1.A Retrospective Evaluation of the Functional Outcome of Open Latarjet Procedure for Recurrent Anterior Shoulder Instability
Ravi Kumar, Bharat Singh, Ajinkya Gautham
Aim: The aim of the study to determine the Functional outcome of open latarjet procedure for recurrent anterior shoulder instability. Methods: 50 patients with Bony Bankart’s lesion representing ≥ 25% of glenoid   lesion, Hill Sach lesion, on track lesion with glenoid bone loss of ≥ 25%, Off track lesion with glenoid bone loss < 25%, Lesions requiring Remplisage correction along with    Latarjet procedure were included in this study. Functional scoring of the patient was determined by ASES (The American Shoulder and Elbow Surgeons) score, Quick DASH (The Disabilities of Arm, Shoulder and Hand) score, Rowe score, ISIS (Injury Severity Index Score score) and Visual analogue scale (VAS) for pain to get a baseline reference. The case was treated with open Latarjet repair after the criteria were met. In which coracoid process along with the conjoint tendon is transferred and fixed with screws to the margin of glenoid. Results: Of total 50 patients 48 were male (96%) with a female (4%). Among 50 patients, 31(62%) patients had their dominant shoulder affected and remaining 19 (38%) had recurrent instability in their non-dominant shoulder. Pre-operative Injury Severity Index Score (ISIS) of the patients were determined. It was found that mean pre- operative ISIS score was 4.01. 2 (4%), 21 (42%), 14 (28%), 7 (14%), 6 (12%) patients had an ISIS score of 2, 3, 4, 5, and 6 respectively. An ISIS score of < 3, 3 – 6 and > 6 predicts a recurrence rate of 5%, 12%, and 72%, respectively. Mean VAS (Visual analogue scale) for pain among the patients in the study also reduced from pre-op value of 5.1 to 2.5, 1 and almost 0 at 1 month, 3 months and 6 months post- op respectively and this reduction in pain was found to be highly significant. ROWE score which takes into account the stability, motion and function of the patient was found to have a highly significant improvement with follow ups at 1 month, 3 months and 6 months with scores of 54.68 (+/- 9.43), 69.59 (+/- 7.83) and 91.59 (+/- 7.2.) respectively. Majority of the patients (N-46; 92%) had excellent functional outcome and 4 patients (8%) had fair outcome. Conclusion: The Open Latarjet repair for anterior shoulder instability is a useful and successful procedure for patients with significant glenoid bone loss and heavy work demand such as contact athletes and manual labourers. Added to this even though Open Latarjet procedure is a non-anatomical repair it provides excellent functional results and patient satisfaction.

2. A Prospective Observational Analysis of Geriatric Patients to Determine the Incidence of Surgical Disorders and Surgical Outcomes
Vikram Jha, Anil Kumar
Aim: The aim of this study to evaluate the surgical diseases and surgical outcomes in geriatric patients. Methods: This prospective observational study which was carried in the Department of General Surgery, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. for 12 months. A total of 120 patients were included who fulfilled study obligations. Elderly patients ≥60 years of age admitted in General surgical wards for operative intervention were included in this study. Enrolled population is grouped into group I and II based on age. Population aged 60 years to 74 years grouped in group I and >74 years in group II. Detailed history, co morbidities and examination performed. Diagnosis made and divided into following systems; hepatobiliary, gastrointestinal, breast and endocrine, respiratory, vascular, hernias and others. Results: A total of 120 patients were studied. In our study, 100 patients were under group I and 20 in group II. Out of 137 patients, 62.04% were men and 37.96% were women. Most common surgical diagnosis in our study population was gallstone disease (GSD/cholelithiasis) with 36% followed by Hernias with 31 cases (31%). About 23 cases were diagnosed with malignancy accounting to 23%. Diagnoses related to trauma were seen in 13 cases i.e. 13% of the population. The most common systems involved were hepatobiliary with 35 cases (35%) followed by Hernias 31cases (31%). Almost 100 cases (83.33%) of our study population were presented with benign conditions whereas 20 cases (16.67%) were malignant cases. About 69 cases (57.5%) of patients had medical co morbidities. 37.5 percent of the study population had hyper-tension and 12.5% had diabetes mellitus. Out of 120 cases, 105 cases had elective surgery and rest 15 had emergency surgery. About 50% of the study patients were ASA II and 12.5% where ASA V. Surgical complications were seen in 19.17% of study patients. Post-operative complications like seroma formation in 10 cases, surgical site infections in 6 cases of study patients were observed. These were managed conservatively. Nearly 5 cases were succumbed to death and mortality rate was 4.17% in our study. Mean Hospital stay in our study was 9.1±9.2 days. Conclusion: Prevalence of medical co-morbidities is higher in elderly population. Out of them, hypertension and diabetes mellitus are the most common co morbid conditions. Most common indications for elective surgery in our study are hernias and gallstone disease.

