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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 10^o-20^o and in 28% of patients, it was <10^o 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.

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.

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.

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.

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.

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.

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.

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.

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.

Aim: The aim of the present study was to compare 0.6mg VS 1.2mg of intrathecal inj. Nalbuphine with inj. bupivacaine heavy 0.5% 3.5cc to establish the most effective dose for maximum postoperative analgesia in lower abdominal and lower limb surgeries. Methods: The present study was conducted in the Department of Anesthesiology, Government Medical College and Hospital, Bettiah, Bihar, India  from January 2021 to December 2021. 50 patients with ASA physical status I or II, aged 20-60 years, weighing 40- 80 kgs, scheduled for elective lower abdominal and lower limb surgeries, of duration less than 2 hrs, under subarachnoid block, were included in the study. Results: The difference in mean age, mean weight and mean duration in both groups was found to be not significant (p>0.05). Mean duration of onset of motor blockade in Group A was 80.1 ± 11.01 seconds and in Group B it was 79.02 ± 7.98. The difference in mean duration in both groups was found to be not significant (p>0.05). Two segment regression time showed that mean duration in Group A was 62.2 ± 7.1 seconds and in Group B it was 76.9± 6.19. The difference in mean duration in both groups was found to be statistically highly significant (p<0.001). It means there is more time required in Group B as compared to Group A. Conclusion: Intrathecal Nalbuphine (1.2mg) added to Intrathecal Bupivacaine 0.5% heavy (17.5mg) provides prolonged postoperative analgesia without increasing risk of side effects. Further studies are required to determine optimal dosage of intrathecal Nalbuphine.

DOI: 10.5281/zenodo.

Aim: To evaluate the orthodontic treatment requirements in Indian school children by using the cosmetic component of the Index of Orthodontic Treatment Need (IOTN). Material and Methods: The present retrospective study was conducted in the Department of Dentistry, Patna Medical College and Hospital, Patna, Bihar, India during January 2019 to December 2019. The age group for selection was 6-12 yrs with mixed dentition. There was a selection criterion which was to be followed. The inclusion criteria were, Children with mixed dentition. Those children who were not having any history of previous orthodontic treatment were included in the study. After all the inclusions and exclusions total 400 subjects were examined (202 boys and 198 girls) Examination was done by a single operator by checking the aesthetic view of the samples and comparing them with set of ten colour photographs showing different levels of dental attractiveness i.e. SCAN -A Standardized Continuum of Aesthetic Need Scale popularly known as “SCAN”. Thus, the aesthetic view was examined and marked according to the aesthetic view in SCAN Index. Results: Of the studied subjects (400) 103 subjects were having their aesthetic view as type 7 of the scan index which was the highest followed by 58 subjects having their aesthetic view as type 5 of the scan index. Need of treatment Borderline (51.25%) Boys =54.63% , Girls =45.36% Immediate (21.75%) Boys=49.42%and  Girls=50.57%. Conclusion: The threshold for borderline values should be reduced. The demarcation between the absence of treatment need and the presence of treatment necessity should be clearly defined. Even though, the Index of Orthodontic Treatment Need may not be an ideal one, but this index could be considered as good malocclusion index, since it fulfils some of criteria of good index as stated by Young and Striffler. The examination only takes less than one minute if the malocclusion is not too complicated.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the acquired demyelinating diseases in children. Methods: The present study was conducted in the Department of Pediatrics, Patna medical College and Hospital, Patna, Bihar, India for the period of 1 year. A total of 50 patients were enrolled in the study. Results: Of these, 33 (66%) cases were of acquired demyelinating encephalomyelitis (ADEM), 10 (20%) of transverse myelitis (TM), 5 (10%) of neuromyelitis optica (NMO), 1 (2%) of optic neuritis (ON) and 1 (2%) of multiple sclerosis (MS). The mean age of presentation was 7.7 years (range: 2-12 years). Of 50 cases, 24 (48%) were male and 26 (52%) females. History of preceding illness was present as upper respiratory infection /acute febrile illness and mean duration between preceding events and onset of symptoms was 7.24±2.9 days. All patients diagnosed with ADEM had encephalopathy. Areas involved in descending order of frequency were subcortical white matter, basal ganglia, thalamus, brainstem, cerebellum and spinal cord involvement. Conclusion: Children presenting with new, subacute focal neurological deficits with history of some preceding event and in absence of trauma, metabolic derangements, or structural abnormalities should be suspected of having acquired CNS demyelination. These patients should be investigated with CSF analysis, serum antibodies and neuroimaging. ADEM is the most common among ADS. Early diagnosis and management with steroid therapy improves outcome in most of the patients.

DOI: 10.5281/zenodo.

The study was carried out to compare the efficacy of nasal transseptal suturing with that of anterior nasal packing after septoplasty in the department of ENT, JLNMCH, Bhagalpur between March 2021 to November 2022. Two groups of 30 patients each were assessed. Group A was assigned to all patients with septoplasty with nasal transeptal suturing while Group B was assigned to all patients where anterior nasal packing was done after septoplasty. The patients were followed up for 6 months.VAS score for post op nasal pain and headache were significantly low in group A.In group A no facial edema was seen. Incidence of synechiae was also less in group A as compared to group B..From this study better results were seen in group A where transseptal suture after septoplasty was done.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the  effect  of  intra-articular  steroid injection  for osteoarthritis knee by using knee society score (KSS) and visual analog scale (VAS). Methods: This retrospective study was conducted in the Department of Orthopedics, Madhubani Medical College and Hospital, Madhubani, Bihar, India for one year. A retrospective  study of 42 patients (50 knees) diagnosed with osteoarthritis of knee were given 80mg of intra-articular methylprednisolone injection. Results: 42 patients (50 knees) between 58 to 84 years of age with a mean age of 67 years were part of the study. 10 patients had bilateral OA knee, 24 males and 18 females. Thus in our study, the p value for knee society score pre- injection and post-injection was found to be >0.05 which was statistically not significant and the p value for visual analog score pre-injection and post-injection was found to be <0.05 which was statistically significant. Conclusion: Intra-articular steroid injection for osteoarthritis of knee produces significant pain relief for most patients even in severe cases but this does not translate to better functional outcomes.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the labetalol and Nifedipine in the management of severe pre-eclampsia. Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Nalanda Medical  College and Hospital, Patna, Bihar, India for Jan  2021 to December 2021 and in this study all the cases of pregnancy induced hypertension patients of acute hypertensive crisis admitted under OBGY department about 50 cases was studied. Patients of acute hypertensive crisis was divided in two groups Group A -25 patients of acute hypertensive crisis treated with Nifedipine Group B-25 patients of acute hypertensive crisis treated with Labetalol. Results: The current study shows pertaining to Labetalol patients, the maximum number women fell in age group of 15-20 yrs,i.e 4, In age group of 21-25 yrs were 12, In age group of 26-30 yrs were 3, In age group of 31-40 were only 4. Similarly patients administered with Nifedipine, in age group of 15-20yrs were 5, in 21- 25 yrs had maximum number of patients as 15, in age group of 26-30yrs were only 5 and no patients belonging in age group of 31-40yrs. In my current study, of severe pre eclamptic women, 68% women were primigravida and whereas 32% were multigravida. Statistical status of intergroup differences of changes in Mean Fetal heart rate after the treatment started, (the P-value obtained was > 0.05), not significant in both Nifedipine and Labetalol group. In Grade of 0 had 12 patients, Grade 1 had 3 patients, Grade 2 had 4 patients, Grade 3 had 6 patients and Grade 4 and grade 5 zero patients were there. Similarly in patients given Labetalol were in grade 0 had 15 patients, Grade 1 had 3 patients, grade 2 had 6 patients, Grade 3 had 1 patient, Grade 4 and Grade 5 category were zero patients. Conclusion: The present study concluded that Nifedipine is the preferred drug in case of severe pre-eclampsia to control blood pressure as it is more efficacious and can be used in the peripheral centers due to cost effectiveness and its ease of administration and storage.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyse the efficacy of various hematological parameters in comparison with blood culture in neonates presented with septicemia. Methods: The present study was a prospective study of 200 cases of neonatal sepsis admitted to Neonatal Intensive Care Unit (NICU), DMCH, Darbhanga, Bihar, India with clinical evidences of septicaemia for the period of 3 years. Detailed clinical history was taken and thorough clinical examination was done for every neonate admitted in NICU. Results: The present study showed a male preponderance. Majority of neonates are of age group less than 7 days (80%), followed by age group of 7-14 days (12%) and 15-28 days (8%) and significant number of neonates presented with sepsis were full term (52%), followed by 32% cases being pre term and 16% cases of late pre term. Majority of babies neonates in present study were having low birth weight (54%), while 6% cases were presented with very low birth weight and 40% are of normal birth weight. Out of 200 neonates, 88 had onset of sepsis within first 72 hours of life, while remaining 112 had late onset of symptoms (>72 hours). Out of 200 cases, 150 cases were culture positive while remaining 50 cases were culture negative. Nearly half of the neonates born by LSCS (48%), followed by normal vaginal birth (47%), and remaining 10 cases by forceps and vaccum assisted delivery respectively. 34 patients had abnormal TLC and140 had abnormal neutrophil count. 114 patients had absolute immature neutrophil count and 22 patients had increased immature to total neutrophil count ratio. 56 patients had nucleated RBCs, 78 patients had abnormal platelet count and 174 patients had increased CRP. Conclusion: Degenerative neutrophil change like toxic granulation was found to be the most useful parameter in detecting sepsis early. CRP also had high sensitivity. NRBC count, I/T Ratio and I/M Ratio were not found to be very useful tests.

DOI: 10.5281/zenodo.

Aim: To test the concentration of blood glucose in EDTA/F plasma and serum samples in a clinical laboratory in the Bihar area. Materials and Methods: This study was conducted in the Department of Microbiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India from Jan 2019 to December 2019. Blood samples for glucose concentration measurements were collected from sixty- three participants irrespective of their age, gender, fasting- and disease state. Written informed consent was obtained from all participants. Different glucose measurements were done for each participant on four occasions based on samples obtained at the same time but collected and handled differently. Results: The P-Glucose and S-Glucose decreased with time, faster in serum than in plasma. The mean glucose concentration at 30 minutes, 4 hours with early centrifugation, and 4 hours with delayed centrifugation along with the percentage decrease in mean blood glucose concentration and the level of significance in between tubes are shown in table 1. The plasma samples at 30 minutes (P1a) were taken as the reference method and were compared with P1b , S1b, and S2a (table 2). An allowable error zone of ±6% around the Deming regression line was calculated and shown as “funnel-shaped” areas. The zones included 98 %, 98 %, and 63 % of the sample results, in the comparison of P1b, S1b, and S2a to P1a, respectively. Conclusions: Blood glucose measurement in serum can be accepted if the serum separation via centrifugation is achieved within 30 minutes. The avoidance of an extra amount of blood draw in a separate NaF tube and better turn-around-time are advantages of using serum tubes. It should be mandatory to have a centrifuge at all collection centers to achieve blood separation within a reasonable time.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the effect of inj. Rocuronium with priming dose and inj. Rocuronium without priming on intubating conditions and onset time of intubation with respect to rocuronium as bolus. Methods: The present study was single-center, retrospective study, conducted in Department of Anesthesia, Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar, India. Study duration was of one year. 100 patients were included in the study. Results: We compared mean age, weight, gender and ASA grade between group C and group P and difference was statistically not significant (p value >0.05). We compared preoperatively baseline mean HR, mean HR at induction, mean HR at intubation, at 1 minute after intubation and at 5 minute after intubation between group C and group P, the difference between two groups was statistically insignificant. We compared mean MAP preoperatively baseline, at induction, at intubation, mean HR at 1 minute after intubation and mean HR at 5 minutes after intubation between group C and group P, the difference between two groups was statistically insignificant. We compared mean SPO2 preoperatively baseline, at induction, at intubation, mean HR at 1 minute after intubation and mean HR at 5 minutes after intubation between group C and group P, the difference between two groups was statistically insignificant. In group C mean Onset Time of Intubation was 93.36 ± 6.24 seconds, while in group P it was 57.00 ± 6.74 seconds, so the difference between the groups on the basis of OTI was statistically highly significant. Conclusion: Rocuronium with priming would be an excellent alternative to succinylcholine, whenever fast induction will be needed. Intubating conditions were good to excellent and comparable in both rocuronium with priming and without priming. NMT monitoring is a useful tool for indicating the clinically acceptable paralysis.

DOI: 10.5281/zenodo.

