Background: Presently Medical education in India is in transforming phase from traditional curriculum to competency-based medical education (CBME) and clinical pharmacology as block 1 elective is a part of it. We found no research done in this field in our country and there is lack of knowledge about the impact of implementing clinical pharmacology as Block 1 elective posting. The areas like prescription audit, prescription writing, case follow up, Pharmacoeconomics, Peer group teaching and skill performance were included. Aims: Our aim was to formulate ideas for successful implementation of clinical pharmacology as elective posting. Settings and Design: The study was a prospective, observational, cross-sectional study done on final prof part 2 students of our institution who pursued clinical pharmacology as elective in SRIMS Durgapur from 12/05/2023 to 10/06/2023. Materials and Methods: The outcome measured in terms of validated feedback questionnaire supplied in printed format. Data were analysed using SPSS version 17 and Microsoft Excel 2007. The data obtained were expressed as mean, SD and SEM. Results: A total of 35 students from 38 allotted students responded. 94% students responded that the course details adequately explained to them. Nearly 91% students were able to interact ask questions to the facilitators. 89% students thought that facilitators focused on communication skills. Most of the students found (83%) the course organised well. Conclusions: The students chosen clinical pharmacology as elective were benefitted by getting more clinical pharmacology exposure that will help them in further development of clinical knowledge and practice.

DOI: 10.5281/zenodo.

Introduction: Fibromyalgia (FM) is a common occurrence among patients diagnosed with rheumatoid arthritis (RA). Our study aimed to assess the variations in psychiatric comorbidities and life challenges between individuals with Rheumatoid arthritis plus FM (secondary fibromyalgia [SFM]) and those with primary FM (PFM). Materials and Methods: We recruited 45 patients with PFM and 53 with SFM for the study. This cross-sectional, observational study involved structured interviews with patients diagnosed with PFM and SFM to determine lifetime occurrences of major depression (MDD), panic disorder (PD), and post-traumatic stress disorder (PTSD). Additionally, participants were evaluated for childhood/adulthood adversities and the severity of FM-related symptoms. Results: Univariate analysis revealed significantly higher lifetime rates of MDD in PFM compared to SFM, as well as higher rates of PD, with no notable difference in PTSD rates. Furthermore, rates of sexual abuse and physical neglect were notably higher in PFM patients than in SFM patients. Life events occurring before the onset of FM differed between the PFM and SFM groups. In the logistic regression model, lifetime PD and physical neglect emerged as independent risk factors for PFM. Conclusion: These findings indicate that PFM and SFM exhibit differences in psychiatric comorbidities and environmental adversities, suggesting that a common pathogenesis may manifest through distinct pathways.

DOI: 10.5281/zenodo.

Background and Aim: Automate peripheral blood count for the diagnosis of anemia is a fundamental process, and the instrument can give some of the basic and advanced parameters; however, there is a need to depend on a manual microscopic scan of peripheral smear for the morphological correlation and other clues which the cell analyzers cannot determine. The purpose of this study was to examine the association between Abbott cell dyn ruby- 5 part analyzer automated haematology analyzer histograms and peripheral smear utilising blood samples from the pathology department at HIMS HASSAN. Material and Methods: In this investigation, 2000 patients’ peripheral blood smears were examined and linked with cell counters produced RBC indices and histograms. Source of data: CBC samples sent for analysis received at Department of Pathology, GAIMS, Bhuj, and Gujarat. RBC indices were observed in conjunction with the histogram pattern. • Microcytic hypochromic anaemia • normocytic normochromic anaemia • macrocytic anaemia • dimorphic anaemia • haemolytic anaemia. Results: The majority of those affected by anaemia were between the ages of 31 and 50. That the majority of patients (69.2%) had Microcytic hypochromic anaemia and displayed diverse histograms. In all, 14% of histograms were normal, 27% had a left-shifted curve, 43% had a broad-based curve, 5% had a short peak, and 6% had a bimodal peaked histogram. In our study, we observed cases of Microcytic hypochromic anaemia with less than normal ranges of Mean Corpuscular Volume (MCV) and Mean Corpuscular Haemoglobin Concentration (MCHC) and increased Red cell Distribution Width (RDW). Conclusion: Technologists can use histograms to help them identify the cases that call for specialised peripheral smear testing. The RBC Histogram becomes a valuable diagnostic tool when the proper interpretation of the curve is combined with the results of blood count features like red cell distribution width and red cell indices.

DOI: 10.5281/zenodo.

Introduction: Organophosphorus (OP) poisoning is a burning health issue in a agriculture dependent country like India. Its exposure is a serious threat that may affect human and animal health because of their various toxicities. Glycemic status of the patient who has consumed organophosphorus compound may help us to predict the severity and prognosis in such patients. Aims and Objectives: (1) To check glycemic status by random blood glucose level at time of admission in acute organophosphorus poisoning. (2) To correlate the blood glucose level with severity and prognosis. Method: this was a prospective analytical study, done at Dept of medicine, AGMC & GBPH from July 2022 to June 2023 with 100 patients. Results: Patients were categorized into hypoglycemic (35%), euglycemic (53%) hyperglycemic (12%) & the outcome in terms of mortality was 57.14%, 5.66% and 41.67% in the respective groups. Further, random blood sugar was compared with POP and PSS to look for statistically significant association between the extremes of glycemic status and higher grades of clinical severity scores using Chi-square test. The established Peradeniya Organophosphorus Poisoning Scale (POP) and Poisoning Severity Scale (PSS) revealed the study to be statistically significant (p value= 0.001) indicating both the extremes of glycemic status are associated with high clinical severity and poorer outcomes.

DOI: 10.5281/zenodo.

Background: As per the proposal of ISO: 15189: NABL -112& CLIA guidelines, a laboratory should ideally establish its own reference intervals for all the parameters specific to the population it serves. Accordingly, a project was taken up to revise and update the reference interval of lipase in the population attending the departmental clinical lab. Material & Methods: This observational, cross sectional database study was carried out at Department of Biochemistry in a teaching hospital. 126 individuals were included in the study provided they satisfied the inclusion and exclusion criteria. Results: On statistical analysis of the compiled data, it was found that the values of lipase ranged from 47.96 U/l – 51.79 U/l(95% confidence interval) with a mean was of 49. 87 U/L. Skewness was found to be 0.990 and kurtosis 1.572 which assured the normal distribution of healthy study population.  No significant age and sex differences were found among males and females. Significance was considered at P value <0.05. Conclusion: We found that the reference interval of the reagent manufacturers were set at a bit higher level for the population and it needs to be updated. This study also established reference interval of lipase did not show significant age and sex differences, suggesting that males and females share the same reference interval.

DOI: 10.5281/zenodo.

Medication errors represent a critical challenge in healthcare, posing risks to patient safety and well-being. This article explores the diverse spectrum of medication errors, aiming to shed light on their complexities and implications for clinical practice. Pharmaceutical omission accounted for 43.51% of all pharmaceutical errors and occurred nearly three times as often as the second most common form of mistake. During the study period, Pharmacist has reported highest medication errors [648 (48.04%)] followed by nursing staff and Doctors [461 (34.17%)] and [240 (17.79%)] respectively. The majority of medication order errors happened during hospital admission (60.12%), which is twice as high as the error rate during the hospital stay (23.8%). Medication omission (43.51%), dosage mistakes (13.79%), and data entry errors (12.08%) were the three most common kinds of errors across all ward specialties.  Medication errors pose significant challenges to patient safety and healthcare quality. By understanding the various types of medication errors, identifying their root causes, and implementing proactive prevention strategies, healthcare providers can mitigate risks and improve medication safety for all patients.

DOI: 10.5281/zenodo.

Background: Low back pain is a very common condition, about 90% of people suffer from it at some point in their lives. Low back pain remains a significant health problem in terms of low quality of life, loss of work, cost of evaluation and varied treatment approaches. Treatment of low backache not only includes treating it symptomatically, but also treating the underlying pathology so that the patient gets satisfactory and lasting relief. Several researchers have indicated that vitamin D deficiency may be possibly related to chronic low back pain. This study was aimed to investigate the relationship between vitamin D levels and idiopathic low back pain in patients and to examine its effects on pain. Material & Methods:  This was a prospective observational study done at Government Medical College, Jammu on 200 patients who visited the out patient department of orthopaedics with complaints of idiopathic non specific low back pain for a period of atleast 3 months or more. Fasting venous blood samples were withdrawn and subjected to an automated chemiluminescence immunoassay (CLIA) analyser to estimate serum Vit D3 levels. Results: Out of 200 patients, around 80 % patients of the patients were found to have inadequate VitD3 levels with 63% of patients being deficient while the rest 17% had insufficient Vit D levels. Conclusion: Evaluation as well as management strategy of Chronic low back ache patients is multidisciplinary. Clinical guidelines for the management of chronic low back pain should include an evaluation of the patient’s vitamin D3 status.

DOI: 10.5281/zenodo.

Background and Aim: Comparative studies on the recovery characteristics of local, general, and regional anaesthesia indicate that local anaesthesia is optimal for day care surgery. The objective of this study was to assess if using a local anesthetic approach is a viable substitute for spinal anaesthesia in hernia repair surgeries. This assessment focused on factors such as operating circumstances, satisfaction of both the patient and surgeon, postoperative pain management, and any potential consequences. Material and Methods: The study was conducted in the surgical department, medical ward, and affiliated hospital. A total of twenty-three individuals were evenly divided between Group A and Group B. Group A had inguinal hernia mesh repairs under local anaesthesia, whereas group B received spinal anaesthesia. Group A received local anaesthesia with 2% xylocaine with adrenaline at a dosage of 4-6 mg/kg (n=60).  Group B received spinal anaesthesia (SA) with a dosage of 0.3 mg/kg in adults and 0.4 mg/kg in children, using a 0.5% bupivacaine solution. The group consisted of 60 participants. Results: Out of the 56 individuals who had spinal anaesthesia, none reported any discomfort (VAS = 0) during surgery. However, two cases each suffered mild and moderate pain. Regarding local anaesthesia, 12 cases reported no discomfort (VAS = 0), 16 cases experienced mild pain (VAS 1-3), 24 cases had moderate pain (VAS 4-6), and 8 cases suffered from severe pain (VAS >= 7). Conclusion: Local anaesthesia is a viable and efficient approach for repairing inguinal hernias in adults. It is comparable to spinal anaesthesia in terms of patient satisfaction regarding factors such as surgery duration, post-operative pain, complications associated with spinal anaesthesia, recovery from anaesthesia (early post-operative ambulation), and length of hospital stay.

DOI: 10.5281/zenodo.

Introduction: Caesarean sections are now frequently performed under spinal anaesthesia to reduce the risk of airway difficulties and the medication transfer to the neonate associated with general anesthesia. Maternal hypotension following spinal anesthesia is a common side effect, even with adequate fluid loading. Aims: In severe pre-eclamptic and normotensive parturients undergoing caesarean sections, to compare the degree of hypotension and the amount of phenylephrine required intraoperatively to treat it in order to assess the safety and effectiveness of spinal anesthesia. Materials and Methods: The study is Observational prospective study. This study was carried out among patients scheduled for Caesarean section. Period Of Study: One and half year (March 2020 – August 2021). This study was conducted after obtaining permission from the institute’s Ethical committee, scientific committee as well as approval of the West Bengal University of Health Sciences. This was conducted at obstetric operation theatre of Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal. Result: The percentage change of mean SBP, DBP, and MAP from baseline did not differ statistically significant between the two groups. Group A (normotensive parturients) consumed more phenylephrine than patient of group B (severe pre eclamptic parturients) and the difference was statistically significant (100.00+14.76 vs. 28.57, p= 0.006). The incidence of hypotension was statistically significant, higher in group A (75% vs.57.1%) than in group B. Conclusion: We compared the changes in hemodynamic parameters between severe pre-eclampsia parturients and normotensive parturients in a prospective comparative study. Although it was not statistically significant, normotensive parturients in our research had more percentage of falls of MAP than parturients with severe pre-eclampsia. Additionally, we discovered that normotensive parturients required more phenylephrine than did parturients with severe pre-eclampsia.

DOI: 10.5281/zenodo.

Background and Objectives: Various antifungal agents, including oral and topical formulations, have been developed for treating dermatophytosis. The study aimed to assess the effectiveness of 1% terbinafine hydrochloride cream and 1% ciclopirox olamine cream, both separately and in combination, for dermatophytosis treatment. Materials and Methods: In this randomized comparative study, 90 patients diagnosed with tinea corporis, tinea cruris, or tinea faciei were allocated randomly into three groups, each comprising 30 patients. Group 1 received topical 1% terbinafine hydrochloride cream twice daily for 6 weeks. Group 2 received topical 1% ciclopirox olamine cream twice daily for 6 weeks. Group 3 received topical 1% terbinafine hydrochloride cream once daily in the morning and 1% ciclopirox olamine cream once daily in the evening for 6 weeks. Therapeutic outcomes were assessed clinically at 3 and 6 weeks post-treatment using a structured questionnaire. Results: After 6 weeks of treatment, Terbinafine group showed no erythema in 0 (0.00%) patient, moderate erythema in 2 (2.22%) patients, and mild erythema in 26 (28.89%) patients. In Ciclopirox group, mild erythema was observed in 19 (21.11%) patients after 6 weeks of treatment. In combination group, moderate erythema was observed in 3 (3.33%) patient, mild erythema in 22 (24.44%) patients, and no erythema in 5 patients after 6 weeks of treatment. None of the patients experienced severe erythema. Conclusion: Combination therapy with terbinafine hydrochloride and ciclopirox olamine demonstrated improved therapeutic response with a lower relapse rate and no significant side effects.

DOI: 10.5281/zenodo.

Background and Objectives: Hoarseness typically represents an initial indicator of both localized and systemic ailments. It is characterized by a voice that is perceived as rough, harsh, or breathy. The underlying pathophysiological mechanisms involve disruptions in vocal cord oscillation due to hypertonic dysphonia, which results from either incomplete glottal closure during phonation or increased vocal cord mass, potentially caused by tumors. Methods: This was a prospective study that included 89 patients chosen via a simple random sampling method. Participants ranged in age from 2 to 70 years and presented with a history of hoarse voice. They were assessed at the E.N.T. outpatient department of a tertiary care medical college and hospital in India. Results: The study identified vocal cord congestion as the most prevalent lesion. Vocal cord nodules was the second most common condition followed by vocal cord polyps. Each of the conditions including supraglottic malignancy and vocal cord growth was found in few patients. Hypopharyngeal malignancies and tonsillar malignancies were also identified in few patients. Also, cases of epiglottic cysts, vocal cord palsy, subglottic malignancy, laryngeal papilloma, vocal cord haemangioma, vocal cord hemorrhage, Reinke’s edema, and vocal cord edema were found. Conclusion: The investigation found that vocal cord congestion were the most common pathological finding, followed by vocal cord nodules then vocal cord polyps. Vocal cord palsy and malignancy related to vocal cord are very rare causes of hoarseness of voice. Factors contributing to these conditions included voice abuse, smoking, and the use of tobacco and betel nuts.

DOI: 10.5281/zenodo.

Background: Physical fitness encompasses more than just being free from debilitating diseases or deformities and the ability to efficiently carry out desk-bound tasks; it also involves a feeling of physical well-being and the ability to handle emergencies that require unusual physical exertion. The Modified Harvard Step Test (HST) is a relatively precise and dependable method for measuring the Physical Fitness Index (PFI). Factors such as body mass index impact cardiorespiratory endurance and lung function. The current study evaluates how body mass index influences cardiac and pulmonary fitness. Methods: This prospective study was conducted in the Department of Physiology on young and healthy adult male and female medical students. Assessment of Physical Fitness Index (PFI): The PFI level at which the subjects of the research were measured was provided through the use of a modified Harvard Step Test. Anthropometric measurements were noted for each participant and blood pressure was measured as per the standard protocol. PFI rating was done according to the modified Harvard Step Test for males and females. Results: The majority of the male participants had lower fitness levels. Fitness among females proved to be higher than in males as a whole. It may be because of the higher prevalence of physical activity in females compared to males of this group. This study found a positive correlation between physical activity and physical fitness. Regularly engaging in physical activity proved to be one of the keys to maintaining a proper fitness level. On the other hand, overweight and obesity were associated with a decline in physical fitness assessments. In the study, a correlation was found between exercise and heart rate variability during exercise. Individuals with higher fitness levels exhibited lower heart rate variability. Conclusion: The findings of the study confirm the traditional connection between exercise and fitness. Regular physical activity is a factor that may influence the level of fitness. Moreover, there was a correlation between fitness levels and heart rate variability during exercise, and the more fit individuals demonstrated lower variability. These results highlight the importance of exercise practice among medical students to increase their physical ability.

DOI: 10.5281/zenodo.

Background: A broad class of aerobic, non-spore-forming bacilli known as non-fermentative gram-negative bacilli (NFGNB) either do not use carbohydrates as a source of energy or break them down by alternative metabolic pathways to fermentation. Patients with certain illnesses or conditions are more likely to become infected with non-fermenters. These include cancers, especially those affecting the reticuloendothelial system, instrumentation, surgery, urinary tract catheterizations, intravascular catheterization, lumbar punctures, tracheostomy, dialysis, lavages, shunt placement, prosthetics, prolonged antibiotic use, and chronic infections. Additional risk factors include exudative lesions, burns, and open wounds. Aim: The study’s goal was to identify NFGNB down to the genus and species level and examine their pattern of antibiotic sensitivity and resistance so that the appropriate empirical therapy could be chosen. Material and Method: The Microbiology Department’s Bacteriology Section is where the current study was carried out. Depending on the clinical diagnosis of each patient, a total of 400 clinical samples were taken from patients who were hospitalized to the hospital’s ICU and different wards. Urine, pus, blood, ear, high vaginal, sputum, endotracheal secretions, tracheal aspirate, and other bodily fluids were among them. Of the total samples, 250 samples were taken from patients admitted to different hospital wards, and 150 samples were taken from patients in the intensive care unit.  In accordance with the guidelines set forth by the institutional ethics committee, each research subject signed an informed consent form.  Patients who wished to participate in the trial or their guardians gave written, informed consent. Results: Non-fermenting Gram-negative bacilli were isolated from 400 clinical specimens accounting for an isolation rate of 10.20%. two fifty specimens (62.5%) showed polymicrobial infection where non-fermenters were isolated along with other organisms, of which E. coli and S. aureus were commonly associated. Pseudomonas aeruginosa isolates in our study were highly susceptible to Colistin (96.79%), Amikacin, Tobramycin (75%), Piperacillin/Tazobactam (62.85%) and imipenem (59.61%) Like Pseudomonas aeruginosa, Acinetobacter baumanii was also highly susceptible to Colistin (85.10%). The drug Imipenem in our institute was more sensitive to Acinetobacter (75.31%) as compared to Pseudomonas (59.61%).Conclusion: NFGNBs are becoming more and more significant opportunistic pathogens, and they are immune to several conventional  antibiotics. Underlying host variables were highly correlated with the result for each of these organisms. Microbiologists and clinics alike have challenges due to the interaction between these multidrug-resistant bacteria and the multidrug-resistant population of immune-compromised patients. Reducing mortality and improving patient management would be achieved by early diagnosis and the implementation of empirical therapy based on the institute’s local antibiogram data.

DOI: 10.5281/zenodo.

Aim: To find out the prevalence of specific risk factors among babies who received exchange transfusion for severe neonatal jaundice and to note their clinical outcome at the end of one month post procedure. Materials and Methods: Retrospective Observational Study done in NICU, SNCU and Level-3 ICU at Niloufer Hospital for Women and Children from 18 months. 56 neonates who received exchange transfusion for severe neonatal jaundice. Results: Majority of the babies were admitted on the day of birth (39%) followed by 1st DOL (14%) followed by 5th DOL (13%). Majority of the babies underwent ET on 1st DOL (18%) followed by day of birth (16%) followed by 5th DOL (16%) neonates. %). Maximum admissions for hyperbilirubinemia occurred on birth day itself.  Mean TSB on DOA was 24.58±4.68 mg/dl. Most common risk factors found during the study were absence of breast feeding (63%), Rh incompatibility (35.7%), ABO incompatibility (25%), Birth Asphyxia (14%), Sepsis (9%), GDM (9%), Preeclampsia (7%). Among the outcomes studied, 4 cases underwent mortality (7%). Of the cases that died, 2 were born preterm at 32 weeks and 35 weeks respectively. All babies had the uniform risk factor of lack of breastfeeding. Two cases had Rh incompatibility, of which one also had a positive sibling history. One case showed ABO incompatibility. 39.2% cases showed no morbidity. 53.5% cases showed morbidities, of which most commonly noted morbidities were thrombocytopenia(23%) followed by sepsis (21%) . Hypocalcaemia was found in 14.2 % cases. Conclusions: Exchange Transfusion, though a lifesaving procedure, effective in rapidly bring down bilirubin levels is not bereft of complications. Significant morbidities identified after the procedure must prompt us to be more stringent in preventive care aspects for severe neonatal jaundice.

DOI: 10.5281/zenodo.

Introduction: Epilepsy is a neurological ailment that is defined by the occurrence of repeated seizures. It is a condition that impacts a large number of people globally. Gaining knowledge of the demographics, treatment patterns, and related variables is essential for the successful administration of care. The objective of this research was to examine the demographic features, drug use, mental health symptoms, and prognosis of epilepsy patients receiving therapy. Materials and Methods: We performed a cross-sectional research comprising 50 individuals with epilepsy who were receiving therapy. Structured questionnaires were used to gather data on demographics, drug utilization, adverse reactions, and mental health symptoms. The Self-Reporting Questionnaire-20 (SRQ-20) was used to evaluate symptoms related to mental health. The prognosis was classified as better, stable, worsened, or not relevant. The data were examined using descriptive statistics. Results: The research had an equal distribution of male and female participants. The majority consisted of adult individuals residing in urban regions. The majority of individuals had generalized epilepsy and had a familial predisposition to the condition. Approximately half of the individuals experienced five or fewer seizures before receiving therapy. Lamotrigine was the predominant antiepileptic medication, with 46% of individuals reporting adverse effects. There was a high incidence of mental health complaints, including headaches, reduced appetite, and disrupted sleep patterns. The prognosis exhibited variability, with 30% of cases demonstrating improvement, 40% remaining stable, and 20% experiencing deterioration. Conclusion: This research offers significant findings about the demographic characteristics, treatment behaviours, and mental health symptoms of individuals with epilepsy. Gaining insight into these aspects may assist healthcare practitioners in customizing treatment plans and support methods to enhance patient outcomes and quality of life.

DOI: 10.5281/zenodo.

Introduction: Subarachnoid anaesthesia is a frequently used method for doing procedures on the lower abdomen and lower limbs. Dexmedetomidine, a drug that activates alpha-2 adrenergic receptors, has been examined as a supplement to subarachnoid block in order to evaluate its impact on maintaining stable blood pressure during surgery and in the recovery period. Methods: A randomized controlled experiment was performed on a sample of 60 patients classified as ASA grade I or II, aged between 20 and 60 years, who were having procedures on the lower abdomen and lower limbs. The patients were assigned randomly to two groups: Group D got dexmedetomidine, whereas Group C received normal saline. Demographic information, as well as heart rate (HR), blood pressure (BP), and respiratory rate (RR) during surgery, were documented at different intervals and analyzed. Results: There were no notable disparities between the groups in relation to demographic characteristics. The intraoperative heart rate (HR) was consistently lower in Group D compared to Group C starting from 5 minutes after the subarachnoid block, and this difference was statistically significant (p < 0.001). Group D exhibited a consistent and substantial decrease in blood pressure compared to other groups starting from 10 minutes after the subarachnoid block (p < 0.001). The statistical analysis, known as RR, did not reveal any significant differences between the groups at any time point (p > 0.05). Conclusion: The addition of dexmedetomidine to a subarachnoid block led to a significant decrease in intraoperative heart rate (HR) and blood pressure (BP) as compared to the use of normal saline. Nevertheless, there were no notable disparities in respiratory rate across the groups. Dexmedetomidine is a valuable addition to subarachnoid anaesthesia for maintaining stable blood pressure during procedures involving the lower abdomen and lower limbs.

DOI: 10.5281/zenodo.

Introduction: Primary ovarian germ cell tumors are rare and a heterogenous group of neoplasms with various histological pattern. It account for for 20% of all ovarian neoplasms and most commonly seen in young female and children and clinically presents with pain abdomen, abdominal lump. Benign ovarian germ cell tumors are more common than malignant tumors which accounts for about 2.5% of all ovarian malignancies. Aim of this study is to determine the clinical presentation of germ cell tumors of ovary in relation to age, parity, symptoms and evaluate the different histomorphological patterns and frequency of various germ cell tumors. Materials and Methods: It is a hospital based retrospective cross sectional study conducted for a period of one and half year in a tertiary care centre of north east India. Study data were retrieved from the histopathology section of Department of Pathology Gauhati medical college and Hospital. All the cases were rechecked and slides were reviewed systematically for histopathological diagnosis. Results: Most commonly affected age group is 26-45 year, mean age 32.8 years. Abdominal pain with lump was most common presentation. Six (18.75%) patients were nulliparous, 18(56.25%) parous and 8(25.0%) were unmarried girls. Out of 32 germ cell tumors 27(84.38%) were benign 5(15.62%) were malignant (P<0.002). Among the 32 germ cell benign cystic teratoma 27(84.38%) was the most common benign neoplasm and mixed germ cell tumor 2(6.25%) was the most common malignant neoplasm. Conclusion: Primary ovarian germ cell tumor are uncommon, most of the tumor seen in 26 to 45 years, malignant germ cell tumor are common in younger age group. Mature teratoma is most common benign tumor and mixed germ cell tumor is most common malignant tumor and surgery is the treatment of choice.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the treatment pattern with Global Initiative for Asthma (GINA) guidelines in patients of bronchial asthma. Methods: The study was a prospective observational study for a period of one year in the outpatient and inpatient Department of Medicine and Paediatrics, Department of Pharmacology, DMCH, Laheriasarai, Darbhanga, Bihar, India. Permission was acquired from the head of department of medicine and paediatrics for the study. Results: The average age of the Patients was 38.52±23.77 Yrs. (Range- 6-83), majority of the patients were Male -53.34% and Females were 46.67%. β2 agonists were the most common antiasthmatic drugs prescribed in all the patients followed by corticosteroids and methylxanthines respectively. The next common drug class prescribed was antimicrobial agents. Oxygen was prescribed in 9 patients. Other drugs prescribed were antacids and antireflux agents, antihistaminics, vitamins and minerals, antidiabetics, antihypertensives and antipyretics and analgesics. β2 agonists were the most common antiasthmatic drugs prescribed in 48 patients followed by corticosteroids and anticholinergics respectively. Magnesium sulphate was prescribed to inpatients only. The next common drug class prescribed was antimicrobial agents. Oxygen was prescribed in 11 patients. Other drugs prescribed were expectorants, antipyretics and analgesics, antacids and antireflux agents and antihistaminics. Conclusion: It was concluded from our study that Overall pattern of drug use showed that β2 agonists and corticosteroids were most common class of antiasthmatic drugs prescribed. A detailed drug utilization of antiasthmatic drugs indicated that the use of oral and nebulised salbutamol, injection hydrocortisone, nebulised budesonide and injection as well as oral theophylline was high in both IPD and OPD medicine patients. The use of oral and nebulised salbutamol, systemic steroids and nebulised budesonide was high only in paediatric IPD patients as compared to paediatric OPD patients. The use of theophylline was only in medicine patients while magnesium sulphate was prescribed to only paediatric patients.

DOI: 10.5281/zenodo.

Aim:  The aim of the present study was to investigate the impact of oral anticholinergics on insulin secretion in subjects with impaired glucose tolerance (IGT), in comparison with volunteers having normal glucose tolerance (NGT). Material & Methods: This prospective observational study was conducted in the Department of Pharmacology, DMCH, Laheriasarai, Darbhanga, Bihar, India and recruited 30 IGT and 30 NGT subjects. An oral glucose tolerance test (OGTT) was conducted twice in the absence and presence of hyoscine butyl-bromide (HBB). The plasma glucose (PG) and insulin levels were serially estimated at 30-min increments for 2 h after the OGTT. Early (ΔI30/ΔPG30) & late (insulin/PGAUC 60-120) phase insulin activity were assessed subsequently. Results: In the present study, 60 subjects including 30 IGT (13 male/17 female, BMI: 26.4±2.4) and 30 NGT (15 male/15 female, BMI: 24±0.6) met the study requirements and completed the experimental protocol. In both the groups, a higher proportion belonged to the “overweight” category. The effect of HBB in the IGT group was examined in terms of pharmacodynamic parameters obtained during a 75 g OGTT (0–120 min). The presence of HBB did not have an impact on their fasting PG and PG Cmax values. In the IGT group, the presence of HBB had no effect on fasting insulin levels and insulin Cmax at t = 60 min. The addition of HBB also did not impact on the insulin total AUC 0–120 min. The presence of HBB had no effect on fasting insulin levels (6.50 ± 1.32 vs. 5.70 ± 0.87 mIU/L) and insulin Cmax at t = 60 min. However, the addition of HBB significantly decreased the insulin total AUC 0-120 min. In the NGT group, similar to the IGT group, the presence of HBB did not impact on the plasma glucose-based parameters, for example, fasting PG. Conclusion: Our study findings indicate that insulin secretion is influenced by cholinergic system and that oral anticholinergics may attenuate the late phase insulin activity in varying degrees of glycemic status.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the retinal changes among patients presenting with pregnancy induced hypertension. Methods: This was a prospective observational study carried out in the Department of Ophthalmology, IGIMS, Patna, Bihar, India. 100 patients who fulfilled diagnostic criteria of PIH during a period of one year were enrolled for the study. Informed consent was taken and baseline data was recorded. Results: Most of the women belonged to 20-30 years of age group. 64 (64%) were primigravida, 26 (26%) were multigravida (2-4 pregnancies), and 10 (10%) were Grand Multi (5 or more deliveries). 36 (36%) patients had mild preeclampsia, 52 (52%) had moderate to severe preeclampsia and 12 (12%) had Eclampsia. Among primigravida patients 34 patients showed fundus changes while out of 26 patients who were multigravida 22 patients had retinal changes. We found a significant correlation between gravidity and retinal changes (p = 0.01). In our study, retinal changes were observed in 11 patients out of 36 patients with non severe preeclampsia, 11 out of 12 patients with severe preeclampsia and all eclampsia patients showed fundus changes. 22 patients had grade I changes, 32 showed grade II changes, grade III and grade IV hypertensive changes was seen in 8 and 3 patients respectively. Six patients developed serous retinal detachment. Conclusion: Grade III and Grade IV retinopathy changes were more frequently noted in patients with severe preeclampsia and eclampsia. Few patients also presented with vision threatening complications such as serous retinal detachment, macular edema and cortical blindness. Presence of macular edema, papilloedema or retinal detachment are the warning signs for termination of pregnancy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine cardiovascular comorbidities associated with different stages of peripheral vascular disease and current use of pharmacological cardiovascular risk reducing therapy among men and women with the disease. Methods: This study was conducted by random selection of 100 cases with Peripheral Arterial disease of the lower extremities admitted to surgical wards of Darbhanga Medical College and Hospital, Darbhanga, Bihar, India done during the period for the period of one year. Results: Among the 80 cases diagnosed with PAD due to Atherosclerosis in this study 70 were males and 10 patients were females. In this study, 20 patients diagnosed with TAO were males. Majority of the cases in atherosclerosis were above the age of 50 yrs., while in the TAO group majority belong to the age group between 31 to 50 yrs. All patients had dry gangrene. Ischemic ulceration was present in ten patients. Majority of the patients had popliteal disease in the atherosclerosis group, with TAO affecting more distal vessels and Atherosclerosis involving the more proximal arteries. Majority of the patients had an uneventful recovery, with complication rates being higher among the atherosclerosis group. In atherosclerosis group, 44 patients required secondary suturing of the surgical wound and two cases underwent revision amputation. Conclusion: TAO and Atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. TAO presented at a younger age group whereas atherosclerosis presented in the older age group.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the preoperative and post-operative astigmatism in small incision non-phaco cataract surgery from superior and temporal incision and phacosurgery. Methods: The current investigation was carried out at the Department of Ophthalmology, IGIMS, Patna, Bihar, India over a duration of one year. A total of 100 patients were chosen for the investigation. All patients received manual small incision cataract surgery (MSICS), with 50 patients undergoing superior scleral incision, 50 patients undergoing superotemporal incision, and the remaining 50 patients undergoing phacosurgery. All individuals were assessed and treated at the same medical facility, and they received post-operative care as outpatients at the same hospital. Results: A randomized comparison of astigmatism at postoperative follow-ups after superior (SI), superotemporal scleral incision (STI), and Phacosurgery in manual small incision cataract surgery in 100 patients, 50 each incision. In this study, 74% of MSICS patients in both groups had visual acuity less than 6/60, whereas 26% had it more than 6/60. In this study, 18 (36%) WTR astigmatism patients underwent SI, 17 (34%) STI, and 16 (32%), while 22 (44%) ATR astigmatism patients underwent SI, 46% STI, and 24 (48%) Phacosurgery. Conclusion: This study demonstrates that sutureless superotemporal scleral incision causes less post-operative astigmatism than superior and phacosurgery. Superotemporal incision causes with-the-rule astigmatism in most cases postoperatively and can neutralize against-the-rule astigmatism in most elderly cataract patients, while superior scleral incision causes mostly against-the-rule.