3. The Endourological Management of Renal and Ureteric Matrix Calculi: Soft Stones with Hard Outcome
Ashish Sharma, Ketul Patel, Ṭ.C. Ṣadasukhi, H. L. Gupta, Manish Gupta, Sandeep Malik
Background: Matrix calculi are rare calculi accounting for 1-2% of all urinary stones. Due to atypical clinical presentation and imaging characteristics, these constitute diagnostic and therapeutic challenges. Material and Methods: We conducted a retrospective review of patients from Jan 2010 to December 2020 at a large tertiary care teaching hospital. The patients of renal/ureteric matrix calculi who were managed at our institute were included for study analysis. Demographic parameters (clinical profile, imaging characteristics), and surgical outcomes were analysed. Results: 40 patients (1.14%) were found to have matrix stones.  The mean age of presentation was 38.81± 15.34 years (range 7-78). The male: female ratio was 2.33:1. Most common presenting symptoms were flank pain (47.5%) followed by UTI (25%). Recurrent urolithiasis was the most common predisposing factor (22.5%). The mean stone size was 2.52 ±0.83 cm. Most cases were managed with endo-urological procedures (PCNL/URS). The mean age of presentation, stone size, operative time and hospital stay was significantly higher in females (p<0.05). Minor complications (mostly Clavein grade 1 and 2) were observed in 10 patients (25%). The stone free rate in immediate postoperative period and at 3 months were 85% and 87.5%. The mean follow up period was 16.55 + 2.38 months (range 12-20). Conclusion: The matrix calculi are rare calculi accounting for 1.14% of upper urinary tract stones. Minimally invasive procedures (PCNL/URSL) are safe and primary treatment modality with acceptable stone-free rates (87.5%). However, overall surgical outcomes are poorer than crystalline stones. In short these “soft stones have hard outcome”.

4. Educating Patient Regarding the Use of INCS Technique for Allergic Rhinitis: An Intervention Study
Raj Kumar Pathak
Aim: The aim of the study to patient education on nasal spray technique for allergic rhinitis. Methods: A cross-sectional prospective study was conducted in the Department of ENT, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 1 year. AR who had never been on steroid nasal spray treatment was included in this study. All patients were treated with intranasal mometasone furoate monohydrate (Nasonex) manufacture by MSD. The dose prescribed was two puffs in each nostril once daily. Each puff contains 50 mcg of Mometasone furoate monohydrate. The patients were reviewed and assessed 4 times after the initial visit. The interval between each visit was 6 weeks. Results: A total of 100 patients satisfied the inclusion criteria and consented to participate in this study. Patients were between 18 to 60 years old (mean=31.2 years) and among them 38 (38%) were male patients and 62 (62%) were female patients. Based on the 2008 ARIA guidelines, 91 (91%) patients were diagnosed with moderate-severe persistent (MSP) AR, 3 (3%) had moderate- severe intermittent (MSI) AR while 6 (6%) had mild persistent (MP) AR. During the 3rd visit despite re-education, only 27% of participants were able to show the correct techniques. However, by the 3rd and 4th visit, a good improvement was seen as more were able to demonstrate the INCS delivery technique correctly. At the end of the study, all 100 (100%) patients successfully applied and demonstrated proper technique of INCS using the Hospital Putrajaya INCS spray delivery technique.  Baseline TNSS on V1 showed that 69 patients (71.9%) came with severe symptoms. Conclusion: The present study strongly advocates that patient are effectively counseled about proper INCS spray application technique when they receive a nasal spray. Patients must be given clear instructions for correct administration.