Aim: To assess the audiological characteristics and success rate of endoscopic composite cartilage transplant tympanoplasty in patients with chronic otitis media in the Bihar area. Material and Methods: This retrospective study was conducted in the Department of ENT, Madhubani Medical College and Hospital, Madhubani, Bihar, India from March 2022 to February 2023. This study included 50 patients of chronic otitis media with dry and safe central perforation (small/medium), who underwent endoscopic composite cartilage tympanoplasty (type I) in the Otolaryngology Department. All selected patients were subjected to a thorough history regarding presenting complaints, any chronic illness, any long-duration medication, or any systemic disorder. Clinical examination, otoscopy, oto- endoscopy, tuning fork tests, and X-ray (bilateral) mastoid (Schuller’s view) were done in all patients. Hearing assessment by pure tone audiometry (PTA) was performed on all patients. The air conduction (ACT) and bone conduction (BCT) pure-tone average were calculated by averaging the thresholds at 0.5, 1, 2, and 4 kHz. Results: In our study, the duration of ear discharge ranged from less than 1 year to more than 5 years. Out of the total 50 cases, 7 (14%) cases had ear discharge for less than 1 year, 25 (50%) for 1-5 years, and 18 (36%) cases for more than 5 years. The maximum number of subjects had a discharge history between 1-5 years (50%). In this study, 4 (8%) cases were found to have decreased hearing for less than 1 year, 31 (62%) cases reported decreased hearing for 1-5 years, and 15 (30%) cases had it for more than 5 years. In our study 8 (16%) cases had diploic mastoid, 28 (56%) had pneumatized mastoid and 14 (28%) had sclerosed mastoid as revealed by X-ray mastoid. In this study of 50 cases, 23 (46%) patients were operated on in the left ear and 27 (54%) patients were operated on in the right ear. The result of this study showed graft uptake success in 47 (94%) cases and failure was seen in 3 (6%) cases. The pre-operative ACT was 42.82±7.33 dB whereas postoperatively it was 31.26±7.48 dB and the difference between the pre-operative and post- operative values was found to be statistically significant. Conclusion: In our study, we conducted an endoscopic composite cartilage graft tympanoplasty (type-I) in 50 cases and observed a graft uptake success rate of 94%. There was good uptake of graft along with improvement in the audiological profile of the patients. Besides the 3 failure cases with residual perforation, no significant postoperative complications were observed during the study.

DOI: 10.5281/zenodo.

Aim: To examine the range of diabetic nephropathy in individuals with type II diabetes mellitus. Material and Methods: This retrospective study was conducted in the department of Medicine, JNKTMCH, Madhepura, Bihar, India for 20 months. A total 30 patients were male and 20 were female. The mean age was 47.2. Informed and written consent was obtained from patient or a responsible attendant before including the patient in the study. We have divided the patients in 2 groups of 25 patients each. Group A: Diabetic patients with hypertension or obesity or hypercholesterolemia. Group B: Diabetic patients without any of comorbidities. Results: A total 30 patients were male and 20 were female. The mean age was 47.2. Out of 50 total patients, 8 patients were detected to have Diabetic Nephropathy. In group A, out of 25 patients 6 (24%) patients had diabetic nephropathy, while in group B, out of 25 patients 2 (8%) patients had diabetic nephropathy. A subgroup analysis was done with regards to multiple co-morbidities, showing increasing number of patients affected with increasing comorbidities of with diabetic nephropathy patients. Conclusion: We conclude that S. Creatinine is a very poor marker of Nephropathy and maybe medical fraternity needs to stop depending on it as screening tool for Diabetic Nephropathy. Hypertension, obesity and hypercholesterolemia can contribute to development of nephropathy, and also, urinary microalbuminuria appears to be much more sensitive than serum creatinine.

DOI: 10.5281/zenodo.

Aim: To determine the effectiveness of several topical treatments for persistent plaque psoriasis. Material and Methods: It was a retrospective study was conducted Department of Dermatology, GMCH, Purnia, Bihar, India for one year. The present study was carried out on patients having chronic plaque type psoriasis vulgaris. After obtaining ethical clearance, written, informed and signed consent patients suffering from stable chronic plaque type psoriasis involving less than 10% of body surface area and those had neither applied topical for last 2 weeks and nor taken systemic drugs for psoriasis for last three months, were enrolled. Total 75 patients were enrolled and were divided in three groups comprising of 20 patients in each group. Group A patients were asked to apply ammonium lactate twice a day, Group B patients were asked to apply ammonium lactate in morning and clobetasol propionate in evening, Group C patients were asked to apply topical ammonium lactate in morning and calcipotriol in evening. Result: No significant difference was noted between study groups (p=0.630). Further on comparison of individual groups it was found that significant difference was present between PASI at 8 weeks between group A and group B (p=0.045), group A and group C (p=0.030) but between group B and group C (p=0.990) difference was not significant. PASI 50 was calculated in all three groups and it was found that 9(45%) out of 20 subjects attained PASI 50 in group A, 13(65%) out of 20 patients in group B and 13(65%) out of 20 patients in group C. Physician global assessment scale shows that in Group A, 5(25%) patients had excellent response, 4(20%) patients had good response, and 4(20%) patients had fair response whereas 7(35%) patients had poor response. In group B, 6(30%) patients had excellent response, 7(35%) patients had good response, and 3(15%) patients had fair response whereas 4(20%) patients had poor response. In group C, 6(30%) patients had excellent response, 7(35%) patients had good response, and 2(10%) patients had fair response whereas 5(25%) patients had poor response. Conclusion: Combination therapy is effective, well tolerated with minimal side effects and better compliance was seen with patients. Ammonium lactate 12% can also be considered as one of the topical options as a monotherapy and also as a maintenance therapy. But more number of Indian studies are required as there is paucity of literature on topical treatment of psoriasis.

DOI: 10.5281/zenodo.

Aim: To compare the pain-relieving effectiveness of Butorphanol and Fentanyl in different surgical procedures. Material and Methods: A prospective randomized, double-blind study was conducted in the Department of Anesthesia, PMCH, Patna, Bihar, India for 12 months.   Physical status of ASA I and ASA II Age group between 18 to 55years. Gender-Both Males and Females were included in this study.  Patients with Cardiovascular diseases like hypertension, ischemic heart disease, valvular heart disease  Respiratory diseases like asthma, pulmonary tuberculosis, COPD Renal or hepatic derangement, Haematological derangements.  Those taking psycho therapeutic drugs. Pregnant females History of narcotic abuse. Results: The study compared the analgesic efficacy and safety profile of Butorphanol and Fentanyl in patients undergoing general anesthesia for various surgeries. Both groups were comparable in terms of demographic data, including age and weight, with no statistically significant differences observed. The duration of surgery was slightly longer in Group A (Butorphanol) compared to Group B (Fentanyl), but the difference was not statistically significant. Baseline VAS and sedation scores were similar between the two groups, indicating comparable preoperative pain and sedation levels. Sedation scores during surgery were higher in Group A at 30 and 60 minutes, with statistically significant differences, suggesting that Butorphanol provided more sedation compared to Fentanyl during these time points. VAS scores for pain were significantly higher in Group B at 60 and 90 minutes postoperatively, indicating that Butorphanol provided better postoperative analgesia compared to Fentanyl . Rescue analgesia was administered to more patients in Group B, but the differences were not statistically significant. Conclusion: Both butorphanol and fentanyl are cardio stable and provide intense intraoperative analgesia. Butorphanol provides significant postoperative analgesia for a longer duration as compared to fentanyl.

DOI: 10.5281/zenodo.

Aim: This study was mainly aimed at analysing electrolyte abnormalities in children with diarrhoea in relation to their type of feeding. Material & Methods: This cross-sectional observational study was conducted in Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India from January 2020  December 2020. Total of 200 children presenting to pediatric unit with acute diarrhoea under five years of age were selected. Results: The mean age of the study participants was 25.05±18.12 months. The median age of the study participant was 18.12 (inter quartile range=9.0-36.5) months. The minimum age was 1.1 months and the maximum age was 60 months. Majority of the children belongs to the age category of less than one year which was 48%. Out of 200 children, 60% were males and 40% were females. In electrolyte imbalance, majority of the participants had hyperkalemia which was 30% followed by 20% had hyponatremia, 15% had hypokalemia, 10% had hypernatremia and 1% had chloride level more than 108 mmol/l. Sodium levels, potassium levels and chloride levels were equally distributed in both the groups with the p value of more than 0.05. Conclusion: Except with hypokalaemia, our study did not find a statistically significant relationship between electrolyte abnormalities in diarrhoea in children with type of feeding. But still, need for exclusive breastfeeding, continuation breast feeding more than two years remains protective against acute diarrhoea in children.

DOI: 10.5281/zenodo.

Aim: To assess the connection between ultrasonography (USG) and X-ray in the assessment of pleural effusion using quantitative analysis. Material and Methods: This study was conducted in the Department of Radiodiagnosis, Patna Medical College and Hospital, Patna, Bihar, India from March 2018 to Feb 2019. Pleural effusion can be defined as accumulation of unwanted fluid in between the tissues in the lungs and chest which hinder the normal functioning of the lungs. In current study, a quantitative analysis is done between the X Ray and Ultrasound to find out better modality for evaluating the quantity of pleural effusion. It is a Prospective, Observational, and comparative study. The source of data for this study includes total 20 patients for chest radiography and ultrasonography from OPD/IPD/ED. Among which 13(65%) were male and 7(35%) were female of average age 38.3years. All the Patient with post-diagnosed of pleural effusion, All the patient IPD & OPD, both male & female patient were included, no age limitation were included in this study. Pregnancy, those patients who were not diagnosed with pleural effusion were excluded from the study. All the patients who have come for Chest Imaging. After the X Ray of Chest is done, if case of any doubt of Pleural effusion, the USG Chest is performed and vice versa. Results: USG showed 10(50%) male, and 3(15%) females had pleural effusion in right lung whereas 5(25%) female and 6(30%) males had pleural effusion in left lung. In x-ray images 8(40%) males and 2(10%) females showed pleural effusion in right lung and 4(20%) female, 3(15%) males had effusion in their left lung. 3(15%) patients had effusion in their right lungs in USG images but not on their X-ray results, while 4(20%) patients’ USG images showed effusion in left lung which cannot be seen on their X-rays. For right lung minimum volume of fluid level 37.8ml and 346mL was maximum volume and the average volume was 93.98mL. In left lung minimum 37.8 ml of fluid was detected and maximum recorded was 221.4mL and average volume recorded is 60.1mL. Conclusion: The present study “USG correlation with X-ray for evaluation of pleural effusion with quantitative analysis” is a prospective study conducted in patients to find the correlation of USG and X-Ray in evaluation of pleural effusion in radio-diagnoses and imaging in hospital. USG is some distance superior than simple X-Ray in locating of minimal pleural & also for quantification of effusion pleural furthermore, intervention like pleural faucet can also done. USG can locate low amount of fluid presence even less than 3 ml, while X- ray fails to help diagnose such low quantity of fluid.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find out the modifiable risk factors which are responsible for the non- adherence among the diabetes population. Methods: The Present retrospective study was performed on 500 diabetes patients who have visited Department of Medicine, Katihar Medical College and Hospital, Katihar, Bihar India for the period of 1 year. Results: Average study cohort age, weight, height, and BMI were 48.62±10.12 years, 64.96±12.08 kgs, 164.76±8.08 cm, and 25.35±4.06kg/m2. Most patients were men 350 (70%). Most of the 500 patients (485/97%) had T2DM, followed by 15 (3%). Only 75 (15%) individuals have diabetes in their families. After 200 (40%) illiterate patients, 140 (28%) graduates were present. Most patients (490) were married (98%). oral antidiabetic medicines 475 (75%) and Ayurvedic plus oral 100 (20%) were used by most patients. Only 25 (5%) were insulin-treated. In this trial, 400 (80%) patients were off therapy for 1-5 months, followed by 60 (12%) for 6-10 months. The most prevalent reason for treatment cessation was long-term medicine (75%), followed by not knowing the repercussions of skipping doses (68%), drug side effects (65%), and financial issues (58%). Conclusion: Identifying patients with low adherence is crucial to improving the causes. Individually reducing risk variables for poor adherence may improve glycemic control in diabetic patients.

DOI: 10.5281/zenodo.