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 1 year in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. The study comprised of 100 cases which met the inclusion criteria were taken for this study. Results: The maximum number of cases 24 (24%) were between the age group of 46-50 years. The most common site biopsy received was from cervix, 43 (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 evaluate the platelet count and platelet indices in patients with hyperlipidemia. Methods: This was a prospective study carried out at Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. The study included all patients of both sexes above 20 years of age coming to our diagnostic centre for routine health checkup. These patients underwent lipid profile testing after 12-14 hours of overnight fasting and a complete blood count as a part of their routine health checkup. 100 patients with hyperlipidemia without any associated diseases and 100 controls with normal lipid profile were included in the study. Results: The patients were divided into 21-40, 41-60, 61-80 and > 80 years of age in both the sexes. Maximum number of patients were in 41-60 years of age (64%) followed by 27% in 21-40 years of age, 8% in 61-80 years age group and one patient above 80 years of age.65% were male and 35% were females. The mean age was 47.3 ± 12.8 in study group and 48.6 ± 12.6 in the control group. The mean cholesterol ,mean triglyceride and mean HDL cholesterol level in study group was 218.6±36.3, 244.3±154, 38.7±9.6 respectively and 158±26.8 ,94.1±34.8,and 42.1±9.3 in control group respectively. Mean LDL cholesterol was 131.1±39.4 in study group and 97.1±25.2 in control group. There was significant difference in cholesterol, triglyceride and LDL cholesterol levels in both the groups. When platelet parameters were compared in both the groups, it was observed that the mean platelet count was 320±78.8 in study group as compared to 306±76.8 in control group. There was a significant difference in platelet counts in both groups with a p value of 0.01. PCT and MPC also showed a p value of 0.04. The mean platelet mass (MPM) was 2.17±0.2 in study group as compared to 2.13±021 in control group. Large platelet count was 7.09±4.9 in study group while it was 5.95±3.81 in control group which was also significantly different. However, the PLC-R did not show a significant difference in both groups. Conclusion: Hyperlipidemia may cause a variety of thromboembolic complications and platelet indices reported by modern day automated haematology analysers are used to assess the risk of such events in hyperlipidemic patients. Our study indicates that PCT, MPM, large platelets and platelet count are significantly higher in hyperlipidemia patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find the effects of simple yogic exercises on Pulmonary Function Tests in healthy adults. Methods: The present study was conducted in the Pulmonary Function Test (PFT) Laboratory, Department of Physiology, Informed (written) consent was taken from each subject before the study. 100 healthy subjects, including both male and female of age group of 40 to 60 years, with no respiratory, cardiovascular or other medical aliments, were selected for the study. Results: The mean age, mean weight and mean height was 64.26 + 6.34 years, 72.48 + 13.47 kgs and 166.74 + 8.32 cms. The pulmonary parameters with respect to FVC % Predicted and MVV % Predicted showed highly significant results. Conclusion: The study revealed that after undergoing six weeks of regular yoga training in healthy individuals, definite improvement in pulmonary function parameters like FVC and MVV is seen. This may be due to regular slow and forceful inspiration and expiration during yogasanas leading to strengthening of respiratory muscles and increased release of surfactant too.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the efficacy of hyperbaric Ropivacaine in patients undergoing lower abdominal and perineal surgeries under spinal anaesthesia. Methods: The present study was prospective, observational study, conducted in the Department of Anaesthesiology & Critical Care, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India. Study duration was of one years. In present study, 50 patients underwent spinal anaesthesia with ropivacaine for lower abdominal and perineal surgeries. Results: Mean age was 47.33 ± 12.16 Years, mean weight was 64.86 ± 10.46 kgs, gender wise 44% were male while 56% were females, ASA class I were 72%, class II were 28% and mean duration of surgery was 64.6 ± 20.44 min. In present study, average time-to achieve sensory block at T10 level was 3.7 ± 0.46 minutes, average time to achieve maximum block was 5 ± 0.35 minutes, average time taken for Two segment regression was 128 ± 19.65 minutes, average total duration of sensory block was 229 ± 23.32 minutes, mean time for achievement of MBS Grade 3 was 3.7 ± 0.42 minutes and mean total duration (motor) (MBS grade 0) block was 245 ± 26.54 minutes. We noted maximum block at T6 level in 3 patient, 6 patients at T10 level and 21 patients at T8 level. Conclusion: We observed that the variables assessed to achieve sensory and motor block were satisfactory, without any adverse effects intra and post-operatively. Hence, Ropivacaine (hyperbaric) 0.75% can be used for lower abdominal and perineal surgeries with desired motor and sensory effects with effective surgical time. It can be used successfully for Day care surgeries.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair. Methods: A prospective, open, randomized, comparative study was undertaken in the Department of General Surgery  for the period of 1 year. Before being included in the study, informed written consent was obtained from all patients. Total 70 patients-30 patients in each group-were included in the study who were fulfilled the selection criteria. Results: Majority of the patients were males. Other preoperative variables-age, BMI, comorbidities, and smoking-did not show a statistically significant difference between the two groups. The operative time was significantly shorter in group 2 patients (45.35±7.23 min), whereas it was 78.42±8.62 min in group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. In terms of postoperative complications, postoperative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups. Conclusion: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable post-operative outcomes and had similar problems. The majority of the patients were receptive to both approaches. The time it took for all groups to return to normal activity and work without pain was longer, most likely because the hernia procedures were bilateral.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the role of CT perfusion in patients with acute ischemic stroke in the patients of less than 12 hrs of acute stroke symptoms. Methods: The present study was a prospective study to determine the value of CT in evaluation of cerebral perfusion by use of a bolus of iodinated contrast medium in 50 patients with acute stroke, carried out in the Department of Radiology, Katihar Medical College and Hospital, Katihar, Bihar, India. All the patients enrolled in study were evaluating in period of 18 months. Results: Majority of subjects in the study were in the age group 61 to 70 yrs. (34%). Mean age of subjects was 61.9 ± 14.26 yrs. Majority of subjects in the study i.e., 56% were males and 44% were females. 48% of lesions were on Right side, 34% of them on Left side, 14% on Midline and 4% on both cerebral hemispheres. Majority of subjects (94%) presented with Weakness as symptom. 68% of subjects presented with duration of <6 hrs and 32% presented with duration >6 hrs. Non contrast CT showed that 26 patients had Loss of Gray Matter Interface, 14 patients had Loss of Insular Ribbon, 10 patients had hyper dense MCA and none of them had hyper dense Basilar. On CT perfusion 7 patients had ACA involvement, 20 patients had LCS of MCA involvement, 15 patients had M1 of MCA involvement, 26 patients had M2 of MCA involvement and 18 patients had M3 of MCA involvement and 2 patients had PCA involvement. Conclusion: PS elevation more than 5ml/min/100gm appears to be a promising marker for predicting the risk of HT in acute stroke patients. More importantly, a small PCT lesion (<100 mL) identifies patients who will have a small final infarct and good clinical outcome. A large PCT lesion (>100ml) identifies patients who will have a large final infarct and poor clinical outcome. PCT can play an important role in guiding acute stroke treatment.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the trigger tool method (TTM) in detection, monitoring, and reporting of adverse drug reactions (ADRs). Methods: This was prospective, interventional, single center study conducted at department of Pharmacology, Darbhanga Medical College, Darbhanga, Bihar, India on a permanent basis, posted in Department of Medicine. A total 650 patients were admitted during the study period in the respective medicine unit. Results: A total of 650 patients who fulfill the selection criteria were enrolled. 70% were male and 30% were females. The mean age of patients was 43.07 ± 16.4 years, and the mean length of hospital stay was 5.75 ± 3.12 days. Of the 650 patient cases, triggers were observed in 80 patients (12.30%).  while 20 (25%) suffered one or more ADRs. A list of 17 triggers was given to 30 nurses for identification of ADEs. List of 17 triggers consists of 9 DT, 1 LT and 7 PT. Of these 17 triggers, 14 triggers were identified by nurses in the study population and 3 triggers were not observed. These 14 triggers were noticed 130 times, with an average 12.53 triggers observed per patient. These included DT (100 times), LT (0 times) and PT (30 times). Triggers were identified for a minimum once and maximum 3 times in 95 patients. Of the various triggers observed, 7 drug triggers and 4 patient triggers were related to ADRs. Hence 11 triggers (64.70%) were positive (related to ADRs), out of total 17 triggers under evaluation. A total 24 ADRs were observed in 25 inpatients during study period. One or more triggers were observed in these patients. The commonly detected ADRs were gastritis, thrombophlebitis, diarrhea and vomiting. Chills, cough, headache, joint pain, metallic taste, pruritus and weight gain were also observed. Conclusion: The reporting system is operational at the study site and ADRs are being reported using a standard form. Patients recovering from the reactions following the withdrawal of the suspected drug, and the majority of ADRs were mild. TTM can be used as an add‑on tool to existing methods like spontaneous method for the health‑care professionals for better detection of ADRs in the pharmacovigilance program. However, further research is required to explore the feasibility and acceptability of TTM.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate and compare the clinical success and parental satisfaction for stainless steel and zirconia crowns in primary molars. Methods: This prospective randomized controlled trial was designed as a split‑mouth study. which exfoliation was imminent, tooth with internal resorption, and tooth with acute infection at Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India. The patients with bilateral pulp therapy treated teeth were randomly divided into two groups by coin toss in which group I consisted of 50 primary second molars which would receive SSC (3M ESPE, Minneapolis, USA) and group II consisted of 50 primary second molars which would receive zirconia crowns (Kinder Krown, Minneapolis USA). Results: Both SSC and zirconia crowns achieved a clinical success rate of 100% during the study period. This was determined by evaluating factors such as crown retention, modified gingival index, stain resistance, gingival marginal extension, occlusion, and proximal contact at placement. The only difference between the two crowns was in the plaque index. The level of parental satisfaction was equivalent for both groups in regards to the factors of shape, size, retention, durability, and overall satisfaction. Out of the total number of parents surveyed, only 21 (42%) expressed satisfaction with the color of SSC, while all 50 parents (100%) were delighted with the color of zirconia. A highly significant statistical difference (P < 0.001) was observed between the groups. There was no change in the parental perspective over the duration of the investigation. Every single one of the 50 patients (100%) expressed satisfaction with the zirconia crowns, but only 27 out of the patients (54%) were satisfied with SSC. There was a substantial statistical disparity (P < 0.001) between both groups. Conclusion: Stainless steel crowns continue to be considered the “Gold Standard” for fully covering the back teeth in primary molars. This is because they require a simpler crown preparation process and are less expensive than zirconia crowns. Zirconia crowns, despite their esthetic appeal, require a more invasive crown preparation procedure, necessitate the use of local anesthesia, and are time-consuming. Consequently, they are not often approved by parents and patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to correlate the levels of serum magnesium and blood glucose in type II diabetic population in a tertiary care hospital. Methods: The present study was conducted in the Department of Medicine, Nalanda medical College and Hospital, Patna, Bihar, India and 150 cases all new and old cases of Type 2 diabetes mellitus patients, aged between 35 to 60 years attended were included in the study for the period of 12 months. Results: In our study, mean and std deviation of all the 3 groups were 54.66±13.7, 57.94±11.8 and 52.68±9.8 respectively. In gender area which was not significant in our study. There was a positive Correlation between the parameters of glycemic status i.e., HbA1C, fasting and post prandial blood glucose but no significant correlation with magnesium. The fasting and post prandial blood glucose values are inversely correlated with magnesium. There was no significance r and p-values between the sr.mg and HbA1C. Conclusion: Serum magnesium levels were lower in DM2 patients when compared with non-diabetic controls. Because of this low level of Mg2+, which reduces insulin sensitivity and may increase risk of secondary complications like retinopathy, hypertension and dyslipidaemia, it may be prudent in clinical practice to periodically investigate plasma Mg2+ concentrations in diabetic patients. If plasma Mg2+ is low, an intervention to increase dietary intake of magnesium may be beneficial.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the incidence and sociodemographic profile of scabies in pediatric patients with different age groups attending secondary health care hospital. Methods: This prospective single centre study was conducted on 200 paediatric cases attending in the Department of Paediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar  India  over a period of 12 months. Results: Out of studied 200 patients, 46 (23%); 64 (32%) and 90 (45%) found to be in age groups < 2 yr.; 2-5 yr. > 6-12 yr., respectively. Boys were more affected 120 (60%) as compared to girls 80 (40%). 66% patients had studied >10^th std. and 90% had over-crowding at home. Commonest duration of symptoms while presentation less than 1 month in 176 (88%) and only 24 (12%) have more than 1 month. Itching was noted in 144 (72%) and absent in 56 (28%). More commonly associated in-patients with poor and average hygiene (99.5%) than in the good hygiene. Conclusion: Scabies was commonly seen in children below 6 years of age with boys affected more than girls. More commonly associated in-patients with poor and average hygiene than in the good hygiene. The important predisposing factors were overcrowding and poor hygiene. It was common in poor economic groups. Thus, improving the socio- economic conditions, hygiene, avoiding overcrowding and proper treatment of cases and close contacts are the sources of infection to children help in preventing scabies in children.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine causes of respiratory distress, pattern of respiratory modality used and its outcome among admitted preterm newborns. Methods: A retrospective descriptive study was conducted in the Department Of Pediatrics, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India over a period of two years targeting all neonates admitted to neonatology department. A Total of 200 patients were admitted in NICU during the study. Results: Mean gestational age was 32.46±2.58 weeks. Most of the newborns (64%) belonged to the gestational age within 28 – <34 weeks category. Mean birth weight was 1665.43±585.58 g among them very low birth weight infants were 42%. Male out numbered female newborns (55% vs 45%). Total 12 (6%) infants had Apgar scores <7 at 5 minutes who required some degree of resuscitation just after birth. After admission 8 (4%) patients got single dose of surfactant. Most of the mother (66%) was multiparous and 51% of them did not receive even a single dose of antenatal corticosteroid. All of them were inborn and cesarean section was the mode of delivery for 80% of the enrolled neonates. Maternal hypertension and diabetes mellitus were present in 140 (70%) and 64 (32%) of mother respectively. Maternal risk factors for sepsis were present in 48 (24%) of infants admitted to the NICU. Conclusion: Respiratory distress syndrome is the commonest cause of respiratory distress. Two third of preterm newborns required respiratory support. Most common mode of respiratory support was non invasive mode in the form of supplemental oxygen, Heated humidified high flow nasal cannula and continuous positive airway pressure. Short term morbidities like nasal trauma, sepsis, septic shock, disseminated intravascular coagulation, necrotising enterocolitis and intraventricular haemorrhage were more common in newborns who required invasive respiratory support (p <0.05). Retinopathy of prematurity and mortality was significantly higher in invasive respiratory support group.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the obstetrics outcomes of uterine fibroids and their consequences in a tertiary hospital. Methods: This study was an observational study conducted in the Department of Obstetrics and Gynaecology in NMCH for one year. The study was carried out for a duration of 12 months, from April 23 to March 24. A total of 200 pregnant women with ultrasound results of fibroid were included in this study. Results: The mean age of study patients was 31 years with standard deviation of 5.85, however 42% were 26-30 years old and 32% were 31-35 years old. 9% of patients were under 25 and 3% were over 40. 42% were primigravida, 38% were second or third gravida, and 20% were fourth gravida. Most patients (73%) had subserous fibroids and 18% had submucous fibroids. Fibroids were most prevalent in the fundus (74%), and 13% were pedunculated. 2–3 fibroids were seen in 47% of individuals. Most instances (80%) were delivered at term in this research. The most prevalent delivery method was cesarean section (62%), followed by vaginal (25%), including instrumental and aided breech. Threatened preterm labor (22%), abortion (17%), PPH (10%), and blood transfusion (21%), were the main pregnancy problems. Conclusion: Uterine fibroid pregnancy is often asymptomatic and accidental. Early pregnancy abortion, term pregnancy PROM, and postpartum PPH are linked to fibroids. Also, malpresentation is more likely. Pregnant uterine fibroid patients have significant cesarean section rates. So, uterine fibroids make a normal pregnancy high-risk.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the renal function in patients with acute stroke and its relationship with in-hospital mortality. Methods: The present study was a prospective, observational study conducted in the Department of Medicine, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for the period of 1 year. 200 patients were considered for present study. Results: 80% were from group A while 20% were from group B. Most patients were from >65 years age group, male, BMI<30. Hypertension, smoking, diabetes mellitus, cardiovascular disease, alcohol consumption, dyslipidemia, previous history of stroke/TIA were common risk factors in both groups. On admission most patients had GCS score 5-13. 104 (65%) patients had ischemic stroke, while 48 (30%) had hemorrhagic stroke. We noted mortality within 30 days in 24 (15%) patients. We distributed patients according to Serum Creatinine concentration at time of presentation, most patients had serum creatinine in the range of 98-118 (32%) followed by 82-97 (30%). Maximum mortality was noted in >119 (40%) followed by 98-118 (35%) serum creatinine group. We distributed patients according to blood urea concentration at time of presentation, most patients had blood urea in the range of 6.8-8.9 (40%) followed by 5.3-6.7 (25%). Maximum mortality was noted in >9 (45%) followed by 6.8-8.9 (30%) blood urea group. We noted that age > 65 years, GCS score > 10 at the time of admission, smoking, diabetes mellitus and aspiration pneumonitis were predictors of death in stroke patients. Conclusion: The severity of impaired kidney function in patients hospitalized with acute stroke is associated with increased mortality independent of age, sex, and major comorbidities. Unrecognized renal insufficiency noted by low eGFR is common in patients with acute stroke and is associated with higher mortality adverse short-term outcomes.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate hemodynamic effects of regional anaesthesia in preeclamptic females. Methods: The observational study was conducted in the Department of Anaesthesia, BMIMS Pawapuri, Nalanda, Bihar, India. Study duration was of 24 months. Study population comprised of 100 normotensive ASA grade II parturients planned for LSCS and 100 ASA grade III preeclamptic parturients planned for LSCS. Results: Mean age in normotensive group was 25.35±4.36 years and in pre- eclamptic group mean age was 24.16±3.07 years. The mean weight at the time of caesarean section was 72.8±6.34 kgs in the preeclamptic group and 74.66±7.53 kgs in preeclamptic. The mean gestational age at the time of caesarean section was 39.14±0.54 weeks in preeclamptic women and 39.07±0.77 weeks in normotensive. Majority of the study participants were nulliparous women in both the group (55% in normotensive group v/s 68% in pre- eclamptic group) while nearly 43% of the participants in the normotensive group and 27% in pre-eclamptic group were primipara. Both groups were comparable in term of mean age, weight, gestational age and parity comparison (p<0.05). All the non-preeclamptic parturients were ASA II while, all parturients in the preeclamptic group were ASA III, and this difference was statistically significant between both groups; (p< 0.001). The incidence of hypotension in non-preeclamptic parturients (93%) was significantly higher and that of preeclamptic parturients (15%). Similarly, bradycardia was also more commonly observed in normotensive group (32%) compared to pre-eclamptic group (2%). Conclusion: Subarachnoid blockade is associated with better perioperative hemodynamic stability and lower risk of hypotension and vasopressor requirements in preeclamptic women compared to the rates of healthy subjects. Subarachnoid block can be safely practiced in patients with preeclampsia undergoing caesarean section. The benefit of rapid, dense and reliable subarachnoid block over epidural anaesthesia should be considered for preeclamptics undergoing caesarean section.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the effects of vitamin A supplementation on iron therapy in anaemic adolescent girls. Methods: It was a Prospective study conducted at Department of Physiology within a period of 1 year. The study population were school going young girls of age 13-16 years. The students of classes 8th, 9th and 10th, aged from 13 to 16 years, were included in the study. 200 girls were included in the study. Results: Severely anaemic students were excluded from the study and referred to medicine and gynaecology OPD for active therapy. Before the study, 68 patients had normal anemia, 44 patients had mild anemia and 88 patients had moderate anemia. The difference between before and after intervention was extremely significant (p<0.0001). In group B mean baseline value for blood haemoglobin was 10.505+1.100 gm/dL and after intervention value was 11.804+1.076 gm/dL. This difference was very significant. In group C, the mean baseline value for blood haemoglobin was 12.664+0.402 gm/dL and after the study duration it was 13.000+0.400 gm/dL. This difference was significant. Conclusion: The present study was conducted to evaluate whether vitamin A supplementation helps to restore the blood haemoglobin level along with iron therapy and helps to improve the status of anaemia. So, further studies involving large population need to be done to establish the definitive role of vitamin A supplementation in anaemia and to recommend it as a standard additive therapeutic agent.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess frequency and antibiotic susceptibility pattern of non-fermenting gram-negative rods isolated from blood culture of patients. Material & Methods: The prospective study was conducted in the Department of Microbiology, Patna Medical College and Hospital, Patna, Bihar, India in between the duration of 1year. Blood Stream Infection (BSI) was defined as the isolation of a pathogen microorganism from >1 blood culture bottle. BSIs were classified as community- and hospital-acquired infections if detected within the first 48 h of hospitalization, or after 48 h of hospitalization, respectively. Results: Total 200 NFGNB were isolated from 1425 culture positive clinical samples accounting for an isolation rate of 14.03%. Urine was the most common specimen (30%) followed by pus (26%), blood (16%), sputum (12%), tracheal aspirate (8%) and remaining 8% included other samples. Acinetobacter baumannii was the predominant isolate, 104 (52%) followed by Pseudomonas aeruginosa 80 (40%) and Burkholderia cepacia complex (BCC) 10 (5%). Burkholderia pseudomallei, Acinetobacter lwoffii and Stenotrophomonas maltophilia altogether accounted for 3%. Among the NFGNB isolated, A. baumannii showed highest sensitivity to gentamicin and lowest sensitivity to ceftriaxone. P. aeruginosa was mostly sensitive to amikacin but least sensitive to ceftriaxone. B. cepacia complex, B. pseudomallei and S. maltophilia showed 100% susceptibility to cotrimoxazole. A. lwoffii showed sensitivity to most of the antibiotics. A. baumannii and P. aeruginosa were mostly sensitive to gentamicin and amikacin and least sensitive to ceftriaxone. Conclusion: This study underlines the need to identify NFGNB in tertiary care hospitals and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. Improved antibiotic stewardship and strict infection control measures especially hand washing need to be implemented to prevent emergence and spread of multidrug resistant NFGNB in health care settings.

DOI: 10.5281/zenodo.

Background: Mandibular foramen is leading to mandibular canal through which inferior alveolar nerve and vessels will transmit and supply the teeth of lower jaw. Inferior alveolar nerve block is common anesthetic procedure prior to dental surgeries on lower jaw. Failure in mandibular anesthesia or injury to neurovascular bundle may be resulted by inaccurate localization of mandibular foramen. Hence this study is aimed to locate the mandibular foramen and its distances from different bone landmarks on internal surface of ramus of dry mandible. Objective: Study to determine the precise position of mandibular foramen in 50 dry mandibles, which is essential for successful inferior alveolar nerve block prior to dental procedures. Materials and Methods: This descriptive study was done on 50 dentulous from Department of Anatomy, Patna Medical College and Hospital, Patna, Bihar, India adult dry human mandibles of unknown sex and age. Distance of mandibular foramen from the mandibular notch, anterior border of the ramus of mandible, posterior border of the ramus of the mandible(angle of mandible), posterior border of the 3rd molar socket and meeting point of base with posterior border of ramus were measured. Further observation regarding the presence of accessory mandibular foramen was done. The observations were tabulated and descriptive statistics was used analyze the data. Result: In the present study, totally 50 mandibular foramina and 18 accessory foramina were observed in the 30 mandible. The mean distance of mandibular foramina to anterior border of ramus is 14.63±3.16 (R) mm and 15.31±3.11 mm(L), to posterior border is (R):12.34±3.10 mm and (L):13.51±3.92 mm, to mandibular notch is (R):21.23±4.56 mm and (L):21.16±3.12 mm, to angle of mandible (R):22.14±3.18 mm and (L):22.1±4.12 mm, to posterior border of 3rd molar socket is (R):14.37±3.16 mm and (L):19.26±2.57 mm. Conclusion: The present study on the precise location of mandibular foramen and on the incidence of accessory mandibular foramen will help the dental surgeons for more successful anesthesia and to perform safer surgeries on the ramus of mandible.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the Knowledge, Attitude and Practices on Breastfeeding among recently delivered women in Bihar region. Methods: It was a cross-sectional observational study at department of community medicine. Women who delivered vaginally or by caesarean section in Department of Obstetrics and Gynaecology, were included in this study. 500 women were selected in the study. Results: 94% women knew that areola should be inside the mouth and 96% women knew about the burping after feeds. 60% women had knowledge about early initiation of breastfeeding and its benefits and 96% knew that breastfeeding remains child healthy. 4% women thought that Breastfeeding is old fashioned and 90% women thought that Breast milk is best milk. 70% of women-initiated breastfeeding within 1 hour of delivery. Maternal Age, sex of child, religion, area of residence, and type of delivery (vaginal or caesarean section) are the factors which determines initiation of breastfeeding and to be eliminated, while maternal educational status, maternal employment status, socioeconomic status, number of ANC visits and antenatal counselling are the factors which are associated with initiation of breastfeeding and to be improved. Conclusion: Our study concluded that targeted and well-coordinated breastfeeding policies and interventions by healthcare workers, eliminating myths regarding prelacteal feeds and promotion of EIBF will improve early initiation of breastfeeding practices for all Indian mothers.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the surgical management of chronic pancreatitis. Methods: The present study was conducted in the Department of General Surgery, Shri Ramkrishna Institute of Medical Sciences, Durgapur, West Bengal, India. 100 patients of chronic pancreatitis were screened during the study period. Results: The mean age was 36.4 years and 38.6 in both the groups respectively and there were male predominance in the study. There were more blood loss in open surgery as compared to laparoscopic surgery but laparoscopic surgery took more operating time. Most of the patients had no intraoperative complications in both the groups. In open surgery, iatrogenic perforation was noted and in laparoscopic surgery, difficulty to identify the MPD was noted. Post-operatively, there were no complications in laparoscopic surgery. 72% patients showed improvement in pain. Conclusion: The two methods of pancreaticojejunostomy are comparable to each other. However, the laparoscopic method has its advantages over the open technique in terms of lesser amount of blood loss encountered, faster onset of enteral nutrition and lesser duration of hospital stay. Intra and post-operative complication profile are similar for both methods. Post-operative pain relief was also similar in both.

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, Patna Medical College and Hospital, Patna, Bihar, India on pregnant women with persistent chronic ectopic pregnancies. 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 objective of the present study was to assess cognitive dysfunction in Type 2 DM during acute mental stress without overt cerebrovascular disease or other vascular risk factors. Material & Methods: The present study was conducted in the Department of Physiology, NMCH, Patna, Bihar, India, 200 subjects within the age group of 30–55 years were included in the study. Informed consent was taken by each subject. They were cleaved into two groups. Group 1 comprised of randomly chosen 100 diagnosed cases of Type 2 DM at least 2 years of duration. Group 2 comprised of 100 age and gender-matched controls. Results: There was no significant difference in age in cases and controls. The mean age of Type 2 DM group was 48.2 years and the control group was 46.4 years. There was a significant statistical difference between weight and BMI. The result showed a significant difference in ART and VRT, both simple and choice in Type 2 DM and controls. There was significant difference ART and VRT, both simple and choice during resting and during mental stress and these RTs were more prolonged in Type 2 DM when compared to controls. Conclusion: The present study concluded that mental stress in Type 2 DM does affect cognition, where grades of deterioration may be related to the difficulty of the given task (mental stress) and prevalence of central nerve deficits and peripheral nerve deficits seen as side-manifestation of Type 2 DM.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the cytomorphology of enlarged lymph nodes to aid in diagnosis and treatment. Methods: This was a retrospective study conducted in the Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India and a total of 200 patients including all age groups and both sexes presenting with palpable or deep lymph nodes in FNAC clinic of our institute over a period of 1 year are included in our study. Results: The age of patient’s ranges from 1 year to 80 years among 200 cases maximum cases were recorded in the age group of less than 20 years i.e. 80 (40%) cases followed by 21-40 years of age i.e. 68 (34%) cases. In the present prospective study total, no of 200 patients with palpable lymph nodes were studied among them 104 (52%) were females & 96 (48%) were males. The category of lymph node lesions on cytomorphology are as follows – Caseating granulomatous lymphadenitis (90 cases), Reactive lymphadenitis (70 cases), Suppurative granulomatous lymphadenitis (18 cases), Suppurative lymphadenitis (12 cases), Metastatic squamous cell carcinoma (3 cases), Metastatic adenocarcinoma (2 cases), Non Hodgkin lymphoma (2 cases), Hodgkin lymphoma (1 case), Kikuchi lymphadenitis (1 case), BCG lymphadenitis (1 case). Conclusion: FNAC Lymph node emphasizes on diagnosing inflammatory treatable conditions and malignant neoplastic conditions, there by guiding the patients for early intervention. Diagnosis of both Inflammatory and Neoplastic lesions can be done by Lymph node FNAC effectively. Also cost effectiveness and ease of the procedure makes FNAC increases patient compliance. A larger sample and longer period of study are required for better representation of community. FNAC is the most suitable diagnostic method for early diagnosis, better management.

DOI: 10.5281/zenodo.

