years old and the oldest age was 14 years old. The average age was 11.49 (2.08) years. Right side fractures 40 (57.14%) were more compared to left side fractures 30 (42.86%). For types of fractures, 25 (35.71%) fractures were transverse, 18 (25.72%) fractures were comminuted, 21 (30%) fractures were oblique, and 6 (8.57%) fractures were spiral. Considering the mode of injury, road traffic accident accounted for 60%, other injuries like fall during playing sports were seen in 15.71%, fall from height accounted for 8.57%. The functional outcomes were evaluated and 64 (91.42%) were excellent, 5 (7.14%) were satisfactory and 1 (1.42%) were poor. Conclusion: Once properly planned and executed correctly the submuscular plating for diaphyseal long bone fractures is one of the reliable treatment modality. It is minimally invasive technique that allows early mobilization with satisfactory radiological and functional outcome with minimal complications.

DOI: 10.5281/zenodo.

63. Assessing Effectiveness of Iron Sucrose Administered Intravenously in Treating Iron Deficient Anemia in Pregnant Patients
Priyanka Gahlout, Snehil, Kumari Bibha
Abstract
Aim: The aim of the present study was to evaluate the efficacy of intravenous iron sucrose for the treatment of iron deficiency anemia in pregnancy. Methods: The present study carried out in the Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar, India . The duration of the study was about 6 months. 50 pregnant women were enrolled for this study. Results: The study results showed that the mean age of the pregnant women was 23.57±4.08 years, their mean weight was 59.61±12.28 kg, their mean gestational week was 28.72±4.08, 8 (16%) of them had gestational diabetes, 5 (10%) of them had hypertension, 4 (8%) of them had hyperthyroidism, 6% had asthma and 6% genitourinary infection whereas 4 (4%) of them had chronic kidney disease. The study results further showed that both the hemoglobin (p<0.001) and ferritin levels (p<0.001) of females were significantly increased at term after receiving intravenous iron sucrose as compared to the baseline. Furthermore, significant difference was observed in PCV (p<0.001) and MCV as well (p<0.001). Conclusion: This study concluded that the administration of iron sucrose intravenously (Axifer) is a secure and effective choice in the management of iron deficiency anemia in pregnant women particularly for those who had inadequate response to oral iron supplementation. Intravenous iron sucrose is well accepted along with controllable safety profile clinically and enhanced Hemoglobin and ferritin level both and thus decrease complications during pregnancy due to iron deficiency anemia.

DOI: 10.5281/zenodo.

64. A Clinico-Etiologic and Pathological Profile Fungal Keratitis: A Retrospective Research
Nishant Kumar
Abstract
Aim: The aim of the present study was to analyse the causes, presentation, and clinico-pathological associations of fungal keratitis in a retrospective series of patients. Material & methods: A retrospective analysis was conducted in the Department of Ophthalmology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India  for the duration the duration of 1 year. The outpatient department saw a total of 1700 patients, of whom 200 cases (11.76%) of microbial keratitis and 20 cases (10%) of keratomycosis were observed. The study was performed in compliance with the Declaration of Helsinki. Patients with fungal keratitis were identified by reviewing medical records in between the duration of 1 year. Risk factors, clinical manifestation and outcome were recorded. Results:  The age incidence of keratomycosis in the current study showed that the age range of 51 to 60 years has the highest incidence (8), followed by 21 to 30 years (4), 41 to 50 years (2), 31 to 40 years (6). In this study, there were 12 affected males (60%) and 8 affected females (40%). In the current study, agricultural labourers have the highest incidence of fungal ulcers 16, i.e. 80%, others (20%, or 2 cases) (Rickshaw drivers, students, and business people). In the present study, aspergillus fungi were found in 10 cases. The current investigation revealed that Fluconazole is effective against Candida Albicans and Natamycin 5% eye drops are effective against Aspergillus species. All of the straightforward fungal corneal ulcers, or those lacking hypopyon, responded well to natamycin eye drops. Conclusion: Natamycin was the better option for the treatment of fungal keratitis. Filamentous fungi (Aspergillus species, fusarium, and curvularia) responded effectively to Natamycin 5% eyedrops. Cases that received good responses revealed corneal opacity.

