Aim: The aim of the study to evaluate the functional outcome of conservative treatment of acute type 3 acromioclavicular joint dislocations. Methods: A retrospective study was conducted in the Department of Orthopaedics, Nalanda Medical College and Hospital, Patna, Bihar, India for 15 months. 50 patients with acromioclavicular dislocation type III treated conservatively were included in this study. These patients were then followed up at 6 weeks, 3 months and 6 months interval. Patients with AC joint dislocation type I and II, men or women >60 yrs age, open dislocation, dislocation in a poly trauma patient and fracture of ipsilateral scapula, and   fracture of the clavicle were excluded from the study. Results: Of the 50 patients, 43 were male (86%) and 7 were female patients (14%). Mean age was 35.5 years. 37 had excellent results having no pain or limitation of movements. 10 had good results and had mild pain only on excessive activity but with terminal restriction of abduction. 3 had fair results and there were no poor results. At final follow up, the mean score was 11.05. There was improvement in the mean score from 9.03 at 6 weeks to 11.05 at 6 months. Improvement in subjective and objective symptoms were highly significant as per Freidman test value (p<0.01). At final follow up, mean score for pain was 3.87 at final follow up. Reduction of pain was found to be highly significant (p<0.01) at final follow up and between each follow up. Mean score for abduction was 4.01 at final follow up. Improvement in the range of abduction was found to be highly significant (p<0.01) at final follow up and between each follow up. At final follow up only 5 patients had restriction of abduction (less than one third of normal side) and 45 patient’s regained full range of movements. Follow up x-rays at the end of 6months showed that 41 A-C joints were still subluxed and 9 joints were dislocated. Mean score was 2.95 at final follow up. Conclusion: Conservative treatment of acute Type 3 Acromioclavicular joint dislocation with short periods of immobilization by bandages and slings and early rehabilitation of shoulder gives good short-term results clinically although not correlated radiographically.

Aim: To determine the clinical features and management of ulcers of the lower limb. Methods: This prospective cross sectional study which was carried in the Department of General Surgery, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 1 year 100 patients of chronic leg ulcers were selected randomly with the help of computer generated random numbers from the patients attending OPD or took admission in surgical ward. After diagnosis of primary cause of the leg ulcers, management of ulcers by proper antibiotic coverage for gram positive, gram negative and anaerobic organisms, proper glycemic control, elevation of leg, compression bandaging, total cessation of smoking and causative drugs, nutritional support, vasoactive agents to restore blood flow, nerve stimulation, proper wound care with debridement slough excision and dressing. Results: The mean (mean±SD) age of the patients was 52.34±12.05 years with range 20-75 years and the median age was 52.0 years. Test of proportion showed that the proportion of the patients with age between 40-70 years (84%) was significantly higher (Z=9.51; p<0.0001). Only 5% and 5% of the patients were with age<30 years and ≥70 years respectively. Thus, leg ulcers were more prevalent in the age group 40-70 years. Test of proportion showed that proportion of males 85% was significantly higher than that of females 15% (Z=9.74; p<0.0001). Thus, the leg ulcers were more prevalent among males. Ulcers in the left leg (49%0 was higher than that of right leg (47%) but it was not significant (Z=0.28; p=0.77). Only 3% of the patients were having ulcers in both legs. Most of the patients (61%) had ulcer at foot followed by gaiter (20%) and leg (19%). (Z=6.14; p<0.0001). Most of the ulcers were diabetic (37%) followed by venous (22%) (Z=2.31; p=0.01). Only 5% and 3% were malignant and trophic ulcers. Peripheral neuropathy (23%) was the most common type of ulcer followed by venous hypertension (22%). Only 1 (1%) case of sickle cell disease was found. Conclusion: With the availability of arsenal of investigation wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of chronic leg ulcers.