Aim: The aim of the present study to assess the clinical profile and factors associated with uterine fibroids at tertiary health care center. Material & Methods: This was a prospective study carried out in the Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar, India for the period of 1 year. Study population were patients presenting with uterine fibroid. Total 100 patients were studied during study period. Results: Majority of the patients were in the age group of 31 -40 years followed by 41-50 years. Fibroid was not seen below 20 years. Majority of the patients with fibroid were with parity 1-2. 10 patients were having parity above 4. Majority (49%) patients were with size of uterus corresponding to 13-20 weeks followed by 21-24 weeks (31%). Uterine size >24 weeks was observed in 20% patients. 75% patients were having menstrual disturbances. 80% patients showed anaemia according to hemoglobin estimation. It can be due to excessive bleeding during menstruation.44% patients complained of abdominal lump. Other symptoms and signs observed were pain in lower abdomen (16%), Dysmenorrhoea (30%), urinary frequency (14%), dyspareunia (13%), infertility (20%) and mass protruding out of vagina (11%). Single intramural fibroid was observed most commonly (63%) followed by multiple submucosal fibroids (17%). Subserous fibroids were seen in 8 patients, cervical fibroids were seen in 10% patients and only 2 patients had broad ligament fibroid. Conclusion:  It was concluded that uterine fibroids are commonly seen in females of reproductive age group and present with menorrhagia and abdominal pain. Uterine fibroids are more commonly seen in 30-40 age group. Menstrual disturbances are the most common symptom.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the effectiveness of combination of Ramosetron 0.3mg and Dexamethasone 8mg v/s Ondansetron 4mg plus Dexamethasone 8mg among geriatric women. Methods: A prospective, randomized double blinded comparative study of Ramosetron hydrochloride and Dexamethasone versus Ondansetron hydrochloride and Dexamethasone on 100 ASA class I/II patients posted for elective gynaecological surgeries under spinal anaesthesia was conducted in the Department of Anaesthesiology & Critical care, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India among geriatric women. Results: The groups were comparable with respect to age and weight. There was no statistically significant difference observed between groups. There was no statistically significant difference in the ASA GRADING in all the two study groups. The complete response (Score-0) was 88%, 76%, 92%, 94%, 96% and 96% in first 3 hours, 4-6 hrs, 6-9hrs, 9-12hrs, 12-18hrs and 18- 24hrs respectively. PONV Score of Nausea 1 was seen in 5 patients in the first 3hr, 10 Patients in 4-6 hrs respectively. Therefore, the incidence of nausea (score 1) was 10% in first 3 hrs, 20% in 4-6 hrs, 0% in 6-9 hrs, 6% in 9-12 hrs, 2% in 12-18 hrs and 2% in 18-24hrs. Nausea with Retching (Score 2) was seen in 1 patient each in first 3hrs, 4-6hrs, and 2 in 6-9 hrs, 1 in 9-12 hrs and 18 -24 hrs respectively. Not seen any patient in 12-18hrs. The complete response (Score-0) in Ram+ Dexa was 84%, 74%, 88%, 92%, 94% and 96% in first 3 hours, 4-6 hrs, 6-9hrs, 9-12hrs, 12-18hrs and 18- 24hrs respectively. Majority of the patients had complete response during the study period. Complete response (Score-0) was 96% in first 3 hrs, 96% in 4- 6hrs, 100% in 6-9hrs, 98% in 9-12hrs, 100% in 12-18hrs and 98% in 18-24hrs. The incidence of nausea (score 1) was 4% in 1st 3hrs, 2% in 4-6 hours, 0% in 6-9hrs, 2% in 9-12hrs, 0% in 12-18hrs and 2% in 18-24hrs. Nausea with retching (score 2) was seen in 1 patient in 4-6hrs period. Vomiting (score 3) was not observed in 24 hour study period. Complete response (Score-0) in Ram+ Dexa was 94% in first 3 hrs, 94% in 4- 6hrs, 100% in 6-9hrs, 96% in 9-12hrs, 98% in 12-18hrs and 96% in 18-24hrs. Conclusion: The study suggested combination of Dexamethasone (8mg) + Ramosetron (0.3mg) is a better alternative to combination of Dexamethasone (8mg) + Ondansetron (4mg) in preventing PONV in high risk patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the obstetrics outcomes of uterine fibroids and their consequences in a tertiary hospital. Methods: The present study was an observational study was undertaken in the Department of Obstetrics and Gynaecology. The study was conducted over a period of 20 months. One hundred pregnant women who had USG findings of fibroid were enrolled in this study. Results: The mean age of patients in study was 32 years with standard deviation of 4.86, but majority of patients (43%) were in the 26-30 years age group, and then in the 31-35 years age group (31%). 8% of patients were less than 25 years and 2% of patients were more than 40 years of age. 41% of patients were primigravida and 39% of patients were of second or third gravida and 20% of patients were of fourth gravida. The majority of patients had subserous fibroids (69%) and 7% of patients had submucous fibroids. The rest were intramural fibroid 24%. The most common location of fibroid was the fundus region (75%) and 14% of patients had pedunculated fibroid. 48% of patients had two to three fibroids. In this study, the majority of cases were delivered at term (80%). The most common mode of delivery was cesarean section (62%), followed by vaginal delivery (25%), including instrumental and assisted breech delivery. Neonatal outcomes in our study were low birth weight (17%), low APGAR score at five minutes (11%), required neonatal resuscitation (15%) and required NICU hospitalization (21%), and neonatal mortality occurred in 2% of cases. Conclusion: Pregnancies with uterine fibroid are many times asymptomatic and are an incidental finding. Fibroid in pregnancy can be associated with abortion in early gestation and PROM in term gestation and PPH in the postpartum period. There is also an increased risk of malpresentation. The rate of cesarean section is high in pregnant patients with uterine fibroid. Thus, uterine fibroids in pregnancy make a normal pregnancy into a high-risk one.

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, Nalanda Medical College and Hospital, Patna, Bihar India on pregnant women with persistent chronic ectopic pregnancies . During the study period of one year, 9015 patients were delivered to the institute. 82 patients were diagnosed with ectopic pregnancy. Hence, the incidence of ectopic pregnancy was 0.90% in our study. Only 7 patients were diagnosed in chronic ectopic frequency (CEP). Results: 28.58% cases were aged ≤ 30 years while rest of the cases was aged more than 30 years. The mean age was 32.58 ± 4.0 years. 42.86% (3 cases) were nullipara, 57.14% (4 cases) were primipara and none of cases were multipara. Our center being tertiary center, 42.86% (3 cases) were referred from other centers while 57.14% (4 cases) were diagnosed at our hospital. Majority of the patients 57.14% (4 cases) presented at 6 to 8 weeks of gestation followed by 42.86% (3 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 (28.58%). 85.72% 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 14.28% (1 case), beta-HCG of less than 1500mIU/ml was in 57.14% (4 cases, and beta-HCG in the range of 3000-5000 mIU/ml was in 28.57% (1 case). 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 to find out the incidence of maternal complications, perinatal mortality and morbidity in postdated pregnancies. Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology from July 2021 to June 2023. Total 200 patients in the antenatal ward and labour room were selected for the study and they were divided into two groups, Control group with Gestational age 37-40 weeks and Study group with Gestational age >40 weeks. Results: Maximum number of patients belonged to the age group of 25-30 years both in cases (45%) and control group (52%). The maximum number of patients in the study group (80%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. 65% of the patients in study group were primigravida and in the control group 55% were primigravida. The percentage of LSCS was 30% which was higher than in the control group where it was 15%. Incidence of instrumental delivery was also higher in the study group as compared to control group (13% as compared to 7%). Among the indications for LSCS, the most common indication among the study group was acute foetal distress which includes meconium stained liquor followed by cephalopelvic disproportion. In the control group, most common indication was non progress of labour followed by acute foetal distress and non-reactive CTG. Maternal complications like LSCS, PPH and sepsis all were higher in the study group as compared to the control group. 17% of infants in the study group had asphyxia as compared to only 7% in the control group. 15% infants of the study group had to be admitted to the NICU as compared to 10% in the control group. 3% was the percentage of intrauterine deaths in the study group as compared to none in the control group. Conclusion: Postdated pregnancy remains a clinical dilemma for an obstetrician. The choice is between watchful expectancy for labour to start or induction in postdated patients. According to our study, postdated pregnancies are related with higher rate of LSCS and instrumental deliveries.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the impact on intraocular pressure (IOP) after Phacoemulsification (PE) with Posterior Chamber Intraocular Lens (PCIOL) implantation and its relation with ocular biometric parameters. Methods: A prospective observational study was done in the Department of Opthalmology, IGIMS, Patna, India. The study population included 150 eyes of 150 patients having age-related cataracts with normal IOP (11-21mmHg). They have undergone eventless PE with PCIOL implantation surgery. Results: The mean pre-operative and post- operative IOP was 12.46±1.96 and 11.55±1.66 mmHg, respectively. The mean pre-operative and post-operative ACD was 3.32±0.26 and 3.67±0.26 mm, respectively. The average axial length before surgery was 23.55±0.72 mm, which was unchanged after surgery. The average IOP of the non-treated fellow eye was 13.6±2.6 mmHg, and after one month was 13.2± 2.4 mm Hg. The average CCT was 548.62±24 µm both pre-operatively and post-operatively. After doing the paired t-test, the post-operative IOP reduction was significantly associated with pre-operative IOP, p<0.001 and ACD<0.001. The average IOP reduction after one month was 1.92±0.64 mmHg. Conclusion: IOP is significantly reduced after PE with IOL implantation surgery in normal eyes having age-related cataracts. In addition to preoperative IOP, ACD is significantly associated with postoperative IOP reduction. The preoperative IOP is proportional to post-operative IOP reduction, and the more the increase in preoperative IOP, the decrease in post-operative IOP is more.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was comparing the pregnancy outcomes in patients with RA and healthy controls as well as to assess the impact of disease-related variables, medications and disease activity on pregnancy and neonatal-related outcomes. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, PMCH, Patna, Bihar, India. A total of 50 pregnant women with RA and 200 healthy pregnant controls were recruited for the study. Results: The mean age of the participants at conception was 32.77 ± 0.66 years for RA patients and for RA patient’s disease duration was 9.16 ± 0.55 years. 80% of pregnancies were planned by both patients and the consulting rheumatologists with medication modification. Our results showed that the age of conception, preterm labor, NICU admission, and low birth weight were statistically significant (p <0.05), and higher in pregnant RA patients than in healthy controls. No significant difference was observed in the events of the rate of abortion, stillbirths, congenital anomalies, cesarean section, ectopic pregnancy, and preeclampsia between pregnant RA patients and healthy controls (p >0.05). We observed that cases with longer disease duration (p <0.001), high ESR (p <0.001), and high CRP levels (p = 0.001) were statistically associated with cases of NICU admission; however, patients with higher age at conception (p = 0.003) were statistically related to stillbirth. Patients with mild and moderate-severe DAS28-CRP have significantly high chances of having an adverse pregnancy outcome and respectively with higher significance in moderate-severe disease activity. Conclusion: We concluded that RA is associated with numerous adverse pregnancy-related outcomes. Patients with active disease were at a higher risk for adverse pregnancy outcomes, including a high risk of preterm labor with or without NICU admission and abortion; nevertheless, tight disease control should be aimed. Disease remission before conception is advised. Pregnant women with RA should be educated and encouraged to plan their pregnancies with their physician as other patients with chronic diseases.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the association between serum bilirubin levels and coronary artery disease in comparison with controls without coronary artery disease. Methods: The cross-sectional study was conducted for a period of a one year in IGIMS, PATNA, Bihar, India. The entire study subjects were divided into two groups of 50 cases (with CVD) and 50 controls. Results: It was seen from the table that majority of the subjects were in the age group between 55 and 65 years. The minimum age was 43 and the maximum age was 75 years. The most common risk factors for CVD like diabetes, hypertension, smoking, obesity and family history of CVD was found to be slightly higher among the cases than the control groups but it was not found to be statistically significant and it proves that the controls were matched for almost all the risk factors for CVD except for dyslipidemia which was found to be significantly higher among the CVD patients than the controls. The duration of CVD among the cases varied from 2 years to 9 years with majority of the subjects’ duration was between 3 and 5 years and the mean duration was 4.4 years. The various liver function test parameters were compared between the cases and controls it was found that the serum bilirubin levels which includes total bilirubin, direct bilirubin and indirect bilirubin was found to be lower among the case group compared to the control group and this difference was found to be statistically significant. Conclusion: This study showed a significant association between the reduced serum bilirubin levels and the occurrence of CAD; therefore, bilirubin level can serve as a predictive factor, together with other influential factors for identifying a person at risk of developing coronary artery disease.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the correlation of peripheral smear with RBC indices and RBC histogram in diagnosis of anemia. Methods: The present study was conducted in the Department of Pathology, Government medical College and Hospital, Purnea, Bihar, India. The Red blood cell histograms of all anemic patients visiting the haematology section were analyzed and tried to find a correlation between histogram and peripheral smear findings. In our study of histograms of various types of anemia total 200 cases were studied. Results: The study had 140 (70%) females and 60 (30%) males. Maximum number of anemia cases was noted in 30-40 years of age range. In our study 40 (20%) cases were normocytic normochromic anemia, 130 (65%) cases were of microcytic hypochromic anemia, 6 (3%) cases were of macrocytic anemia and 20 (10%) cases were of dimorphic anemia. Pancytopenia was seen in 4 (2%) cases. In our study of 200 cases, 32 (16%) cases showed normal curve, left shift were seen in 60 (30%) cases, right shift in 10 (5%) cases, broad base in 76 (38) cases, short peak in 8 (4%) cases and bimodal curve in 14 (7%) cases. Conclusion: Histogram plays an additional role with peripheral smear for diagnosing RBCs disorders. Haematology analyzers were very useful and reliable for evaluation of abnormal peripheral smears. Histogram was correlated with almost all peripherial smear interpretation in anemia cases (p value <0.001, chi square value 70.14). Majority of the cases show good correlation between PS findings and histogram but histogram could be used only as a screening tool and not a diagnostic one.

DOI: 10.5281/zenodo.

Aim: The present study was conducted to assess gynecological disorders among geriatric women. Material & Methods: The present prospective, observational, cross-sectional study was conducted in the Department Of Obstetrics And Gynaecology over a period of one year which comprised of 100 women aged >65 years old. All subjects were enrolled after they agreed to participate in the study after signing written informed consent. Results: Out of 100 patients, 80% belonged to age group 65-74 years. The study population was 65% from rural and 35% urban areas. Only 20% of the patients were literate. Geriatric women had higher number of pregnancies. Their mean age at menopause was 49.11±4.40 years and mean duration of menopause was 21.14±5.85 years.  Something coming out of vagina (SCOV, 22%) and Postmenopausal bleeding (PMB, 35%) were the two major presenting complaints. Amongst the co-morbidities, Hypertension was the single most common followed by Anaemia, Diabetes mellitus, Thyroid disorders, Heart diseases. The most common gynaecological disorder was genital tract malignancies (34%), followed by POP (25%) and urogenital infections (16%). Of those with genital malignancies, 32 had carcinoma cervix, 18 had carcinoma ovary, 14 had carcinoma endometrium, and 2 had carcinoma vulva. 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 was showing a rising trend in this age group. Though cervical cancer were the second most common malignancy in this group, most of these patients presented at advanced stage and hence were inoperable.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the role of intra-abdominal pressure (IAP) monitoring in the management of patients with blunt injury abdomen. Methods: The Hospital based prospective observational study was conducted in the Department of General Surgery in Patna Medical College and Hospital Patna, Bihar, India with blunt injury abdomen, over a period of 12 months and 100 patients were included in the study. Results: Out of 100 patients, 60 were treated conservatively, 40 required surgical intervention. 15 patients required ventilator support in our study. 5 patients expired. Out of 100 patients, 85 were male (85%), 15 were female (15%). Overall hospital stay (considering both conservatively managed and surgically intervened patients) increased significantly as IAP increases at 0, 3, 6, 24, 48, 72, 96 hours, except at 12 hours. Hospital stay decreased as IAP increases in surgically intervened group because IAP returned to normal after surgical decompression, but this finding was statistically significant only at 72 hours (p value was 0.0001) in our study. Conclusion: There was no significant correlation regarding hospital stay and increased IAP in our study as hospital stay increased both in conservatively managed and surgically intervened patients except at 72 hours in surgically intervened group. Before development of IAH and ACS, the potential candidates should be offered surgical decompression at proper time.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the incidence and associated comorbidities which influence the surgical site wound infection. Material & Methods: A prospective longitudinal study was conducted in Department of Microbiology, ANMMC, Gaya, Bihar, India. Total 100 patients operated for general surgical procedures in between the periods of 12 months were included for the present study. Results: The incidence rate of Surgical Site Infections (SSIs) increased with age, ranging from 25% in the 18-29 age group to 30% in those aged 60 and above. The incidence of SSIs was higher among males (26.66%) than females (25%). The incidence rate of Surgical Site Infections (SSIs) showed a positive correlation with increasing BMI, from 20% in underweight subjects to 33.33% in obese subjects. Subjects from urban areas had a higher incidence rate of SSIs (30%) compared to those from rural areas (20%). The rate of SSIs was higher in subjects undergoing elective surgeries (30.76%) compared to emergency surgeries (18.75%). Subjects who were obese had an SSI rate of 46.66%. Among subjects with diabetes, 60% developed SSIs, and among those with anaemia, 37.50% developed SSIs. Conclusion: Our study provides valuable insights into the risk factors associated with SSIs, including age, BMI, and comorbidities. Future research should focus on longitudinal studies to understand the temporal relationship between these factors and SSIs. Interventions targeting these risk factors could potentially reduce the incidence of SSIs.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was comparing cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group. Methods: This study was conducted in the Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India. 100 cases satisfying the inclusion criteria admitted in SKMCH, Muzaffarpur, Bihar, India were included clinically and radiologically. 50 patients were operated with CCS and 50 with dynamic hip screw (DHS). Results: Most of the patients belonged to the age group 41-60 years and there were more male as compared to females. Majority of the patients had duration of fracture ≤ 14 days in the present study. In age group, 20-40 years, satisfactory outcome was noted in 10 patients and 8 patients respectively in DHS group and CS group. In age group 41-60 years, total 26 patients of DHS group and 10 patients of CS group found with satisfactory outcome. In 20 male patients of DHS group and 7 male patients of CS group, outcome was satisfactory. Among female patients, outcome was satisfactory in 20 patients of DHS group while in 12 patients of CS group. In group ≤14 days duration of fracture, outcome was satisfactory in 19 (82.61%) patients and 9 (40.91%) patients of DHS group and CS group. In group >14 days duration of fracture, outcome was found satisfactory in 10 patients of DHS group while in 6 patients of CS group. Conclusion: The present study showed that DHS group had significantly higher proportion of satisfactory outcome as compared to CS group in cases of femur neck fractures. Most of the patients were between 41-60 years of age but difference of satisfactory outcome between DHS group and CS group was not significant. Regarding male patients, significantly higher rate of satisfactory outcome was noted in DHS group as compared to CS group.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the obstetrics outcomes of uterine fibroids and their consequences in a tertiary hospital. Methods: The present study was an observational study was undertaken in the Department of Obstetrics and Gynaecology, Gauri Devi Institute of Medical Science & Hospital, Durgapur, West Bengal, India. The study was conducted over a period of 12 months. 200 pregnant women who had USG findings of fibroid were enrolled in this study. Results: The mean age of patients in study was 31 years with standard deviation of 5.85, but majority of patients (42%) were in the 26-30 years age group, and then in the 31-35 years age group (32%). 9% of patients were less than 25 years and 3% of patients were more than 40 years of age. 42% of patients were primigravida and 38% of patients were of second or third gravida and 20% of patients were of fourth gravida. The majority of the patients had subserous fibroids (73%) and 18% of patients had submucous fibroids. The most common location of fibroid was the fundus region (74%) and 13% of patients had pedunculated fibroid. 47% of patients had two to three fibroids. In this study, the majority of cases were delivered at term (80%). The most common mode of delivery was cesarean section (62%), followed by vaginal delivery (25%), including instrumental and assisted breech delivery. Major complications during pregnancy were threatened preterm labor (22%) and threatened abortion (17%), whereas PPH occurred in 10% of cases, and blood transfusion was required in 21% of cases. Conclusion: Pregnancies with uterine fibroid are many times asymptomatic and are an incidental finding. Fibroid in pregnancy can be associated with abortion in early gestation and PROM in term gestation and PPH in the postpartum period. There is also an increased risk of malpresentation. The rate of cesarean section is high in pregnant patients with uterine fibroid. Thus, uterine fibroids in pregnancy make a normal pregnancy into a high-risk one.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the etiology, clinical profile and outcome of the neonates with thrombocytopenia admitted in the tertiary care hospital. Methods: The present study was prospective, observational study Neonatal intensive care unit (NICU), Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India for the period of six months . In present study total 200 neonates, fulfilling inclusion and exclusion criteria were admitted in NICU. Results: According to birth weight 27 neonates were very low birth weight (less than 1000 gms), 42 were low birth weight (1001-2500 gms) and rest 21 had birthweight > 2500 gms. In present study prematurity (45%) was most common cause noted for neonatal thrombocytopenia, followed by sepsis (24%) and respiratory distress (14%). Depending on the grade of thrombocytopenia neonates with mild thrombocytopenia (1-<1.5 lacs/μl) were 29%, while Moderate thrombocytopenia (50,000-<1 lacs/μl) were 25% and severe thrombocytopenia (<50,000/μl) were 46%. Depending on the time of onset of thrombocytopenia, neonates were labelled as early onset (within 72 hours) and late onset (after 72 hours). Early onset (within 72 hours) was 55% and late onset (after 72 hours) was 45%. Prematurity, sepsis, respiratory distress and intra uterine growth retardation were common causes for both early onset and late onset thrombocytopenia. Anaemia (Hb < 7 gm%) (16%), Hypertensive diseases of pregnancy (14%), Eclampsia (4%), Prolonged rupture of membranes (> 18 hours) (3%) and Oligohydramnios (2%) were common maternal high-risk factors associated with neonatal thrombocytopenia. Conclusion: Prematurity, sepsis and perinatal asphyxia are common causes of neonatal thrombocytopenia and associated mortality. All these are preventable conditions. Early identification and management is must to reduce mortality and morbidity. Severe thrombocytopenia, sepsis, prematurity were found to be an independent risk factor for poor outcome in NICU admitted neonates.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate whether iron deficiency anemia is associated with acute bronchiolitis in children. Material & Methods: This Analytical study was carried out in the Department of Paediatrics, at ANMMCH, Gaya, Bihar for the period between March 2022 to February 2023 ( one-year)  after obtaining ethical approval to explore the association between iron deficiency anemia and bronchiolitis. For this purpose, a total number of 100 patients were enrolled in the study and among them, 50 children with bronchiolitis were considered as cases, and 50 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 13.077±5.725 months in cases and 15.115±7.953 months in controls. The mean age difference was not significant between the two groups (p>0.05). Male participants (32, 64%) were the predominant group in the study and female participants (18, 36%). Exclusive breastfeeding was found in 15 cases and 32 controls respectively. The differences were statistically significant (p<0.05) between the two groups in the chi-square test. Overcrowding was found in 38 cases and 30 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 100 study subjects 40 cases had anemia, followed by 30 controls had anemia. Their difference was statistically significant between the two groups (p<0.05). Conclusion: Iron deficiency anemia has a significant association with bronchiolitis. A larger and more extensive study was recommended.

DOI: 10.5281/zenodo.

Aim: The present study was conducted to assess gynecological disorders among geriatric women. Material & Methods: The present prospective, observational, cross-sectional study was conducted in the Department Of Obstetrics And Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India over a period of one year which comprised of 200 women aged >65 years old. All subjects were enrolled after they agreed to participate in the study after signing written informed consent. Results: Out of 100 patients, 86% belonged to age group 65-74 years. The study population was 70% from rural and 30% urban areas. Only 15% of the patients were literate. Geriatric women had higher number of pregnancies. Their mean age at menopause was 50.15±5.35 years and mean duration of menopause was 20.11±4.64 years. Something coming out of vagina (SCOV, 24%) and Postmenopausal bleeding (PMB, 31%) were the two major presenting complaints. Amongst the co-morbidities, Hypertension was the single most common followed by Anaemia, Diabetes mellitus, Thyroid disorders, Heart diseases. Presence of multiple co-morbidities complicates the diagnosis, treatment and natural course of individual gynaecological health problems in older women. The most common gynaecological disorder was genital tract malignancies (34%), followed by POP (24%) and urogenital infections (17%). Of those with genital malignancies, 32 had carcinoma cervix, 7 had carcinoma ovary, 7 had carcinoma endometrium, and 2 had carcinoma vulva. Conclusion: Pelvic organ prolapse and genital malignancy are the major gynaecological causes of hospital admissions in the patients above 60 years. Postmenopausal period is an important part of a woman’s life. The geriatric phase is even more important as ageing also becomes a factor.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess timely initiation of breastfeeding and associated factors among mothers of children less than 12 months old. Methods: The present study was conducted department of pediatrics, Government Medical College Bettiah, West Champaran, Bihar, India and mothers who have a child less than 12 months of age were included in the study. Total 1000 mothers were included in the study. Results: In this study, 500 mothers had infants less than 12 months participated in this study making the response rate 98%. The mean age of mothers that participated in this study was 24.96 with the standard deviation of (±0.970). About 700 (70) of respondents were Hindus in their religious affiliation. About 400 (40%) of mothers completed primary school and 750 (75%) of them were housewives. Around 520 (52%), and 480 (48%) of them were females and males respectively. About 900 (90%) of the study participants had exposure to mass media and the majority of respondents. The highest majority, 850 (95) of respondents had received antenatal care (ANC). About 800 (88.88%) of participants started their antenatal care before fifth month of gestation. Majority, 520 (57.77%) had four antennal visits. 586 (65.12%) of the study participants had gotten counseling on breast feeding. 500 (55.55%) were receiving counseling on timely initiation of breastfeeding. 800 (80%) respondents delivered at health institutions and 440 (88%) of them were assisted by health professionals. 860 (86%) of the mothers had spontaneous vaginal delivery. About 34% mothers did not give breast milk within 1 hour after delivery to their infants because of maternal illness. The Bivariate logistic regression analysis yielded that sex of the child, place of delivery for the current child, mode of delivery, exposure to media and family type were statistically associated. Conclusion: Prevalence of timely initiation of breast feeding experienced by mothers was 80%. Being male infant, living with nuclear family, spontaneous vaginal delivery and counseling on timely initiation of breast feeding during ANC were factors associated with early initiation of breastfeeding.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine causes of respiratory distress, pattern of respiratory modality used and its outcome among admitted preterm newborns. Methods: A retrospective descriptive study was conducted in the Department of Pediatrics, DMCH, Darbhanga, Bihar, India over a period of two years targeting all neonates admitted to neonatology department. A Total of 200 patients were admitted in NICU during the study. Results: Mean gestational age was 32.46±2.58 weeks. Most of the newborns (64%) belonged to the gestational age within 28 – <34 weeks category. Mean birth weight was 1665.43±585.58 g among them very low birth weight infants were 42%. Male out numbered female newborns (55% vs 45%). Total 12 (6%) infants had Apgar scores <7 at 5 minutes who required some degree of resuscitation just after birth. After admission 8 (4%) patients got single dose of surfactant. Most of the mother (66%) was multiparous and 51% of them did not receive even a single dose of antenatal corticosteroid. All of them were inborn and cesarean section was the mode of delivery for 80% of the enrolled neonates. Maternal hypertension and diabetes mellitus were present in 140 (70%) and 64 (32%) of mother respectively. Maternal risk factors for sepsis were present in 48 (24%) of infants admitted to the NICU. Conclusion: Respiratory distress syndrome is the commonest cause of respiratory distress. Two third of preterm newborns required respiratory support. Most common mode of respiratory support was non invasive mode in the form of supplemental oxygen, Heated humidified high flow nasal cannula and continuous positive airway pressure. Short term morbidities like nasal trauma, sepsis, septic shock, disseminated intravascular coagulation, necrotising enterocolitis and intraventricular haemorrhage were more common in newborns who required invasive respiratory support (p <0.05). Retinopathy of prematurity and mortality was significantly higher in invasive respiratory support group.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the angiographic profile and in hospital outcomes of primary percutaneous coronary intervention among patients presenting with acute ST Elevation Myocardial Infarction and underwent primary PCI. Methods: 100 patients less than 45 years of age who presented to Ford hospital and research centre Pvt. Ltd, Patna, Bihar, India with acute ST elevation myocardial infarction (STEMI) as defined according to fourth universal definitions and underwent primary Percutaneous Coronary Intervention (PPCI) were included in this study. Results: Majority were male 80 (80%) and 20 (20%) were female. The mean age for male was 42.04 years and for female was 36.94 years. 6 patients (5.8%) were below 30 years old, youngest being 25 years old. Among the young patients who underwent primary PCI smoking was the most common coronary risk factor present in 58 (58%) patients. This was followed   by   hypertension in 34 (34%), dyslipidemia   23 (23%) and diabetes 17 (17%). Family history of premature CAD was present in 3 (3%) patients. On analyzing data from Coronary angiogram reports, Single Vessel Disease (SVD) was the most common finding 60 (60%). Multi Vessel Disease (DVD +TVD) was less common comprising of 40 (40%). Conclusion: Though the frequency of young acute STEMI is small, but these patients have different clinical and laboratory characteristics and early clinical outcomes vs. older patients. It is more likely associated with single vessel disease. The LAD and hence anterior wall is the most commonly involved. Smoking is most common modifiable risk factor. Furthermore emphasis should also be given to the contributing factors like homocysteine, fibrinogen, hsCRP, apo B, apo A1, Lp(a), SCAD etc. in all young patients with established CAD without conventional risk factors.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the health status of primary school students in urban and rural areas of Bihar region. Methods: This school based cross sectional study was conducted in the urban and rural field practice areas of community medicine department for the period of 2 years. Convenient sampling technique was adopted to select primary schools from 1st to 5th standard. Total 200 primary school students were included. Results: In the study among which 80 were from urban area and 120 were from rural area. 45 were males and 35 females in urban area and 70 were males and 50 were females in rural area were examined. Majority of the students in urban area were from 4th standard followed by 5th standard while in rural areas majority were from 5th followed by 2nd standard. Most common morbidity identified was ENT problems (ear wax, ear discharge) in both urban and rural students and the difference between them was found be statistically significant (p value <0.00001). Followed by pallor, Dental issues like caries, plaque etc. The difference between the nutritional status in urban and rural students was found to be statistically significant. Conclusion: The common infirmities found in students were ear wax and discharge, dental caries, anemia, poor personal hygiene and undernutrition. Effective implementation and monitoring of school health services is need of the hour. The present study also highlights the role of teachers and parents in educating the students about good sanitation and personal hygiene.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the effect of phototherapy on serum magnesium level in term neonates with hyperbilirubinemia. Material & Methods: A prospective hospital‑based comparative study was conducted on 200 eligible neonates admitted in Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India receiving phototherapy for the period of 2 years. After approval of the ethical committee, informed consent was obtained from the parents of the selected neonates. This study included 200 full‑term neonates who were subjected to phototherapy for treating neonatal hyperbilirubinemia according to the guidelines of the American Academy of Pediatrics. Results: Our study included 200 full‑term neonates with jaundice who received phototherapy for treating neonatal indirect hyperbilirubinemia, comprising 130 (65%) males, and 70 (35%) females, with the mean gestational age of 37± 0.8 weeks and mean postnatal age of 5.2 ± 1.4 days. There were 68 (34%) neonates delivered by normal vaginal delivery and 132 (66%) neonates delivered by cesarean section. Mean birth weight was 3.1 kg. The mean difference of jaundice onset age, intrauterine age, admission weight and mother’s age were not significant. The amount of total serum bilirubin decreases in all groups. Serum total magnesium level in single and double phototherapy decreases after treatment, but this decrease is significant only in the double phototherapy group (P = 0.022). In the intensive group, this parameter has slightly increased, which was not statistically significant (P = 0.530). The serum total magnesium level and its changes were reported in three groups before and after phototherapy. The serum magnesium level in new borns before treatment was normal in all three treatment groups. The status of each patient showed that single, double, and intensive phototherapy groups have magnesium content of more than 2.2 mg/dl, respectively. Conclusion: In the present study, the serum magnesium level showed a significant reduction only in the double phototherapy method and remained in the normal range in the other two groups. On the other hand, in all three treatment groups, the level of serum magnesium before the treatment was normal and did not increase significantly.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the maternal and fetal outcome in previous caesarean section. Methods: This retrospective study was done in the Department of Gynaecology, SKMCH, Muzaffarpur, Bihar, India over a period of 9 months. The study has been done on women admitted for safe confinement with previous cesarean section.  During the study period, there were total 12000 admissions. Results: Cesarean section was done for 1800 women, include primary and repeat cesarean section (rate of CS 15%). There were 800 women with history of previous one CS. Elective CS was done for 500 cases. Successful vaginal delivery was conducted for 200 cases and failure of trial among 100 cases. Cesarean section was done for 1800 women, include primary and repeat cesarean section (rate of CS 15%). There were 800 women with history of previous one CS. Elective CS was done for 500 cases. Successful vaginal delivery was conducted for 200 cases and failure of trial among 100 cases. Fetal distress was the major indications for emergency repeat CS (52%), followed by non progress of labor (34%). In elective repeat CS, major indication was CPD (40%), followed by fetal distress (16%). 12% had adhesions followed by 8% with obliterated UV fold. Conclusion: The overall maternal risks are increased in repeat CS, but successful vaginal delivery is possible if women are managed well. They should be counseled about maternal and perinatal risks and benefits of planned vaginal birth after cesarean section and elective repeat CS. Elective repeat CS should preferably be done at 39 completed weeks of gestation to avoid the risk of preterm birth.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the predictive value of ocular trauma score in cases of mechanical ocular trauma. Methods: A retrospective study of 100 patients who presented to Department of Ophthalmology,  Darbhanga Medical College and Hospital, Darbhanga, Bihar, India   with mechanical eye. Results: Out of 100 patients mean age was 29.43 years, with majority between 21 to 50 years of age. Males were 80% and 20% were females. Most injuries were unintentional. The inflicting agents in 55% (55 cases) were metallic object, in 33% (33 cases) wood. In 12% (12 cases) road traffic accident was the aetiology while broken glass was responsible in 2% (2 cases). The initial visual acuity was no perception of light in 24% (24 cases) and two patients (2%) had vision between 1/200 to 19/200. Eight patients (8%) were presented with the vision between 20/200 and 20/50. Out of 100 eyes forty-three eyes affected with globe rupture (85%), three eyes with retinal detachment (6%), RAPD noted in (6%) and one patient showed signs of endophthalmitis (2%). Conclusion: OTS helps treating ophthalmic team to assess evidence based prognosis of a traumatized eye in advance. With the guidance of OTS the patient and their family can be counselled for further management.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the relationship of High-Sensitivity serum C-reactive protein and lipid profile in women with pregnancy induced hypertension. Methods: This was a case-control study conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India for the period of 1 year. The study population was 18-35 years old pregnant women after 20 weeks of gestation. Results: The age of the respondents of case (28.02±5.25) years and control (27.73±5.02) years groups was almost similar. Majority of the respondents both in case (60%) and control (76%) groups were educated below SSC level. Most of them were housewife (case vs control: 88% vs 98%) and belonged from lower middle-class family. All these findings were statistically non-significant (p≥0.05). A significant finding was observed in regards of area of residence where majority among case came from rural (48%) area and among control more than half came from semi-urban (66%) area. There were non-significant findings in regards of past medical history of respondents among case and control. Among case 18 (36%) and among control 20 (40%) had positive family history of DM. Among case 21 (42%) and among control 20 (40%) had positive family history of HTN. Among case (2%) and among control none of the respondents (0.0%) had positive family history of renal disease. Among the case 17 (34%) had positive history of proteinuria and none of the control had positive history of proteinuria. This finding was statistically significant (<0.001). The mean serum total cholesterol, serum LDL, serum triglycerides and CRP were higher in case compared to that in control. Mean serum HDL was lower in case compared to that in control. Conclusion: The present study concluded that high hs-CRP and dyslipidemia were associated with pregnancy induced hypertension.