Aim: Evaluate the frequency of pterygium recurrence after surgery using conjunctival autograft and fibrin glue. Materials and Methods: The present study was conducted in the Department of Ophthalmology, DMCH, Darbhanga, Bihar, India for 12 months. it comprised of 72 patients of pterygium of both genders. All were well informed regarding the study and written consent was obtained. Ethical clearance was taken prior to the surgery. Pterygium was graded in four stages, grade 1 (less than 2.0 mm), grade 2 (2.0 mm – 4.0 mm), grade 3 (higher than 4.00 mm, without covering the visual axis) and grade 4 (tissue covering the visual axis). Mixture of gatifloxacin 0.3% prednisolone acetate 1.0% every 6 hours, starting one day before the operation and then, every 2 hours until two days and after that every 6 hours during the next 20 days. Ketorolac 0.5% topical drops, every 8 hours, starting one day before and after the operation for 20 days was prescribed. Routine follow-up time was performed in all cases. Results: out of 72 patients, males were 42 and females were 30. Table 2, graph I shows that grade I was seen in 16 patients, grade 2 in 28, grade 3 in 20 and grade 4 in 8 patients. Recurrence rate was 0 with grade I, 1 with grade 2, 2 with grade 3 and 2 with grade 4. The difference was significant (P< 0.05). Table 3 shows that time of follow ups was 3 months in 4 cases, 6 months in 2, 9 months in 6 cases, 12 months in 14, 15 months in 20 cases. Conclusion: we found that Pterygium management with conjunctival autograft is a very simple, easy, economical and with less complication’s procedure. A low pterygium recurrence rate was observed after conjunctival autograft with fibrin glue.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the etiological profile of febrile thrombocytopenia in children aged between 1 month to 12 years admitted to the pediatric department. Methods: The present study was a hospital based observational study done in the department of Pediatrics at JLNMCH Bhagalpur, Bihar, India for the period of one year. Patients between 1 month to 12 years of age who presented with fever in whom complete blood picture showed thrombocytopenia (platelet count <1,50,000 /mm3) at the time of hospitalization were taken up for the study. Patients less than 1 month and greater than 12 years of age and patients on drugs known to cause thrombocytopenia were excluded from the study. Results: Majority of the cases (52%) belonged to the age group 1-6 years, and (45.5%) belong to the age group of 7-12 years. Among these cases females (55%) are more common than males (45%). The most common etiology of fever with thrombocytopenia was dengue fever (61%), followed by malaria (12%), enteric fever (10%), other undifferentiated viral fevers (10%) and MIS-C (multisystem inflammatory syndrome in children) (5%), immune thrombocytopenic purpura (2%), leukaemia (0.5%) and hepatitis A (0.5%). The common symptoms associated with patients having febrile thrombocytopenia were headache in 70%, followed by body ache in 51%, retro-orbital pain 42%, pain abdomen 30% and bleeding manifestations 22% cases. 104 patients had mild thrombocytopenia, 36 patients had moderate thrombocytopenia and 60 patients had severe thrombocytopenia. Among the total dengue cases (n=122), severe thrombocytopenia was seen in 71 children. Duration of hospital stay in majority of cases (65%) was prolonged to due to bleeding manifestations and associated complications. Conclusion: Febrile thrombocytopenia is a common clinical presentation in children. Majority of the dengue cases responded well to treatment given as per WHO guidelines. In most of the other infections, thrombocytopenia was transient and asymptomatic with lesser severity and resolved with the treatment of underlying condition.

DOI: 10.5281/zenodo.

Aim: The aim of the study was to analyse the prescriptions for completeness. Methods: The present study was carried out by  Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. Duplicate carbonless copies of the prescriptions with at least one antibiotics were collected from the doctors at regular intervals. Total of 1713 prescriptions were collected and analysed. Results: 3942 drugs were prescribed, out of which 1614 were antibiotics. Average number of drugs per prescription is 2.6 and average number of antibiotics per prescription is 1.1. In department of ENT more than one antibiotic was prescribed in 33.24% of prescriptions. Analysis of prescriptions in each department reveals that mentioning of gender and age of the patient along with date of prescribing was least in department of general medicine. Department of urology followed by department of general surgery have prescriptions with least outpatient number mentioned in them. Outpatient number and age of the patient were least mentioned variables among all the departments analysed. Inappropriate antibiotic dosage formulations were mostly seen in the departments of urology, general medicine and OBG. Conclusion: Primary care services are at the heart of health care services in any country. Improving safety in primary care is essential when striving to ensure universal health coverage and the sustainability of health care. Medication errors have a negative impact on patients’ health and therefore should be minimized. Understanding the magnitude and addressing issues of prescription errors is essential to improve patient safety in health care. Interventions to prevent prescription errors need to be implemented.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find the prevalence and risk factors associated with sensorineural hearing loss in patients with systemic hypertension. Material & Methods: A cross-sectional study conducted during the period of 12 months aimed at finding out the prevalence of sensorineural hearing loss and the risk factors related to hearing impairment among systemic hypertensives in Department of ENT, Nalanda medical college and Hospital, Patna, Bihar, India. 200 patients attending the outpatient Department of ENT, Nalanda medical college and Hospital, Patna, Bihar, India meeting the inclusion and exclusion criteria were recruited for the study. Results: Maximum participants were in the 56-60 age groups (47%). Female participants predominated in our study (65%).When right ear and left ear were studied separately, 68 patients (34%) had sensorineural hearing loss in the right ear, whereas 66 patients (33%) had sensorineural hearing loss in left ear. When hearing thresholds at individual frequencies were noted, in the right ear 84 patients (42%) had hearing loss at 250 Hz, 68 patients (34%) had hearing loss at 500 Hz, 64 patients (32%) had hearing loss at 1 kHz. Similarly, in the left ear, 74 patients (37%) had hearing loss at 250 Hz, 66 patients (33%) had hearing loss at 500 Hz, 56 patients (28%) had hearing loss at 1 kHz, 64 patients (32%) had hearing loss at 2 kHz, 88 patients (44%) had a hearing loss at 4 kHz and 116 patients (58%) had hearing loss at 8 kHz. The patients in 55-60 age group had a higher incidence of hearing loss when compared to the remaining study population. In our study, we had around 24newly detected hypertensives, 44 patients with duration of hypertension less than 1 year, 70 patients with duration of illness ranging from 1-5 years, 40 patients with 6-10 years duration of hypertension and 11 patients having hypertension for more than 10 years. Conclusion: Sensorineural hearing loss has a high prevalence among patients with systemic hypertension. Hence, apure tone audiometry should be done routinely in all hypertensives, particularly in elderly patients with long standing systemic hypertension. Periodic audiological assessment should be incorporated in them to start rehabilitation as early as possible. Early diagnosis of systemic hypertension in the community and initiation of treatment can help to further hinder the progression of microvascular disease that leads to target organ damage.

DOI: 10.5281/zenodo.

Aim: To assess ocular anterior segment and corneal parameters in individuals with celiac disease. Materials and Methods: This study was conducted in the department of Ophthalmology, Patna medical college and hospital, Patna, Bihar, India for 7 months. Adult   subjects with a diagnosis of celiac disease, consecutively evaluated and a control group of healthy subjects chosen among spouses of patients and hospital staff were enrolled in this retrospective study. Diagnosis of celiac disease was confirmed by intestinal biopsy and serology, regardless of the time of diagnosis. Since the diagnosis, all celiac patients were under treatment with a gluten-free diet. Concerning control subjects, they had at least one negative specific serology for celiac disease and no diagnosis of any gastrointestinal diseases. Results: Seventy patients with celiac disease and 70 healthy subjects were included, while three celiac patients with anterior segment disease (two patients with Fuchs disease and one with pterygium) and another who underwent refractive surgery were excluded. The mean disease duration of the celiac patients was 9.3 ± 8.5 years (range: 0–41 years). The demographic characteristics of the two groups, no statistically significant differences for gender, age and AL between the two groups. Concerning slit-lamp examination, no clinical signs of corneal damage were found in the included celiac patients. Regarding all analyzed tomographic parameters, no statistically significant differences were found between the two studied groups. The same results were obtained by comparing males and females between the two groups. Conclusion: In conclusion, the ocular anterior segment parameters of celiac patients are not significantly different from those of healthy subjects, suggesting none of the underlying pathogenetic implications of this disease affects the assessed structures. Nevertheless, due to the association between celiac disease and other ocular disorders, such as cataract, uveitis, dry eye, neuro-ophthalmic manifestations, night blindness, occlusion of the central retinal vein, and orbitopathy associated with thyroid, a routine ophthalmological examination for all celiac patients should be recommended throughout their lifetimes.

DOI: 10.5281/zenodo.

Aim: To investigate the range of cytopathological abnormalities seen in thyroid lesions in a tertiary care hospital. Material and Methods: This study was conducted in the department of pathology, NMCH Patna, Bihar, India from June 2019 to May 2020. A total of 801 thyroidectomy specimens received in the histopathology laboratory, were included in the study. All biopsies were fixed in formalin and embedded in paraffin. The sections were stained with haematoxylin and eosin. Special stains like Congo Red, Periodic acid Schiff and reticulin were used whenever needed. After pathological diagnosis, the demographic data and final report were systematically entered into the register. The biopsy registers were reviewed and different lesions were categorized. Age and sex-wise variations of the lesions were noted. Results: Multinodular goiter is the most common non-neoplastic thyroid lesion (71.5%) followed by thyroiditis. There were only 6 cases of toxic goiter among all the thyroid lesions received. Among the 801 thyroid lesions, there were 151 carcinomas (18.8%). Maximum numbers of carcinomas are seen in age group 31-40 with 43 cases, followed closely by fourth decade. There were no thyroid malignancies upto second decade. The numbers of malignancies were very minimum above 70 years (2.7%). The frequency of carcinomas among the total thyroid lesions is almost same for both males and females (18.82% and 18.85%). Papillary carcinoma was the most frequent malignancy, out of which half were of the micropapillary subtype. One of the thyroidectomy specimens showed two different primary malignancies (follicular carcinoma and papillary micro carcinoma). Anaplastic carcinoma was seen in only one thyroidectomy specimen. There was one metastatic thyroid carcinoma from a primary lung carcinoma. Conclusion: Multinodular goiter was found to be the most common thyroid lesion in this study. The percentage of malignant thyroid tumors was high compared to other studies done in Bihar. Papillary carcinoma was the most common malignant neoplasm. The micropapillary variant comprised 50% of the papillary carcinoma.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinic-investigative profiles of newly diagnosed type II diabetes patients. Methods: A retrospective study was conducted on out patients (OPD) of medicine department of Mata Gujari Memorial Medical College, Kishanganj, Bihar, India. Present study was conducted for the period from December 2018 to November 2019 and 100 patients were included in the study. All the newly diagnosed diabetes mellitus patients of either gender, who are willing to give informed consent were included in this study. Results: Out of that 55% were males and heart 45% were females. The mean age of the patients was 51.64 ± 9.51 years. Majority of diabetes patients were of 51-60 years (34%) of age. other common involved age groups were 41 to 50 years and 61 to 70 years. In all there group’s statistical significant difference was seen in fasting sugar level. PPBS levels were found to be statistical significant among patients having diabetic complication and not having complication. The difference of mean HbA1C level found to be statistical significant. Pearson’s correlation test between HbA1C level and lipid profile found to be not significant. Conclusion: The present study concluded that male and female have somewhat similar predisposition for diabetes mellitus. Commonest symptoms among diabetes are polyuria, polydipsia and polyphagia etc. Diabetic neuropathy and nephropathy are commonest complication among study participants and adults should be screen earliest to diagnose diabetes and to prevent its complications.

DOI: 10.5281/zenodo.

Aim: To determine the influence of maternal variables on the occurrence of low birth weight deliveries in the state of Bihar. Material and Methods: This study was done in the Department of Pediatrics, SKMCH, Muzaffarpur, Bihar, India. During this era, there were a total of 650 births, with 120 infants having a birth weight below 2.5 kg. The mothers of low birth weight (LBW) infants were interviewed using a pre-tested semi-structured interview schedule to collect information on prenatal, intranatal, and postnatal events. Prior written informed consent was obtained before conducting the interviews. Mothers who remained unresponsive after three consecutive visits or who did not provide permission were not included in the research. The research analyzed many parameters, such as the incidence of low birth weight (LBW), the demographic characteristics of mothers (age, education, employment), socioeconomic level, consanguinity, method of delivery, the number of antenatal care (ANC) visits, maternal height, and the presence of medical conditions. Results: The research included a total of 650 births, with 120 infants being categorized as having low birth weight (weighing less than 2.5 kg). This yielded a prevalence rate of 18.46% for low birth weight. Out of the total number of newborns, 530 of them had a birth weight that was within the normal range, which makes up 81.54% of the total. Out of all the births, 66.67% were delivered vaginally and 33.33% were delivered by cesarean section. The percentage distribution of prenatal care (ANC) visits among the mothers is as follows: 8.33% had no ANC visits, 41.67% had 1-2 visits, 33.33% had 3-4 visits, and 16.67% had five or more visits. Regarding the height and medical conditions of the moms, 41.67% of them had a height below 150 cm, while 58.33% had a height of 150 cm or above. With respect to medical conditions, half of the moms had anemia, 16.67% had hypertension, 8.33% had diabetes, and 25% had no medical conditions. Conclusion: In conclusion, our study highlights the significant prevalence of low birth weight and the associated demographic, socioeconomic, and health-related factors among mothers in our community. These findings emphasize the need for targeted interventions to improve maternal and neonatal health outcomes, such as enhancing access to education, improving socioeconomic conditions, promoting regular antenatal care, and managing maternal health conditions effectively.