DOI: 10.5281/zenodo.

65. Functional Outcome Evaluation of Surgically Controlled Intra-Articular Calcaneum Fractures using Plate Fixation
Aurangzeb, Sushil Kumar Singh, Deepak Kumar
Abstract
Aim: To evaluate the functional result of surgically controlled intra-articular calcaneum fractures using plate fixation. Material and Methods: This study was conducted in the Department of Orthopaedics, Jannayak  Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India for 18 months. A total of 25 patients with intra-articular calcaneal fractures meeting the inclusion and exclusion criteria were chosen for the study. Patients aged between 18-60yrs, Intra-articular fracture of calcaneum (Sander’s classification), Ability to understand the content of the subject information/informed consent form and to be willing to participate in the clinical investigation were included in this study. Results: The majority of the patients in the study were males, with   92% of the study population. In this study, 56% of the patients had right side involvement and 44% of the patients had left side involvement. The most common mode of injury in the study group was falling from height followed by RTA. The most common fracture type in our study was Sander’s type II, followed by type IV. Type III was the least common. In all the patients included in the study, surgery was delayed until the appearance of wrinkles on the skin to avoid the complication of wound dehiscence and for appropriate wound closure. The number of days from the injury to surgery varied from 4 to 14 days with an average of 7.8 days. The average time period for the radiological union was 13.64 weeks in the study population. About 72% of patients had a bohler’s angle between 10o-20o and in 28% of patients, it was <10o in the pre-operative period, with a mean bohler’s angle of 11.750. Whereas in the post-operative period, 48% of patients had a bohler’s angle between 200-300 and 52% had it between 300-400, with a mean post-operative bohler’s angle of 29.670. The difference between pre-operative and post-operative mean bohler’s angle was statistically significant with a p value <0.01. The difference between pre-operative and post-operative mean Gissane’s angle was statistically significant with a p value <0.01. Conclusion: We conclude that: Good quality radiographs like lateral and axial view and pre- operative CT scan is necessary in understanding the displacement of major fragments and help to classify the fracture pattern according to Sander’s classification, which is vital in pre-operative planning and assessment of the prognosis of fracture. The timing of the surgery is a crucial determinant for the treatment outcome and is to be done once the wrinkle sign is positive.

DOI: 10.5281/zenodo.

66. A Descriptive Cross-Sectional Study Determining the Association between Sleep Quality and Levels of Sadness, Stress, and Anxiety among Medical Undergraduates
Poonam Rani, Neera Kumari, Kumar Saurabh
Abstract
Aim: To examine the correlation between sleep quality and levels of sadness, stress, and anxiety among medical students. Material and Methods: Medical students in their second to last year participated in this cross-sectional research. Those who passed their first-year test and attended at least one year in medical school were included. The socio-demographic data was collected using surveys. Medical students’ depression, anxiety, and stress were assessed using a validated DASS 21. Results: According to the DASS-21 score, 21% exhibited depressive symptomatology (3% severe or very severe), 30% had anxiety symptoms (6% severe or extremely severe), and 33% had stress symptoms (5% severe or extremely severe). The non-parametric chi square test showed that females had a 28.48% greater likelihood of poor sleep quality than the control group, although the difference was not statistically significant (p>0.05). Other study variables, such as second-year MBBS students (35.00%), rental house residents (30%), students who take over 30 minutes to fall asleep (50.00%), students who go to bed after 2:00am (52.38%), and those who spend less time in bed (52.78%), were associated with poor sleep quality (p-value 0.05). Conclusion: An increasing number of medical students are suffering from mental health issues, such as depression, anxiety, stress, and inadequate sleep. Family expectations, test pressure, a lengthy course, apprehension about entering the medical field, discontent with administration, and other similar factors are often cited as probable causes of this condition.

DOI: 10.5281/zenodo.