DOI: 10.5281/zenodo.

Aim: Comparing the use of cemented and uncemented hemiarthroplasty for treating displaced neck of femur fractures in the hip. Material and Methods: This study was conducted at Department of Orthopaedics, Jannayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India for 1year. All individuals older than 55 years who presented to the emergency room with a displaced femoral neck fracture were evaluated during our study period. Patients with fractures scheduled for hemiarthroplasty by the attending orthopedic surgeon were recruited for potential participation from these cases. Patients who fulfilled inclusion criteria and consented were randomized to cemented or uncemented hemiarthroplasty. Eligible patients were those with a nonpathological displaced sub capital femoral neck fracture that was scheduled for surgical reconstruction with a hemiarthroplasty by the attending surgeon and were older than 55 years. Patients must have been able to ambulate 10 feet before the presentation. Results: The average anesthesia and operative times were 161 and 98 minutes, respectively. The average estimated blood loss was 244 mL; 100% of patients received perioperative antibiotics (100% cefotaxime). There were no intraop fractures. In comparing the surgery-related characteristics of the 2 study groups, no statistically significant differences were identified. At admission, the average hemoglobin level was 10.9 g/dL (SD, 1.6), and the average preoperative level was 11.4 g/dL (SD, 1.5). Before discharge, all participants had average hemoglobin of 10.4 g/dL (SD, 1.1). A blood transfusion was performed before surgery in 5 patients (11.36%), during surgery in 8 patients (18.18%), and after surgery in 6 individuals (13.63%). No significant difference was identified in hemoglobin levels or transfusion rates between the 2 groups. No difference in acute complications was found between the cemented and uncemented groups. Seven patients (15.90%) experienced an acute complication: 4 patients (9.09%) were transferred to the intensive care unit, 2 wound infections (4.54%), and 1 reoperation (2.27%). There were no cerebral vascular accidents (0%), no cases of major hemorrhage (0%), and no thromboembolic events (0%). There were no deaths during the hospitalization (0%), and 1 patient was deceased within 30 days of surgery (2.27%). By 60 days, 2 patients had died (4.54%) and 5 patients were deceased at 1 year (11.36%). Conclusions: In treating femoral neck fractures, cemented and uncemented femoral components are associated with similar functional outcomes at 1 year. Neither of the treatment modalities has a statistically significant advantage over the other. Either can be chosen according to the surgeon’s preference, implant availability and affordability, and familiarity with the technique.

DOI: 10.5281/zenodo.

Aim: The objective of the present study was to assess association between socio-demographic, behavioural and clinical risk factors and diabetic foot and response of patients to various treatment modalities. Methods: A prospective study was conducted in the General Surgery Department of for 7 months. 50 patients were included in the study. All patients who presented to surgical outpatient department or were admitted to the surgical wards with signs and symptoms of diabetic foot during the 7 months period were included. Results: Out of 50 patients in our study, 20 (40%) were in the age group of 51-60 years followed by 13 (26%) in the age group 61-70 years. There was a male preponderance in our study with 36 (72%) patients out of 50. Majority of the study subjects were literate with overall literacy rate being 60%. 96% study subjects belonged to low class. Among the 50 patients, 13 (26%) were unmarried showing lack of support and care and rest (74%) were married. Labourers accounted for 34% of study participants, farmers constituted 30%, businessmen 18% and others 18% of study subjects. Most of the participants had type II diabetes for >10 years. 80% of study participants had family history of diabetes. 92% of study participants were overweight (BMI 25-29.9) and remaining 8% were obese (BMI ≥30). Hypertension was present in 72% of study participants, ischemic heart disease in 60% and hypercholesterolemia in 70%. Conclusion: Diabetic foot is a common complication of long-standing diabetes. Several socio-demographic factors like advancing age, low socio-economic status, lack of family support, occupations involving risk of trauma to foot contribute to the risk of developing diabetic foot in diabetics. Hence it is essential to educate all the diabetic patients at risk about good glycemic control, risk factors, proper foot care, periodic foot examination and neurological examination of lower limbs, prompt treatment of foot lesions and regular follow-up.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyze the post-operative pain management in elective laparotomies in a tertiary care center. Methods: This retrospective study conducted in the Department of General Surgery, Anugrah Narayan Magadh medical College and Hospital Gaya, Bihar, India from March 2019 to February 2020. All patients who underwent elective laparotomy were provided details about the study and method. Informed written consent was obtained. A total of 200 patients were included. Detailed history of the patient, condition, surgery performed, analgesics used were documented. NRS score was calculated. Results: A total of 200 patients were included among which 40 (40%) were female and 120 (60%) were the male patients. The patients who underwent elective laparotomies were aged between 20-70 years and 80 (40%) patients were in the age group of 40-50 years. The 20 different types of surgeries were recorded. The most common surgery performed in our study was open appendectomy which included 42 (21%) patients followed by open cholecystectomy (for carcinoma gall bladder and other indications) which included 18 (9%) patients. Most common was general anesthesia with transverse plane block which was used in 76 (38%) patients, followed by general anesthesia with quadratus lumborum block which was used in 42 (21%) patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural. Severity of pain gradually reduced from post -operative days 1-3 with the use of various analgesics. 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 present study was aimed to study the effectiveness vasopressin for the patients undergoing Laparoscopic Myomectomy. Methods: The present study was conducted in the Department of Anesthesiology, IGIMS, Patna, Bihar, India for 7 months and obtaining written informed consent, a study was conducted on 150 patients with uterine fibroid and American Society of Anesthesiologists (ASA) physical status I and II, undergoing elective laparoscopic myomectomy. Results: The two groups were almost similar in respect to their past surgical and medical history. The two study groups were comparable with respect to the number of uterine fibroids. There was no significant difference in the pre-operative hemoglobin level in the two study groups. There is no statistical significance in the two groups with a ‘p’ value of > 0.05. The mean pre-operative Hb and mean post-operative hemoglobin in patients of group A was 11 (SD 1.124) and 10.4 (SD 1.485) respectively with a ‘p’ value of 0.06. Conclusion: Intra-operative blood loss was significantly more in cases where no measure was adopted for controlling blood loss. Use of vasopressin resulted in reduction of blood loss. Technically, the use of vasopressin is a safe and simple procedure. Vasopressin being cheap and easily available can be used routinely while doing myomectomy whether laparoscopic or abdominal.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare diagnostic efficacy of ultrasonography and FNAC in evaluating thyroid nodules. Methods: The present study was prospective, observational study conducted at in the Department of Radiodiagnosis, Indira Gandhi Institute of Medical science, Patna, Bihar, India for the period of 2 years. In present study total 100 patients were included. Results: The average age of patients was 36 years. Most common age group was 21-30 years (36%), followed by age group 31-40 years (26%). 80% patients in our study were female. 83% cases were benign, while only 18% were malignant as per final cyto-pathological diagnosis. Whenever histopathology report was available, that report was considered in final cyto- pathological diagnosis. Colloid nodule (64%) was most common benign lesion, other were follicular adenoma (7%), Hashimoto’s thyroiditis (5%), subacute thyroiditis (2%), cyst (4%). Most common malignancies were papillary carcinoma (10%) followed by follicular carcinoma (6%), medullary carcinoma (2%), anaplastic carcinoma (1%). Radiologically features were compared in accordance to cyto-pathological diagnosis. Most common feature for internal composition was solid (46%) and predominantly solid (21%). Most lesions were hyperechoic (54%), well defined margins (78%), with peripheral halo (76%), without calcification (73%), without vascularity (77%). Conclusion: Ultrasound evaluation is non-invasive, readily available, relatively inexpensive and with good resolution it helps to detect non-palpable and clinically silent nodules. USG also guides for fine needle aspiration of suspicious nodules. USG-thyroid should be considered as a first step and as an investigation of choice in evaluation of thyroid nodule.

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 NMCH, Patna, Bihar, India. This study group consisted of 200 cases of low-risk singleton pregnancies attending the antenatal clinic of NMCH, 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: To evaluate the functional result of treating displaced proximal tibia fractures using plate osteosynthesis. Materials and Methods: This retrospectively study was done in the Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar, India for 7 months. 30 patients involving proximal tibia fracture managed using LCP 20 patients with minimally invasive plate osteosynthesis, (MIPPO) technique and 10 patients with Open reduction and internal fixation (ORIF) technique. Total 30 patients were involved in this study with inclusion criteria of age more than 18 years and patients having closed intra articular and extra articular fractures of proximal tibia. Patients which were excluded was age less than 18 years, open fractures (any grade) and pathological fractures. Patient placed in supine and under Spinal anesthesia, and Pneumatic tourniquet was applied after exsanguinations and time noted. Painting and draping was done. Through anterolateral approach, intraarticular fractures were exposed and reduced anatomically, whereas extraarticular fractures were treated through MIPPO technique. Results: In 67% of the cases minimally invasive percutaneous plate osteosynthesis (MIPPO) technique was used which in terms of duration of procedure and soft tissue injuries were less compared to ORIF. Wound healing with MIPPO was also better and faster. In 90% of the cases open reduction and internal fixation (ORIF) technique was used. The average time for proximal tibia fracture union was 16 weeks (range from 12-24 weeks). In majority of the cases, around 33.33% had union of proximal tibia fracture by 16th weeks, 30% had fracture union by 18th week. 10% had fracture union by 20th and 22nd week, 6.67% had fracture union by 14th and 24th week and 3.33% had fracture union by 12th week. (table 1) Infection occurred in 7% of cases at the post-operative site. Approximately 20% of the cases developed knee joint stiffness. Out of 30 Cases, according to Ramussen score 66% had an excellent functional outcome, 14% had good functional outcome, 16.67 had fair functional outcome and 3.33% had poor functional outcome. Conclusion: Locking compression plate system acts as a good biological fixation for proximal tibia fractures even in complex fracture situations. MIPPO technique offers short duration of procedure, less blood loss, less soft tissue injury excellent, early wound healing and faster and better functional outcome than ORIF in patients with proximal tibia fracture. However, MIPPO demands more learning curve.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the correlation between new born size and maternal first trimester hemoglobin concentration. Methods: The retrospective study, conducted in the Department of Obstetrics and Gynecology, AIIMS, New Delhi, India. included 200 mothers registered for antenatal care (ANC) and willing to continue till confinement were recruited after written informed consent as per routine protocol. Results: Out of 200 women patients, 55% had normal Hb level followed by mild 32% and 13% moderate. The correlation between hemoglobin concentration and birth weight and other anthropometric parameters was measured by using chi square test and student’s t-test. P-value was considered significant if it was below and highly significant in case <0.001. Conclusion: Increased incidence of low birth weight babies is seen if the mother is anemic in her first trimester with significant association when hemoglobin is less than 8 gm%. Increased incidence of preterm deliveries is seen if the mother is anemic in her first trimester. We observed better neonatal outcome in the form of weight and anthropometry if maternal hemoglobin is in range of 10 to 13 gm%.

DOI: 10.5281/zenodo.

Aim: The aim of this study was to study clinical predictors of hypoxemia in patients of acute lower respiratory infections in children. Material & Methods: The observational prospective study was conducted in the Department of Pediatrics, IGIMS, Patna, Bihar, India. This was a hospital-based study completed for 1 year. The sample size taken for this study was 100. All children admitted with acute lower respiratory tract infections between the age group of 2 month to 5 years of age and diagnosed with pneumonia or bronchiolitis were included in the study. Results: A total of 100 cases were enrolled in the study, out of which 70 were male and 30 were female.  Out of the 100 cases enrolled, 48 were below the age of 12 months and 52 were above 12 months of age. The mean age was 16.4 months. The most common and significant symptoms were rapid breathing and difficulty breathing. The least common symptom was noisy breathing and pain in the abdomen. Tachypnea (88%), pallor (86%) and nasal flaring (80%), crepitations (added sounds), and subcostal retractions had better sensitivity for detecting hypoxemia. However, these signs had low specificity for hypoxemia. Head nodding (95%), intercostal retractions (82%), and cyanosis (85%) were highly specific for predicting hypoxemia. Males 68 out of 70 were significantly more hypoxemic than females 27 out of 30. Most cases have moderate hypoxemia which includes 80%. 35 cases out of the total 100 were diagnosed to have bronchiolitis, whereas 65 cases had pneumonia. Conclusion: It was observed that a combination of clinical signs and symptoms can be used to predict hypoxemia when facilities of pulse oximetry and arterial blood gas analysis are not available, especially in low-resource settings.

DOI: 10.5281/zenodo.

Aim: To investigate the effectiveness of using a partogram in the management of labor in patients with a history of prior lower segment cesarean section (LSCS). Material and Methods: A retrospective observational study was study was carried out in the Department of Obstetrics & Gynaecology Jawaharlal Nehru medical college & Hospital, Bhagalpur, Bihar, India. 25 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. Examination was done including general physical examination, abdominal examination for fundal height, lie, presentation, engagement, amount of liquor, palpable uterine contraction and fetal heart rate. Pelvic examination was done for pelvic assessment and Bishop score. Results: Our study included a total of 25 patients with average age 24.04 years with minimum age of a patient being 19 years while the maximum age was 33 years. In present study 21 out of 25 patients delivered at the gestational age of 37-40 weeks (84%). Out of these the patients who underwent repeat LSCS were 13 (52%) and those who delivered vaginally were 8 (32%). 4 patients delivered at gestational age of more than 40 weeks (16%). Out of which 2 patients undergone LSCS (8%) and 2 delivered vaginally (8%). There was no statistically significant association between gestational age and mode of delivery. Out of 15 patients who undergone repeat LSCS, 2 patients had scar dehiscence (13.33%), 3 patients were taken for LSCS due to non-progression of labor (20%) and 10 patients had fetal distress (66.66%). Out of 10 patients who delivered vaginally, 2 underwent instrumental delivery (20%). 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. Thus with a careful selection of cases for trial of labour in patients with previous LSCS it resulted in successful vaginal delivery. And with the better infrastructure and antenatal and postnatal care of these patients, the chances of maternal and perinatal morbidity and mortality can also be reduced successfully.

DOI: 10.5281/zenodo.

Aim: To compare the effectiveness of misoprostol and oxytocin in preventing postpartum bleeding after labor induction. Materials and Methods: The study was a randomized clinical trial carried out at the Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical college and hospital Bhagalpur, Bihar, India. 110 patients were included. The targeted population was booked women admitted into the labor room anticipating vaginal delivery and who had a singleton pregnancy with cervical dilatation of 6 cm or less and packed cell volume of at least 30%. Women in advanced stage of labor (cervical dilatation >6cm), known allergies to prostaglandins, oxytocin homologues or excipients, had a serious cardiovascular disorder, serious hepatic or renal disease, or epilepsy were not eligible. All the participants gave a written informed consent. Results: Total 110 women with term pregnancy in two groups of 55 each were studied. The mean gestational age of women was 39.43±1.17 in the misoprostol group and 39.32±1.17 weeks in the oxytocin group. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58±244.12 vs. 253.27±171.74 ml; (p=0.11). The mean duration of third stage of labor was similar and the difference was not statistically significant (6.65±3.47 vs. 6.08±3.07 minutes) (P=0.38), as well as need for additional oxytocics (14.5% vs. 7.2% p=0.18) misoprostol and oxytocin, respectively. There were no differences at the 5% level of significance between groups with regard to the incidence of PPH (20.8% vs. 14.5% respectively; p=0.43). Among the women who were recruited (safety population), the frequencies of the expected side effects did not differ significantly between the two groups. In misoprostol group, side effects were shivering, fever, nausea and abdominal pains, while the oxytocin group abdominal pains, headaches and shivering. Conclusions: we concluded that the risk of increased blood loss, prolongation of the third stage of labor, need for additional uterotonics, increased risk of PPH, and increased incidence of side effects. The use of misoprostol is particularly important for resource-limited settings, where the availability and storage of heat-susceptible oxytocin are challenging.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the effect of mupirocin and intensified hygienic practices in the decolonization of MRSA in nasal carriers. Methods: The present study was conducted in the Department of Microbiology, Madhubani Medical College and Hospital, Madhubani, Bihar, India and 300 (100 from Inpatients, 100 from Community, 100 from Health care workers). Results: Out of 100 Inpatients, 15 (15%) were MRSA carriers. Out of 100 HCWs, 10 (10%) were MRSA carriers. Out of 100 samples from the community, 5 (5%) were MRSA carriers. Overall MRSA carriage was 30 (10%). However, this observation was not statistically significant. Out of 15 cultures, positive MRSA from Inpatients, 6 were sensitive to Mupirocin and 6 were resistant to Mupirocin. Out of 15 cultures, positive MRSA from Health care workers, 4 were sensitive to Mupirocin and 4 were resistant to Mupirocin. Out of 5 cultures, positive MRSA from the Community 2 isolates were sensitive to Mupirocin and 2 were resistant to Mupirocin. Conclusion: Decolonization with modified hygienic practices like regular hand washing, nasal washing gave good results than using 2% Mupirocin ointment. Regular cleansing of the nostrils appears to not allow the stagnation of secretions, thereby preventing colonization and hence transmission of Staphylococcus aureus. Nasal washing in particular and maintaining body hygiene in general is a simple and inexpensive method that reduces MRSA colonization, relieves a variety of nasal conditions and also helps in minimizing antibiotic resistance.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the effect of mupirocin and intensified hygienic practices in the decolonization of MRSA in nasal carriers. Methods: The present study was conducted in the Department of Microbiology, Madhubani Medical College and Hospital, Madhubani, Bihar, India and 300 (100 from Inpatients, 100 from Community, 100 from Health care workers). Results: Out of 100 Inpatients, 15 (15%) were MRSA carriers. Out of 100 HCWs, 10 (10%) were MRSA carriers. Out of 100 samples from the community, 5 (5%) were MRSA carriers. Overall MRSA carriage was 30 (10%). However, this observation was not statistically significant. Out of 15 cultures, positive MRSA from Inpatients, 6 were sensitive to Mupirocin and 6 were resistant to Mupirocin. Out of 15 cultures, positive MRSA from Health care workers, 4 were sensitive to Mupirocin and 4 were resistant to Mupirocin. Out of 5 cultures, positive MRSA from the Community 2 isolates were sensitive to Mupirocin and 2 were resistant to Mupirocin. Conclusion: Decolonization with modified hygienic practices like regular hand washing, nasal washing gave good results than using 2% Mupirocin ointment. Regular cleansing of the nostrils appears to not allow the stagnation of secretions, thereby preventing colonization and hence transmission of Staphylococcus aureus. Nasal washing in particular and maintaining body hygiene in general is a simple and inexpensive method that reduces MRSA colonization, relieves a variety of nasal conditions and also helps in minimizing antibiotic resistance.

DOI: 10.5281/zenodo.

Aim: To compare canine retraction using active tieback and power chain in an in vivo implant research. Materials and Methods:  A Retrospective study comprising 20 patients in each group (irrespective of sex) was conducted in the Department of Dentistry, Patna Medical College and Hospital, Patna, Bihar, India during January 2018 to December 2018. Patients 18-25 years of age, Patient with class I and class II malocclusion, Patients requiring bilateral extraction of first premolars with minimal crowding, Patient completed his levelling and alignment phase and Patient with no systemic illness were included in this study. Patients with Missing tooth anterior to the first molar, Severe crowding, Patient with systemic illness, compromised periodontium, Patient who are allergic to titanium and Local bone pathology as detected in Orthopantomogram were excluded from the study. All the patients were divided in to groups. Group I: retraction on right side of maxilla with Power chain and Group II: retraction on left side of maxilla with active tie- back. Results: 20 patients between 18-25 years of age included in each group. Mean age of the study subjects is 20.89 years. 12 female and 8 male were in both the groups. Clinical measurements show that canines retracted 6.90 ± 1.10 mm in 179 days by Power chain and 7.08± 1.25 mm in 160 days by active tie-back. The speed of canine retraction was 1.29± 0.58 mm/mo by Power chain and 1.40± 0.43 mm/mo by active tieback without significant differences between the two methods. Conclusion: The present randomized clinical study concluded that both methods are effective to achieve space closure. The mean canine retraction rate was more rapid with active tieback than Power chain modality. Additional RCT’s with sufficient sample size are required to determine the effectiveness of one technique of canine retraction over the other. Furthermore study may be done using CBCT for accurate canine retraction measurement.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the efficacy and safety of preemptive use of intravenous paracetamol and intramuscular ketorolac for management of postoperative pain after laparoscopic cholecystectomy. Methods: The retrospective study was conducted in the Department of Anesthesiology, Government Medical College and Hospital, Bettiah, Bihar , India  and included a total of 100 patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia. Age of the patients ranged between 19-59 years with body weight of 50-70 kg. The study was done on patients with American Society of Anesthesiologists grade I and II. Results: In our study, both the study groups were comparable in terms of mean age, weight, sex ratio and operative time. Baseline heart rate (HR) and mean arterial pressure (MAP) were comparable between the two treatment groups pre- operatively, just after intubation, at 5 min, 15 min, 30 min, 45 min, at the end of surgical procedures as well as at extubation. No statistically significant difference was found between two groups (p-value>0.05). In the paracetamol and ketorolac groups, laparoscopic cholecystectomies were done in a mean operative time of 58.2 and 57.6 minutes respectively (Range 31-108 min). All patients were monitored for VAS in the post-operative period which was found to be persistently higher in paracetamol group as compared to ketorolac group. The Mean VAS scores on the intergroup comparison post- operatively at 30 min, 1 hour, 3 hours and 6 hours were found to be statistically significant (p-value< 0.05), however at 12 and 24 hours the difference was insignificant. Conclusion: Pre-emptive intramuscular ketorolac (30 mg) is more effective in reducing postoperative pain scores (VAS) after laparoscopic cholecystectomy in the first 6 hours as compared to intravenous paracetamol infusion (1 gm). However both regimes were equally effective in doing so at 12 hours and thereafter. Intramuscular ketorolac is better than paracetamol infusion in reducing the need and prolonging the time for need of a rescue analgesic.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the efficacy and tolerability of oxaceprol, in comparison to the relatively weak opioid tramadol, in the treatment of symptomatic knee osteoarthritis. Material & Methods: A parallel group, double-blind, randomized controlled trial was carried out in the Department of Pharmacology, Anugrah Narayan Magadh Medical College and Hospital Gaya, Bihar, India from October 2018 to December2019.  This retrospective study was carried among patients diagnosed as Osteoarthritis. Consent was taken from the patient. A total of 200 patients were included in the study with knee joint pain intensity of at least 35 mm on a 100 mm visual analogue scale (VAS) present for at least preceding 3 months and with confirmed degenerative changes in knee skiagram. Results: In tramadol group, 47% were males and 53% were females and mean age of participants was 52.48 years whereas in Oxaceprol group 49% were males and 51% were females and mean age of participants was 51.39 years. No statistically significant difference was observed between groups for WOMAC scores. Significant reduction in pain, stiffness and physical function was observed between oxaceprol and tramadol group at baseline and after 6 months follow-up. No statistically significant difference was observed between groups for WOMAC scores. Significant reduction in pain, stiffness and physical function was observed between oxaceprol and tramadol group at baseline and after 6 months follow-up. Conclusion: Efficacy and tolerability of oxaceprol were comparable to tramadol, and the drug can be considered as an alternative to low-potency opioids in the management of knee osteoarthritis.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the FNAC findings in lymphadenitis. Methods: This study was done in the Department of Pathology, DMCH, Darbhanga, Bihar, India and conducted for one year. All slides and reports which were collected from the Department of Pathology and MRD were collected and reported. The total sample size was thus 100. The design of the study was retrospective cross sectional. Results: In the present study, 68% lymphadenopathy was at cervical followed by axillary. According to cytological study, 48 had Tuberculous lymphadenitis followed by Chronic reactive hyperplasia. Conclusion: Enlarged lymph nodes are easily accessible for aspiration, fine needle aspiration (FNAC) is advocated for the initial diagnosis and management of patients with lymphadenopathy. The technique being simple and leads to minimizing complications. It has been found that it offers a nearly accurate diagnosis of various pathologies including reactive lymphadenitis/inflammatory conditions, granulomatous disorders and neoplastic disorders.

DOI: 10.5281/zenodo.

Aim: The aim of the study was to compare effect of 0.0625% bupivacaine with 2% fentanyl and 0.125% bupivacaine with 2% fentanyl epidural infusion on hemodynamic parameters for 48 hrs in infraumbilical surgeries and VAS as the secondary objective with preserved hemodynamic parameters. Methods: The proposed study was conducted in the Department of Anesthesia and Critical Care, A. N. Magadh Medical College and Hospital, Gaya, Bihar, India from November 2020 to September 2021. A total of 50 patients with consenting candidates who satisfy necessary inclusion/exclusion criteria during this period were included. Patients accepted in ASA I and II in whom surgeries were performed by infra umbilical incision and required epidural infusion were included. Valid Written Informed Written Consent of patient was taken. Results: Among study population, 21 (42%) of them had diagnosis of Carcinoma Ovary and 20 (40%) had diagnosis of Fibroid Uterus followed by 3 (6%) had diagnosis of Carcinoma Endometrium. There was no statistically significant difference between two groups in parameter Pulse Rate, Respiration rate, Diastolic Blood Pressure (P>0.05). There was no statistical difference of mean systolic pressure between two groups at starting period, 3 hrs, 6 hrs, 9 hrs, 12 hrs, 15 hrs, 18 hrs, 21 hrs, 24 hrs and 48 hrs (p>0.05) of infusion. There was no statistical difference of mean diastolic pressure between two groups at starting period, 3 hrs, 9 hrs, 12 hrs, 15 hrs, 21 hrs, 24 hrs and 48 hrs (p>0.05). There is statistical difference between two groups at 6 hrs and 18 hrs. Conclusion: The study showed that the infusion of 0.125% bupivacaine with 2 μg fentanyl lead to stoppage of infusion in 12 patients in view of Hypotension and no significant changes in VAS score was noted in two groups of patients.

DOI: 10.5281/zenodo.

Aim: To study the correlation C-reactive protein and length of antibiotic treatment for newborn bacterial infections. Material and Method: A total of 80 newborns were examined in the Department of Pediatrics, NMCH, Jamuhar, Sasaram, Bihar, India for one year. The research included neonates who were less than 28 days old and had a birth weight of more than 1500 grams, and were believed to have septicaemia. Neonates have had surgery as a result of a wound infection. Infants diagnosed with meningitis, which necessitates a prolonged course of antibiotics, were not included in the research. Following admission, the patient had blood culture and sensitivity testing, routine blood investigations, urine culture and sensitivity testing, chest x-ray, and CRP testing. The C-reactive protein (CRP) level was measured within 24-48 hours after the patient was admitted. Neonates were categorized based on their levels of C-reactive protein (CRP) in the bloodstream. Neonates were monitored for up to 48 hours after discontinuing the medications to see whether the symptoms of septicaemia reappeared. Results: The study aimed to assess the efficacy of CRP levels as a measure for determining the duration of antibiotic treatment by calculating the negative predictive value (NPV) of CRP. Neonates with C-reactive protein (CRP) levels below 10 mg/L had the greatest negative predictive value (NPV) of 96%, suggesting that these neonates had the least likelihood of needing further antibiotic therapy. The negative predictive value (NPV) for newborns with C-reactive protein (CRP) levels between 10-20 mg/L was 93%, but it was 80% for those with CRP levels over 20 mg/L. This demonstrates that decreased levels of C-reactive protein (CRP) serve as robust indications of a successful course of antibiotic therapy, obviating the need for further treatment. Conclusion: Our work conclusively shows that CRP levels play a crucial role in determining the appropriate length of antibiotic treatment for newborn bacterial infections. The findings align with previous research and strengthen the effectiveness of CRP as a dependable biomarker for forecasting treatment outcomes and the likelihood of recurrence. Additional investigation should examine the incorporation of CRP levels with other biomarkers to improve the accuracy of determining the duration of antibiotic treatment in newborns.

DOI: 10.5281/zenodo.