DOI: 10.5281/zenodo.

Aim: The purpose of this study was to investigate the relationship between gingival health status and dental caries in elementary school children. Methods: One hundred children (50 boys and 50 girls) in attendance were enrolled in this study in the Department of Dentistry, RDJMMCH, Turki, Muzaffarpur, Bihar, India for one year. Consent to a dental check-up was obtained from both the participants and their parents. Results: For the whole sample, the percentages of the A-group, B-group and C-group were 38 %, 35 % and 27 %, respectively. The percentages of children in the A-group aged 7, 8, 9, 10, 11 and 12 years were 50 %, 37.03 %, 30.76 %, 36.6 %, 33.33 % and 45.45 %, respectively. The percentages of the children in the B-group aged 7, 8, 9, 10, 11 and 12 years were 30 %, 29.62 %, 3846 %, 40 %, 44.44 % and 27.27 %, respectively. The percentages of the children in the C-group aged 7, 8, 9, 10, 11 and 12 years were 20 %, 33.33 %, 30.76 %, 23.33 %, 22.22 % and 27 %, respectively. The caries prevalence, caries experience and gingival status of elementary school children by gender were almost similar. Conclusion: The results of the study suggested that oral hygiene instruction should be given to children beginning in their early school years in order to motivate self-care to prevent not only dental caries but also gingivitis. Although the presence of gingivitis cannot be used to predict periodontitis, management of gingivitis in elementary school children should be recommended.

DOI: 10.5281/zenodo.

Background: Ligamentum Flavum (LF) wraps around the medial aspect spinal articulation and is composed more elastic than collagen fibres, hence it’s yellow in colour. Its elasticity diminishes with age and there is loss of elastic fibres and a concomitant increase of collagen fibres. The study compared the thickness of the LF between individuals with normal spinal conditions and those with lumbar spinal stenosis (LSS). The goal was to investigate variations in LF thickness and asymmetry observed in CT images, taking into account the size of the associated vertebral bodies across different ages and sexes. Method: The study involved measuring the thickness of the Ligamentum Flavum (LF) in 50 individuals with lumbar spinal stenosis (LSS) and 50 controls visiting Patna Medical College and Hospital, Patna, Bihar India, for one year, using CT images at the levels of L3-L4, L4-L5, and L5-S1. Analysis: A ‘t’ test and P-value analysis were performed to compare the results between the LSS and control groups. Results: The cross-sectional area of the dural sac was significantly smaller in the LSS group compared to the control group: at L3-L4 (control: mean 132.5, SD±46; LSS: mean 65.2, SD±23), L4-L5 (control: mean 133.3, SD±44; LSS: mean 48.3, SD±25), and L5-S1 (control: mean 136.2, SD±46; LSS: mean 91.2, SD±36). The thickness of LF at L3-L4, L4-L5, and L5-S1 showed significant differences between the LSS and control groups (P<0.01). Additionally, LF thickness in both sexes of the control group also showed significant differences (P<0.01). Conclusion: This empirical retrospective suggests that measuring LF thickness can be diagnostically valuable in assessing lumbar spinal stenosis across different ages and genders.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the effect of the timing of DCC on hemoglobin levels, neonatal outcomes and developmental status in neonatal. Methods: The study was conducted at Department of Obstetrics and Gynecology, IGIMS, Patna, Bihar, India. upon birth and at four months old on infants born to 200 pregnant women presenting to a healthcare center affiliated to IGIMS, Patna, Bihar, India  for one year. Results: The results obtained showed no significant differences between the two groups in terms of the mothers’ mean age. The mean level of umbilical cord blood hemoglobin was significantly higher in the intervention group compared to in the controls; the infants in the intervention group had developed jaundice more frequently than the controls, although there were no significant differences between the two groups in terms of the need for phototherapy. Studying the infants in terms of the different dimensions of their development at four months old showed problem-solving to be the only dimension in which the two groups differed, as the intervention group received higher scores for it nevertheless, no significant differences were observed in terms of the other dimensions and the overall score. Conclusion: The present study concluded that delays in umbilical cord clamping can significantly elevate umbilical cord hemoglobin levels; however, it also increases the risk of neonatal jaundice and has no effects on developmental status, except in the problem-solving dimension.

DOI: 10.5281/zenodo.

Aim: COVID-19 Range of high-resolution computed tomography chest findings in DMCH, Darbhanga. Material and Methods: This study was conducted in the department of Radiology, Katihar Medical college and Hospital, Katihar, Bihar, India for one year. 40 patients aged 22 to 83 years who were tested positive for COVID-19 by RT-PCR along with simultaneous conduction of HRCT chest in Radiology Department. These patients presented in either outpatient or emergency with symptoms of fever, cough/sore throat, or shortness of breath. PCR negative patients with positive HRCT chest findings for COVID-19 were excluded. All images were taken on 128 slice CT scanner with patient in supine position and scanning done from lung apices to costo-phrenic angles. The main scanning parameters were 120 KVP, 450 mAs, pitch 1.4, FOV of 406 mm and slice thickness of 1mm. CT was done without contrast. Images were sent to workstation and picture archiving and communication systems (PACS). Results: The most frequent finding on HRCT chest was combined GGO and consolidation 19(47.5%) with posterior and sub-pleural distribution 37(92.5%). Bilaterality was seen in 37(92.5%) while one (2.5%) had unilateral finding. Associated findings were lymphadenopathy 11(27.5%), pleural effusion 6(15.0%), bronchiectasis 5(12.5%) and emphysema 2(5.0%). Among two patients of early stage (0-2 days), one had normal HRCT, while other had GGO alone. Consolidation, crazy-paving and vascular enlargement were absent. Of nine patients of progressive stage (3-5 days), combined GGO and consolidation 4(44.4%) and GGO alone 3(33.3%) were seen. During late stage (6-12 days), among 29 patients, combined GGO and consolidation 15(51.7%), sub-pleural lines/bands 14(48.3%), vascular enlargement 13(44.8%) and crazy paving pattern 11(37.9%) were noted. Conclusion: HRCT chest evolving characteristics are effective in understanding variation in pattern of coronavirus disease. Identification of imaging patterns with respect to infection time course is an effective paramount for disease diagnosis, understanding progression and potential complications of disease.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the Diabetes and Hypertension among patients with psychiatric illnesses attending outpatient services. Material & Methods: A retrospective study was conducted among 500 patients seeking psychiatric care at the out-patient of Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India carried out between the duration of 8 months. Results: The mean age of the entire sample population was 42.8 years, with mean age comparable between males and females. Males represented 40% of the study population. Mean body mass index (BMI) and mean blood pressure (BP) of the study population was 26.4 kg/m2 and 120.5/75.5 mmHg, respectively. A large proportion of patients did not smoke (90%) or consume alcohol (95%). 15% had diabetes and 8% and hypertension. 5% had both diabetes and hypertension. 46.66% of patients with diabetes had the condition for less than 5 years while 53.34% of patients with hypertension had the condition for at least 5 years or longer. More than 86.66% of patients with diabetes or hypertension were undergoing treatment for their physical NCD. Twenty patients (4%) had both diabetes and hypertension. Age, presence of a family history of any physical NCD and duration of psychiatric illness of ≥5years were significantly associated with the presence of diabetes or hypertension (p<0.05). Schizophrenia, schizotypal and delusional disorders were most prevalent among patients with diabetes or hypertension, and combinations of antipsychotics with other psychotropic medications were predominantly prescribed to patients with these physical NCDs. No association was observed between the psychiatric diagnosis or psychotropic medications with the presence of diabetes or hypertension. Conclusion: Diabetes and hypertension are common physical NCDs in patients with psychiatric illness. Therefore, it is important that psychiatrists be aware of and identify patients who are at risk for such NCDs.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the efficacy and safety of 1% Terbinafine HCl ointment with 1% Naftifine HCl in patients with Tinea cruris. Methods: This study was done in the Department of Pharmacology and Department of Dermatology, Venereology & Leprosy, Patna Medical College and Hospital, Patna for one year. The study was conducted after approval from Institutional Ethical Committee, Patna Medical College, Patna. Results: The difference between these two groups in terms of demographic details was not statistically significant. Most of the study participants had presented with multiple lesions in both group A (terbinafine group) and group B (butenafine group). The difference between these two groups was not statistically significant. In group A (terbinafine group), erythema was present in 40 (100.0%) cases, scaling was present in 40 (100.0%) cases, central clearing was present in 34 (85%) cases, papule was present in 37 (92.5%) cases. The difference was not statistically significant (p>0.05) between two groups. The difference between the Clinical assessment score of the two groups was significant (p=0.001) after 1^st and 2^nd week. Transient burning sensation at the application site was found in one of 2 (5%) cases of Group A (terbinafine group); but it resolved spontaneously and did not require discontinuation of therapy. In contrast, no side effects were reported by Group B (butenafine group) participants. The difference was not statistically significant (p>0.05). Conclusion: The present study concluded that there was significant difference between the mean clinical assessment score of the two groups at the end of 2 weeks treatment period. Butenafine produced the quickest result and clinical efficacy was much higher with butenafine cream than that of terbinafine cream and this difference was statistically significant. Therefore, treatment with butenafine 1% cream was reported superior to treatment with terbinafine 1% cream in case of tinea cruris.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the serum free light chain assay and urine protein immunofixation in the diagnosis of patients with monoclonal gammopathy. Methods: The study included 22 patients, most of whom had monoclonal gammopathies and were hospitalized at Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India for one  year. Results: The median age of the patients (13 men and 9 women) was 64 years. 3 patients were suffering only from LCDD λ and 1 patient was suffering from non-secretory myeloma with FLC κ. 11 patients had multiple myeloma (6 with IgG κ, 1 with IgG λ, and 4 without isotype determination), 1 patient had type κ bi clonal gammopathy, 1 patient had AL amyloidosis, and 2 patients had no monoclonal gammopathy. 14 patients had a positive BJP (10 free κ and 4 free λ) and of these 14 patients 100% had an abnormal κ / λ ratio. 3 patients had no BJP but had an abnormal κ / λ ratio. Bence Jones proteinuria was detected in all patients with LCDD, non-secretory multiple myeloma and in the patient with AL amyloidosis. In contrast, BJP was detected in only 50% of patients with IgG κ multiple myeloma and was not detected in the patient with IgG λ myeloma. The 11 patients with a GFR lower than 60 had an abnormal ratio / and positive Bence Jones proteinuria. Conclusion: In conclusion, even if it has been demonstrated the higher sensitivity of the FLC assay in the diagnosis of monoclonal gammopathies, BJP still remains a marker that has its importance in these pathologies.

DOI: 10.5281/zenodo.

Aim: To analyse the clinical characteristics of falciparum, vivax, and mixed infections of malaria in a tertiary care hospital in Bihar, India. Material and Methods: A retrospective study was conducted in the Department of general medicine, Netaji subhas medical college and hospital, Bihta, Patna, Bihar, India for one year. All adult patients (>15 years of age) admitted with the diagnosis of P. vivax malaria, P. falciparum, and mixed malarial infection. The diagnosis of malaria was made based on the detection of malaria parasites by conventional thick and thin peripheral blood films, stained with Giemsa stain, and rapid diagnostic tests (RDTs). The RDTs were based on the detection of specific Plasmodium antigen, lactate dehydrogenase. The Care Start™ malaria parasite lactate dehydrogenase/histidine-rich protein 2 (pLDH/HRP2) combo (Pf/Pv) test was used. It consists of a conjugate pad dispensed with two monoclonal antibodies, which are specific to pLDH of P. vivax and HRP 2 of P. falciparum. Results: The most common species was vivax (62%), followed by falciparum (29%) and mixed plasmodium spp. (9%). The mean age of the patients was 34.23 ± 15.7 years. The predominant age group affected was between 21 and 40 years. There was no statistically significant difference in the age of cases in the uncomplicated or severe malaria. Males were predominantly affected, constituting 64.4%, while females were 35.6%. Fever (100%) was the most common symptom observed among the study population, followed by chills (73.4%), headache (48%), icterus (46.2%), vomiting (46%), abdominal pain (29%), decreased urine output (20%), and altered sensorium (16%), while pallor (60.9%) and splenomegaly (34.6%) were the common physical findings present in study participants. Comparison of different laboratory parameters between various types of malaria. In the present study, Hb was significantly lower in falciparum malaria as compared to vivax and mixed malaria and leukocyte count was significantly lower in mixed malaria as compared to vivax and falciparum malaria. However, no statistically significant differences were observed in other haematological and biochemical parameters. Presence of comorbid conditions was observed in a significant proportion (32%) of patients. Conclusion: Malaria is still an important public health issue despite a consistent decline in its incidence. P. vivax is the plasmodium species which is responsible for most of the cases. Its potential to cause life-threatening illness is the cause of concern. The role of comorbid conditions in influencing the clinical outcome of malaria should be further explored.