67. Functional Outcome of Dynamic Hip Screw and Proximal Femoral Nailing in the Treatment of Intertrochanteric Fractures: A Comparative Study
Adnan Qamar, Saurabh Chaudhary
Abstract
Aim: The aim of the present study was to compare the functional outcome of dynamic hip screw and proximal femoral nailing in the treatment of intertrochanteric fractures. Methods: The present study was conducted in the Department of Orthopaedics, Netaji Subhas medical college and Hospital, Bihta, Patna, Bihar, India for the period of nine months  and all patients with type I, type II or type III intertrochanteric fractures undergoing PFNA2 or DHS fixation. A total of 100 patients were taken and patients were divided to two groups of 50 each for DHS and PFNA2. Results: There was no significant difference in gender distribution, mode of injury and Boyd and Griffin classification distribution between the two groups. The mean six weeks score in Group DHS was 33.47 ± 3.20 and in Group PFN was 34.36 ± 2.7. There was not much significant difference in the mean six weeks comparison between the two groups. The mean 12 weeks score in Group DHS was 53.67 ± 2.68 and in Group PFN was 63.19 ± 5.95. There was a significant difference in the mean 12 weeks comparison between the two groups. The mean 24 weeks score in Group DHS was 82.5 ± 7.63 and in Group PFN was 88.22 ± 6.54. There was a significant difference in the mean 24 weeks comparison between the two groups.  In Group DHS, results were excellent in 34%, good in 42%, fair in 18% and poor in 6%. In Group PFN, results were excellent in 56%, good in 34% and fair in 10%. There was not much significant difference in results distribution between the two groups. Conclusion: From the study based on the functional outcome derived from Harris Hip Score, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS fixation. This was concluded based on the final outcome, range of movements, and HHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group.

DOI: 10.5281/zenodo.

68. Assessment of the Diagnostic Efficacy of C-Reactive Protein (CRP)/Albumin to Globulin Ratio (AGR) Test as a Good Diagnostic Tool for Periprosthetic Joint Infection
Lokesh Anand, Kundan Kumar Singh, Arun Kumar, Rakesh Kumar
Abstract
Aim: To assess C-reactive protein (CRP)/albumin to globulin ratio (AGR) test as a good diagnostic tool for periprosthetic joint infection. Materials and Methods: This study was done in the department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India for six months. The study design involved a retrospective analysis of clinical data obtained from patients who were diagnosed with peri prosthetic joint infections. The collected data consists of various parameters such as age, gender and pre-operatic serum markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), globulin (GLB), Albumin to globulin ratio (A/G), CRP/AGR ratio. Results: Among 30 patients 21 had positive culture results, 9 patients had negative culture results. Based on the culture reports the most common organism involved is Staphylococcus aureus 85.71% followed by Staph. Epidermidis 14.28%. Average values for culture sensitive CRP/AGR values 69 (Ranging from 29 to 96). Average CRP value is 66.85 mg/L (ranging from 46 mg/L to 94 mg/L). ESR average value of 55mm/hr(ranging from 27 mm/hr to 98 mm/hr) . Average values for culture negative CRP/AGR 15.22 (ranging from 8 to 44). CRP average value 15.77 mg/L ranging from (11 mg/L to 23 mg/L). ESR 32.77 mm/hr ranging from (27 mm/hr to 39 mm/hr). For culture sensitive patients the diagnosing accuracy for in culture patients CRP is 91.75%, ESR is 69.46%, CRP/AGR 93.75%, (whereas in culture negative the threshold for diagnosing accuracy for CRP is 60%, CRP/AGR is 61%, ESR is 51%. Conclusion: In conclusion, our findings indicate that the patients diagnosed with PJI (Periprosthetic joint infection) exhibited significantly elevated levels of ESR, CRP, CRP/AGR. These biomarkers show promising results for the diagnosis of PJI. However, when used alone, CRP/AGR demonstrated excellent diagnostic performance, followed by CRP and ESR with good diagnostic performance.

