Volume13,Issue3

1. KAP Study Regarding Breast Feeding Among Post-Natal Mothers: A Questionnaire Based Survey.
Bhagraj Choudhary
Abstract
Aim: To evaluate the Knowledge, attitude and practice of breast feeding among postnatal mothers. Methods: The prospective cross-sectional study which was carried in the Department of Community Medicine, Netaji Subhas Medical College and Hospital, Amhara, Bihar, Patna, Bihar, India for 1 year, the study population included 100 post- natal mothers admitted in the hospital. A face-to-face interview was conducted after delivery during second post-natal day using pretested questionnaire. The performa included questions regarding knowledge, attitude and practice of breast feeding along with socio demographic details of study population. The respondents rating of questionnaire of knowledge, attitude and practice was classified as good or poor based on their response. Results: Majority (96%) of mothers answered mothers’ milk is best for baby. Most (63%) of them were aware that breast feeding should be initiated within half an hour following vaginal delivery and 2 Hours in caesarian section. About 80% of the mothers knew that exclusive breastfeeding was giving only breast milk till 6 months of age. Most of the mothers (63%) answered that they would feed every second hourly for the question regarding frequency of breastfeeding. Almost half of mothers (51%) answered that breast feeding has advantage only to baby and only 39% of mothers were aware of advantage to both mother and baby. Majority of mothers answered that the major advantage of breast milk is providing nutrition to baby (55%), but only 41% were also aware about maternal bonding and immunological benefits. More than two third (90%) of mothers answered that prelacteal feeds should not be given and 45% of study population knew that baby sucking is the important stimulus for breast feeding. Though 89% of mothers knew about proper position and attachment for breast feeding, only 45% were aware of signs of adequacy of feeding. Conclusion: Antenatal counselling promotes good breast-feeding practices hence existing antenatal counselling on breastfeeding needs to be strengthened by informing all pregnant women about the benefits of breastfeeding and motivating them by curtailing their ill beliefs regarding breastfeeding and educating them that breast Feeding is the healthiest and safest way to feed babies.

2. Serum Lipid Profile Abnormalities in Nephrotic Syndrome Patients
Musarrat Parveen, Santosh Kumar, Vijay Shankar
Abstract
Aim: To evaluate serum lipid profile related with nephrotic syndrome. Methods: This observational study was carried out in the Department of Biochemistry, Nalanda Medical College and Hospital Patna, Bihar, India from July 2019 to February 2020. Total 200 patients were included in this study and divided into two groups. Among them 100 diagnosed nephrotic syndrome patients represented as case or study groups and 100 age and sex matched healthy patient’s individuals represented as control. Results: The mean±SD age of case or Study group and control were 35.47±5.76 years and 38.76±5.77years respectively. No statistically significant difference was found regarding age of the case and control groups (p>0.05). Mean±SD of serum total cholesterol (Tc), TAG, HDLC, LDL-C of Study group and control were 277.20±34.81mg/dL, 169.77±19.54mg/dL, 22.91±4.39mg/dL, 221.76±33.20mg/dL and 164.17±22.27mg/dL, 125.78±21.77mg/dL, 36.5±7.11mg/dL, 104.31±35.71mg/dL respectively. Serum Tc, TAG, LDL-C levels were significantly higher in cases than the control (p<0.0001) but serum HDL-C level was significantly lower in cases than the control (p<0.0001). Conclusions: Routine check-up of lipid profile will help to prevent the development of cardiovascular and cerebrovascular complications in adult nephrotic syndrome patients.