DOI: 10.5281/zenodo.

Aim: To establish a correlation between cardiac symptoms and the severity of dengue illness. Material and Methods: The Department of Medicine, IGIMS, Patna, Bihar, India for one year, did this research on dengue fever hospitalized patients. This research covered 110 patients. Participants in this research were patients aged > 13 years, admitted to a hospital, with confirmed dengue serology (Dengue IgG/IgM/NS1 positive), meeting WHO criteria, and providing written informed permission. According to WHO standards, admitted patients were categorized as dengue fever, DHF, or shock syndrome. Results: Out of 110 dengue patients, 69.1% had fever, 7.3% had shock syndrome, and 23.6% had hemorrhagic fever. 56.36% of patients had normal ECGs upon admission, whereas 43.64% had alterations. In the second ECG on day three, 87.27% were normal and 12.73% had changes. All dengue patients had normal ECGs upon discharge, suggesting transitory ECG alterations. In this research, 59.09% had normal sinus rhythm, 36.4% had sinus bradycardia, 3.6% had sinus tachycardia, and 10.9% showed NSST-T alterations. Six (75%) of eight DSS patients exhibited positive troponin I. Seven (26.9%) of 26 DHF patients reported positive troponin I. DF patients showed no troponin I positive. The proportion of dengue patients with positive troponin I corresponds with fever severity. The difference was substantial (P<0.001). Conclusion: ECG, cardiac enzymes, and echocardiography are used to identify dengue fever myocardial involvement. DF patients demonstrated less cardiac involvement than DHF and DSS.

DOI: 10.5281/zenodo.

Aim: Unusual Oral Candidiasis in a Patient with a Normal Immune System. Materials and Methods: This study was conducted in the Department of Microbiology, Nalanda Medical College and Hospital, Patna, Bihar, India from December 2017 to November 2018. Data such as sex, age, general disease, a use of dentures, complaints of dry mouth, smoking or alcohol consumption, culture results in potato dextrose agar (PDA) and chromogenic agar (CA) medium, and duration of anti- fungal drug administration were collected. The diagnosis of oral candidiasis in this study was made according to the clinical features established in other studies based on clinical tests [1,3,8]. In this study, a total of 180 clinical specimens (2 for every 90 patients) were collected by rubbing the palatal mucosa and tongue of patients with a sterile cotton swab who visited the Oral medicine Department for culture of Candida strains. All specimens were plated on PDA medium and CA medium. CA medium was obtained by purchasing Candida Chromogenic Agar powder, made by the Department of microbiology, according to the manufacturer’s instructions, and distributed 20 mL each in a 60 mm× 15 mm petri dish. After smear, the medium was cultured for 48 hours in incubator (IN-20A) at 37°C. On the PDA medium, all colonies were cream-colored, and the colonies’ size and margin were varied. Results: As a result of surveying the number of each disease group and the percentage of all patients, 4 patients with blood and blood forming organs diseases and certain disorders involving the immune mechanism (2.4%), 37 patients with endocrine, nutritional and metabolic diseases (22.0%), 11 patients with mental and behavioural disorders (6.5%), 8 patients with nervous system diseases (4.8%), 2 patients with eye and appendage diseases (1.2%), 9 patients with circulatory system diseases (20.8%), 6 patients respiratory system disease (3.6%), 14 patients with digestive system disease (8.3%), 4 patients with skin and subcutaneous tissue disease (2.4%), 16 patients with musculoskeletal and connective tissue diseases (9.5%), 10 patients with urogenital diseases (6.0%), and 1 patient with pregnancy, childbirth and delivery (0.6%), of which endocrine, nutrition and metabolic dis- eases accounted for the highest proportion. Conclusion: Patients complaining of dry mouth could not be confirmed using test methods such as saliva secretion. In addition, this study had its own limitations in that it was not possible to perform large sample sizes, candida species identification, and antifungal susceptibility tests.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to measure the various dimensions in Indian adult human lumbar vertebral pedicles and to prepare data of lumbar pedicles useful in various surgical procedures. Methods: The study was implemented on 45 dry, fully ossified normal lumbar vertebral sets from the Department of Anatomy, Nalanda Medical College, Patna, Bihar, India from Jan 2023 to November 2023.  For study purpose, all vertebrae were categorized into typical (L1 to L4) and atypical (L5). Exclusion of deformed vertebrae was done. Results: In present study, the mean length and height of pedicles in typical vertebrae (L1 to L4) ranged from 8.85 mm to 10 mm and 13.08 mm to 13.81mm respectively. The pedicle thickness of typical vertebrae was noted between 7.11 mm 11.22 mm. For L5, the mean values of PDL, PDH and PDTh were 8.80 mm, 12.79 mm and 16.10 mm respectively. It was observed that PDL increased till L3 but after that it declined at L5. There was a gradual gain in PDH from L1 to L4. However, it was reduced at L5. PDTh was enhanced from L1 to L5 but in the fifth lumbar vertebra, the thickness of pedicle suddenly increased as compared to that of fourth. The transverse angle of pedicle elevated steadily from L1 to L4 but at L5, it abruptly increased than in L4. The mean transverse angle of right and left side (22.63 degree and 21.61 degree) of pedicle at L5 was greater than L4 (16.98 degree and 15.81 degree), Pedicle axial length rose from L1 to L3 and subsequently it dropped from L4 to L5 (Table 2). However, mean sagittal angle and mean axis length of pedicle of L5 was found to be less than L4. However, there was no any significant change in sagittal angle of typical as well as atypical vertebra. Conclusion: The present study revealed significant differences in multiple dimensions of pedicles of typical as well as atypical lumbar vertebrae. These differences bear critical implications for neurosurgeons to operate in safe environment on patients in Indian settings.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the intraoperative awareness during general anesthesia leads to anxiety, depression and post-traumatic stress disorder. Methods: It was a retrospective, observational and questionnaire-based type of study, patients involving in study were undergoing general Anesthesia and had blood loss of 20% or more at Department of Anesthesia, Vardhman Institute of Medical Science, Pawapuri, Nalanda, Bihar, India from December 2016 to November 2017. Written informed consent from the patients involved in study, total 50 patients were enrolled in study. Results: The demographic data including age less than 20 years of 16%,21-40 years 40%, 41-60 years were 34% and>60 years 10%. Male patients around 74% and females were 26%. ASA 1 patients were 68% and ASA2 were 32%. Blood loss of 20-30% blood volume was 32 patients, 30-40 % was 15 patients and more than 40%were 3 patients. Conclusion: The present study concluded that awareness should always be kept in mind whenever there is blood loss. The dreaming without pain is also considered sometimes as pleasant. But pain followed by auditory type of awareness is always unpleasant for patients.

DOI: 10.5281/zenodo.

Aim: A comparative analysis of the functional and surgical outcomes of interlock nailing and dynamic compression plating in the treatment of humerus diaphyseal fractures. Material and Methods: This was an interventional retrospective randomized study was conducted in the Department Of orthopedics, SKMCH, Muzaffarpur, Bihar, India for one year. Patients were randomly divided into two groups with the help of computer-generated coded envelopes; group A (humerus diaphyseal fractures treated with dynamic compression plating) and group B (humerus diaphyseal fractures treated with interlock nailing with 20 patients in each group. Patients with humerus shaft fractures treated with standard surgical techniques; and those with age above 18 years were included. Results: In our study of 40 patients constant Murley score was 92.50±2.92 in patients treated by dynamic compression plating and 86.35±5.61 in patients treated by interlock nailing after 1 year. 4 (20%) of patients operated by dynamic compression plating had constant Murley score 81-90, 16 (80%) of patients operated by dynamic compression plating had constant Murley score >90. 5 (25%) of patients operated by interlock nailing had constant Murley score of <80, 11 (55%) of patients operated by interlock nailing had constant Murley score 81-90, 4 (20%) of patients operated by interlock nailing had constant Murley score >90. There was significant difference in constant Murley score between dynamic compression plating and interlock nailing with p value <0.001. Conclusion: Constant Murley score was more in dynamic compression plating which was statistically more significant with marked shoulder stiffness in patients treated with Interlock nailing suggestive of decreased shoulder function postoperatively in patients of interlock nailing. Mayo elbow performance score was more in dynamic compression plating which was statistically not significant.

DOI: 10.5281/zenodo.

Aim: To compare the effectiveness of case-based learning with didactic learning in the clinical instruction of orthopaedics. Material and Methods: A retrospective study was conducted in the Department Of orthopedics, Patna medical college and Hospital, Patna, Bihar, India for one year. 100 students of final year M.B.B.S part II were enrolled into the study after obtaining Informed consent. Inclusion criteria: 8th semester Students of Final year M.B.B.S Part -II. Exclusion criteria Students who were not interested to participate and who were absent in any one of the classes. By lottery method Students were divided into group A and group B with 50 students each. Group A was given case-based learning (CBL) and Group B was given power point aided didactic lectures (DL). Both groups were given three sessions of Case based learning (CBL) and Didactic lectures (DL) on orthopedics topics at two different venues simultaneously. Results: A total of 100 students have participated in this study and they were divided in to group A (CBL group) and group B(LBL group) with 50 students each. with respect to gender and age there was no statistical difference between the two groups. The information that the mean examination scores of the CBL group were significantly higher than the LBL group. (p<0.01). After the completion of CBL session, Perceptions of students about CBL was assessed by pre-validated questionnaire using a five-point Likert scale. 94% of the students felt that method is interesting, 94% of the students felt that it motivated to read more. 94 of the students felt that it helped better understanding. 90% of the students that motivated to read more, 90% of the students felt that it motivated critical thinking, 90% of the students felt that it helped in the management of disease. 88% of students felt that it has increased group interaction. 90% of the students felt that it gives them confidence in bedside. Conclusion: Result from Post-test and the positive perceptions of students indicate that CBL was an effective teaching learning method in orthopedics. It helps the students to apply knowledge in solving the clinical cases.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare accommodative convergence over accommodation (AC/A) ratio when Myopic patient changes from Spectacles to Contact lenses. Methods: A Prospective, cross-sectional study included 50 myopic subjects in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India from July 2017 to June 2018. Written informed consent was obtained from all the subjects who were included in the study. Subjects who had spherical myopia from at least –0.75 DS to -6 of both eyes, an astigmatic ametropia ≤1.00 D and anisometropia. Results: There was no statistically significant difference in amplitude of accommodation by either method (push-up and minus lenses) P: 0.102, P: 0.059 respectively. But the means of accommodative amplitude by all methods increased with contact lenses as compared to the spectacle lenses. Fusional vergence (positive and negative) showed no significant difference when wearing spectacles compared to soft contact lenses P: 0.317 in both. The positive Fusional vergence mean increased with contact lenses as compared to the spectacles and the negative fusional vergence mean decreased with contact lenses as compared to the spectacle. Stimulation horizontal dissociated phoria (with+3DS and – 3DS) showed less exophoric values in near and more esophoria values in distance with contact lenses as compared to spectacles with no significant difference P:0.180 and P:0.317 respectively. There were no significant differences in both AC/A ratio while using gradient and heterophoria methods when subjects changed from spectacles to contact lenses P:(0.285, 0.317) with +/-3DS in gradient method respectively and P:0.317 in heterophoria method. Conclusion: No significant change in the AC/A ratio has been found when myope shifts from spectacles to contact lenses. Although there was increase in accommodation amount, increase in convergence and reduction of horizontal exophoria at near when use contact lenses, which should be considered when myopic patients become symptomatic when shift from spectacles to contact lenses.

DOI: 10.5281/zenodo.

Aim:  The aim of the present study was to assess the various dimensions of the C1 in relation to the vertebral artery groove. Material & Methods: 100 atlas vertebrae, available in the Patna Medical College, Patna, Bihar, India were studied for six months. The specimens selected were dry, complete, of human cadaveric vertebrae of Indian origin. Vertebrae with gross vertebral pathology were excluded. Results: Test of significance (paired t-test) was carried out for comparison of right and left sides. The p value < 0.05 was considered to be significant and > 0.05 was considered to be insignificant. For all parameters, this was insignificant showing bilateral symmetry. Conclusion: The overall goal of this study was to generate information that would be useful for geometric modelling of vertebrae and give necessary morphometric data on human atlas vertebra in   of Indian population.