Aim: The aim of the present study to evaluate the laryngotracheal injuries following endotracheal intubation. Methods: A prospective study was conducted in the Department of ENT, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India,for 15 months. 50 Patients intubated for more than 48 hours and admitted in medical ICU and aged more than 15 years were included in this study. To find the incidence, types of injury and to study the factors influencing LTI following intubation. Results: Of 50, 32 were males and 18 were females with age ranging from 15 to 70 years. Majority of patients (70%) were between 15-29 years. Endotracheal tube of size 7.5 and 8 were used in 84% of patients. Majority of the patients (52%) were cases of organophosphorus (OP) poisoning followed by metabolic disorders like diabetic ketoacidosis and chronic kidney disease with encephalopathy. 36% of the patients were intubated for more than 10 days. The x-ray was normal in 36 patients (72%) while the abnormality was picked up in 14 (28%) patients. On 70-degree endoscopy, 4 patients (8%) had granulation tissue in the posterior commissure and one patient had bilateral vocal cord fixation. All the patients who had LTI were aged less than 45 years and 16 of 20 cases affected were males. Among the cases of LTI, 16(80%) out of 20 cases were intubated with endotracheal tubes of size more than 7. 12 (60%) of the total cases of LTI had intubation for more than 10 days. OP poisoning was the etiology for LTI in 16 cases (80%). Conclusion: A high incidence of LTI especially in cases of OP poisoning warrants one to be cautious in managing these intubated patients. Those patients requiring prolonged intubation should be considered for other alternative airway managements like tracheostomy in addition to using low pressure, high volume cuffed tubes.

Aim: The aim of the present study to assess the cough profile and trends in cough management in children across Bihar. Methods: This cross-sectional questionnaire based survey was conducted in the Upgraded Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. 200 children aged 1 to 12 years, with cough as the chief complaints were included in this study. Demographic details, duration of cough, history of similar episodes in past 12 months, nature, intensity and frequency of cough, associated symptoms, co-morbid conditions, concomitant medications, history of self-medication, adverse effects due to self-medications, classes and duration of drugs prescribed for cough and patient preference for treatment. Results: A total of 200 children 57.5% males; 42.5% females. Majority (40.5 %) of children enrolled in this survey belonged to 4-8 years of age. While 1-8 years old comprised 74% of children surveyed. 70% children had cough symptoms below 5 days prior to OPD visit while 3.5% children had symptoms above 10 days.A total of 47.5% of the children had 4-6 similar episodes of cough symptom in the preceding 12 months.A total of 62% of the children had productive cough while 25.5 % had dry cough with no or minimal sputum.70% of the children had fairly intense symptoms but were able to continue their routine activities while 21% had cough symptoms severe enough to affect their routine life and low in intensity and 9 % high in intensity symptoms.5% children reported 0-1 cough bouts per day, 35% children reported 2-6 cough bouts per day ,  38% the children had more than 6 bouts and 22% reported more than 20 cough bouts per day. Fever (63.5%) was the most commonly reported associated symptom with their current cough episode. Other reported symptoms included running nose (54.5%), sore throat or throat pain (46%), nasal stuffiness (44.5%), sneezing (41%), headache (39%), sleep disturbance (including snoring) (37.5%), breathlessness (32.5%), hoarseness of voice (30%) and nasal irritation or itching (23%). 3.5% of the children also had fatigue, body ache and skin rashes during the cough episodes. Conclusion: Acute onset and recurrent cough is common in children. Exposures to modifiable risk factors such as environmental pollutants are commonly seen to be associated with pediatric cough.