5. Molecular Profiling of Glutamicibacter Mysorens Strain YKIKM.MU and Bioactive Peptides Characterization for Antibacterial Activity
Yalpi Karthik and Manjula Ishwara Kalyani
The increasing resistance of microbe to the existing synthetic drugs is being substituted with the alternative protein biomolecule as an importance source of new agents for treating various ailments. Actinomycetes are prevalent in diverse habitat across world. The coastal Mangrove vegetation is unique habitat for Actinomycetes isolation, high salinity and deprived oxygen levels are challenging conditions results a rare biologically important species. In present studies was carried to explore diversity of actinomycetes as a result Glutamicibacter mysorens isolated from Mangroves of Mangalore. This culture used for protein production using starch casein nitrate broth and yielded proteins of 1mg/ml and shown efficient antibacterial activity against Bacillus cereus, Proteus vulgaris, Salmonella typhimurium, Staphylococcus aureus, Pseudomonas aeroginosa pathogenic bacteria. These proteins are characterized using 10% discontinuous anionic sodium dodecyl sulfate poly acryl amide gel electrophoresis and liquid chromatography-mass spectrophotometer analysis shown elution profile maximum at 3.11min with molecular weight of 265D, 266D, 267D. Actinomycete culture identification was carried through both polyphasic and molecular studies, biochemical tests, 16s rRNA gene sequence submitted to Genbank, accession number MW647910 under Arthrobacter genera species named as Glutamicibacter mysorens strain YKIKM.MU and Phylogenetic tree was plotted shown next maximum resemblance with Arthrobacter mysorens with 98.28%.

6. Survey About Student’s Satisfaction During Training Sessions in Radiography at Teerthanker Mahaveer University Moradabad
Jyoti Yadav, Raushan Kumar, Navreet Boora, Niraj Kumar Sah
Background: Radiological Technology tends to play an integral role in the system associated with the healthcare industry. The practical and clinical training sessions contributing to the professional learning in medical education is also regarded as an essential pedagogical approach that covers the students into healthcare professionals. Apart from assisting the students in enhancing their knowledge and skills pertaining to radiological technology and medical imaging, the clinical and practical training sessions are found to serve as essential means for developing the interpersonal or soft skills in them. Aim: This study aims at determining the satisfaction of students during Practical and Clinical training sessions in Radiography. Material and methods: A questionnaire based cross sectional study was carried out in college of paramedical sciences at Teerthanker Mahaveer University, Moradabad. The study was conducted amongst 112 students who were pursuing undergraduate & postgraduate from radiological imaging techniques department of paramedical sciences. Results: Majority of the participants (70.5%) were from 21 to 24 age groups.  (61.6%) were males and (38.4%) were female participants. The mean of Age of the study subjects was 22.49 years. Overall, 80.4% internship students were satisfied, 5.6% posting students were satisfied and 33.7% overall students were satisfied with the practical and clinical satisfaction in this study. Conclusion: The individual level wise comparison of satisfaction for Clinical training accounted to be satisfied to some extent for maximum of the students. Whereas the majority of them were not satisfied with their hands on experience and thought that it won’t be able to help them in their future.

7. Assessment of Infectious Vaginal Discharge and Its Etiologic Profile: An Observational Study
Aim:  The aim of the present study is to evaluate the spectrum of various microorganisms responsible for the infectious vaginal discharge. Methods: 100 sexually active women in reproductive age group with complain of abnormal vaginal discharge were included in this study. A detailed history of patient was taken regarding nature of discharge, colour, smell along with dysuria, dyspareunia, itching of vulva and lower abdominal pain. Sterile cotton wool vaginal swabs were used to take high vaginal swab by rubbing and rotating in the posterior vaginal fornix. One swab was taken for wet mount and second swab was sent for microbiology for gram stain and culture. Bacterial vaginosis was diagnosed by gram stain, Trichomonas vaginalis was diagnosed by wet smear microscopy and Candidiasis was diagnosed by gram’s stain. Results:  Out of 100, 52% patients presented with pruritus vulva. Characteristic of discharge was different in different patients, Curdy discharge was present in 62% of cases, frothy discharge was present in 18% and homogeneous charge was present in 19%. Dysuria was present in 49% patients. Dyspareunia was present in 28% patients and 57% patients presented with lower abdominal pain. Clinical findings were different in different patients. Regarding changes in vulva, 16 % patients have excoriation and erythema was present in 11 % patients. Cervical changes were present in 7%. Vaginal erythema was present in 11% patients. Regarding nature of discharge, it was excessive in 32% patients with malodour in 20% patients and purulent in 43% patients. Regarding microbiological spectrum of vaginal discharge out of 100 patients 57 patients have bacterial vaginosis. Trichomonas vaginitis was present in 9% patients. Candidiasis was present in 6% patients. Some patients were having more than one infection like Bacterial vaginosis and Trichomonas vaginitis was coexisting in 12%, Bacterial vaginosis + Candidiasis were present in 8% patients. Mixed infection was present in 8%. Conclusion: The patients commonly presented with curdy white discharge, pruritus vulva and lower abdominal pain. Erythema and excoriation in vulva were common presentation, followed by erythema of vagina.