DOI: 10.5281/zenodo.

Aim: Investigate the range of MRI patterns associated with internal knee abnormalities. Material and Methods: This study was conducted in the Department of Radiology, Darbhanga medical college and Hospital, Darbhanga, and Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Bihar, India for 10 months. A total number of 72 cases with IDK who underwent MR imaging of knee in the Radiology department, served as the subjects for this study. All patients are subjected to MR imaging and followed by arthroscopy in selected cases (wherever applicable. MRI i. T1 and PDFS weighted sequences in sagittal and coronal planes. ii. T2- weighted in axial, coronal and sagittal planes. MRI Data evaluated for: Joint effusion, Anterior Cruciate Ligament tear , Partial/Complete Posterior Cruciate Ligament tear, Partial/Complete Medial Collateral Ligament tear with grading, Lateral Collateral Ligament tear with grading, Medial Meniscal Tear with grading, Lateral Meniscal Tear with grading and Osseous /Osteochondral lesions. Arthroscopy/ Arthrotomy was carried out in OT by orthopedic surgeons in selected and available cases for diagnostic or therapeutic purposes. Results: A total of 72 cases with internal derangement of the knee (IDK) who underwent MR imaging in the Radiology department were included in the study. All patients underwent MRI, and selected cases proceeded with arthroscopy or arthrotomy for diagnostic or therapeutic purposes. The MRI sequences used were T1 and PDFS weighted sequences in sagittal and coronal planes, and T2-weighted sequences in axial, coronal, and sagittal planes. The analysis of MRI data revealed a spectrum of internal derangements in the knee. Joint effusion was the most common finding, present in 48 cases (66.7%). Anterior Cruciate Ligament (ACL) tears were identified in 30 patients (41.7%), while Posterior Cruciate Ligament (PCL) tears were observed in 12 patients (16.7%). Medial Collateral Ligament (MCL) tears were noted in 22 patients (30.6%), and Lateral Collateral Ligament (LCL) tears were found in 10 patients (13.9%). Meniscal tears were also prevalent, with medial meniscal tears occurring in 40 patients (55.6%) and lateral meniscal tears in 25 patients (34.7%). Osseous or osteochondral lesions were detected in 18 patients (25.0%). The ligament and meniscal tears were further classified into grades based on severity. For MCL tears, 10 cases were classified as Grade I, 8 as Grade II, and 4 as Grade III, totalling 22 cases. LCL tears were classified into 4 Grade I, 3 Grade II, and 3 Grade III cases, totalling 10 cases. Medial meniscal tears included 15 Grade I, 17 Grade II, and 8 Grade III cases, totalling 40 cases. Lateral meniscal tears comprised 9 Grade I, 10 Grade II, and 6 Grade III cases, totalling 25 cases. Conclusions: Most common injury was found to be ACL tear in which complete tears were more common than partial tears. Posterior cruciate ligament tears were less common. Among the Meniscal injuries medial Meniscal tears outnumbered lateral meniscus and grade 3 tears are more common in both. Lateral collateral ligament tears outnumbered medial ligament tears and grade3 tears are more common in collateral ligaments. Osseous/Osteochondral lesions were seen in 52 patients (46.8%). Most of these were bony contusions involving the femoral and tibial condyles. Good statistical co-relation was seen between MRI findings and Arthroscopic findings.

DOI: 10.5281/zenodo.

Aim: To evaluate the impact of cataract surgery on the visual acuity of individuals with diabetes. Material and Methods: This study was conducted in the Department of RIO, IGIMS, Patna, Bihar, India for one year. A total of 100 study subjects who met the inclusion criteria were selected for the purpose of the study as cases and 100 cases were selected as controls who did not have any kind of comorbidities. All patients diagnosed with cataract and diabetes mellitus, Patients presenting with all types of cataracts i.e. Cortical, Nuclear, Sub capsular and Capsular and 100 non diabetic patients with cataract age matched as control were taken were included in this study. Results: A total of 100 study subjects both in case and control group were selected and analysed. The Mean age of the Patients in Diabetic Group was 60.15 Years and in Control group it was 58.43 years of age. Nearly 48 % of them in Diabetic group were aged between 60 to 69 years of age and in the control group nearly 50 % of them were in the same age group in control group. Among Diabetic group nearly 59% of them were female and 41 % were male and in control group Female were 56% and Male were 44 %. In this study in diabetic group 15% had vision of light perception, 75% had vision from HM-6/60, 6% had vision of 6/36 and only 4% had vision of 6/24. In control 12% of the patients had vision of light perception, 77% had vision of HM6/60, 7% had vision of 6/36 and only 4% had 6/24. In this study, post-operative visual acuity in 8% of Diabetics and 2% of Control was < 6/60. 9% of Diabetics and 10% of Control was 6/36. 13% of Diabetics and 18% of Control was 6/24. 26% of Diabetics and 18% of Control was 6/18. 44% of Diabetics and 52% of Control was greater or equal to 6/12. The Association was found to be statistically non-significant. Conclusion: The diabetic patients with cataract have an overall good visual outcome. With adequate blood sugar control, careful preoperative planning, atraumatic surgical techniques, appropriate postoperative medicines and close postoperative supervision, diabetic patients can achieve excellent vision after cataract surgery just like our other cataract patients.

DOI: 10.5281/zenodo.

Background: Chronic ectopic pregnancy (CEP) is characterized by low serum HCG levels and tolerance to methotrexate (MTX) treatment. Histologically, CEP is identified by a compact adnexal mass containing degraded chorionic villi, areas of necrosis, and multiple blood clots resulting from recurrent small ruptures in the fallopian tube wall. CEP often manifests as an asymptomatic pelvic mass with low serum hCG levels. Methods: This retrospective study was conducted at the Department of Obstetrics & Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi, India, for one year. The study enrolled pregnant women diagnosed with chronic ectopic pregnancies between June 2023 and May 2024. Eligible patients from prenatal clinics and labour rooms provided written informed consent. Results: Beta-HCG levels ranged from 3000 to 5000 mIU/ml in 20% of cases, less than 1500 mIU/ml in 3 instances, and over 5000 mIU/ml in 1 case. Haemoglobin levels were between 7 and 10 g/dl across all patients. The most common sites of ectopic pregnancy were the ampulla (80%) and fimbria (20%). Surgical salpingectomy was performed in four out of five cases of prolonged ectopic pregnancy. Five patients required blood transfusions: one unit for 60% (3 cases), two units for 20% (1 case), and three units for another 20% (1 case). Conclusion: Clinicians should consider persistent ectopic pregnancy as a differential diagnosis in young multiparous women presenting with abnormal uterine bleeding (AUB) and abdominal pain, especially if ultrasound reveals a heterogeneous mass in the pouch of Douglas (POD) and/or adnexa without internal vascularity on color Doppler imaging (CD).

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the effect of umbilical cord milking in improving hematological and clinical outcome in preterm babies. Methods: This randomized controlled trial was done in the Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai ,Darbhanga, Bihar, India from March 2018 to February 2019. A total of 114 mothers anticipated for preterm delivery were admitted in this hospital during the study period who were eligible for this study. Among 114 preterm neonates 57 were umbilical cord milking group and 57 were non milking group. Results: Most of the mothers were in age group 21 to 30 years. There was no statistically significant difference in parity of mother, maternal morbidities, antenatal visit & antenatal corticosteroid. Mean gestational age (weeks) was 32.5±1.8 Vs 32.6±2 in milking & non milking group respectively. Birth weight was mostly between 1000 gm to 2499 gm in both the groups with a mean birth weight (gram) 1513±440 Vs 1607±453 in milking & non milking group respectively. Most of the babies were AGA in both the groups. In cord milking group 36.8% was SGA and in non-milking group 22.8% was SGA. Gender distribution reflected male predominance. Most of the infants were born by LUCS. Resuscitation needed 5.3% babies in cord milking group & 07% babies non milking group. Only one baby of cord milking group was intubated in delivery room. Conclusion: Umbilical cord milking increases hematocrit levels in preterm babies. Newborn who receives cord milking, needs less number of blood transfusion and need of assisted ventilation is less in them. But there is no significant difference in blood pressure, jaundice, need of phototherapy, intraventricular hemorrhage & necrotizing enterocolitis in cord milking & non milking group.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the attitude of MBBS students towards implementing ECE modules in their 1st professional year subjects. Methods: This study was a Questionnaire- based conducted in the Department of Anatomy, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India from November 2020 to October 2021. Results: The study included 298 MBBS students in their second and third professional years. Their attitude towards implementing the Early Clinical Exposure (ECE) module in first professional year subjects was assessed using a feedback questionnaire using a 5-point Likert scale, and the results were tabulated. Many students strongly agreed that the ECE module changed their perspective on learning pre-clinical subjects, helped them better assimilate knowledge, and sensitized them to the clinical setting. Additionally, most students expressed satisfaction with the number of hours allotted to each subject and believed that the ECE teaching method enhanced their understanding of the topics. Conclusion: ECE allows students to contextualize their theoretical knowledge by exposing them to real-world clinical settings early in their training. This helps students understand the relevance of their studies to clinical practice from the outset. By observing and interacting with patients, medical students can develop essential clinical skills such as communication, history-taking, physical examination, and bedside manner. It provides opportunities for students to hone these skills under supervision. Exposure to clinical environments early in medical training instils professionalism, empathy, and ethical values in students.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the  titers of salmonella enterica serotypes typhi and paratyphoid A and B agglutinins among apparently healthy individuals using tube (serial dilution) method. Methods: The study was carried out in the Serology section of Dept of Microbiology, Rajendra Institute of Medical Sciences, Ranchi ,Jharkhand, India for a period of 12 months. Volunteers of both the sexes of 18-50 years of age group of different community of Ranchi who live here for more than 5 years and coming to our microbiology and biochemistry department for different routine test were included. 300 patients were selected in the study. Results: There were equal number of male and females. People of 18-50 years of age group were included. Among them maximum no. of people were from 21-30 yrs age- group and minimum no. of people were from 18-20 yrs. 20% were illiterate and 42.33% had tap water form municipal as source of water. 52.67% had food born disease awareness. Among 300 samples under the study, 170 had positive (i.e. ≥ 20) end titre value and 130 had negative (i.e. <20) end titre value. Salmonella end titres (≥20) for any agglutinins. Among 300 (100%) samples positive end titres values (≥20) of S. Typhi O, S.Typhi H, S. paratyphoid AH, S. Para typhi BH were 135 (45%), 98 (32.67%), 20 (6.67%), 23 (7.67%) respectively.  Conclusion: The average titer for antibodies to “O” and “H” antigens of Salmonella enterica serotype typhi was 1:40 and hence, based on the above results, it could be recommended to use a cutoff level of ≥1:80 for a single antibody test titer. Similarly, average titre for antibody to H antigen of Salmonella enterica serotype Para typhi A and Para typhi B was 1:80 and the cutoff level was ≥1:160 for a single antibody test titre.

DOI: 10.5281/zenodo.

Aim: To determine the socio-epidemiological aspects that impact poisoning. Material and Methods: This retrospective study was conducted in Department of FMT, Gouri Devi Institute of Medical Science and Hospital, Durgapur, West Bengal, India for one year. The subjects of the study were 433 poisoning victims whose autopsy was done, and various internal and external findings observed during the procedure noted and necessary specimen were sent for chemical analysis. The detailed history regarding the poisonous cases that were brought dead was obtained from the inquest from the relevant investigating officer, relative of the deceased and hospital records. The observations were analyzed and subjected to comparison with studies along the same line. Inclusion criteria: hose victims of poisoning whose body was autopsied in the mortuary of our tertiary care government hospital. Results: The population was found to consists mostly of males (66.74%). The females made up remaining 33.26% of study population. On taking into account the educational qualification of the victim to the poison to the illiterates (62.59%) more often turned to poison than the literate people (36.26%). A 1.15% of population where the children who never went to school. It was noted that poisoning was more rampant among married individuals (64.90%). The unmarried persons (23.32%) were next prone to poisoning. The widow/widower (6.93%) married but separated individuals (4.39%) and divorcees (0.46%) were also among the population studied. The family pattern of individuals when observed as a whole revealed that the incidence of poisoning was more common in people living in nuclear family (95.38%). The number of poison cases in people living in joint family (4.62%) was far less in number. A vast majority of cases belonged to a low (81.29%) socio economic status. Conclusion: Poisoning is more common through self-poisoning in male, married individuals, literate people and those with a poor socio-economic status. To reduce the incidence, proper counselling of the risky population is necessary. Sale of insecticides and pesticides to the public should be strictly controlled by law.