DOI: 10.5281/zenodo.

69. A Clinicopathological Assessing Maternal Complications and Perinatal Mortality in Postdated Pregnancy
Manisha Bharti, Sunesh Kumar
Abstract
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 Gynecology, AIIMS, New Delhi, India . Total 200 patients in the antenatal ward and labor 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: The majority of patients were 25-30. In both instances (50%) and controls (50%), most patients were 25-30 years old. The majority of patients (82%) were 40-41 weeks pregnant, whereas all controls were 37-40 weeks. 65% of study participants and 55% of control women were primigravida. The LSCS rate was 30%, greater than 15% in the control group. In the study group, 10% of deliveries were instrumental, compared to 5% in the control group. within the reasons for LSCS, the most prevalent indication within the study group was acute fetal distress which comprises meconium-stained fluid (10%) followed by cephalopelvic disproportion (9%). Non-progress of labor (4%) was the most prevalent control group indication, followed by acute fetal distress (01%) and non-reactive CTG (1%). Conclusion: Obstetricians still face postdated pregnancies. Watchful expectation or induction for postdated labor are options. Our research found that postdated pregnancies increase LSCS and instrumental deliveries.

DOI: 10.5281/zenodo.

70. Assessment of Uterine Lesions in Perimenopausal and Postmenopausal Women: Histopathological Study
Shikha Verma, Khushboo Yasmin, Indu Kumari
Abstract
Aim: The aim of the present study was to assess the histopathological spectrum of uterine lesions in perimenopausal and postmenopausal women. Methods: The present study was conducted for a period of six months in the Department of obstetrics and Gynaecology , NMCH, Patna, Bihar, India. The study comprised of 200 cases which met the inclusion criteria were taken for this study. Results: The maximum number of cases 56 (28%) were between the age group of 46-50 years. The most common site biopsy received was from cervix, 86 (43%). Postmenopausal bleeding was due to benign causes. Atrophic endometrium was the commonest benign. Conclusion: PMB is a symptom which should not be taken lightly. Accurate diagnosis is usually made by histopathological examination. In our study, a wide spectrum of both neoplastic and non- neoplastic conditions of female genital tract has displayed as a cause of PMB with predominance of benign causes. Cervical cancer is still the most common cause of PMB, which point out that the effective implementation of screening program is utmost important. More awareness among people, especially elderly women should be made about the importance of pap screening.

DOI: 10.5281/zenodo.

71. A Hospital Based Clinical Assessment of the Effect of Dexmedetomidine Infusion on the Duration of Analgesia with Spinal Bupivacaine for Adult Patients Undergoing Herniorrhaphy
Neeraj Kumar, P.K. Sinhha
Abstract
Aim: The aim of the present study was to assess the effect of Dexmedetomidine infusion on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess side effects. Methods: A double blind prospective randomized control study done in the Department of Anaesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya , Bihar, India from July 2019 to June 2020. and 100 patients were included in the study. Results: All the variables in study are comparable in groups. The amount of time required for the first analgesic dose to be requested was recorded and compared to total analgesic use. In comparison to Group B, patients in Group BD had a longer pain-free interval. The number of injections of diclofenac was also much lower in Group BD patients. Patients were asked to rate their pain on 11-point scale (NRS) ranging from No pain to worst possible pain in post- anaesthesia care unit. It was found that NRS scores were significantly lower in patients who are given with dexmedetomidine i. e. Group BD as compared to Group B. The groups experienced similar side effects such as nausea, vomiting, shivering, bradycardia, hypotension, and drowsiness. Conclusion: Hemodynamic alterations caused by dexmedetomidine are temporary, although they respond to pharmacological medications and intravenous fluid delivery. Dexmedetomidine is a good sedative for surgery, and sedation levels return to normal within 15 minutes after the drug is stopped. Dexmedetomidine works well for intraoperative sedation, postoperative analgesia, and reducing postoperative shivering.

DOI: 10.5281/zenodo.