Aim: The aim of the present was to compare the locked versus non-locked Plating of distal fibula fractures. Methods: The present study was conducted in the Department of Orthopaedics, ESICMCH, Bihta, Bihar, India and reviewed a consecutive cohort of patients admitted within the 24-month period for fixation of closed malleolar fractures of the ankle. 200 patients with ankle fractures underwent surgical fixation with a distal fibular plate. Results: Of the 200 patients, 120 (60%) received an STP, 30 (15%) an LC-DCP, and 50 (25%) an LCP-F. The mean interval to full weightbearing was 6.9 weeks for the STP group, 7.2 weeks for the LC-DCP group, and 7.6 weeks for the LCP-F group. Of the 200 patients, 8 had wound issues, 4 patients returned to the operating room for wound washout, and 12 required antibiotics. Conclusion: In conclusion, bone-specific LCP-Fs add to the portfolio of implants available. They provide rigid fixation with a stable construct and thus are particularly attractive for multifragmentary fractures and patients with poor bone quality. Their unit cost is significantly greater than that of STPs and LC-DCPs but they provide a satisfactory alter- native for those patients in whom and fracture patterns in which fixation is more likely to fail using non-locking techniques.

DOI: 10.5281/zenodo.

Background & Objectives: There are many methods for tonsillectomy. The present study was carried out to assess and compare the bipolar electrocautery method to cold dissection method of tonsillectomy. Methods:  60 patients presenting with chronic tonsillitis who underwent tonsillectomy between December 2021 and May 2023 in the department of ENT, JLN,MCH, Bhagalpur were included in the study. The patients were randomly assigned into two groups. Bipolar electrocautery method was used in group A while cold dissection method was used in group B. Data collected and analysed .The patients were followed up for a period of 3 months. Results: Significant reduction in operation time and reduced intraoperative blood loss were seen in group A whereas group B patients showed a decrease in intensity of otalgia and nausea / vomiting. Interpretation & Conclusion: Bipolar electrocautery gave better results in terms of intraoperative blood loss and operation time, hence could be a better option in children. Whereas when the post operative pain is considered, cold dissection method gave better.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical outcome of treatment of distal femur fractures using locking compression plates. Methods: The present study was done in the Department of Orthopedics, Madhubani Medical College and Hospital, Madhubani, Bihar, India for 10 months. Written consent was obtained from all the participants of the study. A total of n=30 cases were selected for the study based on the inclusion and exclusion criteria. Results: Majority of the patients belonged to 19-30 years of age followed by 41-50 years. In our study of the 30 patients, 18 (60%) were Males, 12 (40%) were Females. The mode of injury was road traffic accident in 17 patients (56.66%), fall from height/stairs in 13 patients (43.34%). The average range of knee flexion achieved was about 91°. Maximum gain in knee flexion was 110° and minimum gain about 70°. The average knee score of 80 points was rated using the Neer functional score. (Max 100) Neer’s scores consist of Functional (70 units) and Anatomic (30 units). The Neer’s pain score, functional score, knee flexion score, score of gross anatomy was used to assess the outcome of surgery, for adult distal femoral fractures. Overall results were excellent in 8 patients out of 30 cases and were satisfactory in 21 cases and one had an unsatisfactory result. We observed that all the excellent results were from type A fracture and satisfactory results were seen in type A, B, C. One patient developed superficial wound infection in 1st week and was promptly treated with appropriate antibiotics, wound care and secondary suturing. One diabetic patient had delayed wound healing but was otherwise uneventful. One patient developed a tibial pin tract infection. Late complications included knee stiffness in the n=1 patient, in one of whom it was observed that the patient was not cooperative for physiotherapy and also had a low threshold for pain. Conclusion: Within the limitations of the present study, we have found higher Neer’s scores in this study. The LCP also prevents compression of periosteal vessels. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is a valuable technique in the management of these fractures. But however, in type C fractures the outcome is poorer.

DOI: 10.5281/zenodo.

Aim: To identify the presence of mycobacterium tuberculosis by the use of sputum evaluation techniques at a medical facility specializing in advanced care. Materials and Methods: The Study was conducted as a retrospective epidemiological study. Total of 143 sputum samples obtained from both in-patients and out-patients of Department of Microbiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India from March 2019 to February 2019. TB and RD and Orthopaedics were subjected to decontamination by both HS-SH method and NALC-NAOH methods. Slides were then examined under oil immersion for acid fast bacilli by conventional Ziehl-Nelsen staining microscopic method. Results: Out of 143 microbiological sputum samples, 104 were found to be positive for acid fast bacilli by both Modified Petroff’s method and Hypertonic Saline Sodium Hydroxide method (HS-SH) of concentration and decontamination and 39 samples were negative by both these methods. Sensitivity, Specificity, Positive predictive value and Negative predictive value of the HS- SH method was found to be 100%. Conclusion: In conclusion, the HSSH sputum decontamination method is equally sensitive, specific, cost-effective, feasible and less time-consuming procedure compared to the gold standard NALC-NaOH method for decontamination of Mycobacterium tuberculosis from sputum samples and can be routinely used in all peripheral health centres because of the low cost, especially in developing countries.

DOI: 10.5281/zenodo.

Aim: To determine the relationship between bacterial vaginosis and both spontaneous preterm and term delivery. Materials and Methods: This was a retrospective study which was carried out in Department of obstetrics and Gynecology, JLNMCH, Bhagalpur, Bihar, India for eight months. In this study, 100 pregnant women were selected. 75 pregnant women were considered as test cases and 25 pregnant women were considered as controls. Inclusion criteria was patients with preterm labor with gestational age of 26 to 36 weeks, singleton pregnancy, with intact membrane, threatened preterm labor and preterm labor with regular uterine contractions at least 3 every 10 minutes, and cervical dilatation of minimum 1 cm but not more than 3 cm. To note the discharge type and to exclude the leaking membranes, speculum examination, systemic and obstetric examination was done. Detailed history was taken. In last 24 hours, the pregnant women shouldn’t have douched and during last 48 hours, vaginal medication should not have been taken. Results: out of 75 pregnant women in study group, 25 pregnant women were followed till delivery who had bacterial vaginosis and 42 pregnant women were followed till delivery who did not have bacterial vaginosis. Bacterial vaginosis incidence was 37% in study group and 24% in control group and this showed high statistical difference (p<0.001). 60% cases were unbooked cases and were common in preterm labor and maximum women were from rural areas (70%) and were of lower socioeconomic class (55%). Commonly, preterm labor was seen in women of age group 21-30 years and in primigravidae (40%). Bacterial vaginosis was common in 55% of study group and 25% in control group and this showed high statistical difference (p<0.001). Majority of women delivered with BV were 56% and delivered before 34 weeks, 32% delivered between 34- 36 weeks and 12% delivered at term. 67% delivered at term were tested negative for bacterial vaginosis. Thus, BV was significantly associated with preterm birth. Conclusion: Important cause of perinatal mortality and morbidity is due to preterm delivery. There is no effective treatment of preterm delivery. Majority of vaginitis cases is caused by bacterial vaginosis and is asymptomatic in more than half of cases. The association of bacterial vaginosis and preterm labor, low birth weight and puerperal sepsis is proven by present study.

DOI: 10.5281/zenodo.

Aim: To determine the effects of maternal anaemia on pregnant women and pregnancy outcomes. Material and Methods: Among the 350 deliveries conducted in Department of Obstetrics and Gynecology department, Anugrah Narayan Magadh Medical College and Hospital, Gaya Bihar, India for 6 months, seen throughout the research period, 120 individuals were diagnosed with anemia.  The individuals were categorized based on the WHO criteria, with hemoglobin levels determined using Sahli’s technique. Information on therapy, such as oral iron, intravenous iron, or blood transfusion, as well as delivery methods, maternal outcomes, and perinatal outcomes, were obtained from records. The research also examined the age of the mothers and the degree of anemia in the patients. Results: Out of the 350 deliveries during the study period, 120 pregnant women were found to be anaemic. The prevalence of anaemia in this population was thus 34.3%. Maternal complications among anaemic pregnant women showed a variety of outcomes. Low birth weight was observed in 25% of the cases, while premature delivery was reported in 21.67%. A significant number of women (29.17%) underwent lower segment caesarean section (LSCS). Other notable complications included obstructed labour (1.67%), prolonged labour (2.5%), preeclampsia (2.5%), and postpartum haemorrhaged (1.67%). A variety of other complications were recorded in 15.83% of the cases. This data highlights a broad range of maternal health issues associated with anaemia in pregnancy. Perinatal outcomes revealed that 20.83% of the pregnancies resulted in preterm births, and 25% of the newborns had low birth weight. Neonatal intensive care unit (NICU) admissions were necessary for 12.5% of the infants, and there was a stillbirth rate of 4.67%. However, 37.5% of the pregnancies resulted in full-term deliveries, suggesting that despite the high incidence of complications, a notable proportion of the pregnancies had favourable outcomes. Conclusion: This research emphasizes the substantial occurrence of anaemia during pregnancy and its correlation with unfavourable maternal and neonatal consequences. In order to enhance the health outcomes for both mothers and foetuses, it is advisable to enhance primary health care services, with a particular focus on promoting the intake of iron and folic acid throughout pregnancy. In order to minimize these problems, it is essential to do early screening for anaemia and provide appropriate and efficacious treatment, along with counselling on the matter.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine the functional outcome of endoscopic composite cartilage tympanoplasty in patients having chronic otitis media (mucosal variety) with dry central perforation (small or medium). Methods: This study was conducted to investigate the effectiveness of endoscopic composite cartilage tympanoplasty (type I) in treating chronic otitis media (mucosal variety) with dry   central perforation (small to medium). The study comprised 100 patients who were treated at the Otolaryngology Department of Nalanda Medical College and Hospital, Patna, Bihar, India. The sample size was determined based on the projected availability of surgical cases over the 12-month study period. Results: This study investigated 100 individuals, 62 of them were female and 38 male. Patients 12 and older were selected for this study. There were 22 cases in the 13-20 age group, 33 in the 21-30 age group, 37 in the 31-40 age group, and 8 over 40. The average age of patients in this study was 33.7±8.12 years. Most of our patients (65) had medium-sized perforation, whereas 35 had small perforation. From 100 cases investigated in this study, 46 patients had left ear surgery and 54 had right ear surgery. The pre-operative auditory threshold, Air Conduction Test (ACT) was 45.2±5.2 dB, while the post-operative ACT averaged 26.3±5.4 dB. The pre- and post-operative differences were statistically significant. Conclusion: Our findings indicate that endoscopic composite cartilage  type I tympanoplasty is a viable, secure, minimally invasive, and efficient surgery that produces favourable results.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the diagnostic value of disorganization of retinal inner layers as a predictor of macular capillary non-perfusion and vision loss in patients with center involving diabetic macular edema. Methods: This study was conducted in sant parmanand hospital, Delhi. Total 65 patients of either sex, age > 35 years with center involving Diabetic Macular edema were included. Results: 32.31% of the patients were in the age group less than 50 years and 51-60 years each; and 35.38% of the patients were in the age group 61-70 years. In this study, 64.62% were males and 35.38% were females. In this study, distribution of left and right eye was 50% each. Majority (76.92%) of patients were diabetic for less than 5 years. Fasting blood sugar of 50.77% of study subjects were below 110 mg/dl, 27.69% of study subjects had fasting blood sugar between (110-126) mg/dl and 21.54% had blood sugar level more than 126mg/dl at baseline. Fasting blood sugar of 78.46%% of study subjects were below 110 mg/dl and 21.54% of study subjects had fasting blood sugar between 110-126 mg/dl at 3 months. In this study, 32.50% of patients had mild non-proliferative diabetic retinopathy, 45% of patients had moderate non-proliferative diabetic retinopathy and 22.50% of patients had severe non-proliferative diabetic retinopathy. Disorganization of retinal inner layers was present in 32.50% of study subjects at baseline. Disorganization of retinal inner layers was newly present in 3.75% of study subjects, stationary in 27.50% of patients and increased in 5% of patients at 3 months. Conclusion: The present study concluded that DRIL is a predictive tool in identifying macular CNP but its absence does not rule out CNP. DRIL is modestly correlated with vision loss. It is helpful in predicting future visual outcomes. Significant association was seen between DRIL, blood sugar levels (fasting and post prandial) and Hb1Ac. Significant association is seen between DRIL activity and treatment profile of patients.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to examine the effectiveness of eye-light therapy in improving the dry eye symptoms. Methods: The present study was conducted in the Department of Ophthalmology, Netaji Subhas medical college and Hospital, Bihta, Patna, Bihar, India where medical records of subjects who had undergone Eye-light® therapy were analyzed.  Adheres to the tenets of declaration of Helsinki. Since this was retrospective study, informed consent was not obtained. Results: We noted significant negative association between OSDI and NBUT. We also noted borderline significant negative association of OSDI with lipid layer thickness and tear height. OSDI was positively associated with upper lid meibography and lower lid meibography. We noted reduction in OSDI score post therapy however it did not reach statistical significance. NBUT was similar post therapy. The lipid layer thickness and tear height was found to increase post light therapy however the difference was not statistical significant. Meibography of upper lid was reduced post therapy however meibography of lower lid did not alter much. In grade 2 there was significant improvement in tear height however did not found any significant changes in NBUT, LLT, meibography of Upper and lower lid. In grade 3, we did not find significant improvement in any of the parameters. Conclusion: Eye-light therapy is effective in reducing dry eye related symptoms with minimal immediate effect on tear film parameters post therapy. Eye-light therapy acts as an adjunct to ameliorate MGD, which being a chronic disease requires sustained topical medication with environmental changes. Long term evaluation is required to assess the tear film changes and the pattern of efficacy of light therapy.

DOI: 10.5281/zenodo.

Aim: to assess dental health knowledge, attitudes, and practices among school children in Patna. Materials and Methods: It employed a cross-sectional epidemiological approach, where each student completed a questionnaire on oral health. Results: The study included 800 participants, with 54.8% being male and 45.2% female. Findings revealed that 59.1% of participants had fair knowledge about oral health. Significant associations were observed between age, school type, and educational level with oral health knowledge (p < 0.05). Approximately 57.2% of students exhibited positive attitudes, while only 45.3% demonstrated satisfactory oral health practices. Educational level significantly influenced attitudes and practices among students (p < 0.05). Conclusion: Overall, the average level of knowledge, attitude, and practice was 53.9%, indicating a need for improvement in these areas. Strengthening these aspects could lead to better oral health outcomes among school children in Patna.

DOI: 10.5281/zenodo.

Aim: To identify the factors that influence the outcomes of therapy in paediatric patients with acute rhinosinusitis resulting in ocular problems. Material and Methods: Retrospective cross-sectional research was carried out in the Department of ENT, Madhubani Medical College and Hospital, Madhubani, Bihar, India from May 2022 to April 2023. Throughout this time, all children hospitalized with orbital complications caused by ARS were included in the study. Clinical and radiological examination, Microbiological analyses and Surgical intervention were studied. Patients with visual impairment and those who failed medical therapy required surgical intervention. Fever despite 2 days of antibiotic therapy, increasing symptoms, and worsening of inflammatory markers were all considered as treatment failure. Results: The research included 78 children who were hospitalized for orbital complications after ARS. Prior to admission, the 54 patients (69.2%) had orbital complications of Chandler grade I or II. Seventeen (21.8%) of the patients developed SPOA (grade III), and seven (8.9%) had an orbital abscess (grade IV). There was no evidence of cavernous sinus thrombosis in any of the individuals (grade V). In 62 (85.9%) of the patients, computed tomography of the paranasal sinuses was done. Table 1 shows the demographic and clinical features of the patients. We collected 78 sinonasal secretion samples from all patients and 46 tissue samples from those who had EES. Staphylococcus aureus was cultured in 31 (34.8%) of patients, followed by Streptococcus pyogenes in 26 (29.2%), Streptococcus pneumoniae in 18 (20.2%), Haemophilus influenzae in 9 (10.1 %), and Moraxella catarrhalis in 5 (5.6%). Only 36 (40.4%) of the patients’ isolates matched when comparing microbiological growth in syno-nasal secretion and tissue samples. Microbial growth was not seen in six re- hospitalized individuals. The average hospitalization age groups (<7 years verses >7 years) were 7.7 and 13.6 days, correspondingly (p=0.03). The 45% of children and 15.8% of younger children who underwent pre-hospital antibiotics therapy developed grade III or IV orbital complications prior to the admission (p<0.001). Furthermore, older children required surgery at a higher rate than younger children, 62.5% against 39.5% (p<0.01). Conclusion: In conclusion, orbital complications obtained as the results of acute sinusitis in pediatric population remain highly prevalent and are serious pediatric and surgical problem. Children of age over seven years with acute sinusitis caused stage II or III orbital complications were independent predictors of the failure to antibiotic therapy. Pediatricians should consider patients’ age and severity of orbital complications to refer to therapeutic or surgical interventions.

DOI: 10.5281/zenodo.

Aim: To study the Infectious Dermatological Conditions Observed in children. Material and Methods: This retrospective study was conducted Department of Dermatology, GMCH, Purnia, Bihar, India for one year. 250 children were included in this study. Relevant data were extracted from their medical files using a data collection proforma and these included age, gender, history of skin diseases and type of skin disease diagnosed. Diagnosis of skin diseases in the clinic were made by trained dermatologists. The diagnoses were mainly clinical but laboratory confirmation was done where necessary. The infectious skin diseases diagnosed were categorized into bacterial, fungal, viral disorders and infestations. Results: A total of 250 children aged less than 18 years were seen in the Dermatology clinic over the 1 year period. The mean age of children with ISDs was 8.12±6.3 years with a male to female ratio of 1.22:1. ISDs were diagnosed in 100 (40%) of these children. The most frequent ISDs according to a etiologic group were: Scabies in 44 (44%), Verruca Vulgaris in 12 (12%), Tinea corporis in 16(16%) and Impetigo in 10 (10%). Relationship of age and gender occurrence of ISDs Age and Gender showed no significant association with the occurrence of skin diseases. Conclusion: ISDs are common in children with a prevalence of 40%. Scabies was the leading ISDs in   our study. Age and gender showed no significant association with the occurrence of ISDs among the children studied. It is hoped that findings from this study will be useful in the formulation of policies towards the prevention and control of these ISDs.

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, GMC, Azamgarh, Uttar Pradesh, 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 freeT3. 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 evaluate and compare the efficacy and hemodynamic stability of ketamine / fentanyl along with propofol and also assess recovery profile, post-operative analgesia and complications in patients undergoing Dilatation and Curettage. Methods: The present study was carried out in the Department of Anesthesia  Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar, India for one year, patients written informed consent, the study was conducted in 100 patients, aged 18-35 years of ASA Grade 1&2 scheduled for Dilatation and Curettage procedures lasting up to 30 minutes. Results: Pre-induction heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, spo2 were comparable in both the groups with a statistically no significant difference between them (p<0.05). Conclusion: It may be concluded from our present study that propofol with ketamine as an adjuvant in the dose of 0.75 mg/kg compared to propofol with fentanyl as adjuvant in the dose of 2 mcg/kg provides deep sedation. But propofol-ketamine group is more efficacious and provides better peri-operative hemodynamic stability during anesthesia as compared to propofol-fentanyl group. Also the propofol-ketamine combination produces good analgesia with less requirement of rescue drug in post-operative period with fewer peri- operative complications than propofol-fentanyl combination. We have not encountered any psychotomimetic effects of injection Ketamine in the 0.75mg/kg dose. Hence propofol-ketamine combination is a better choice especially when hemodynamic stability is of great importance in patients undergoing dilatation and curettage.

DOI: 10.5281/zenodo.

Aim: To determine the prevalence and identify the variables related with diabetic retinopathy in individuals diagnosed with type 2 diabetes. Material and Methods: A retrospective study was conducted in the department of Community Medicine, NMCH, Patna, Bihar, India  from June 2022 to Jan. 2023. Total 489 patients were included in this study. Study participants were selected using a systematic random sampling technique based on daily attendance in the hospital. Adults with type 2 diabetes for at least one year, on antidiabetic medication and free from acute concomitant diseases, such as heart attack or stroke, who attended the clinic for a routine visit were included consecutively. The patient’s self-reported adherence to drug therapy was collected by a face-to-face interview technique. Blood pressure, height, weight, waist to hip ratio, fasting plasma glucose (FPG) and 2 hours after postprandial glucose (2hPPG) were recorded for every participant. Retinal fundus photography was obtained from all participants. Results: The mean age of the participants was 52.4±11.2 years. The mean duration of diabetes was 9.7±7.0 years. More than half of the study subjects were housewives (51.1%). 16.0% of the participants came from the high-income class and 31.5% had a lower middle income. 19.6% of the study subjects were obese, 47.5% were overweight and 1.4% were underweight. Based on FPG, 339 (69.3%) of the participants had uncontrolled diabetes, whereas 150 (30.7%) had adequate metabolic control. The full baseline data are portrayed in Table 1. We detected diabetic retinopathy in 92 individuals (18.8%;). Overall, the prevalence of DR increased with the known duration of diabetes, from 3% with less than 3 years to 40% with 15 years or more. Higher drug non-adherence was observed in individuals with DR compared to those without DR. Conclusion: Regular screening for DR should therefore be included in standard patient care, in particular with a longer duration of diabetes. Furthermore, adequate patient education and universal access to sufficient doses of medication should be supported to reduce the risk of non-adherence to drug therapy.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the clinical profile and analysis of visual field pattern in optic disc edema cases. Methods: This study was prospective observational study conducted on patients diagnosed with disc edema attending outpatient clinic or referred from other departments to Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India. In the present study, a total of 100 patients were enrolled. Results: Most common age group was 21 to 40 years (53%), followed by 41 to 60 years (28%), more than 60 years (14%) and only 5% were aged less than 20 years. Mean age of all patients in the present study was 39.7±15.43 years. There were 60 females and 40 males. The most common presenting compliant was headache, which was reported by 64% of the patients. Out of 100 patients, 25 (25%) patients had hypertension. There were 9% patients with diabetes mellitus and 8% with tuberculosis. There was no change in visual acuity of the right and left eye in any of the patient after 48 hours of presentation. There was no change observed in stages of papilledema in any of the patient even after 48 hours of presentation. Conclusion: While evaluating a patient of disc edema both systemic and local causes should be kept in mind. Detailed history taking, supportive examinations such as visual field, color-vision and imaging tests should be performed. Ocular examination and neuroimaging helps in early diagnosis of several intracranial lesions in patients with papilledema which provides better prognosis and may save the life of patient by early intervention. Thus thorough ocular examination helps in early diagnosis of disc edema and prompt treatment may prevent progress of disease and loss of vision.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to determine neurodevelopmental outcome of these babies requiring neonatal intensive care unit (NICU) stay during their initial days at the age of 8-10 years. Methods: The present study was conducted in the Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India from January 2013 to December 2013. Retrospective analysis of data of 240 high risk newborns admitted in NICU for more than 48 hours. In this study of 240 babies, 200 babies were followed up for clinical assessment at the age of 8-10 years. These were contacted and followed up for clinical assessment including motor and neurological function, visiomotor integrative skills, academic achievement, language, executive function, behavioral issues and child behavioral checklist applied. Findings described in simple descriptive manner. Results: In the present study, 48% were male and 52% females. 33% babies were preterm born prior to 37 weeks, 67% were term babies.  46% babies were born low birth weight. 52% were normal vaginal deliveries, 44% were cesarean and 2% were assisted deliveries. 34.5% babies required NICU stay for more than 8 days. 65% required less than 7 days of NICU stay. 12% babies required more than 30 days of NICU stay, 11% required 15-30 days, 12% required 8-14 days. 17.5% had behavioral issues including excessive anxiety, 12% had withdrawal, 16% had aggressiveness, 20% babies had features of attention deficit hyperactivity disorder and 2% had features related to autism. Immediate complications 25% babies had neonatal hypoglycemia, 8% babies had neonatal seizures, 64% babies required phototherapy for hyperbilirubinemia. 28% had neonatal sepsis requiring antibiotics. Conclusion: Neonatal period is a critical period for proper neurodevelopment, having impact on child development. Babies with difficulties during transition period including prematurity, prolonged requirement for neonatal intensive care, resuscitation, ventilation, birth asphyxia, meconium complicating pregnancy had higher immediate as well as long term morbidities.

DOI: 10.5281/zenodo.

Aim: A clinical investigation on the many risk factors linked to surgical site infection in a tertiary hospital. Material and Methods: A hospital based, retrospective, observational study was conducted at Department of Microbiology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for February 2021 to November 2021. Patients with surgical site infections following non-traumatic exploratory laparotomy during study period were considered for this study. Patients 18-70 years age, of either gender, underwent non-traumatic exploratory laparotomy, had surgical site infections following laparotomy, willing to participate in present study. Results: During study period, among 1332 laparotomies, 81 patients had surgical site infections, thus incidence of SSI was 6.08 %. Majority cases were from 41-50 years age group (28.4%), followed by 51-60 years age group (20.99%). Mean age of study patients was 50.4 ± 8.24. Male (64.2%) outnumbered female (35.8%) cases. Common co-morbidities noted were diabetes (43.21%) followed by BMI 25-30 kg/m2 (41.98%), dyslipidaemia (33.33%), smoking (28.4%) and hypertension (25.03%). Most patients had ASA score 2 (50.62%) and duration of surgery > 2 hours (53.09%). In present study, SSI was most common in Exploratory laparotomy with appendicectomy and peritoneal lavage (28.4%) followed by open appendicectomy (14.81%), adhesiolysis/resection anastomosis and peritoneal lavage (11.11% each). In SSI patients, surgical wounds were labelled as clean, clean contaminated and contaminated, majority of wounds were Clean (45.68%) followed by Clean contaminated (29.63%), Contaminated (16.0%) and Dirty or infected (8.64%). Conclusion: Surgical site infection is a preventable morbidity. BMI > 25, co-morbidities such as diabetes, smoking, dyslipidaemia, surgery > 2 hours, appendicectomy were few high-risk factors noted for surgical site infections following elective/emergency abdominal surgeries. Pre-operative assessment, evaluation of high-risk factors, intraoperative care and postoperative monitoring is important to prevent SSI.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the association of anemia and hypoalbuminemia with the mortality of CKD patients undergoing routine hemodialysis. Methods: A retrospective cohort research was undertaken in the Department of Medicine, Katihar Medical College and Hospital, Katihar, Bihar, India over a one-year period. The inclusion criteria consisted of chronic kidney disease (CKD) patients who were at least 19 years old and had received regular hemodialysis treatment at our institution. A total of 200 patients were included in this investigation. Results: Out of 200 patients, 56% were men and 44% women. Patients were mostly adults (64%) and elderly (36%). CKD was caused by diabetic (44%), hypertensive (29%), obstructive (17%), and other (10%) nephropathy. At dialysis commencement, 81% used subclavian vein catheters, 8% internal jugular vein catheters, 10% femoral access, and 1% arteriovenous fistula. At dialysis start, 70% had anemia and 70% had hypoalbuminemia. The mean hemoglobin level was 9.145±2.24 g/dl, whereas the mean albumin serum level was 3.27±0.63 g/dl. The dialysis therapy killed 56 people (28%). A majority of individuals exhibited hypoalbuminemia and anemia. In regular HD patients, anemia (p=0.184) and hypoalbuminemia (p=0.332) did not significantly affect death. Conclusion: Anemia and hypoalbuminemia increased mortality. Although our research found no statistically significant association between anemia and hypoalbuminemia and CKD mortality, they may still be predictive for regular HD patients.

DOI: 10.5281/zenodo.

Aim: To determine the ocular symptoms of neurofibromatosis type-1 in a rural community. Materials and Methods: The present study is an observational study was conducted in the Department of Ophthalmology, Patna medical college and hospital, Patna, Bihar, India for six Months. The study included 36 patients with NF, presenting to Ophthalmology OPD with any complaints. Diagnosis of Neurofibromatosis was done based on the criteria proposed by the National Institutes of Health Consensus Development. A thorough clinical assessment of these patients was done by taking a brief history of presenting complaints, family history, and then thorough examination is done, which included Assessment of visual acuity through Snellen’s chart, slit lamp examination, Fundus evaluation by direct and indirect ophthalmoscopy. Ultrasonography / Computed tomography / Magnetic resonance imaging of orbits were done wherever necessary. All the patients who satisfy the criteria of Neurofibromatosis according to National Institutes of Health Consensus Development Conference and Patients who are willing to participate in the study. Results: The most common ophthalmic manifestation in these patients was Lisch nodules (83.3%) and Neurofibromas of the upper and lower eyelid (83.3%). Plexiform neuro fibroma was seen in 8 patients (22.2%) among which, 5 (62.5%) patients have upper lid involvement and 3 (37.5%) patients have both upper and lower lid involvement. Orbital neuro fibroma was seen in 8 (22.2%) patients. Among 36 cases normal visual acuity was observed in 24 cases (66.7%), visual impairment was seen in 12 cases (33.3%). Out of 12 (33.3%) patients with visual impairment, 3 (25%) patients had stimulus deprivation amblyopia due to plexiform neuro fibroma, 3 (25%) had compressive optic neuropathy due to orbital neuro fibroma, 5 (41.7%) had both plexiform and orbital neuro fibromas, 1 (8.3%) patient had coloboma choroid involving macular area. Regarding the genetic pattern of inheritance, among 36 patients, single generation was affected in 18 (50%) patients, 2-generations were affected in 9 (25%) patients, 3-generations were affected in 3(8.3%) patients, 4-generations were affected in 3 (8.3%) patients, 5-generations were affected in 3 (8.3%). Conclusion: In conclusion, Lisch nodules in iris and neuro fibromas of eyelids are the most common manifestation in Neurofibromatosis patients in our study. Visual impairment as a result of the disease can occur in 33% of patients either due to stimulus deprivation amblyopia or due to compressive optic neuropathy, which can be intervened by early diagnosis. Denovo mutations are more common accounting for 50% of cases in this study.

DOI: 10.5281/zenodo.

Aim: To study the breast pain in women with mammography and ultrasound. Materials and Methods: A Retrospective study was conducted in the Department of Radiodiagnosis, Patna Medical College and Hospital, Patna, Bihar, India from January 2019 to December 2019. Study participants were all women with palpable and nonpalpable breast lesions detected on clinical examination/self-breast examination and referred for MG and women in high‑risk groups (family history of breast cancer, previous history of breast cancer and disease such as fibrocystic disease, and excessive exposure to ionizing radiation, and history of endometrial, ovarian, or colonic carcinoma). A total of 53 patients were studied. Study tools were MG machine (Digital MG Novation DR. SIEMENS) and USG machine (WIPRO G E Healthcare Ultrasound LOGIC–P5). Results: The sensitivity, specificity, PPV, and negative predictive value (NPV) of MG in detecting carcinoma breast are 77.77%, 97.72%, 87.5%, and 95.55%, respectively. USG independently detected six patients as suspicious of breast carcinoma and missed four lesions, which were subsequently proved as carcinoma. USG falsely detected one patient as suspicious lesion, which proved benign in other studies. The sensitivity, specificity, PPV, and NPV of USG in detecting carcinoma breast are 55.55%, 97.72%, 83.33%, and 91.48%, respectively. Two malignant lesions which were occult in MG due to dense breast parenchyma and were detected in USG. The four cases of carcinoma breast which could not be picked up in USG were diagnosed by MG. The correlation coefficients of MG alone (0.792), USG alone (0.631), and MG and USG combination (0.884) with FNAC are all positive, and P values are significant of all the modalities, which signify that all are the effective diagnostic procedures of detecting breast malignancy, but among the three procedure, the combination of MG with ultrasonography shows the strongest correlation (correlation coefficient = 0.884) with the finding of FNAC. Conclusion: We therefore conclude that with the combination of two noninvasive procedures, MG and ultrasound; we can almost achieve the accuracy of the FNAC in detecting breast malignancy.

DOI: 10.5281/zenodo.