DOI: 10.5281/zenodo.

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

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the effectiveness of trans-vaginal ultrasound (TVS) to determine the endometrial thickness and its correlation with histopathology in abnormal uterine bleeding. Methods: A total of 100 patients who presented to the Gynecology OPD, IGIMS, Patna, Bihar, India from July 2021 to December 2021 with clinical presentation of abnormal uterine bleeding were studied. These patients were in peri-menopausal and postmenopausal age groups. They were referred to the department of Radiodiagnosis for transvaginal ultrasound examination. Results: Majority of the patients were between 40-45 years (37%) in the present study. Among 100 patients, menorrhagia was present in 41 cases (41%). In our study, 45 patients (45%) had an ET between 8-10 mm and 20 patients (20%) had an ET between 10-15 mm. In our study, 40 (40%) patients showed endometrial hyperplasia and 34 (34%) patients showed proliferative type of endometrium. Among 40 patients of endometrial hyperplasia, only 4 patients (10%) had atypical hyperplasia. Majority 65% had simple hyperplasia. Conclusion: The present study concluded that in abnormal uterine bleeding, the first investigation should be transvaginal ultrasound. In peri- menopausal patients if the endometrial thickness exceeds 10mm, a dilatation and curettage procedure is to be done to rule out any endometrial hyperplasia. No complications were seen with the procedure in this study. In postmenopausal women dilatation and curettage is recommended if endometrial thickness exceeds 5 mm. The method of measuring the endometrium, the experience and skill of the radiologist influence the TVS results. Histopathology plays a major role in the definitive diagnosis.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the acquired demyelinating diseases in children. Methods: The present study was conducted in the Department of Paediatrics, IGIMS, Patna, Bihar, India from December 2016 to November 2018. A total of 50 patients were enrolled in the study. Results: Of these, 33 (66%) cases were of acquired demyelinating encephalomyelitis (ADEM), 10 (20%) of transverse myelitis (TM), 5 (10%) of neuromyelitis optica (NMO), 1 (2%) of optic neuritis (ON) and 1 (2%) of multiple sclerosis (MS). The mean age of presentation was 7.7 years (range: 2-12 years). Of 50 cases, 24 (48%) were male and 26 (52%) females. History of preceding illness was present as upper respiratory infection /acute febrile illness and mean duration between preceding events and onset of symptoms was 7.24±2.9 days. All patients diagnosed with ADEM had encephalopathy. Areas involved in descending order of frequency were subcortical white matter, basal ganglia, thalamus, brainstem, cerebellum and spinal cord involvement. Conclusion: Children presenting with new, subacute focal neurological deficits with history of some preceding event and in absence of trauma, metabolic derangements, or structural abnormalities should be suspected of having acquired CNS demyelination. These patients should be investigated with CSF analysis, serum antibodies and neuroimaging. ADEM is the most common among ADS. Early diagnosis and management with steroid therapy improves outcome in most of the patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the common bacteria associated with UTI cases and their antibiotic susceptibility pattern. Methods: A retrospective study was done for one year( January 2021 to December 2021) in  Department of Pharmacology, ANMMCH, Gaya, Bihar, India. The study included all in-patients of either gender above 18 years of age with a diagnosis of UTI. Data was collected from the patient’s case record files, which were retrieved from the medical records department of our hospital. Results: Out of 120 significant isolates, gram-negative organisms accounted for 81%. Fungal isolates were seen only in 2% of cases. E.coli was the most predominant uropathies isolated followed by Klebsiella spp, Enterococcus faecalis and Acinetobacter spp. Other uropathies included MRSA bacteria, Staphylococcus aureus, Candida spp, Citrobacter Freunde, Pseudomonas spp and Streptococcus spp. E.coli, showed considerable resistance to ampicillin, ceftriaxone, Co-Trimoxazole and fluoroquinolones. Low level of resistance was observed with Nitrofurantoin, piperacillin+ tazobactam and Ticarcillin. Klebsiella spp, the second most common uropathies showed high level of resistance with ampicillin, cephalexin, cefuroxime, ceftriaxone and Nitrofurantoin. Conclusion: Most of the identified bacteria were resistant to several of the popular antibiotics used in clinical settings. Consequently, it is vital to prescribe antibiotics rationally both before and after culture reports. Pattern needs to be studied further and the outcome should be communicated to the prescribing physicians in that area.

DOI: 10.5281/zenodo.

Aim: Assessing the use of anterior segment optical coherence tomography in the assessment of microbial keratitis. Materials and Methods: A hospital based, retrospective, observational study was conducted Department of Ophthalmology, JLNMCH, Bhagalpur, Bihar, India. Patients with clinically diagnosed microbial keratitis seeking treatment were recruited. Children below 12 years and recruited patients lost to follow up were excluded from the study. Finally, 17 patients were analyzed. A complete ophthalmic history was taken and slit lamp examination including examination of the conjunctiva, tear film, cornea, anterior chamber, iris, lens and anterior vitreous was done. Anterior segment imaging was carried out by a commercially available OCT device, 3D OCT -1Maestro (3D OPTICAL COHERENCE TOMOGRAPHY). 3D-OCT and slit-lamp examination were carried out on presentation (day 0) and, subsequently on days 3, 7, 14, 28 and 6 weeks of treatment. All patients underwent treatment based on clinical findings. Results:  The corneal thickness (CT) on presentation ranged from 444-954 µm with a mean of 710.88 µm. Infiltrate thickness (IT) ranged from 112-443 µm with a mean of 288.76 µm. The overall CT in the infiltrated area on day 0 had a mean value of 710.88 µm. On days 3, 7, 14, 28 and 6 weeks mean CT had decreased to 665.12 µm, 650.24 µm, 584.35 µm, 549 µm, 507.47 µm respectively. IT on presentation had a mean value of 288.76 µm. On days 3, 7, 14, 28 and 6 weeks mean IT was 287.24 µm, 244.41 µm, 197 µm, 174.59 µm and 154.82 µm respectively. Serial AS-OCT imaging and change in CT and IT of a representative case, on treatment. Both parameters decreased as the corneal edema and inflammation subsided clinically. CT showed a statistically significant decrease in the early (day 0-7), middle (day 7-14), and late phase (day 14-6 weeks) of treatment with daily change of 3.65% (p=0.023), 1.4% (p=0.0319) and 0.47% (p<0.0001) respectively. IT decreased at a daily rate of 2.24% (p=0.0267) in the middle phase and 0.38% (p<0.0001) in the late phase. The overall decrease in CT and IT over the course of treatment was found to be statistically significant with an average percentage reduction at 0.67% per day (p<0.0001) and 1.01% per day (p<0.0001). Conclusion: This study involved both quantitative and qualitative analysis of resolving microbial keratitis. With treatment, both CT and IT showed a significant decrease. This correlated well with the slit lamp examination which showed a decrease in acute inflammatory signs such as conjunctival congestion, corneal infiltration and hypopyon height. Thus, serial scans helped to evaluate the response to treatment. Secondly, certain histological patterns were seen on AS-OCT which cannot be seen on slit lamp such as stromal thinning, cystic spaces, microcystic edema.

DOI: 10.5281/zenodo.

Aim: To determine the significance of the Central Venous – Arterial pCO2 Difference in identifying Microcirculatory Hypoperfusion after Off-Pump Coronary Artery Bypass Grafting Surgery. Material and Methods: This study was conducted in  Indira Gandhi institute of cardiology, Patna, Bihar, India for one year, 100 patients scheduled for elective off-pump CABG surgery were included in the study. In this prospective observational study, we evaluated the central venous to arterial PCO₂ difference (dCO₂) in patients with a central venous saturation (ScvO₂) ≥70% and its relationship to the postoperative hemodynamic profile, outcome and complications. Inclusion criteria were written informed consent, age >18 and <75 years, elective off-pump coronary artery bypass graft surgery, preoperative haemoglobin ≥10 g/dl and American Society of Anaesthesiology (ASA) Grade 1 and 2. Results: The observed hemodynamic, oximetric and laboratory alterations were associated with a significantly prolonged need for mechanical ventilation (14.90 ± 10.33 vs 10 ± 9.65 hrs, P = 0.04) and ICU stay (5.05 ± 2.52 vs 3.75 ± 2.36 days, P = 0.049) in group A. Incidence of re-exploration was similar in both the groups. The total duration of hospital stay was significantly higher in group A. In the high dCO₂ group, out of 20 patients, one patient died due to multi-organ failure and septic shock, while in the low dCO₂ group, out of 45 patients, one patient died due to respiratory failure and sepsis. Conclusion: We observed that high dCO₂ (>8 mmHg) was associated with decreased DO₂I, increased oxygen extraction ratio, increased postoperative complication rate, the longer need for mechanical ventilation and longer ICU stay.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find the impact of maternal anemia on perinatal outcome. Methods: The present study was conducted in the Department of community medicine, JNKTMCH, Madhepura, Bihar, India from Jan 2021 to December  2021 and 100 patients were included in the study. Results: Most (43% & 39%) of the pregnant women were in the 25-29 & 20-24 yrs of age group. Only 9% of the pregnant women were less than 20 years of age and 9% were more than 30 years. As the level of education increased, severity of anemia decreased although the difference is not statistically significant. Most of the patients were second gravid i.e. 44%. Most the pregnant women were moderately anemic i.e. 49% followed by mild (45%) and severe (4%) respectively. Among the pregnant women most common type of anemia is Iron deficiency anemia (69%) followed by Sickle cell anemia (16%) and other cause (11%). The distribution of various maternal outcome related to anemia, in which most common found to be low birth weight (31%) followed by premature delivery (24%). The distribution of various fetal outcome in anemic mother in the form of preterm (15%) followed by NICU admission (13%) and FGR (9%). Conclusion: Anemia being one of the most important cause of poor feto maternal outcome should be treated preconceptionally. There is a need of health education programmers and adequate intake of iron rich diet during pregnancy, to be strengthened for safe maternal and fetal outcomes.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the correlation of Apo-lipoprotein B and dyslipidemia in Type 2 Diabetes mellitus and its relation with Albuminuria. Methods: This Cross-Sectional Study was conducted in the Department of Medicine, Government medical College and Hospital, Madhepura, Bihar, India  from July 2022 to June 2023 with 100 patients. Results: Mean age of the study population was found to be 52.48±12.96 years with minimum and maximum age being 22 and 75 respectively. Among 100 patients, 55 (55%) and 45 (45%) patients were accordingly female and male. It was observed that 52 (52%), 14 (14%), 6 (6%), 6 (6%), 3 (3%), and 10 (10%) patients had HTN, IHD, CKD, CVA, Hypothyroidism and Other comorbidities correspondingly. Total of 9 (9%) patients had no comorbidities at all. Total of 20 (20%) and 80 (80%) patients belonged to HbA1c values <7 and >7 groups respectively. Distribution of ACR values with respect to different ranges of TC was not statistically significant (P value >0.05). Distribution of ACR with respect to HDL levels was fond to be suggestively significant at 91% level of confidence. Different level of triglyceride (0-10, 11-200 and >200) distribution of ACR (404(52.095-998.2), 713.6(81.5775-1158.8) and 350(144.5-770.5)) was not statistically significant. There was no significant difference was established in distribution of ACR with respect different levels of APO- A1, APO- B and APO B/APO A1. Significant positive correlation was found among TC, TG, LDL VLDL, and ApoB with correlation coefficient of 0.4, 0.34, 0.47, 0.24 and 0.32 respectively (P value<0.05). Conclusion: In the present study, there was a significant positive correlation between Apolipoprotein B and albuminuria among patients with type 2 diabetes mellitus.  There was also a positive correlation between Apolipoprotein B and dyslipidemia among these patients, who showed elevated total cholesterol, LDL cholesterol, and triglyceride levels.

DOI: 10.5281/zenodo.