72. An Observational Evaluation of Pregnancy Induced Hypertension (PIH) and Intrauterine Growth Restriction (IUGR) In Primigravida
Niharika Anand, Padmini Ghosh, Anupama Sinha
Abstract
Aim: To assess the use of doppler studies in the assessment of pregnancy induced hypertension (PIH) and intrauterine growth restriction (IUGR) in first-time pregnant women. Material and Method: This observational study was carried out in the Department of Obstetrics & Gynaecology Jawaharlal Nehru medical college & Hospital, Bhagalpur, Bihar, India. In our study a total of 100 Primigravida patients between 18 to 35 years of age, attending antenatal outpatient department, were screened at 18 to 22 weeks of gestation with USG along with Doppler study. Follow up Doppler studies were done after 30 weeks of gestation in the third trimester as per indicated to determine a favorable or worsening trend in Doppler indices. Result: The study group included patients whose gestational age ranged from 18-22 weeks of gestation. Mean gestational age at the time of 1st scan was 20.10 weeks. The study group included patients whose gestational age ranged from 30-38 weeks of gestation. Mean gestational age at the time of 2st scan was 33.58 weeks. Of the 100 cases included in the study, 8 patients developed only PIH (3 PE + 5 GH); 9 patients had only IUGR and 7 patients were complicated by both PIH and IUGR. Incidence of PIH was 15% and IUGR was 16%.  Mean gestational age at time of delivery – 37.68 weeks. Preterm delivery – 21%. Term delivery – 79%. Minimum Birth weight – 1.40 kilograms. Maximum Birth weight -3.24 kilograms. Mean Birth weight at time of delivery – 2.7023 kilograms. Stay in NICU – 22%. Minimum stay in NICU – 3 days. Maximum stay in NICU – 14 days. IUGR – 16%. Amongst 24 patients with abnormal Doppler: 7 patients delivered vaginally (29.17%). 17 patients underwent LSCS (70.83%). Amongst 76 patients with normal Doppler: 68 patients delivered vaginally (89.47%). 8 patients underwent LSCS (10.53%). In 100 patients: 75% had Vaginal delivery. 21% had Emergency LSCS. 4% had Elective LSCS. Conclusion: Elevated uterine artery PI and presence of diastolic notch appears to be more significantly superior to other parameters in prediction of Preeclampsia. Umbilical artery Doppler findings are better predictor of perinatal outcome than abnormal MCA in early weeks of gestation whereas MCA PI Doppler is more useful than Umbilical PI or uterine artery in predicting the adverse perinatal outcome in later weeks.

DOI: 10.5281/zenodo.

73. A Retrospective Study of Clinical Profile and Risk Factors of Pulmonary Arterial Hypertension in Chronic Kidney Disease
Gangesh Kumar Gunjan, Anand Kumar Jha
Abstract
Aim: The aim of the present study was to assess the occurrence of pulmonary arterial hypertension in chronic kidney disease and to study the risk factors for development of pulmonary arterial in these patients. Methods: This was an observational cross section study conducted on 100 patients of CKD (based on KDIGO 2012 criteria) attending medicine OPD or admitted to Department of General Medicine, Jannayak Karpoori Thakur Medical College and Hospital Madhepura,, Bihar, India. Results: Pulmonary hypertension was found in 60 patients (60%) of the study population. No significant association was seen between age, BMI, presence of diabetes and S. Uric acid with presence of PH. Significant association was seen of systolic and diastolic blood pressure with PH. Significant association was also seen of severity of CKD with PH. Presence of hemodialysis and dialysis duration were significantly associated with PH. Of 60 patients with PH, 23 patients had mild PH, 32 patients had moderate PH and 5 patients had severe PH. Conclusion: We concluded that pulmonary arterial hypertension is significantly associated in patients of CKD and increase in severity of PAH occurs with deterioration of renal function in CKD cases. Anemia, duration of dialysis, hypertension, hyperparathyroidism, AV fistula, increased calcium phosphate product and left ventricular failure are risk factors for development of PAH.

DOI: 10.5281/zenodo.

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