Aim: To investigate the efficacy of single extra-articular humerus plating and bipillar plating in the treatment of distal humerus fractures in a tertiary healthcare center. Material and Methods: This study was conducted in the Department of orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India from   October 2019 to August 2022. Total 80 patients were included in this study. Patients were grouped into two groups. Group A included humerus fracture treated with single extra articular plating and Group B included patients treated by bipillar plating. Results: Mean duration of surgery was significantly less in Group A (92.43± 13.27mins) than Group B (183.53± 5.38 mins) (P<0.05). Mean operative blood loss in Group A was 178± 42 ml while in Group B it was 215± 36 ml. Difference between these two groups is statistically significant (p<0.05). Mean fracture union time was 23.2±1.1 and 22.4± 1.2 in Group A and Group B respectively. Bone impingement was not seen in Group A. only one patient had Bone impingement in Group B. Table 2 shows comparison of both the groups according to Mayo Elbow Performance Score. Score of > 90 was considered as excellent and score of 75-89 was considered as good. In our study we found that 29 patients from group A were with excellent score and 27 patients from Group B were with excellent score. Good score was achieved by 1 patient in Group A and 3 patients in Group B. Conclusion: Single extra articular humerus plating is better than bipillar plating for distal humerus fracture as it has less duration of surgery and less blood loss with good performance score.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the perinatal outcome with respect to maternal and neonatal characteristics and to evaluate the neonatal morbidity/ mortality. Methods: The retrospective study was conducted in the Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India from February 2020 to January 2021. Total Eighty-two women presented with eclampsia over the study period resulting in an incidence of eclampsia of 9.8 per 1000 deliveries (0.98%), of which 75 women fulfilling inclusion criteria were included in the study. Results: The majority of eclamptic mothers were primigravida (73.33%), Mean maternal age was 22 years. Mean gestational age at presentation was 34 + 6 weeks with a range of 28 weeks – 40 weeks and 36% of them reached term. Caesarean delivery was the commonest mode of delivery 56 (74.7%) among the subjects with eclampsia. The total number of births in our series was 76, which included 74 singleton births and 1 set of twins with a mean birth weight of 1.92 ± 0.66 Kg and a range of 0.99 Kg –3.16 Kg. Of 68 live born; 39 neonates required admission in the special /intensive neonatal care unit. Indications for admission were prematurity 15 (38.5%), sepsis 12 (30.8%), Intra-uterine growth restriction (IUGR) 12 (30.8%) and perinatal asphyxia 3 (7.7%). Of the total 75 pregnant women, 6 patients were presented with intrauterine death. 2 patients who had presented with live fetuses, had fresh still births and 2 patients had early neonatal deaths. Causes of neonatal death were extreme LBW/prematurity and neonatal sepsis. Less than optimum ANC, young age, nulliparity and premature delivery are contributory factors for adverse outcome. Conclusion: Eclampsia among rural population of India still remains a significant risk factor for neonatal morbidities like preterm, LBW, IUGR and birth asphyxia. Young age, nulliparity, mode of delivery being vaginal and high maternal serum LDH levels were risk factors for adverse perinatal outcomes. This study emphasises the need to prevent development of eclampsia at a community level through optimal antenatal care.

DOI: 10.5281/zenodo.

Aim: To determine the specific cause of microcytic anemia in a tertiary care hospital. Material and Methods: This study was conducted in the Department of pathology, ANMMCH, Gaya, Bihar, India from August 2019 to July 2020. Total 100 Cases of microcytic hypochromic anemias were taken from Outpatient Department and indoor. After taking written consent from all patient’s workup was done according to seems etiology. The study was approved by the ethical committee of the institute. Age >18-year and Patient of microcytic hypochromic Anemia were included in this study. Results: The etiological distribution of microcytic hypochromic anemia in the studied population revealed that iron deficiency anemia (IDA) was the most prevalent, affecting 61% of the participants. Anemia of chronic disease (AOCD) accounted for 28% of the cases, while thalassemia was identified in 11% of the subjects. Among the cases of AOCD, tuberculosis was the leading cause, responsible for 39.29% of the cases. This was followed by chronic kidney disease (10.71%), systemic lupus erythematosus (10.71%), rheumatoid arthritis (7.14%), diabetes mellitus (7.14%), multiple myeloma (7.14%), chronic lymphocytic leukemia (3.57%), non-Hodgkin lymphoma (3.57%), Hodgkin lymphoma (3.57%), lung carcinoma (3.57%), and Crohn’s disease (3.57%). In the thalassemia group, the majority were diagnosed with thalassemia trait, which constituted 81.8% of the cases. Delta B thalassemia and double heterozygote HBE and B-thalassemia each accounted for 9% of the cases. The mean corpuscular indices revealed significant differences among the groups. The mean corpuscular volume (MCV) was highest in the IDA group (24.2115±7.25806 fL), followed by AOCD (15.5786±2.49345 fL), and lowest in thalassemia (13.5073±3.30384 fL) with a p-value of <0.001. The red cell distribution width (RDW) was significantly higher in IDA (19.466±1.9141%) compared to AOCD (15.650±1.3304%) and thalassemia (15.409±1.0222%) with a p-value of <0.001. Conclusion: Anemia is not an illness in and of itself, but rather a symptom of another, hence finding the under- lying cause is significantly more important. People suffering from chronic illnesses, which form a large group as a result of nutritional insufficiency and anaemia from chronic diseases, can be avoided to some extent by the ongoing and uninterrupted implementation of anti-tuberculosis programmes in third-world countries such as India.

DOI: 10.5281/zenodo.

Aim: This study aims to evaluate the indication and outcome of different surgical management modalities in local complications of acute pancreatitis. Methods: A hospital-based retrospective study was conducted in the Department of General Surgery, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. 50 patients required surgical intervention due to failure of endoscopic or radiological intervention or positions of lesions being inaccessible to these techniques. Results: Of the 50 cases, males made up 54%. Pseudocyst pancreatic fluid collection was observed in 34% of cases, while 50% had ethanol origin. Where they were, 70% were either at the body or the tail. Grade 2 accounted for 30%, grade 1 for 26%, and grade 4 for 20%, all based on the Clavien-Dindo system. Conclusion: Despite the availability of different endoscopic procedures for managing pancreatic fluid accumulation and pancreatic necrosis, surgery remains necessary for treating the illness.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate treatment response to anemia of various types in females admitted in our tertiary care hospital. Methods: The present study was conducted in the Department of Medicine, Mata Gujari Memorial Medical College, Kishanganj, Bihar, India from January 2019 to December 2019. A total of 150 females were selected and divided 50 in each group and there were three groups (12-30years) (31-50years) (more than 50years). Results: The incidence of moderate anemia is maximum among the three age groups. The incidence of moderate grade of anemia is maximum in all three age groups. The causes of anemia in the three age groups which shows that the iron deficiency is the most common type of anemia in all the three age groups. The improvement in hematological indices in iron deficiency anemia cases in different ages showed that the hematological indices such as Hb, HCT, MCV has significant p values and henceforth prove that they improve with the iron supplementations. The improvement in hematological indices in megaloblastic anemia cases in different ages which showed that the hematological indices such as Hb, HCT, MCV has significant p values in age group (12-30years) and (31-50years) but only Hb and HCT improved in (age group >50years) henceforth megaloblastic anemia improve faster in younger age groups. There was significant p value for hematological index Hb and HCT and hence suggestive of significant improvement. Conclusion: In the present study the incidence according to grades of severity is maximum for moderate grade of anemia having the highest number of cases in the lower start of the society. This suggest that poverty causing lack of balanced diet, illiteracy ,lack of awareness as the important factors leading to the development of anemia. The present need of the health care system is to develop the awareness among the females about importance of balanced diet, regular checkup, menstrual hygiene.

DOI: 10.5281/zenodo.

Aim: To determine the impact of Caudal Epidural Steroid Injection (CESI) on the condition of Backache Sciatica Syndrome. Material and Methods: This study was done in the Department of PMR, ANMMCH, Gaya.  A total of 120 individuals with chronic LBA and symptoms who had not responded to therapy or other non-invasive, non-surgical conservative treatment options were included in the study. The patients underwent cervical epidural steroid injection (CESI) under sterile conditions in the OT with fluoroscopic guidance. The study evaluated the results of the caudal epidural steroid injections by measuring ache scores on the Oswestry disability index (ODI) and visual analog scale (VAS). Results: Of the 120 cases, 37 had lumbar disc herniation, 11 had lumbar canal stenosis, 22 had degenerative disc disease, and 50 had non-specific LBA. This passage describes a study in which patients were treated with a procedure called CESI, and their pain levels were measured before the procedure (mean VAS of 7.11) and at various follow-up intervals, including 1 week, 1 month, and 3 months up to 1 year after the procedure. At 1 year, the mean VAS was 4.82, indicating a decrease in pain from before the procedure. This passage discusses the results of a study that looked at the effectiveness of ESI treatment (presumably epidural steroid injection) on patients’ scores on ODI before and after treatment. The study found that the mean ODI score before treatment (was 59.12), and after 12 months of treatment with injection, it was 44.64. The study also reported that 27.5% of patients had excellent results, 38.33% had good results, 21.67% had fair results, and 12.5% had poor results from the treatment. Conclusion: This study suggests epidural steroid injections significantly reduce pain for patients with chronic function-limiting low back aches. This study may pave the way for further research in this area.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the association between dental procedures and the acquisition of infective endocarditis. Material & Methods: A retrospective study was conducted in the Department of Dentistry, RDJMMCH, TURKI, Muzaffarpur,  Bihar, India for 24 month  to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no infective endocarditis developed. 200 patients were included in the study. Results: The mean age was 56.0 (18.6) years; 40% of patients were 65 years and older. Men accounted for 65% of all patients. In terms of co-morbidities, hypertension was the most common followed by diabetes and ischemic heart disease. Out of 200 patients, 43 patients were exposed to infective endocarditis. Conclusion: In conclusion, using a case-crossover design, this population-based study found that dental procedures are not significantly associated with the risk of IE.

DOI: 10.5281/zenodo.

Aim: This study investigates the role of MRI in diagnosing, classifying, and assessing the additional clinical value of preoperative imaging for surgeons. Material and Methods: This retrospective study included 70 patients presenting with perianal discharge, referred to the Department of Radiodiagnosis at Patna Medical College and Hospital, Patna, Bihar, India for one year. MRI examinations were conducted using a 1.5 Tesla MRI system (GE Signa 1.5T), employing multiplanar T1-weighted, T2-weighted, and fat-suppressed T2-weighted sequences. Results: Among the 70 patients studied, the findings were categorized as follows: 23 cases (32.8%) were grade 1 (simple linear inter sphincter fistula), 10 cases (14.3%) were grade 2 (inter sphincteric with abscess or secondary tract), 4 cases (5.7%) were grade 3 (trans sphincteric), 21 cases (30%) were grade 4 (trans sphincteric with abscess or secondary tract in ischiorectal or isochronal fossa), and 2 cases (2.9%) were grade 5 (supra levator and trans levator). Additionally, 10 patients had perianal sinuses identified. Conclusion: MRI proves valuable in the effective management of perianal fistulas by accurately assessing the extent of disease and its relationship to the sphincter complex.

DOI: 10.5281/zenodo.

Aim: To assess the level of awareness of polycystic ovarian syndrome in adolescents using a cross-sectional survey. Material and Methods: This study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India. The survey was conducted on 200 medical students of 1st, 2nd and 3rd year of different colleges by using simple random sampling technique. The data was collected by using structured knowledge questionnaire on PCOS. The investigator obtained permission from the students, prior to the data collection and assured confidentiality to the subject to get their cooperation and explained the purpose of the study. Results: In present study, 33% adolescent and young girls had information about PCOS from teacher, 19% got information from friend, 11.5% got information from a doctor, 3.5% got information from newspaper while 5% got information from internet. 28% adolescent and young girls were unaware of PCOS. Being medical students, main source of information was teacher. Still 28% of girls were unaware about PCOS when they are in first or second year. So, 72% girls were aware of PCOS while 28% were unaware of PCOS. In this study, 9.5% girls consulted dermatologist for either hirsutism or acne, 4.5% consulted gynaecologist for irregularity of menses, 1% girls sought ayurvedic treatment while 1% opted for homeopathy. Amongst 16% girls who consulted a doctor, 9% girls did ultrasonography and blood investigations. Amongst them, 6% girls were diagnosed as having PCOS. So, prevalence of PCOS in present study is 6%. Conclusion: It is concluded that 72% of girls were aware of PCOS while 28% of girls were unaware of PCOS. Prevalence of PCOS in present study is 6%. Most common source of information about PCOS was teacher as the girls were medical students. Girls who were having BMI more than 23 should be educated about its hazards and should be advised weight loss. Girls who had irregularity of menses and signs of hyperandrogenism should be investigated and must be managed accordingly.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the role of intravaginal micronized progesterone in preterm labor in prolonging the pregnancy up to term. Methods: A retrospective study was conducted in the Department of Obstetrics and Gynecology, IGIMS, Patna, Bihar, India for one year.  Patients were randomly divided into two groups having 100 women in each group by computer generated randomization tables. Results: There was no significant difference between the two groups in their demographic characteristics. The randomly allocated groups were comparable in terms of age, parity, region at the time of inclusion in study. Age varied from 19-35 yrs, mean age being 23.67 ± 2.68and 24.66 ± 3.57 in group I & II respectively. Parity varied from 0-4, median parity observed in both groups was1.Majority belonged to rural area. Period of gestation at admission varied from 26 to 34 weeks but maximum patients presented at 30-34 weeks gestation in both groups. Mean gestation age was 31.82 ± 1.80 & 31.55 ± 1.81 weeks in the two groups respectively. The mean number of uterine contractions per ten minutes was 2.17 ± 0.37 and 2.13 ± 0.32 in Group I & II respectively (p = 0.56). No significant difference in cervical dilatation (1.48 vs 1.42 cm; p=0.27) and cervical effacement (43.4% vs 41.6%; p= 0.15) was seen between the two groups. In Group I, the mean gestational age at delivery was 35.805 ± 1.70 weeks whereas in Group II, it was found to be 34.974 ±  1.81 weeks. In Group I, 60% of the patients delivered at more than 37 weeks as compared to 14% in Group II. Significant difference was found between the two groups. The difference between the mean birth weight of the two groups was statistically significant. Conclusion: In patients of preterm labour vaginal micronized progesterone when used along with tocolytics and supportive therapy significantly prolongs the pregnancy and hence gestational age at delivery. Progesterone therapy leads to higher number of women reaching term and delivering beyond 37 weeks and also better neonatal outcome in terms of higher birth weight and fewer complications.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the efficacy and safety of naftifine hydrochloride 2% w/w in the patients with dermatophytosis versus terbinafine hydrochloride 1% w/w. Methods: A retrospective, randomized, two-arm, double-blind, active-controlled, parallel, multicenter, non-inferiority, phase III clinical trial was conducted in the Department of Dermatology and department of Pharmacology, Venereology and Leprosy, Patna Medical College and Hospital, Patna, Bihar, India, for one year. The study involved adult patients diagnosed with superficial fungal infections of tinea cruris and tinea corporis. 60 patients were divided into two study groups based on inclusion and exclusion criteria. Results: The baseline demographics and characteristics of the disease among these patients were comparable. The test drug showed to be non-inferior to the reference drug for the proportion of patients achieving clinical cure, mycological cure, and composite cure at the end of treatment. The study found that a total of 8 adverse events (AEs) were reported in 10 patients in the group A and 9 in the group B. Conclusion: The present study concluded that naftifine 2% cream proved to be both effective and safe for Indian patients suffering from dermatophytosis. Further, its efficacy as evaluated by clinical and mycological cure and safety as evaluated by adverse events were found comparable to Terbinafine 1% cream.

DOI: 10.5281/zenodo.

Aim: To investigate the efficacy of anaemia therapy in female patients admitted to a tertiary care hospital. Material and Methods: The Department of Medicine, IGIMS, Patna, Bihar, India for 16 months, undertook this retrospective study. Sixty women were recruited for each of three age groups: 12-30, 31-50, and beyond 50. This research included all women over 12 attending tertiary care centers with Hb levels below 12gm/dl. Results: Moderate anemia is most common in all three age groups. In all three age categories, iron deficiency is the most prevalent cause of anemia. Hematological indices including Hb, HCT, and MCV improve with iron supplementation in iron deficient anemia patients of various ages according to substantial p values. Hematological indices like Hb, HCT, and MCV have significant p values in age groups (12-30 years) and (31-50 years), but only Hb and HCT improved in age group >50 years, so megaloblastic anemia improves faster in younger age groups. In our research, 8 chronic kidney disease females were treated with inj. erythropoietin for anemia. Hematological index Hb and HCT imply considerable improvement due to significant p values. Conclusion: Consignee marriages may cause hemoglobinopathies in progeny, rendering them blood transfusion dependent. Due to hormonal changes and secondary chronic conditions, elderly women, particularly postmenopausal women, are more prone to anemia. Healthy living and regular checkups may help prevent these issues.

DOI: 10.5281/zenodo.

Aim: To determine the correlation between cholelithiasis and body mass index (BMI) and waist-to-hip ratio. Material and Methods: This research was done in the Department of General surgery, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for one year, on a sample of 100 individuals who presented with abdominal discomfort and met the specified inclusion criteria. The test group consisted of 50 individuals who were diagnosed with cholelithiasis, whereas the control group consisted of 50 patients who had abdominal discomfort due to causes other than cholelithiasis. The patients underwent investigations including complete blood count (CBC), liver function tests (LFT), renal function tests (RFT), and abdominal ultrasound (USG). The BMI was computed using the usual calculation known as Quetelet’s index, which involves dividing the weight (in kilograms) by the square of the height (in meters). The Waist Hip ratio was assessed using the World Health Organization (WHO) methodology. Results:  The Cholelithiasis group had a mean Body Mass Index (BMI) of 28.85±1.28, with a median of 25.23. The least BMI observed was 18.55, while the greatest was 35.23. The group without cholelithiasis had an average BMI of 25.23±1.87, with a median of 23.88 (ranging from a low of 17.25 to a high of 32.33). Within the cholelithiasis group, 11 patients (22%) out of a total of 50 had a BMI within the normal range, whereas 39 patients (78%) had a BMI beyond the normal range.  Waist hip ratio was matched between the two groups and was found to be significant (p<0.05) (Table 5). cholelithiasis group had a mean WHR of 1.13±0.02 with a median of 0.8 (minimum=0.7 and maximum=1.2). Non cholelithiasis group had a mean of 1.22±0.03 with a median of 0.7 (minimum=0.6, maximum age=1.2) In cholelithiasis group, 3(6%) patients out of 50 were found to be within normal WHR limit, whereas 47 patients (94%) were within higher WHR limits. In non-cholelithiasis group, 10 patients (20%) out of 50 were found to be within normal WHR limits, whereas 40 patients (80%) were within higher WHR limits. Conclusion: Our findings indicate that there is a correlation between being female, being obese, and having a higher chance of developing cholelithiasis.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the prevalence of depression and disability among alcohol dependent patients. Methods: The present study was a retrospective study. It was conducted in psychiatry department of  Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for a period of 7 months. Sample size of 100 patients was taken by consecutive sampling. Results: All of the patients were Males (100%). Majority of the subjects were married (81%) and studied up to secondary education (41%), belonged to Hindu religion (78%), low socioeconomic status (65%). Most common occupation was semiskilled (53%) and unskilled (31%). In terms of severity, Moderate (32%) and very severe depression (20%) was more common. Disability was assessed using WHO DAS 2.0 Scale. Among the individual domains, life activities (30%), which include both household and work activities was most affected, followed by participation in the society (20%). In terms of severity, most of the patients had moderate (40%) to severe (38%) disability. Conclusion: AUDs, depression, and their co-occurrence impose a tremendous burden on individuals, families and communities. Three fourths of the patients with alcohol dependence syndrome are suffering from depression. Alcohol dependence is also associated with greater levels of disability, irrespective of the presence or absence of depression. Further research in disability assessment of alcohol users can help in formulating preventive early intervention strategies for specific disabilities. Alcohol control policies need to shift focus from economic issues to the social issues associated with alcohol use.

DOI: 10.5281/zenodo.

Aim: To investigate the prevalence of pulmonary TB in individuals with chronic asthma. Material and Methods: This study was conducted in the Department of Microbiology, Nalanda Medical College and Hospital, Patna, Bihar, India from February 2018 to January 2019. Study population was 150 asthmatic patients who were taking treatment for more than 2 years. Data was collected with pre tested questionnaire. Data included demographic data like age, sex and occupation. Detailed clinical history was taken from the patients. Clinical history related to duration of asthma, treatment taking for asthma, frequency of asthmatic attacks, past history of tuberculosis, family history of asthma was noted. A through clinical examination of the patients was done. All these patients were treated with anti-histaminics steroids, antibiotics bronchodilators meter dose inhaler pumps on and off frequently. Routine investigations like complete blood count, renal and liver function tests were done. Results: In our study out of 150 patients 130 patients were outside workers and 20 females were housewife. In our study, we enquired about the smoking habit in the patients. Out of 150 patients, 80(53.33%) were nonsmokers. Current smokers were 40(26.67%). 20% of the patients have stopped smoking. Duration of smoking in current smoker ranges from 1-23 years. All patients were treated with anti-histaminics, steroids, antibiotics bronchodilators meter dose inhaler pumps on and off frequently. Majority of the patients used inhaled steroids 60(40%) followed by bronchodilators 48 (32%). Pulmonary function test were done in 150 patients and results were in favour of obstructive lung pathology. All the patients were subjected to chest x-ray, sputum examination for acid fast bacilli by Zeil nelson stain. Out of total 150 patients 6 patients were found positive for acid-fast bacilli on ZN stain. Only TWO X-ray were suspecting koch’s out of 150 patients. Conclusion: All chronic asthamatics patients should be screened for AFB by Zn stain.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess histological changes in liver due to poisoning. Material & Methods: A two-year retrospective study on assessment of histopathological changes in liver due to agricultural poisoning cases was studied amongst autopsies conducted in the Department of Forensic Medicine and Toxicology, SKMCH Muzaffarpur, Bihar India from May 2018 to April 2020. In the present study, a total of 1785 autopsies were conducted. Of the total, 500 cases with the history of poisoning were studied in that 300 cases were females and 200 cases were male. Results: Age of the individuals varied from 7 years to 65 years amongst 51% of cases was in the age group of 25 to 35 years. Of 500 cases in 350 cases poisons were confirmed by chemical analysis of state forensic science laboratory, in that 200 cases were organo phosphorus compound, 100 cases were aluminium phosphide and zinc phosphide, 50 cases were Pyrethrin compounds and in remaining cases poison was not detected by chemical analysis. Of 500 cases, 200 were organophosphorus compound in that Congestion, sinusoidal dilatation, mononuclear and neutrophilic infiltration (Group I) were predominantly seen. 100 cases are phosphide compounds in that Cytoplasmic vacuolization, hydronic degeneration, Patchy or centrilobular necrosis and patchy haemorrhages (group II & III) were predominant. In 50 cases of Pyrethrin compound group I & II changes were predominantly, in remaining unidentified poison cases mixed feature was observed. Amongst 500 cases, 325 cases were hospitalized for 0 – 1 day. In that group I histological feature were predominantly seen, 100 cases were hospitalized for 2-5 days; in that group II changes were predominant, 75 cases were hospitalized for 5- 10 days; in that group III changes were seen. Conclusion: By knowing the exact histopathological changes in these organs, it is easier to attribute death to a failure of one of these organs as a consequence of organophosphate consumption. Knowing the rapidity of involvement of an organ is beneficial to the treating physician as well thereby helping him reduce the morbidity and hence mortality.

DOI: 10.5281/zenodo.

Aim: to compare between intrathecal dexmedetomidine (5mcg) and intrathecal meperidine (0.2mg/kg) for decreasing the incidence and intensity of shivering after spinal anesthesia for lower abdominal operations. Methods: The present study was conducted in the Department of Anesthesia, Vardhman Institute of Medical Science, Pawapuri, Nalanda, Bihar, India from jan 2017 to December 2017, and ninety patients scheduled for lower abdominal operations under spinal anesthesia were randomly allocated to three groups. Spinal anesthesia consisted of 12.5 mg hyperbaric bupivacaine 0.5% in addition to dexmedetomidine (5mcg) (group D) or meperidine (0.2 mg/kg) (group M) or, normal saline (group S). Different parameters, including sublingual temperature, sensory block, motor block, incidence and intensity of shivering, blood pressure, heart rate, pruritus, nausea, and vomiting was performed at 10-minute intervals. Results: Hypothermia was recorded in 17 patients in group D, 16 patients in group M and 18 patients in group S, while shivering developed in 6 patients in group D, 7 patients in group M and 8 patients in group S, however, pruritus, nausea and vomiting was more common in the meperidine group compared to the other two groups. Conclusion: To conclude, intrathecal dexmedetomidine and meperidine lowered the incidence of shivering and increased duration of sensory and motor block during lower abdominal operations. Intrathecal meperidine caused more pruritus, nausea and vomiting than intrathecal dexmedetomidine.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find out the prevalence of Non- Strabismic Binocular Vision Anomalies in children with hearing impairment. Methods: The study was conducted among hearing-impaired children in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India from April 2016 to Jan 2017. Children were included in this study based on the inclusion and exclusion criteria of the study. Hearing-impaired students age ranges 8-20 years were included in the study. Among a total of 103 children screened. Results: When compared between severe and profound HI, there was no statistically significant difference in NPA. The response of accommodation did not show a statistically significant difference when compared between severe and profound HI. NRA and PRA values did not show any statistically significant difference when the values were compared between subjects with severe and profound HI. Similarly, binocular and monocular AF also did not show any significant difference when compared between subjects with severe and profound HI. There was no statistically significant difference in NPC break and recovery, NFV break (distance and near), and PFV break (distance and near) values when compared between the children with severe and profound HI. Conclusion: Non-strabismus binocular vision anomalies were found among profound and severe hearing-impaired subjects. So, it is important to consider binocular evaluation among hearing-impaired subjects.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to measure the location of greater palatine foramen (GPF), according to clinically identifiable anatomical landmarks. Methods: The study was performed on 50 dry human skulls. The skulls were obtained from Department of Anatomy, Patna Medical College, Patna, Bihar, India for eight months. Results: The situation of the GPF in relation to 3rd maxillary molar was in 20 of the skulls. The average values of the distance between the GPF & midline palatine suture (MPS) & posterior border of hard palate (PBHP) were 16.4 mm (SD 1.4) & 6.4 mm (SD 1.3), respectively. Conclusion: Diverse locations of greater palatine foramen arouse difficulties in locating exact position during anesthesia. Therefore, understanding the different positions of greater palatine foramen can help surgeons to improve their surgical procedures.

DOI: 10.5281/zenodo.

Aim: To study the clinic-epidemiological profile and early outcome of patients with traumatic spine injury. Material and Methods: This was a retrospective study conducted in the Department of Orthopedics, SKMCH, Muzaffarpur, Bihar, India for one year. 200 patients were included in the study. All patients with traumatic spine injuries attending OPD or admitted in emergency, willing to participate in study were included in this study. Radiological imaging (X-rays, CT scan, and MRI) were done. After clinical and radiological examination patients’ further treatment options (operative/non operative) were planned. Results: Follow up ASIA score after 2 weeks in patients was A in 14% patients, B in 8%, C in 16%, D in 12%, E in 50%. Follow up ASIA score after 3 months in patients was A in 8% patients, B in 5%, C in 6%, D in 15%, E in 68%. Follow up ASIA score after 6 months in patients was A in 9% patients, B in 5%, C in 4%, D in 16%, E in 66%. Follow up ASIA score after 9 months in patients was A in 8% patients, B in 6%, C in 4%, D in 20, E in 60%. Follow up ASIA score after 12 months in patients was A in 12%, D in 28, E in 60%. Conclusion: Leading causes in deaths at cervical level were due to respiratory failure and leading causes of deaths in thoracic and lumbar vertebral level were due to secondary complications of long-standing bed sores. Despite limited sources, outcomes of SCI patients in India appear favorable with evidence of clinical improvement and low mortality.

DOI: 10.5281/zenodo.

Aim: To evaluate the impact of thyroid disorders on the health of both fetus and the mother during pregnancy. Material and Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology, NMCH Patna, Bihar, India for one year. We recruited 294 antenatal women in third trimester admitted into the obstetric ward with singleton pregnancy for other obstetric indications. Informed consent was obtained from all subjects. Subjects were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancies, a known case of thyroid disorder, on any treatment or with any pre-existing medical disorder, such as diabetes mellitus, or cardiac or pulmonary disease were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with a deranged thyroid profile were subsequently assessed for maternal and fetal complications. Infertility, family history of thyroid disorder, menstrual history, recurrent abortions, mean T3, T4, TSH levels, haemoglobin levels, maternal and fetal outcome were the main study variables. Results: Of the 294 women screened, 46 (15.64%) had abnormal thyroid function. Prevalence of subclinical hypothyroidism, overt hypothyroidism, and subclinical hyperthyroidism was 7.48% (n = 22), 5.10% (n = 15), and 3.06% (n = 9), respectively demonstrating that the occurrence of subclinical hypothyroidism is more common during pregnancy. Of the 46 women with dysfunction, 23.91% had a history of irregular menstrual rhythm; 4.34% had history of infertility treatment; 4.34% had family history of thyroid disorder and 4.34% had history of recurrent miscarriage. There was no statistically significant association between any of these factors and the occurrence of thyroid disorder (p values were 0.655, 0.217, 0.079, and 0.752, respectively). Conclusion: Association of maternal anemia, preeclampsia, increased cesarean delivery, presence of LBW babies, low Apgar score and increased number of NICU admission; is a major finding of this study.

DOI: 10.5281/zenodo.

Background: Human immunodeficiency virus (HIV), the third most widespread epidemic in the world, is a huge burden to the lower-middle-income country (LMIC), India. Although the number is lesser than other LMICs, India’s population, estimated at 1.3 billion, manifests to 2.1 million people living with the disease. In recent years, clinicians observed elevated cholesterol and often markedly elevated triglyceride levels in HIV-infected persons maintained on HAART. Our study aims to measure the development of dyslipidemia and lipodystrophy and recommend solutions from the evidence available so far. Materials and Methods: A prospective study was carried out in the Microbiology and Biochemistry lab, Jhalawar Medical College, Jhalawar between January 2023 to April 2023 for lipid profile i.e., serum LDL, HDL, TG and TC, in HIV-positive patients. The present study is designed to measure the levels of lipid profiles in HIV-positive patients from the data available in the Biochemistry Lab. All the data was collected through pre-designed Performa and data was entered in MS Excel software.  Data was analyzed by SPSS 23.0 Software. Result: A total of 100 HIV Positive cases were taken in the study, out of these 100 patients, 56 (56%) were male and 44 (44%) were female. The mean age of the patients was 35 ± 10.6 years. The Mean cholesterol of HIV Patients was 247.36 ± 39.25, mean Triglycerides was 203.57 ± 42.39. the mean LDL and HDL were 196.37 ± 37.6 and 65.39 ± 26.7 respectively in HIV patients. Conclusion: In summary, atherogenic lipids including TG, VLDL-C, and LDL-C have been shown to rise in HIV-positive individuals. As the illness worsens, healthy cholesterol (HDL-C) levels drastically decline.

DOI: 10.5281/zenodo.