Aim: To investigate the correlation between walking exercise and physical function in older individuals living in the community. Material and Methods: This cross-sectional study was done in the department of PMR, NMCH, Patna, Bihar, India for one year.  The participants were men and women aged 65–75 years who lived in this city and responded to a community needs survey and who were not certified as requiring nursing support or care. Considering the size of the district, 5000 respondents were randomly selected and mailed the survey invitation and questionnaire. We included the 949 respondents who participated in the measurement sessions. A final total of 846 subjects (399 men and 447 women) who met the criteria for valid data on physical activity (≥4 days and ≥10 h of wear time) of a tri-axis accelerometer. Results: In the N group, 114 of the 212 subjects were physically frail or pre-frail. In the W group, 33 of the 75 subjects (44.0%) were physical frailly or pre-frail. The OR (95%CI, p-value) for physical frailty or pre-frailty in the W group compared to the N group was 0.77 (0.44–1.33, p = 0.35), with no significant difference. On the other hand, in the W + O group, 71 of the 204 subjects (34.8%) were physically frail or pre-frail, with a significantly lower OR at 0.51 (0.33–0.77, p = 0.0014). Similar results were observed in the O group (OR: 0.66, 95%CI: 0.46–0.94, p = 0.02), in which 146 of the 355 subjects (41.2%) were physically frail or pre-frail. Regarding the association with the components of physical frailty, the W + O group had a significantly lower OR at 0.30 (95%CI: 0.15–0.59, p = 0.0005) for exhaustion and 0.20 (95%CI: 0.06–0.71, p = 0.01) for slowness. The O group also had a significantly lower OR for exhaustion (OR: 0.51, 95%CI: 0.31–0.84, p = 0.008) and a lower trend for slowness (OR: 0.47, 95%CI: 0.22–1.01, p = 0.054). Conclusion: Older adults who only practiced walking as an exercise do not have lower risks of physical frailty and pre-frailty.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the relationship between cord blood gas analysis and neonatal outcome. Methods: A retrospective hospital-based observational study was conducted at the Department of Paediatrics, JLNMCH, Bhagalpur, Bihar, India for the duration of 12 months. A total of 100 term neonates were delivered at our hospital to mothers who experienced a prolonged second stage of labour, foetal heart rate deceleration or acceleration, an emergency caesarean section for foetal or maternal problems, and placental insufficiency were all included. Results: In the present study, 66% were male neonates and 34% were female neonates. 2840.8±432 was the mean body weight of neonates. 60% were delivered vaginally, followed by instrumental labour. 100 babies were included in the study; among them, 45 babies had pH <7.25, and 55 babies had pH >7.25. Out of 100 babies, 15 babies needed resuscitation, 8 needed for NICU admission and 4 had convulsions. Conclusion:  When compared to those with pH >7.25, high-risk term babies with cord pH <7.25 have an increased need for resuscitation, NICU admission, and delay in achieving full feeds. In this study, there is no statistical correlation between cord blood pH and the incidence of convulsions and encephalopathy in term high-risk newborns. When comparing high-risk newborns to other babies, the median cord blood pH is significantly lower in those who required resuscitation, NICU admission, or had a delay in achieving full feeds. All high-risk newborns should have their cord blood pH measured.

DOI: 10.5281/zenodo.

Aim:  The aim of the present study was to quantify the amount of protein intake and to compare growth parameters at hospital discharge (as measured by discharge weight and head circumference percentiles) when using two different methodologies (BW versus current daily weight until BW is regained) for calculating fluid and protein intake in the first two weeks after birth in ELBW infants. Material & Methods: The present study was conducted in the Upgraded Department Of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India from January 2014 to December 2014 and all ELBW admissions to the NICU were included except those regaining BW in ≤ 3 days, those who were transferred to another facility, or those who died before reaching discharge. Results: We studied 150 infants with 100 and 50 infants in P1 and P2 periods, respectively. Mean gestational age was lower during Phase 1 (24.86 ±1.34 vs. 25.45 ±1.85 weeks). P value =0.01). However, the birth weights were not different between the two periods. The incidence of SGA at birth was higher during Phase 2. Compared to P1, babies in P2 received 1 g/kg/day more protein till BW was regained. This average daily protein deficit would have resulted in a cumulative protein deficit of 5.1 g/kg if the infant’s current weight was used for protein calculations for the duration of 1 week (P2 phase). There were no significant differences in protein and fluid intakes. However, there was a higher caloric intake in P2 compared to P1. Conclusion: Basing nutrition calculations in ELBW on birth weight rather than current daily weight until the birth weight is regained resulted in significantly greater protein delivery, a significant decrease in the incidence of failure to thrive and smaller head circumference percentiles at discharge in ELBW infants.

DOI: 10.5281/zenodo.

Aim: To determine the frequency and factors associated with social phobia among undergraduate medical students. Materials and Methods: A study was conducted in the department of psychiatry, PMCH, Patna, Bihar, India for one year. 600 undergraduate medical students were included in this study. The sample included students currently enrolled in the undergraduate medical course ranging from 1st year to 4th year and who are willing to participate in the study. All the students who had pre-existent psychiatric illness and those who were not willing to participate in the study were excluded from the sample. The scales used in this study are Social Phobia Inventory Scale and Oslo 3- Item Social Support Scale. Results: The answers provided by the respondents were summed and a value was generated. This number was categorized between 5 sections – students in whom social phobia cannot be observed (score>30); students in whom mild social phobia was observed (31<score<36); students in whom moderate level of social phobia was observed (37<score<42); students who exhibited a severe level of social phobia (43<score<58); students who experienced very severe levels of social phobia (score>58). As can be observed, the distribution between the categories is quiet even. It was observed that 22% of the students had no observation of social phobia. 18% and 17% of the students reported mild and moderate levels of social phobia respectively. A staggering 31% reported severe social phobia while 10% of the respondents reported very severe social phobia.  The shows the mean of the individual scores in SPI scale and it was observed that two factors in particular, I avoid talking to people I do not know (mean = 3.02) and I avoid having to give speeches (mean = 3.02) had the highest scores. Conclusion: In line with several studies in the past, this study too concludes that being a female student leads to higher prevalence of having social phobia. The overall proportion of students who reported social phobia was much higher than averages from studies in other countries.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the role of CSF flow indices in patients with symptoms of  normal pressure hydrocephalus   and to establish its diagnostic value. Methods: The present study was conducted at Department of Radiodiagnosis, Shri Ramkrishna Institute of Medical Sciences, Durgapur, West Bengal, India for one year. Total no of 60 participants age range was between 38 to 88 were enrolled into the study. Results: 58.3% population was >60 years, 26.7% population group was in between 51-60 years and 15% population was < 50 years age. Overall gender distribution in case group (n=30) 25 was male and 5 was female and in  control group( n=30) 22 was male and 8 was female. Gait Disturbances was present in 86.7%, Dementia was present in 73.3% and Urinary Incontinence was present in 70% in Case Population. Ventriculomegaly was present in 93.3%, Symmetrical trans ependymal edema was present in 90%, Sulcus effacement was present in 90%, Corpus callosal thinning   was in 83.3%, Corpus callosal angle  was between 50 -80 degree  in 83.3% and Flow Void  at cerebral aqueduct was present in 62.2%. Grade I was present in 66.7%, Grade II  was present in 16.7% and Grade III was in 16.7 cases population. Conclusion: CSF wave form obtained from Phase contrast MRI  were analysis in our study its  appeared  to be reliable, reproducible, and sensitive tool for differentiation of NPH patients and normal volunteers.

DOI: 10.5281/zenodo.

Aim: To investigate the correlation between elevated levels of high-sensitivity C-reactive protein and dyslipidaemia with the occurrence of pregnancy-induced hypertension. Material and Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India from January 2020 to December 2020. The study population was 18-35 years old pregnant women after 20 weeks of gestation. Case: Women with pregnancy-induced hypertension with age 18-35 years after 20 weeks of gestation. Case includes- Gestational hypertension, Pre-eclampsia and Eclampsia. Control: Pregnant normotensive women with the same age group and gestation. As this study includes more variables so for better statistical results sample size is increased to 60 in each group. 60 patients with pregnancy-induced hypertension with age between 18-35 years after 20 weeks of gestation (case). 60 pregnant normotensive patients of the same age and gestation (Control). Results: Mean serum total cholesterol (261.13±68.62), serum LDL (183.76±66.51), serum triglycerides (285.98± 125.61) and CRP (6.98±4.21) were higher in case compared to that in control (220.46±54.16), (121.90±33.36), (189.03±64.38) and (5.26±2.72) respectively. Mean serum HDL was lower in the case (45.86±15.25) as compared to that in control (54.06±12.03). All these findings were statistically significant (p≤0.05). Table 6 describes the comparison of lipid profile and C-reactive protein among groups-preeclampsia, eclampsia, gestational HTN and normotensive pregnancy, which were statistically significant (p≤0.05). Among the cases 58.3% and among controls 31.7% had serum cholesterol ≥ 299 mg/dl and respondents with serum cholesterol ≥ 299 mg/dl had a 3.02 times more chance to develop pregnancy-induced hypertension which was statistically significant (p=0.003). Among cases 15.0% and among controls 3.3% had serum HDL < 52mg/dl and respondents with serum HDL < 52 mg/dl had 5.11 times more chance to develop pregnancy-induced hypertension which was statistically significant (p=0.027). Among cases 61.7% and among controls 11.7% had serum LDL level ≥ 184 mg/dl and respondents with serum LDL level ≥ 184 mg/dl had 10.18 times more chance to develop pregnancy-induced hypertension which was statistically significant (p<0.001). Among cases 68.3% and among control 38.3% had serum TG level ≥ 382 mg/dl and respondents with serum TG level ≥ 382 mg/dl had 3.47 times more chance to develop pregnancy-induced hypertension which was statistically significant (p=0.001). Conclusion: In conclusion, based on the results presented in this study we found that high CRP and dyslipidemia were associated with pregnancy-induced hypertension.

DOI: 10.5281/zenodo.

Aim: The present study was conducted for morphometric study of segments of humerus. Methods: Our study was a retrospective study conducted in the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for 12 months. The present study was performed on 50 cadaveric humeri (25 left sided and 25 right sided). All were of unknown age and gender. Results: The length of humerus of right side was more as compare to left side. AP diameter of head is almost equal of both sides. Mediolateral diameter of head was more of left side whereas head height was more of left humerus. Conclusion: The morpho-metric dimensions of right side of humerus were more than that of left side. There was variability in dimensions which was found in different studies. Proper measurements are required when surgical procedures are to be done. More studies should be conducted measuring head heights.

DOI: 10.5281/zenodo.

Aim: This study was conducted with the aim to evaluate the frequency and patterns of different cutaneous granulomatous lesions with its clinico-histopathological correlation to reach etiological diagnosis. Materials and Methods: The present cross-sectional observational was conducted in the Department of Pathology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for the period of 1 year. This prospective cross sectional study enrolled 100 cases of skin biopsies after histopathological confirmation of granulomatous lesions. Results: Among 100 cases were studied in which male predominance was noted with 64 (64%) cases and females constituted 36 (36%). Most of the patients were noted in age group of 21 to 31 years i.e 36 (36%) cases followed by 20 (20%) case in 31 to 41 years. 86% of cases were seen below 50 years of age in our study. Leprosy remained the significant causative reason for infectious granulomatous dermatoses succeeded by tuberculosis of skin. Borderline tuberculoid leprosy was found to be predominant, constituting 24 (24%) cases followed by indeterminate 22 (22%) and lepromatous leprosy had 21 (21%) cases, tuberculoid leprosy 18 (18%) case and 8 (8%) of borderline lepromatous. Lupus vulgaris constituted 2 cases (2%) and only 2 (2%) case of sarcoidosis was found. Conclusion: Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction. Among the cases of leprosy, borderline tuberculoid leprosy and tuberculoid leprosy were the commonest subtype.

DOI: 10.5281/zenodo.

Aim: To determine the importance of dietary patterns in relation to oxidative stress in individuals recently diagnosed with essential hypertension. Materials and Methods: This study was done in the Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for one year. A hospital-based case control study was conducted among 200 subjects of age group between 20–50 years, irrespective of sex in the department of Physiology. All the subjects were chosen randomly and following groups were made according to JNC7 criteria. 75 normotensive subjects PreHT group: 75 cases of prehypertension HT group: 75 cases of newly diagnosed cases of essential hypertension with SBP= 140-159 mmHg, DBP= 90-99 mmHg. Patients with secondary hypertension, gout, diabetes mellitus, gestational hypertension, and patients taking antihypertensive, smokers and alcohol consumers were excluded from the study. Results: The difference in mean ± SD of SBP & DBP between three groups were highly significant (p<0.0001). Mean ± SD value of both SBP and DBP were higher in NV as compared to V among all three groups but the results were not significant (p>0.05). Mean ± SD of SUA and S. MDA level between control, preHT and HT group were found to be highly significant (p<0.0001). Mean ± SD of SUA was significantly higher in NV as compared to vegetarians in all groups (p<0.001). Mean ± SD of S.MDA level was higher in NV as compared to V among HT, preHT and control group but this difference was not statistically significant (p>0.05). Conclusion: The present study indicates that vegetarian nutrition provides sufficient antioxidants which efficaciously prevent the free radical generation and thus responsible for better antioxidant status and decreased oxidative stress. Maintenance of the oxidative balance in hypertensive patients would be helpful in preventing the CVD and other diseases associated with hypertension.

DOI: 10.5281/zenodo.