Aim: This study was conducted to evaluation of clinico epidemiological profile and patterns of antibiotic sensitivity of enteric fever in Bihar region. Methods: A prospective observational study was conducted in the Upgraded Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India for for 1 year. Total 170 Children aged below 18 years with history of fever of more than 4-14 days duration were included in this study. In each case, age, sex, presenting complaint, laboratory investigations and antibiotic sensitivity pattern are collected and analysed. Results: Out of 170 cases, 110 cases (64.71%) were males and 60 cases (35.29%) were females. The most common symptom was fever (100%), followed by anorexia (61.76%), vomiting (44.12%), pain abdomen (20.59%), diarrhea (8.24%), headache (7.06%), and cough (5.89%). The most common sign we observed was toxic look in 72.94% of the cases followed by coated tongue in 48.82%, hepatomegaly 43.53%, splenomegaly 23.53%, hepatosplenomegaly in 17.65% of cases and pallor in 5.88% of cases. Anemia found in 40 (23.53%) cases, leucopenia and leucocytosis was observed in 55(32.35%) cases and 36(21.18%) cases respectively. Neutropenia found in 66(38.82%) cases and neutrophilia was found in 57(33.53%) cases. Eosinopenia was seen in 80(47.06%) cases, eosinophilia in 10(5.88%) cases and thrombocytopenia in 26(15.29%) cases. SGOT levels was elevated (>200IU/ml) in 23(13.53%) cases and SGPT (>200IU/ml) in 24(14.12%) cases. The elevated levels of liver enzymes lasted only few days. There were no complications observed during our study period. Salmonella typhi O titres >1:100 was seen in 158(92.94%) cases and TH titres >1:200 in 127(74.71%) cases. Blood culture positive for Salmonella typhi noted in 40(23.53%) cases. Conclusion: Fever, malaise, anorexia, vomiting, chills, headache, coated tongue, diarrhea and organomegaly are the common clinical manifestations of enteric fever. Normal to raised leukocyte count is more common, however, neutropenia and eosinopenia may be a prominent finding.

Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India for 10 months. Total 110 cases were diagnosed with ectopic pregnancy. Results: During the study period, 42000 deliveries and 110 ectopic pregnancies. The most common site of ectopic pregnancy was fallopian tube 97(88.18%). Ampulla was the commonest site 75(68.18%) for ectopic implantation in the fallopian tube. Heterotopic pregnancy is rare where pregnancy is seen in the uterus and tube at the same time. In our study, there were 3(2.73%) cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 50(45.45%) followed by H/o previous abortion 21(19.09%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 33(30%). Although any form of contraception decreases the overall risk of pregnancy including ectopic Pregnancy, when contraceptive failure occurs in women using an IUCD or following tubal sterilization, risk of Ectopic Pregnancy is elevated. In our study, 18(16.36 %) patients were using copper IUCD. H/o infertility due to tubal block or other causes, treatment associated with infertility, endometriosis and H/o previous ectopic pregnancy were other identified risk factors. In the present study, urine pregnancy test was positive in 105(95.45%) of patients. Culdocentesis was positive in 47(42.73%) of patients. Ultrasound was able to diagnose 91(82.73 %) of cases. USG findings suggestive of ectopic pregnancy were extra-uterine gestational sac 17(115.45%), haemoperitoneum 64(58.18%) and adnexal mass 83(75.45%). Conclusion: Early diagnosis, timely referral, improved access to health care, aggressive management and improvement of blood bank facilities can reduce the maternal morbidity and mortality associated with ectopic pregnancy.

Aim: To study the effect of intrathecal buprenorphine on the haemodynamic response in patients undergoing laparoscopic appendicectomy under general anaesthesia. Methods: This comparative observational longitudinal study conducted in the, Department of  Anaesthesiology and critical care, Era’s Lucknow Medical college and Hospital, Lucknow, Uttar Pardesh, India, for 10 months. 100 patients were divided into two groups of 50 each by random sampling. All of them belonged to Physical Status or as outlined by the American Society of Anaesthesiologists (ASA). Patients were divided into two groups of 50 each by random sampling. The first group was GA group (General anaesthesia group) and the other was GA+SAB group (General anaesthesia with intrathecal buprenorphine group).The principal investigator observed the procedure and had no role in the assignment of cases to different modalities of anaesthesia. Results: In both the groups, drop-in heart rate was noted in patients after pneumoperitonium is achieved. There was no statistically significant difference in the heart rate, systolic and diastolic blood pressure between the GA group and GA+SAB group at preoperative period, after induction, after intubation after pneumoperitonium and after extubation. Percentage change in heart rate, systolic and diastolic from the baseline values showed a similar pattern in both the groups. Oxygen saturation post extubation showed statistically significant difference (p value = 0.027) between GA group and GA+SAB group (98.8± 0.5% versus 98.3± 1.2%). but was clinically insignificant. Conclusions: When compared to general anaesthesia alone, addition of intrathecal buprenorphine provides little advantage in preventing stress response during laparoscopic appendicectomy.