Aim: This study was designed to compare the clinical efficacy of plain and hyperbaric solutions of 0.75% ropivacaine in spinal anesthesia in elective lower abdominal and lower limb surgeries. Methods: The present study was conducted in the Department of Anesthesiology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India from February 2023 August 2023, and Fifty ASA grade I–II patients who were to undergo elective perineal (gynecological or urological) surgery under spinal anesthesia gave written informed consent to take part in the study. Results: In the study, the mean specific gravity of the freshly prepared hyperbaric ropivacaine 0.75% solution (by the addition of 50 mg/mL dextrose) observed was 1.148 and plain ropivacaine 0.75% was 1.160. The two groups were comparable with regard to age, sex, height, weight, ASA status, and types of surgeries and the mean difference was statistically not significant. Hyperbaric ropivacaine produced a more rapid onset of more extensive, but less variable sensory block, which, nonetheless, ultimately regressed more quickly. The onset of analgesia to pinprick at T10 was more rapid, and the maximum block height (median T4 vs T8) was greater, but less variable. Median time to maximum block height was the same in both groups, but the range was considerably greater with the plain solution. The onset of lower limb motor block was slightly faster in the hyperbaric group, but the maximum degree obtained was the same in both groups. Conclusion: Addition of glucose 50 mg ml1 to ropivacaine 5 mg ml1 increases the speed of onset, block reliability, duration of useful block for perineal surgery, and speed of recovery. Plain solutions are less reliable for surgery above a dermatomal level of L1.

DOI: 10.5281/zenodo.

Aim: To evaluate the effectiveness of a modified Marshall scoring system in determining the severity of acute pancreatitis, as compared to the Ranson score. Material and Methods: It was retrospective study carried out at Department of General surgery, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for one year. The sample size was taken as 60 patients admitted with the diagnosis of acute pancreatitis irrespective of etiology.  Modified Marshall score was calculated at admission taking into account the arterial blood gas analysis, blood pressure and serum Creatinine while the Ranson’s score was calculated on admission and completed at 48 hours for the same patient as per the mentioned parameters. A Score >2 was defined as organ failure as per the Modified Marshall’s score while Ranson’s score ≥3 at 48 hours was classified as severe pancreatitis. Results of both the scoring systems were compared to predict severity of the disease which was evaluated with number of days of hospital stay and mortality. Patients were discharged when the total leucocyte counts were normal and were accepting oral diet. Identity of the participants was kept absolutely confidential. Patients were followed up for a period of 7 days and at 4 weeks post admission. Results: Interestingly the patients with single organ failure (35%) had no mortality while 2/3 patients with all three-organ system failure died. On comparing the 2 scores out of 36 patients who had severe pancreatitis by Ranson’s score, 26 patients were categorized as severe pancreatitis & 10 patients as mild pancreatitis based on Modified Marshall score. Out of 21 patients categorized as mild pancreatitis by Ranson’s score, 3 patients had severe pancreatitis & 18 patients had mild pancreatitis as per Modified Marshall’s score. The area under the curve (AUC) value of the ROC curve showed that Modified Marshall score is a significant predictor of severity of acute pancreatitis with value of 0.863 (p<0.001). At cut off value of Modified Marshall score for predicting severity of acute pancreatitis ≥2, the score had a sensitivity, specificity, PPV & NPV of 72.22%, 85.71%, 89.66% & 64.29% respectively. The accuracy of the score in prediction was 77.19%. The correlation coefficient was strongly positive and statistically significant (p<0.001) for the relationship between Ranson’s score, Modified Marshall score and duration of hospital stay in patients of acute pancreatitis. The coefficient between duration of hospital stay and Ranson’s and Modified Marshall score was 0.571 and 0.746 respectively and that between Ranson’s score and Modified Marshall score was 0.819. Conclusion: We concluded that the Modified Marshall score is equally effective in evaluation of severity and predicting mortality in patients with acute pancreatitis as Ranson’s score. Moreover, its components are easily available and it does not require 48 hours for completion of assessment like the Ranson’s score and can be used for reassessment during period of hospitalization unlike the Ranson’s score which is calculated once only after admission at 48 hours.

DOI: 10.5281/zenodo.

Aim:  Comparative analysis of diagnostic tests and conjunctival impression cytology in individuals diagnosed with dry eye illness and a control group of healthy individuals. Material and Methods: This study was conducted in the Department of RIO, IGIMS, Patna, Bihar, India for one year. A total of 142 patients (74 cases and 68 controls) successfully completed the study. Informed consent was obtained from all patients prior to enrolment in this study. For cases, patients from 20 years up to the age of 60 years, either sex who fulfilled the inclusion/exclusion criteria, were included. For controls, patients from 20 years up to the age of 60 years who fulfilled the inclusion/exclusion criteria were included. All the subjects who were included as cases or controls were asked to respond to OSDI questionnaire. Based on their OSDI scores, patients were categorized as having a normal ocular surface (0-12 points) or as having mild (13-22 points), moderate (23-32 points), and severe (33-100 points) ocular surface disease. The participants attaining the score 0-12 were selected as controls while those with score 13-100 were taken as dry eye patients. The enrolled participants were subjected to detailed medical history and clinical examination as per Performa. Results: Conjunctival congestion was seen in 78.4% of cases and 58.8% of controls. Similarly, Normal conjunctiva was seen in 16.2% of cases and 38.2% of controls. The difference was significant (p< 0.05). For schirmer’s test, 8.8% eyes of cases and 6.6% eyes of controls had schirmer values of <5mm, similarly 12.8% of cases and 7.4% of controls had values between 5 and 10mm. The values of >15mm were observed in 70.3% of cases and 77.9% of controls. The difference was found not to be significant (p=0.379). For control group, the mean was 24.32± 10.088, for case group, the mean was 23.34±11.662.  For TBUT test, 18.9% eyes of cases and 13.2% eyes of controls had TBUT value of <5 sec, similarly 36.5% of cases and 24.3% of controls had values between 5 and 10 sec. Conclusion: TBUT and BME hold good diagnostic accuracy for dry eye evaluation in patients.

DOI: 10.5281/zenodo.

Aim: To study the severe bilateral lower limb ischemia in a patient with COVID-19 infection. 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 one year. This was a multi-centre, observational, and retrospective study. Records of all patients ≥18 years of age admitted with ALI and a confirmed diagnosis of COVID-19 infection were retrospectively examined. Data collected included demographics, co-morbidities, biological findings, COVID-19 pneumonia and ALI severity, anatomical location of arterial thromboembolism, treatments, and outcomes. Surgical techniques included thrombo-embolectomy, bypass, and amputations. Procedures were performed under general and loco-regional anaesthesia. Results:  The lower limbs were the most affected (95.4%). In our cohort, preoperative CT angiography was the golden standard, which was performed for 19 patients (86.4%). However, two patients underwent a Doppler ultrasound. The remaining patient was too unstable for transport to imaging, and the diagnosis was based on clinical signs of acute ischemia. Over two-thirds (63.6%) of patients had more than one segment thrombosis, and ischemia had occurred simultaneously in the upper and lower extremity in one case. The most involved vessels were the popliteal artery (59.1%), iliofemoral segment (31.8%), and tibial arteries (36.4%). Moreover, abdominal aortic floating thrombus was found in four cases (18.2%). The rate of limb salvage was 68.2%, and overall, in-hospital mortality was 27.3%. Additionally, deaths were related to acute respiratory distress syndrome in four cases and secondary to reperfusion injury in two patients. At one-month follow-up, re-intervention was required for four patients. Of those, three amputations of stump necrosis were treated by surgical debridement, and one operative site hematoma was evacuated. It’s noteworthy that in the same period, non-COVID-19 ALI was managed. Conclusion: COVID-19-positive patients are at increased risk of ALI and resultant mortality, given the hypercoagulable state. The lower extremities were the most involved territory. Revascularization techniques included open TE, adjunctive endovascular therapy, and in some cases, thrombolysis.

DOI: 10.5281/zenodo.

Background: Polycystic ovarian syndrome (PCOS) is an endocrine disorder that commonly affects adolescent girls. Awareness and accurate diagnosis are crucial initial steps in managing PCOS, as they can significantly enhance the patient’s quality of life. This study aimed to evaluate the level of knowledge about PCOS among medical students. Methods: A survey involving 200 female students in Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi, India was conducted to assess their knowledge of polycystic ovarian syndrome across various medical colleges. Participants were enrolled from the 1st, 2nd, and 3rd years of study, and data were collected using a structured questionnaire. Duration of study for one year. Results: In the study, 51% of the girls had a normal BMI, 19.5% were overweight, 16.5% were obese, and 13% were underweight. Symptoms reported included acne (33.5%), irregular menstrual cycles (16%), hirsutism (5%), and infertility (2%). Regarding awareness of PCOS, 33% of participants learned about it from teachers, 19% from friends, 11.5% from doctors, 3.5% from newspapers, and 5% from the internet. Alarmingly, 28% of adolescent girls were unaware of PCOS. Conclusions: The findings suggest a need for comprehensive education about PCOS in medical curricula, which could enhance awareness and promote lifestyle modifications among adolescents. Early and accurate diagnosis during youth is critical in managing this disorder effectively.

DOI: 10.5281/zenodo.

Aim: To report the prevalence of refractive error among the school students of Bihar region, India. Material & Method: A cross-sectional study was conducted among the school children of Bihar over a period of 2 years. The screening was carried out in 5 schools which included primary and higher secondary schools. A total of 1002 children were screened for refractive errors. Results: A total of 1002 school children were screened from 5 different schools of Bihar. Refractive error was highly prevalent in the age group of 14–17 years (n = 63). Regarding gender, out of 320 males, 11.25% (n=36) had refractive errors whereas 12.9% (n=88) out of 682 females. From a total of 1002 students studying in different schools, the prevalence of refractive errors was 12.4% (n = 124) among which myopia was the most common with 47.58% (n = 59), followed by 29.8% (n = 37) with astigmatism, and the remaining 22.5% of hypermetropia (n = 28). Conclusion: The study gives relevant and baseline information on refractive error in Bihar school children. To acquire a fuller picture of refractive error and other eye-related disorders, broader research should be done in all of the state’s schools to uncover vision problems as early as feasible.

DOI: 10.5281/zenodo.

Aim: Analysis of injury patterns resulting from road traffic accidents at a tertiary care teaching hospital. Materials and Methods: The present study was conducted was conducted in department of FMT, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India for one year. The study included all the patients admitted to the Advanced Trauma Centre. Unknown patient, Patient unwilling to give consent for study, Abscond and LAMA were excluded from the study. 410 participants were included in this study. Injury patterns included mode of injury, type of injury, type of road accidents and location of injury. Results: In the majority of the patients, the type of injury seen was 35.9% (147) cases of head, neck and back injuries, followed by 24.4% cases with multiple injuries, 11.0% had hand/wrist injuries were seen, 9.3% cases of knee/lower legs, 8.6% cases have hip/thigh injuries, 6.4% cases had foot/ankle injuries, and 4.4% cases had shoulder/elbow injuries. It was seen that in maximum cases, the location of the accident site was road/street 63.2% (259), followed by workplace 20% (82), then home 13.9% (57), sports grounds 2% (8), school/colleges 0.5% (2) and others 0.5% (2). In the injury pattern, RTA was more in males, followed by fall from height. Similarly, in females, the most common is RTA, followed by falls from height. Furthermore, it was seen that motorbike/scooter collision with a vehicle; that is, two-wheeler is the most common cause of accident, followed by a fall from the vehicle but in the female gender, it was a fall from the vehicle was the most common cause, followed by motorbike/scooter collision with the vehicle. Also, the most common type of injury seen in both males and females was head, neck and back injury, followed by multiple injuries. Conclusion: Trauma affects the nation’s productive age group and is a major preventable cause of mortality and morbidity. However, if the right policies are implemented at the individual and governmental levels, a significant part of trauma can be avoided.

DOI: 10.5281/zenodo.

Aim: A comprehensive analysis of thyroid enlargement and its treatment via a clinicopathological investigation. Material and Methods: This is a retrospective hospital-based study was conducted in the Department of Pathology, BMIMS Pawapuri, Nalanda, Bihar, India for 6 months. 100 Patients with thyroid swelling, who are fit to undergo thyroid surgery, and willing to give consent to participate in the study. After clinical assessment, thyroid status was determined by estimation of T3, T4, TSH. FNAC, USG NECK was done. Complete haematological investigations were done. 100 patients of thyroid swelling were evaluated and the main outcome measures were the clinicopathology and sonological correlates. Results: All cases presented with swelling in front of neck (100%). Associated complaints were 05 (05%) subjects of bulky thyroid swelling complained of difficulty in swallowing, 03 (03%) subjects complained pain in neck, 01 (01%) subject presented with cervical lymphadenopathy and 01 (01%) subject with hoarseness of voice. Most of the thyroid swellings were firm in consistency 45 (45%) followed by nodular 20 (20%), cystic consistency in 12 (12%) cases and soft consistency in 09 (09%) cases. Hard swellings accounted for 14 (14%) cases, most of which turned out to be malignant. On USG, Colloid nodule was found in 31 (31%) cases, followed by Multinodular goitre which was 27 (27%) cases, neoplastic etiology found in 23 (23%) cases, solitary thyroid nodule found in 12 (12%) cases and colloid cyst in 07 (7%) cases. FNAC findings were colloid goitre (61%), nodular goitre (19%), follicular neoplasm (10%), papillary carcinoma (9%) and medullary carcinoma (01%). Conclusion: The present study was undertaken to evaluate the usefulness of clinical examination, histo-cytology, and USG of thyroid in the management of thyroid swelling. Females have greater preponderance for thyroid disease. USG can diagnose multi nodularity and intra thyroid lesion in better way than any other radiological modality. FNAC is simple, safe and cost-effective modality in pre- operative investigation of thyroid swellings with good sensitivity, high specificity and diagnostic accuracy to differentiate between benign and malignant lesion. Malignant cases diagnosed on FNAC underwent total thyroidectomy at primary surgery, thereby obviating the need of revision surgery.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to establish the cut off titers and to determine the significant titers for the Widal agglutination test for the diagnosis of enteric fever by a single serum test in RIMS, Ranchi. 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 titer value. Highest frequency (7.69% ) of samples with overall positive end titer values for Salmonella Para typhi AH agglutinin belongs to age group 18-20 years, followed by age group 41-50 years (7.1%), then 31-40 years (6.9%) and lastly of 21-30 years (5.88%) respectively. Overall positive end titer values for Salmonella Para typhi BH shown by 7.67% samples only. Conclusion: Overall, the level of H agglutinins was found to be more helpful than the level of O agglutinins. When the O-agglutinin titer is ≥400 or the H-agglutinin titer is ≥200, typhoid can be diagnosed with reasonable confidence.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the prevalence of obesity and overweight and to find out predictors for obesity. Methods: This cross-sectional study was carried out among adult individuals (aged 18-55 years) in the Department of Community Medicine, SKMCH, Muzaffarpur, Bihar, India  for period of 6 months. All the individuals were residents of the rural and urban areas. Results: Most of the participants were males 200 (66.66%) and 100 (33.34%) were female. Out of total study subject 264 (88%) were resident of urban area and 36 (12%) from rural area. Maximum number of participants was non worker 125 (41.66%). Socioeconomic status assesses most of them from upper class category 170 (56.66%). The age specific prevalence of obesity 55 (18.33%) in 36-55 years and 46 (15.33%) in 18-35 years, however the prevalence of and overweight was 35 (11.66%) in 18-35 years and 20 (6.66%) in 36-55 years. it was found to be statistically significant. Prevalence of obesity and overweight among males was 76 (25.33%) and 47 (15.66%) and among females 28 (9.33%) and 14 (3.33%) respectively. it was found to be statistically significant. The mean weight and height were highly significant among both the sexes. (p<0.001) slightly greater mean of BMI was found among males (23.7±3.14 kg/m2) as compare to females (22.8±3.67 kg/m2). The overall prevalence obesity (≥25 kg/m2) was 105 (35%) and overweight (≥23 kg/m2) 58 (16.66%). The prevalence of obesity was observed higher among males 75 (25%) and 30 (10%) female. However, the prevalence of overweight was also higher among the males 40 (13.33%) than female 10 (3.33%). Conclusion: Suitable health care strategy and intervention programs along with health education are needed to reduce the impact.  These results suggested that overweight and obesity may be serious public health problems. It is important to carry out further studies in order to explore the potential relationship between overweight and obesity on the one hand, and behavioral variables, such as smoking and alcohol consumption, on the other.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the marketed product TriNyros (combination of Rosehip, Irido Force TM, Aflapin) (Nutragenix Healthcare Pvt. Ltd.) as an additive treatment in OA patients and its effect in patients with & without comorbidity. Methods: A phase IV post marketing surveillance study of Cap. TriNyros (Nutragenix Healthcare Pvt. Ltd.) was conducted at Department of Orthopedics, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India for six months  During the study total 160 patients were selected based on inclusion and exclusion criteria in which comprises 60 (37.5%) males and 100 (62.5%) females. The mean age of the subject was 58.60 years, and 70% patients belong to the age group above 50 years. Out of 160 patients, 75% patients had comorbidities such as hypertension, anxiety, diabetes mellitus, thyroid disorders etc. All the subjects selected during the study received TriNyros capsule two times daily for three months. Results: During analysis of clinical symptoms parameters such as joint line tendinitis on palpations, limitation of mobility, joint crepitus, swelling and redness were included in the study. The treatment with TriNyros for 3 months leads to 60.64% reduction in pain on palpations of OA patient. Movement of a joint affected by OA may cause a crackling or grating sensation called “crepitus”. The reduction rate for joint crepitus is similar in OA patient with comorbidity (72.65%) & without comorbidity (66.70%). Conclusion: OA as it has an important effect on the treatment. Finally, only one fixed dose of TriNyros was used during the study to evaluate its efficacy; hence we could not validate effect of different doses on safety and efficacy in OA patient. The findings of the current phase IV post marketing surveillance suggest that TriNyros (Nutragenix Healthcare Pvt. Ltd) act synergistically to exert anti‐inflammatory/anti‐arthritic activity. Cap TriNyros efficaciously reduces joint pain and improves the physical functional ability of OA patient.

DOI: 10.5281/zenodo.

Aim:  The aim of the present study was to investigate the impact of oral anticholinergics on insulin secretion in subjects with impaired glucose tolerance (IGT), in comparison with volunteers having normal glucose tolerance (NGT). Material & Methods: This retrospective study was conducted in the Department of Pharmacology, ANMMCH, Gaya, Bihar, India from November 2019 to October 2020, and recruited 30 IGT and 30 NGT subjects. An oral glucose tolerance test (OGTT) was conducted twice in the absence and presence of hyoscine butyl-bromide (HBB). The plasma glucose (PG) and insulin levels were serially estimated at 30-min increments for 2 h after the OGTT. Early (ΔI30/ΔPG30) & late (insulin/PGAUC 60-120) phase insulin activity were assessed subsequently. Results: In the present study, 60 subjects including 30 IGT (13 male/17 female, BMI: 26.4±2.4) and 30 NGT (15 male/15 female, BMI: 24±0.6) met the study requirements and completed the experimental protocol. In both the groups, a higher proportion belonged to the “overweight” category. The effect of HBB in the IGT group was examined in terms of pharmacodynamic parameters obtained during a 75 g OGTT (0–120 min). The presence of HBB did not have an impact on their fasting PG and PG Cmax values. In the IGT group, the presence of HBB had no effect on fasting insulin levels and insulin Cmax at t = 60 min. The addition of HBB also did not impact on the insulin total AUC 0–120 min. The presence of HBB had no effect on fasting insulin levels (6.50 ± 1.32 vs. 5.70 ± 0.87 mIU/L) and insulin Cmax at t = 60 min. However, the addition of HBB significantly decreased the insulin total AUC 0-120 min. In the NGT group, similar to the IGT group, the presence of HBB did not impact on the plasma glucose-based parameters, for example, fasting PG. Conclusion: Our study findings indicate that insulin secretion is influenced by cholinergic system and that oral anticholinergics may attenuate the late phase insulin activity in varying degrees of glycemic status.

DOI: 10.5281/zenodo.

Aim: A comparative analysis of the effects of fentanyl, morphine, and nalbuphine in reducing the stress response and serum cortisol levels during endotracheal intubation. Material and Methods: This study employed a randomized, controlled, double-blind design and was conducted in  Department of Anesthesiology, NMCH, Patna, Bihar, India  for one year. A total of 100 adult patients scheduled for elective surgery requiring endotracheal intubation were included in the study. The inclusion criteria were adults aged 18-65 years, ASA physical status I or II, patients scheduled for elective surgery under general anaesthesia, and those who provided informed consent. Participants were randomly assigned to one of three groups: fentanyl (Group F), morphine (Group M), or nalbuphine (Group N). Randomization was achieved using a computer-generated randomization schedule. Both patients and clinicians were blinded to the group assignments. Group F received 2 μg/kg fentanyl IV, Group M received 0.1 mg/kg morphine IV, and Group N received 0.2 mg/kg nalbuphine IV. All medications were administered 5 minutes before induction of anaesthesia. Results: The hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), at various time points. At baseline, the mean HR and MAP were similar across the groups, with no significant differences (HR: p = 0.91, MAP: p = 0.85). Pre-intubation, post-intubation, and 5 minutes post-intubation measurements also showed no significant differences among the groups (pre-intubation HR: p = 0.78, post-intubation HR: p = 0.67, 5 min post-intubation HR: p = 0.73; pre-intubation MAP: p = 0.77, post-intubation MAP: p = 0.62, 5 min post-intubation MAP: p = 0.80). These findings indicate that fentanyl, morphine, and nalbuphine had similar effects on hemodynamic stability during the intubation process. The change in heart rate from baseline to post-intubation was slightly higher in the morphine group (17.1 ± 3.1) compared to the fentanyl (14.4 ± 2.7) and nalbuphine (14.1 ± 2.5) groups, but this difference was not statistically significant (p = 0.55). The change in MAP from baseline to post-intubation was also higher in the morphine group (14.6 ± 2.8) compared to fentanyl (10.4 ± 2.2) and nalbuphine (8.9 ± 2.0), but again, this difference did not reach statistical significance (p = 0.60). The change in cortisol levels from baseline to 30 minutes post-intubation was slightly higher in the morphine group (4.7 ± 1.1) compared to fentanyl (3.4 ± 0.8) and nalbuphine (3.3 ± 0.7), but this was not statistically significant (p = 0.72). Conclusion: In conclusion, fentanyl, morphine, and nalbuphine are all effective in attenuating the hemodynamic and endocrine stress responses during endotracheal intubation. There were no significant differences among the three drugs in terms of their impact on heart rate, mean arterial pressure, or serum cortisol levels.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical profile of patients with acute kidney injury following acute gastroenteritis. Methods: The Present study was conducted in the Department of Medicine, Government medical College and Hospital, Madhepura, Bihar, India  from August 2021 to July 2022. After applying inclusion and exclusion criteria, total 100 patients of AGE with AKI were considered for this study. Results: Most common age group in this study was age group of 61–70 years (30%), followed by age group of 51–60 years (23%). Mean age of study patients was 54.6 ± 12.8 years. Male patients (65%) were more than female patients (35%). According to clinical presentation most common symptom was loose stools (100%), followed by fever (78%) and vomiting (70%). Other complaints were shortness of breath (20%) and altered sensorium (16%). AKI was staged for severity according to the KDIGO criteria. At the time of diagnosis most patients were in stage 1 (58%), while 31% and 11% were in stage 2 and 3 respectively. Conclusion: Acute kidney injury in patients with acute gastroenteritis had good prognosis if detected earlier. Early recognition of AKI is essential to ensure prompt and appropriate management, and to avoid progression to deadlier stages of the disease.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical evaluation of perfusion index (PI) as a predictor of post spinal hypotension in lower segment caesarean section (LSCS). Methods: The present study was conducted in the Department of Obstetrics and Gynecology, JLNMCH, Bhagalpur, Bihar, India for one year. Informed & written consent was obtained from every parturient who came for caesarean section. A total of 50 subjects were analyzed. Results: Out of 7 parturient had high standard PI (PI>3.5), 6 parturient foster hypotension, though out of 43 parturient had low pattern PI (PI≤3.5), 10 parturient foster hypotension. The parturient with high & low standard PI, systolic pulse diminished altogether after spinal infusion. However, more prominent reduction in systolic pulse at 5-10 min & 25 min in parturient having high benchmark PI had after spinal infusion than parturient having low standard PI. Conclusion: Perfusion Index (PI) can be used to predict post spinal hypotension in healthy parturient undergoing lower segment caesarean section. Parturient higher risk of developing post spinal hypotension with baseline PI more than 3.5 compared to those with baseline PI less than 3.5.

DOI: 10.5281/zenodo.

Aim: To study the patient attendance pattern in the psychiatric outpatient department (OPD) of a tertiary healthcare center. Material and Methods: This retrospective study was carried out in the Department of Psychiatry, PMCH, Patna, Bihar, India for one year. A total of 50 patients attending the psychiatric care facility of the institute were included in the study after getting informed consent. Anxiety was evaluated with GAD-7 scale which is a short 7 item scale. Each item is scored on a four-point Likert scale (0–3) with total scores ranging from 0 to 21 with higher scores reflecting greater degree of anxiety. Results: The mean age of the patients was 35.85 years. More than half of the patients included in the study were male (60%). Of the total number of patients, 56% were employed, 72% belonged to nuclear families, 64% belonged to a lower middle socio- economic status and 58% were educated beyond secondary school. A total of 50 number of patients attended the psychiatric care facility of our institute. 28(56%) of these patients had come with a first episode of psychiatric illness whereas 23(46%) patients had previous episodes of psychiatric disease. Among the new patients approximately half of patients presented with anxiety symptoms 23(46%) whereas anxiety with predominant insomnia was seen in 5(10%) patients. 2(4%) patients presented acute transient psychosis (ATP). 1(2%) patient was diagnosed as depression and 3(6%) patients presented with dissociation. Conclusion: We concluded that the patients with both previous psychiatric illness or without any psychiatric are equally vulnerable for psychological reactions.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the common complications of the neonates. Methods: A facility-based in retrospective study was conducted among neonates born at JLNMCH, Bhagalpur, Bihar, India for 10 months, and some mother delivered at other hospital and came for the treatment as out-patient or in-patient to the JLNMCH, Bhagalpur, Bihar, India. In-patients and Out-patients born/attended the Hospital during the study period were about 294 neonates. The researcher included all the Neonates born/attended at the hospital (Normal delivery or by Caesarean) in this study. Results: Male ratio was higher than the female ratio in the present study.. Regarding Neonates age, the highest percentage (male-41.83% and female-37.41%) was observed during the stay in the hospital is in 1-5 days group (average mean value was 39.62). In other age groups, the percentages were very low. In the study area, most of the ladies (90.10%) were delivered their babies in term (47.61% males and 43.19% females). But less percentage of ladies delivered with preterm babies (4.42% males and 4.76% of females). Highest percentage (72.10%) of neonates (33.67% of male and 38.43% of females) has the birth weight of 3-4kgs and followed by 1-2 kgs. Very few neonates were born with 5-6kgs at birth weight. Average birth weights of the neonates are 3.2kgs. Conclusion: Neonatal jaundice (51.01%), sepsis17.00%), low birth weight, preterm birth, TTN, RDS and MAS were the most common morbidities. 89.77% of the babies were undergone phototherapy and 79.91% of babies treated with First line antibiotics. The overall mortality rate was 8.33% with more death during mechanical ventilation usage. Strengthening perinatal care, emergency obstetric care services and neonatal resuscitation skills are necessary to reduce the neonatal complications and mortality.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess MRI CSF flowmetry in evaluation of different neurological diseases. 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 transependymal edema was present in 90 %, Sulcus effacement was present in 90 %, Corpus collasal thinning   was in 83.3 %, Corpus collasal angle was between 50 -80 degree in 83.3 % and Flow Void at cerebral aqueduct was present in 62.2%. PDV, PSV, and SV were found significantly higher in cases group. Conclusion: MRI CSF flowmetry provides an easy, accurate, and non-invasive method for diagnosis of different neurological diseases that cause CSF flow abnormality. Moreover, this diagnostic modality could be helpful in selecting the therapeutic option.

DOI: 10.5281/zenodo.

Aim: To establish a correlation between anti-müllerian hormones in patients diagnosed with polycystic ovarian syndrome in a tertiary care hospital. Material and methods: This study was done in the Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for 12 months. This study included 50 PCOS patients and 50 healthy women of fertile age as controls who are attending the outpatient Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. Rotterdam criteria were used to select these patients using a convenient sampling technique. The PCOS was diagnosed when ≥2 through the following three criteria: oligomenorrhea or amenorrhea, clinical hyperandrogenism or hyperandrogenemia, and polycystic ovaries on ultrasonography. Results: Baseline characteristics of subjects revealed statistically higher BMI (26.7 ± 4.5 vs. 21.7 ± 2.8, kg/m2; p <0.001) in PCOS than that of control. Menstrual irregularity (86.3% vs. 1.3%; p<0.001) and infertility rate (p<0.001) were also significantly higher in the PCOS. AMH level was significantly higher (9.21 ± 0.50 vs. 4.40 ± 0.41, ng/ml; p<0.001) in the PCOS patients than that of controls. However, when compared according to age-group, this was significantly different between PCOS and controls in the age group 23-27 years (9.91 ± 0.71 vs. 4.52 ± 0.54, ng/ml; p<0.001) and age-group 28-31 years (8.28 ± 1.51 vs. 4.22 ± 0.68, ng/ml; p<0.011). The subgroups of PCOS and control subjects divided on the basis of a cut-off value of AMH at 3.5ng/ml. AMH ≥ 3.5ng/ml was considered as positive in the diagnosis of PCOS. Conclusion: It may be concluded that PCOS has significantly higher serum AMH than healthy women during the reproductive period. Age-related decline of AMH occurs in healthy women as well as in PCOS women.

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 in the Department of Pathology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India during for the period of one year and total 500 patients were screened. The patients were in the age range of 19-69 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 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: To compare the efficacy of Oxaceprol with tramadol in treating knee osteoarthritis Materials and Methods: The study was conducted at Department of Orthopaedics,IGESI Hospital, Delhi India for one year. Only patients providing written informed consent were recruited. Ninety-one ambulatory patients over 50 years of age, with knee joint pain intensity of at least 35 mm on a 100 mm visual analogue scale (VAS) present for at least preceding 3 months and with confirmed degenerative changes in knee skiagram. If joint involvement was bilateral, the worse off knee was considered. Results: Although 38 (88.37%) patients from oxaceprol group and 23 (63.89%) from tramadol group rated CGI as improved too much improved in the 5-point Likert scale at the final visit, the difference was not statistically significant (P = 0.080). The 50% responder rate at final visit was modest at 16 subjects (37.21%) in oxaceprol and 8 (22.22%) in tramadol (P = 0.219) arms. Dose up-titration was required for 6 subjects (13.95%) on oxaceprol and 7 (19.44%) on tramadol, this difference again being statistically nonsignificant (P = 0.555). Rescue medication requirement over the whole study period in the study arms. The difference is not significant statistically (P = 0.175). Adverse events were reported for 18 patients out of the 91 initially recruited – 10 subjects had multiple complaints. However, there were no significant changes in weight, pulse rate, blood pressure and laboratory safety parameters. Treatment-emergent events encountered numbered 6 in the oxaceprol arm (commonest dizziness in 2 instances) and 22 in the tramadol arm (the most common nausea and dizziness in 6 instances each). Conclusion: Despite the limitations, we can conclude that the efficacy and tolerability of oxaceprol were comparable to that of tramadol and the drug can be considered as an alternative to low-potency opioids in the management of knee osteoarthritis. Further studies are required to explore clinical utility in osteoarthritis at other locations and potential chondroprotective action.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to correlate the clinical diagnosis with histopathologic findings. Methods: This study was conducted in the Department of Skin & V. D, Nalanda Medical College & Hospital, Patna, Bihar, India from November 2020 to October  2021. 50 patients were included in the study. Results: Of the 50 patients, 14 were males (28%) and females were 36 (72%), with an age range between 7 to 69 years and a mean (SD) of 35.5 years±16.8. Skin biopsies were taken from the lower extremities (40%), upper limbs (26%), trunk (18%) and head (6%) and other sites (10%). Most patients had a single clinical diagnosis which matched the histopathologic diagnosis. Conclusion: Dermatologists often exceedingly rely on histopathological examination of the skin for diagnostic purposes. As discussed in our study, providing a comprehensive clinical description increases the diagnostic accuracy rate. Repeat biopsy may be useful in certain cases to arrive at an accurate and definite diagnosis.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was aimed to determine the sufficient level of vitamin D [25 hydroxyvitamin D, 25(OH)D] in relation to intact parathormone (iPTH) in apparently healthy adult volunteers. Methods: This observational cross-sectional study was conducted in the Department of Medicine, JLNMCH, Bhagalpur, Bihar, India for the period of one year. Informed written consent was taken from the participants. After exclusion, a total of 100 apparently healthy adults were enrolled in the study. Results: Most individuals were 30-39 years old and male. 75% were urban and 30% had elementary schooling. 48% were middle-class and 68% non-smokers. 33% were obese, 85% normotensive. The vitamin D levels (ng/ml) of patients with insufficient sunshine exposure duration, body surface area, and sunscreen usage were considerably lower than those without sunscreen use. Under all three criteria, persons with enough sunshine exposure had substantially greater vitamin D (ng/ml). The quantity of milk, eggs, and big fish consumed did not affect vitamin D levels. Conclusion: At least 30 ng/ml of serum 25(OH)D is ideal for healthy persons. Large-scale studies including individuals from diverse parts of our nation and monitoring blood vitamin D year-round may provide higher levels. We can better determine the appropriate vitamin D level for the general population by measuring BMD, biochemical markers (osteocalcin, N-telopeptides, etc.), and calcium absorption simultaneously.

DOI: 10.5281/zenodo.

Aim: To determine the clinical and etiological characteristics of infants presenting with jaundice at a tertiary care hospital. Material and Methods: This retrospective study was conducted in the Department of Pediatrics, MGM Medical College, Jamshedpur, Jharkhand, India for one year. A total of 400 cases were enrolled for the study. Neonates with jaundice admitted in NICU or neonatology ward during study period, with serum bilirubin more than 10 mg/dL were included. Neonates with jaundice not admitted in NICU, attending outpatient department only, neonates with jaundice opted discharge against medical advice and parents not willing to participate in this study were excluded. Results: During study period, 400 newborns were considered for present study, as they were satisfying inclusion and exclusion criteria. Out of 400 jaundiced neonates, 236 (59%) were males and 164 (41%) were females. Among 400 newborns studied, 342 (85.5%) were born at term gestation and the remaining 58 (14.5%) were preterm babies as shown in Table 1. Table 2 shows that out of 400 newborns included in this study, majority of the babies had birth weight ≥2500 gm (80%). Only 40 babies had birth weight <2500 gm (20%). Table 3 shows that physiological jaundice constituted the major (40.5%) etiological factor in neonatal jaundice. This was followed by ABO incompatibility which constituted 20%. of these 50% were due to OA incompatibility and 50% were due to OB incompatibility. Other common causes were Rh incompatibility (16.5%), sepsis (8%), idiopathic (5%) and prematurity (4%). Neonatal jaundice was attributed to cephalhematoma in 16 (4%) cases. Breastfeeding jaundice was found in 8 (2%) cases. Conclusion: We concluded that the less common causes are cephalhematoma, breast feeding jaundice and hemolytic anemia. Understanding the etiological and risk factors for neonatal jaundice in our setting helps in prioritizing the group of neonates who require more intensive monitoring for early identification and timely management of this condition.

DOI: 10.5281/zenodo.

Background: The clinical diagnosis of children exhibiting evidence of inflammatory lesions in the brain and acute onset of symptoms is acute encephalitis. For the purpose of saving lives and maintaining brain functions, a rapid diagnosis is required. The author’s goals were to uncover etiological factors and ascertain the profile and prognosis of children hospitalised with acute encephalitis syndrome (AES). Methods: Study consist of a retrospective analysis of hospital records of children up to 12 years of age admitted with a diagnosis of AES in the pediatric ward, Patna medical college, Patna from October 2020 to September 2022. Results: In a total of 148 patients of AES, clinical features like fever (100%), altered sensorium (100%), convulsion (78.4%), headache (36.5%) and neuro deficit (40%) and vomiting (50%). The average Glasgow coma scale at admission was 8. There are 40.5% of cases in the 5 to15 yr age group (p>0.05). Both Encephalitis (58.1%) and meningitis (41.9%) were documented significantly more in males as compared to females (p<0.01). 68 cases were discharged, 58 cases expired, and 22 cases were referred or left against medical device (p<0.001). JE IgM positive cases contributed to 28.0%, of which 24 males and 18 were females recorded. Male children are more likely to play outdoors where the mosquito vector of the disease is abundant. Conclusions: Significant morbidity and mortality are associated with JE, which can be avoided by vaccination and decreased with prompt supportive management. Children aged one to five who play outside, attend school, or work in agricultural areas should take precautions to avoid being bitten by mosquitoes.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the association of body mass index (BMI) measurements in adult hypertensive patients with normal weight and overweight including obesity. Methods: The study was carried out at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. The study included 100 patients aged 32- 90 years of hypertension after taking well informed written consent. Results: The mean values for weight, height and BMI according to sex were comparable in the study. In men and women, the dominant class of BMI category was overweight. We found that hypertensive patients who have a normal weight or were underweight have normal/low blood pressure. Blood pressure was significantly higher in patients who are overweight or obese. Conclusion: The present study concluded the significant relations between body weight and blood pressure. The relationship between body weight and hypertension in our study were nor influenced by gender. This proves the importance of losing weight for hypertension subjects in order to improve the blood pressure control and reducing its complications. A modest weight 1oss, especially when maintain over time, significantly reduces the risk of complication associated with hypertension in overweight adults.

DOI: 10.5281/zenodo.

Aim: The present study was conducted to study the presence of bacteremia, markers of sepsis and Inflammation, along with correlation of hematological abnormalities with sepsis in renal failure patients on hemodialysis. Material & Methods: The Department of General Medicine, Rajeshwar Hospital, Patna, Bihar, India, enrolled 100 patients of both sexes who were diagnosed with renal failure, including acute kidney injury (AKI) and CKD, based on clinical history, examination, biochemical markers, and hemodialysis advice. Results: Among the 100 patients with renal failure undergoing hemodialysis in our research, the average age was 48.52±14.26 years, and 74 of them were male. Among the 100 patients, 28% tested positive for both blood and catheter tip culture, whereas 72% tested negative for both. Out of 200 sepsis patients 36 (18%) were 15–25 years old, 36 (18%) were 26–35 years old, 32 (16%) were 36–45 years old, and 96 (48%) were above 45. Out of 100 sepsis patients 19 (19%) were 15–25 years old, 36 (17%) were 26–35, 15 (15%) were 36–45, and 49 (49%) were above 45. All 100 patients exhibited fever with chills and rigidity, 46 had redness and discomfort at the hemodialysis catheter site, 31 were confused, disoriented, or unconscious, and 19 had hypotension. None of 100 renal failure with sepsis patients had TLC less than 4.8/cumm (leucopenia), 18 (18%) had 4.8–10.8/cumm, and 82 (82%) had more than 10.8/cumm. 32 patients (80%) had positive blood cultures for S. aureus, 4 (10%) for E. coli, 2 (5%) for Acinetobacter, and 2 (5%) for Candida. For 50 renal failure hemodialysis patients with sepsis, 12 (24%) had internal jugular hemodialysis lines, 4 (8%) subclavian lines, and 34 (68%) femoral lines. Conclusion: Patients in need of hemodialysis, who possess non-modifiable risk variables such as age, sex, and other risk factors for infection, should be managed in order to decrease the occurrence of infection.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the effect of Butorphanol and Fentanyl as a premedication on haemodynamic changes during laproscopic cholecystectomy surgeries and postoperative analgesia. Methods: This prospective randomised double-blind study was conducted in the Department of Anesthesiology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India and written informed consent from the patients. For this study 100 adult patients undergoing, laproscopic cholecystectomy surgeries of age group 20-60 years of either sex, ASA I and II were selected. They were divided randomly into two groups, Group B received inj. Butorphanol 40 mcg/kg IV and Group F received inj. Fentanyl 2 mcg/kg IV. Results: There were no differences in age, sex, weight, ASA grading and duration of surgery in both groups. The preoperative values of pulse, systolic blood pressure and diastolic pressure in both the groups were comparable. There was no significant changes in pulse rate were seen till 9 min after intubation, however significant difference in pulse rate was started at 12 min after intubation and persisted till 2nd hour of postoperative period. No statistical difference was found between both the groups at 3rd and 4th hour of postoperative period. Conclusion: We concluded that butorphanol is better alternative to fentanyl as a premedication for use in laproscopic surgeries because of its ability to produce haemodynamic stability and prolong analgesia.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the association of homocystine level and lipid profiles with ischemic heart disease. Methods: This prospective case control study was conducted over a period of 2 years in a tertiary care hospital. Patients of Ischemic Heart Disease (IHD) admitted in Department of Medicine were included. The data for the study was collected from the inpatients and outpatients of the hospital, who fulfilled the inclusion and exclusion criteria. Normal healthy population was selected from people who came for routine health checkup and staff members of the hospital. Results: There was a significant difference between homocysteine levels of cases and controls. Thus we found that higher homocysteine levels were significantly associated with IHD in our study. By using chi-square test p-value >0.05, there was no significant difference between cholesterol levels among the cases and controls. Thus we did not find a strong association between hypercholesterolemia and IHD. There was no significant difference between triglyceride levels among the cases and controls. There was no significant difference between HDL levels among the cases and controls. Conclusion: Based on the outcome of the present study we conclude that Hyperhomocysteinemia status is independently associated with hypertriglyceridemia, high total cholesterol level, high LDL level and low HDL levels in the blood.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the feasibility, stone‑free rate, and complications of RIRS in children <5 years of age. Methods: All children less <5 years of age with a stone size <2 cm (renal/proximal ureteric), who underwent RIRS at Department of Urology, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India for the period of one year were included in this retrospective study. A total of 100 children with 64 renal units met the inclusion criteria. From our hospital database, demographic data, complete history, clinical examination findings, laboratory reports of complete hemogram, serum biochemistry, urine analysis, and urine culture were retrieved. Results: A total of 100 pediatric patients were evaluated, out of whom, 8 had bilateral renal stones (108 renal units). Out of these 100 renal units, 8 patients had multiple stones in the same renal unit. The youngest child was a 4‑month‑old boy who presented with anuria due to bilateral upper ureteric stones. The most common location of the stone was the pelvis and the lower pole. Stones were most commonly of the mixed composition (46%), followed by calcium oxalate dihydrate (22%). UAS 9.5/11.5 Fr could be successfully inserted only in 60 out of 100 renal units (60%) even after prior stenting. Conclusion: Pediatric RIRS is a promising option in young children as it offers an acceptable stone free rates and a low incidence of high grade complications. However, it requires expertise and should be offered at tertiary care centers.

DOI: 10.5281/zenodo.

Aim: This research paper aims to evaluate the clinical profiles of perirenal and renal infections through a case study. Methods: A prospective observational study that was carried out at Department of Surgery, RDJM Medical College and Hospital, Turki, Muzaffarpur, Bihar, India  for one  year. which provides specialized medical treatment. Routine laboratory and radiological investigations were conducted on a total of 60 patients. If indicated, the patient underwent appropriate open surgical or laparoscopic surgery and was monitored for immediate and late postoperative complications. Results: The most common clinical symptom was seen costovertebral pain, reported in 33.3% of cases. The final diagnosis revealed that 6.7 percent had Emphysematous pyelonephritis, 36.7 percent had perirenal abscess, 6.7 percent had renal tuberculosis, 3.3% had Xanthomata’s pyelonephritis, and 46.7% of the cases had renal abscess. The largest proportion of patients (26.7 percent) had treatment with percutaneous pigtail, followed by open surgical drainage (18.3%), DJ stenting (16.7%), PCNL (15%), percutaneous nephrostomy (10%), and partial (6.7%). The procedures performed were nephrectomy, cystourethroscopy with a 5% incidence rate, and cystourethroscopy with DJ stenting with a 1.7% incidence rate. Conclusion: Renal and perirenal infections are quite prevalent in contemporary times. The most prevalent predisposing factors identified were diabetes and calculi. Therefore, this finding assists the physicians in determining the appropriate course of action and reducing the occurrence of additional issues.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate effectiveness of various management strategies in the management of liver abscess. Material & methods: It was a Retrospective study carried out in 100 patients of age 12-80 years for the period of 8 months who presented to general surgery department and diagnosed with liver abscess at Lord Buddha Koshi medical College and Hospital, Saharsa, Bihar, India. Results: Highest incidence was noted in age group of 51-60 years (30%) with a mean age of 46.84 years. Out of total 100 cases, 84 patients were male and 16 patients were female. Out of 100 patients 78 patients had liver abscess cavity of size 51-500cc (78%) followed by 12 patients who had <50 cc size cavity. Out of 100 cases 60 patients were treated with percutaneous needle aspiration with 16G metallic needle, 20 patients were treated with Percutaneous pigtail catheterisation, 10 patients were treated conservatively whereas 20 patients required surgical drainage. In the present study we can observe that 30 of 50 cases had volume aspirated between the range of 51-150 cc which correlates to high no of patients with residual liver abscess less than 150 cc. 26 of 50 cases (52%) were treated with a single aspiration along with antibiotics. 19 of 50 cases (38%) required second aspiration attempt. 3 of 50 cases required three attempts of aspiration and only 2 cases required fourth attempt of aspiration. 96% patients treated successfully. Conclusion: The present study concluded that conservative treatment with only intravenous antibiotics can be done for liver abscess with size less than or equal to 5 cm and volume less than 50 CC. Percutaneous needle aspiration is the best treatment modality for liver abscess measuring 5 10 cm, Percutaneous pigtail catheter drainage is a choice of treatment for large cavity size more than 10 cm and abscess having thick unliquified pus.

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 research was an observational study undertaken at the Department of Obstetrics and Gynaecology,  over a period of 12 months. A total of 200 patients were chosen for the research from the prenatal ward and labour room. They were separated into two groups: the Control group, consisting of patients with a gestational age between 37-40 weeks, and the research group, consisting of patients with a gestational age more than 40 weeks. Results: The majority of patients were in the age group of 25-30. In both instances, research group (50%) and control group (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 research participants and 55% of control participants were primigravida. The LSCS rate was 30% in research group greater than 15% in the control group. In the research group, most prevalent LSCS indication was acute fetal distress due to meconium-stained liquid (10%) and 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 evaluate the reasons and the risk factors for postoperative ICU admissions. Methods: This retrospective study was conducted at SSH Hospital IMS BHU for the period of 12 months. A total of 200 patients were included in our study and 100 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: A total of 200 patients were included in our study. Among them, 100 were cases vs. 100 as controls. Among cases, 91 (91%) patients had GA followed by 4 regional blocks/neuraxial blocks and 2 sedations only. Among controls, 86 (86%) patients had GA followed by 9 cases of regional. 38 (76%) of cases were known hypertensive vs. 42 (42%) in controls. 72 (72%) of cases were diabetic vs 48 (48%) among controls. 23 (23%) of cases had respiratory diseases vs. 44 (44%) in controls. 29 (29%) of the patients among cases were ventilated in ICU. The most common reasons for ICU admission among cases was for neuro-observation 37 (37%) cases followed by requirement for cardiovascular monitoring 29 (29%), sepsis 22 (22%), intraoperative cardiac events 7 (7%), prolonged surgery 5 (5%), intraoperative arrest 2 (2%), Diabetic ketoacidosis 2 (2%) and increased Oxygen requirement postoperatively 2 (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.

Aim: The aim of the present study was to evaluate ventral hernias regarding their epidemiologic aspects, clinical features and various surgical methods employed for their repair. Methods: This was a prospective observational study conducted in the Department of General surgery, ANMMCH Gaya, Bihar, India for the period of 2 years. 200 patients were included in the study. Results: Incidence of incisional hernia was the highest followed by umbilical and epigastric hernias. Overall the incisional hernias were even more common in females but umbilical hernias were more frequent among males. Most ventral hernias were found in 40-60 year age group patients followed by 20-40 year age group patients. Mean age of presentation was 46.14±6.64 years. Overall, most of the patients presented with painless swelling. In epigastric hernias pain with or without visible swelling was the most common presentation. Emergency presentations like irreducibility or obstruction were less common. Incisional hernias were found to have occurred mainly after laparotomy and gynaecological surgeries like hysterectomy and caesarean section. Laparoscopic port site incisional hernias were uncommon. In emergency cases darning herniorrhaphy was the choice of repair instead of mesh repair. All elective incisional hernia repairs were open on lay repairs.  Pain was the most common complaint following ventral hernia repairs followed by fever and seroma formation. Patients undergoing elective hernioplasty suffered lesser complications as compared to emergency repair such as wound dehiscence, pelvic collection etc. which were statistically highly significant. Conclusion: We found ventral hernias to be more prevalent in the elderly and females. Incisional, umbilical, epigastric hernias were the more common types. Laparotomy, gynaecological procedures and midline incisions were found to be major risk factors for development of incisional hernias.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare laparoscopic and open appendectomy in terms of clinical outcome and complication rates. Methods: This was a retrospective study carried out on 150 patients who were operated by open or laparoscopic approach for acute appendicitis at Department of General surgery, ANMMCH Gaya, Bihar, India. Total 150 patients were included in this study with 50 in laparoscopic group while 100 patients in the open group. Results: According to disease severity score, most of the patients were under Grade 3 followed by Grade 1. The patient groups were compared in terms to age and gender. 3 patients of laparoscopic group were converted to open technique while in 6 patients of open appendectomy procedure was converted to midline approach due to diffuse peritonitis. Mean hospital stay was 3±0.62 days in open appendectomy group and it was 2±0.08 days in laparoscopic group. Wound infection was the most common complication noticed in 12 patients of open surgery group. Conclusion: Laparoscopic appendectomy is an advanced and feasible approach for the operative treatment of acute appendicitis. Present study concluded that an experienced surgeon can effortlessly perform laparoscopic appendectomy. The overall complication rate and length of hospital stay was found to be less in laparoscopic appendectomy but operative time was slightly higher.

DOI: 10.5281/zenodo.

Aim: To study the clinical characteristics of patients presenting with non-traumatic acute abdomen in a tertiary care hospital. Materials and Methods: This study was a retrospective study that was conducted in the Department of General Surgery, Jawaharlal Nehru medical college and Hospital, Bhagalpur, Bihar, India for nine months The study included all non-trauma patients over the age of 15 who presented to the emergency department with stomach pain. The study excluded all pregnant women who had been diagnosed. For all patients, an X-ray abdomen and Ultrasonography (USG) were performed after a comprehensive clinical examination and detailed history was collected. Other radiological and blood tests were performed as needed. Analgesics were given orally or intravenously, depending on the degree of the pain. The patients were followed up with until they were discharged from the ED/admitted ward, and the final diagnosis was recorded at that time. 300 patients were included in the study. Results: The majority of patients were in the age group of 16-31 years (58.3%), 30.7% were in the age group of 32-51 years, and 11% were above 51 years. The majority were males, comprising 65.6%, while females made up 34.4%. 68% of patients experienced pain for less than 3 days, while 32% of patients had pain for more than 3 days. 5% of patients had hypertension, 7% had type 2 diabetes, 1% had IHD, 4% had post laparotomy, 3% had malignancy, and 1% had tuberculosis. the most common etiology of acute abdomen in patients presenting during an emergency was acute appendicitis, observed in 31.7% of patients. metabolic acidosis was the most common complication observed in 7.7% of patients. Conclusion: Acute abdomen is a common emergency room complaint, and numerous intraabdominal disorders have similar symptoms. Aside from easing the patient’s symptoms, the primary job of the emergency physician is to identify instances that require prompt action to reduce morbidity and mortality. In a tiny proportion of these individuals, despite a complete history, clinical examination, laboratory, and radiographic studies, diagnosis remains elusive.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the outcome of high grade Acromioclavicular (Grade 3 and above) treated by Reconstruction with Ethibond sutures with Coracoid sling procedure. Methods: The study was done at Department of Orthopaedics, JNKTMCH, Madhepura, Bihar, India for the period of 1 year. Total cases studied were 50 cases. Results: Male cases 40 and Female cases were 10. RTA was 38 and Fall 8 cases. According to Rockwood Classification, 42 patients had grade IV fracture. The average preprocedural VAS score was 6.74 and after 3 months it came to 0.94. The average pre procedural DASH score was 22.48 and after 3 months it came to 3.77. Conclusion: Among the biological fixations of Acromioclavicular joint dislocations; this procedure gives promising results, less demanding and less expensive technique.

DOI: 10.5281/zenodo.

Aim: To determine the effectiveness of skin grafting in the healing process of ulcers on the lower extremities. Material and Methods: A retrospective study was conducted in Department of Surgery, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India from March 2019 to Feb 2020. Eighty cases of healing ulcers were admitted and treated accordingly. Inclusion criteria were patients >18 years, both sexes. Exclusion criteria were paediatrics, and patients with malignant and tubercular ulcers. Written informed consent was taken from the patients who agreed to participate in the study. Patient’s data was documented as per the preforma which included the demography, presenting chief complains, with history of presenting illness, past history, personal history and family history and local examination findings. X-ray of the ulcer region to rule out osteomyelitis, Routine blood investigations such as CBC, RFT, LFT, FBS, HIV, HbsAg, culture sensitivity of the discharge from the ulcer were done. Results: 80 patients with healing ulcers were studied, of which 48 (60%) were males and 32 (40%) were females. 7 (8.75%) patients had venous ulcers, 2 (2.5%) varicose ulcers, 4 (5%) post burn ulcers, 22 (27.5%) traumatic ulcers, 22 (27.5%) were healing pressure ulcers and 23 (28.75%) diabetic foot ulcers. Skin grafting was performed-split thickness skin grafting 70 (87.5%) and full thickness skin grafting 10 (12.5%). The outcome of skin grafting was 70-80% graft uptake in 11 (13.75%), 80-90% in 20 (25%), 90-99% in 24 (30%) and 100% graft uptake in 25 (31.25%). Complications post graft were observed in 4 (5%) acquired infection post graft, 5 (6.25%) no graft uptake and 77 patients (88.75%) had no complication. Conclusion: Although FTSG can be offered in some cases, STGS is the gold standard in terms of efficacy for healing ulcers. Outcome of the graft depends not only on type of graft also on quality of recipient bed. Skin grafting improves the quality of life in reducing pain.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the prevalence of metabolic syndrome among patients with epilepsy. Methods: This was a cross-sectional descriptive study conducted and the participants were chosen from patients who attended Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India 3 months. A total of 100 patients who met the study’s inclusion and exclusion criteria were chosen at random. Results: Subjects were 64 men and 36 women. At the lowest age-related risk of coronary artery disease and metabolic syndrome, adults aged 20–49 were selected. 46% were 20–29. 24% of patients were 30–39 years old, and 30% were 40–49. On average, individuals were 33.7 years old. Monotherapy was utilized by 50% of patients. Valproate was the most prevalent monotherapy, at 40%. Many individuals used carbamazepine (24%) and phenytoin (18%) alone to treat epilepsy. No correlation was found between epilepsy duration and metabolic syndrome. There was no correlation between treatment time or medication usage and metabolic syndrome. 40 patients got dual therapy. Ten individuals receiving three or more drugs underwent polytherapy. Conclusion: Valproate and carbamazepine, specifically, affect lipid profiles and abdominal adiposity in people on therapy. Adult epilepsy patients aged <50 are more likely to have metabolic syndrome compared to the general population. Antiepileptic drugs, notably valproate, may explain this disparity. Antiepileptic patients should be monitored for dyslipidemia and obesity.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical and radiological profile of recurrent ischemic stroke patients. Methods: The present study was conducted in the Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The study included 100 patients of who satisfied the case definitions of Recurrent Ischemic Stroke. Results: Males had a 65% recurrence rate in our research. Patients over 60 and 45-60 are at higher risk for recurrence than those under 45. Most patients had high blood pressure (>140/90) and poor sugar management (pre- and post-prandial glucose >130mg/dl and HbA1c >7%). High blood pressure affected 64% of individuals. At presentation, 35% had Anterior and MCA region infarcts and 10% had Posterior circulation. Watershed zone infarcts affected 4% of patients. Conclusion: Dual antiplatelet and statins are recommended for patients with large vascular disease, numerous risk factors, and increased brain imaging disease load. To improve patient care and quality of life, first-time ischemic stroke patients should be evaluated for recurrence, followed up regularly, and educated about the risk, medication compliance, and daily life effects.

DOI: 10.5281/zenodo.

Aim: A comparative analysis of the Widal test and immunochromatographic assay for the quick diagnosis of typhoid illness in a tertiary care hospital. Material and Methods: This prospective cross-sectional study was conducted in   the Department of Microbiology, Jawaharlal Nehru medical college and Hospital, Bhagalpur, Bihar, India for 12 months. A total of 247 clinically suspected typhoid fever cases were included in this study.  From each patient included in the study, under strict aseptic precautions 3ml venous blood was withdrawn in a well labeled plain vaccutainer tube. The blood was allowed to clot followed by centrifugation of the tube at 3000 rpm for 15 min to separate serum. Widal slide agglutination test and Immunochromatographic test were performed. Results: Out of 247 patients, 18 (7.29%) were positive and 229 (92.71%) were negative by the slide widal test. Out of 247 cases, 22 (8.90%) were positive and 225 (91.10%) were negative by the immunochromatography test. Out of 22 immunochromatography test-positive cases, 4 were negative by the widal test. The sensitivity and specificity of the immunochromatographic method were 100% and 98.5% respectively, considering the widal test as the standard. The positive predictive value (PPV) was 81.82% and the negative predictive value (NPV) was 100%. The disease accuracy of the immunochromatography test was 98.38%. Conclusion: The study concludes that ICT can be used as the suitable method for rapid diagnosis of typhoid fever. Detection of antibody from ICT method is more easy, non-invasive and highly sensitive and specific method. It is useful for small, less equipped as well as for the laboratories with fewer facilities. Since detection rate of antibody by ICT method is quite satisfactory.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate relationship between serum 25 (OH) vitamin D and insulin resistance in prediabetes. Methods: The present study was conducted in the Department of General Medicine, Laxmi Chandravanshi Medical College, (LCMCH) Palamu, Jharkhand, India and the sample selected was 70 diabetics, 60 pre-diabetes and 50 healthy control individuals. Inclusion criteria used was subjects in age ranged 40-75 years of either gender with persistent IFG or IGT over 2 OGTTs. Results: Maximum pre- diabetes subjects had serum 25 (OH) D >30 ng/ml, diabetes between 21-30 ng/ml and control >30 ng/ml. In diabetes, pre-diabetes and control subjects had BMI of 24.6 kg/m², 25.5 kg/m² and 23.7 kg/m², waist circumference of 91.7 cm, 88.2 cm and 86.4 cm, waist- height ratio of 0.84, 0.52 and 0.50, waist- hip ratio of 0.94, 0.90 and 0.86, LDL- C of 97.3 mg/dl, 106.4 mg/dl and 98.6 mg/dl, HDL- C of 46.2 mg/dl, 48.4 mg/dl and 49.6 mg/dl, TG of 148.4 mg/dl, 146.4 mg/dl and 117.4 mg/dl respectively. HbA1C found to be 7.3%, 6.5% and 5.6%, HOMA2-IR was 2.52, 1.52 and 0.82, HOMA2-β was 63.7, 82.6 and 86.4 and 25 (OH) D level was 25.5 ng/ml, 24.2 ng/ml and 22.8 ng/ml. A significant difference was observed (P< 0.05). 1 hour PG blood glucose had statistically significant positive correlation with FBS and 2 hours PG blood glucose (P< 0.05). Conclusion: It is important to understand association of vitamin D and diabetes. Vitamin-D deficiency led to worsening of insulin resistance in individuals with prediabetes.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the histopathological finding in the clinically diagnosed patient of lichen planus presenting in the skin OPD in Patna Medical College. Methods: The Cross-sectional study was conducted in the Department of Pathology Patna Medical College and Hospital, Patna, Bihar from November 2019 to December 2021. Patients of Clinically diagnosed Lichen planus were selected at random from the outpatients of the Department of Dermatology, Patna Medical College during the period from November 2019 to December 2021. Results: Total numbers of biopsies inclusive of LP and LP-like lesions were 105. The highest incidence of LP among the male was observed in the age group between 21-30 years with 32.35% cases followed by 11-20 years with 23.53% cases. Among female patients, 26% LP were observed among 21–30year age group followed by 20% in 31-40 year age group. Of the total 105 cases, 84 were diagnosed for LP which include 34 males and 50 females with a male:female ratio of 0.68:1. The majority of the Lichen planus lesions were Plaque (44.05%) and Papule (21.43%) followed by Hypertrophic (16.67%) and Pigmentated (11.90%) (fig 3).The least observed lesions were Erosive found only in two patients among 84, followed by Follicular were found only in three patients. The most common variants were lichen planus in 64.29% of cases followed by lichen planus hypertrophicus and lichen planus pigmentosus in 17.86% and 11.90% cases respectively. The least observed variant of lichen planus was lichen planopilaris found only in 5.95% of cases. Conclusion: LP is an inflammatory papulosquamous disease affecting the skin, mucous membranes, and nails, which may present with several morphological variants that can pose a diagnostic dilemma for dermatologists and dermatopathologists. Clinical features of LP, such as violaceous polygonal papules with Wickham’s striae, give important clues to diagnosis. However, histopathological examination is considered the gold standard for definitive diagnosis of LP. It can, therefore, be emphasized that combining clinical and histopathological findings can help accurately categorize and adequately manage these cases.

DOI: 10.5281/zenodo.

Aim: The aim of the present study mainly focuses on the different types of biochemical alterations and electrolyte disturbances in cases of acute diarrhoea among children. Material & Methods: The present prospective study was conducted at Department of Pediatrics, Laxmi Chandravanshi Medical College, (LCMCH) Palamu, Jharkhand, India for a period of 2 years. All cases of acute diarrhoea attending with signs and symptoms of moderate and severe dehydration were included. Clinical history and necessary biochemical investigations including serum electrolytes were performed. Results: In the present prospective study, 200 cases were enrolled with male predominance (120/200, 60%) and females (80/200, 40%). The most common age group in the study population was between 1 month to 5 years with 68 cases (34%) with males accounting for 40 and females 28 followed in order by >5 years -<10 years (64 cases, 32%), >10 years – <15 years (40 cases, 20%) and least >15 years -18 years (28 cases, 14%). Fever and Tachypnoea were observed in 48% of cases in the study. Increased thirst and sunken eyeball were seen in 35% of cases. Less commonly observed was altered sensorium, only in 10% of cases in the study. Grading of PEM was done as per IAP classification and majority were observed with Grade-1 (MILD) (17%) followed in order by grade-II (MODERATE) (12%), Grade-III (9%) and severe Grade-IV only in 3% of the cases in the study. Isolated Hypokalemia was observed in 27% of cases in the study, isolated Hypernatremia in 10% of cases, Hyponatremia with hyperkalemia in 8%, hypernatremia with hypokalemia in 7% of cases in present study. No cases of isolated hyperkalemia were observed in present study. Conclusion: Diarrhoeal disorders can be easily prevented with proper hand hygiene practices, health awareness programmes, increased breast-feeding practices and proper disinfection of water. Hyponatremia, hypokalemia, combined Hyponatremia and hypokalemia are major electrolyte abnormalities in cases of diarrhoea.

DOI: 10.5281/zenodo.