3. A Retrospective Research at A Tertiary Care Centre in The Bihar Region to Assess Salivary Gland Tumours
Amit Prakash, Rashmi Kumari
Abstract
Aim: To evaluate the salivary gland tumours at a tertiary care centre in Bihar region. Methods: A retrospective study was conducted in the Department of ENT, Darbhanga Medical College & Hospital, Darbhanga, Bihar, India, for 1 year, 60 biopsied salivary gland specimens received at the Department of Histopathology 60 histologically diagnosed as SGTs formed the focus of this study. Corresponding slides were also retrieved and, where necessary, new sections were made from the corresponding paraffin-embedded tissue blocks. Results: A total of 24000 surgical specimens were received in the Department of Pathology during this study period. Of these, 4100 specimens were neoplastic. SGTs accounted for 60 cases, constituting 0.25% of all surgical specimens and 1.46% of all neoplasms received. The age range of patients was 2-77 years, with a mean age of 40.63 ± 15.87 years. The mean ages for benign and malignant SGTs were 36.75 ± 14.55 and 42.87 ± 20.32 years, respectively. The peak incidence for the benign and the malignant tumors were in the 3rd and 6th decades, respectively. The anatomical distributions of the tumors include parotid gland (60%), submandibular gland (14%) and minor salivary glands (26%). The palate, buccal mucosa, tongue, lip, retro molar mucosa and neck were the anatomical sites of the minor SGTs in this study, with the palate accounting for 80% of the cases. 55 percent of these tumors were benign, with pleomorphic adenoma accounting for 72.73% of them. The most common malignant tumors in this study were adenoid cystic carcinoma, mucoepidermoid carcinoma and acinic cell carcinoma, accounting for 25.93%, 18.52% and 14.81% of all malignant tumors seen. Few cases of squamous cell, basal cell, salivary duct and small cell carcinomas, sialoblastoma, hemangiopericytoma, myxoid liposarcoma and polymorphous low-grade adenocarcinoma were also seen. Conclusion: We found the peak incidences of benign and malignant tumors were in the 3rd and 6th decades, respectively. Pleomorphic adenoma and adenoid cystic carcinoma were the most common benign and malignant SGTs in our study populace.

4. An Observational Study to Figure out the Clinical Spectrum of Dengue Fever at A Tertiary Care Facility
Anil kumar Mahto
Abstract
Aim: The aim of the study was to determine the clinical spectrum of dengue at a tertiary care hospital in Bihar region. Methods: A prospective study was conducted in the Department of General Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India, for 1 year. Total 140 patients with complaints of fever and clinical features of dengue with positive NS1 antigen test or dengue antibody serology IgM or IgG or both were included in the study. Results: Most of the cases (46.43%) were seen in the 20-30 year age group. The male to female ratio was 1.98:1. Fever was the most common presentation and was seen in 66 cases (47.14%) cases and followed by Fever and Myalgia 14.29%, Myalgia 12.86%, Petechiae 9.29%, Fever and Skin rashes, Nausea and vomiting and Fever and Itching. The hemoglobin range of 6.5 gm% to 16.5 gm%. 64 (45.71%) cases showed Hb of 9-12 gm %, followed by 45(32.14%) cases showed Hb of 12-15 gm %, 10(7.14%) had Hb of below 9 gm % and 21 (15%) had Hb of above 15 gm% (Table – 3). The 73(54.14 %) cases showed hematocrit of 25-35% and 42 (30 %) showed hematocrit of 35-45%. The total leukocyte count ranged from 1500 cells/cumm to >11000 cells/cumm. Out of 140 cases of dengue fever, 87.86% cases had thrombocytopenia and 12.14% cases had severe thrombocytopenia (< 20,000/cumm) with bleeding manifestations. Conclusion: Haemoconcentration, leukopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that dengue cases can be diagnosed in their initial stages.

5. Combined Small Incision Cataract Surgery Vs. Trabeculectomy: A Retrospective Comparative Study To Assess The Outcome on IOP
Binod Kumar, Mrityunjay Kumar
Abstract
Aim: To evaluate the combined small incision cataract surgery and trabeculectomy on intra ocular pressure outcome. Methods: A retrospective study was conducted in the department of ophthalmology, Jan Nayak Karpoori Thakur Medical College & Hospital, Madhepura (JNKTMCH), Bihar, India for 1 year. 100 patients who underwent combined manual small incision cataract surgery and trabeculectomy were included in this study. Patients with a diagnosis of combined vision impairing cataract and preoperative glaucoma (including primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma (PXFG), chronic angle closure glaucoma, phacomorphic glaucoma, steroid induced glaucoma or ocular hypertension), and who had postoperative follow-up visits for a year and beyond were included in the study. Results: 100 patients were included in the study. Females were larger in number, 60 (60%), than males, 40 (40%). Their age ranged from 42-78 years while the mean age was 65.25 + 10.98 years. The preoperative ocular characteristics of the operated 100 eyes are depicted in Table 2. The Snellen visual acuity was less than 6/18 in all eyes, and 75 (75%) eyes had vision 6/60 and below. Pseudoexfoliative glaucoma and Primary open-angle glaucoma were the common diagnosis made in 45 (45%) and 25 (25%) eyes, respectively. Cataract that was dense enough not to allow assessment of the optic nerve head was found in 53eyes (53%). Postoperatively the preoperative mean intraocular pressure, 28.14 mmHg, decreased statistically significant (P < 0.0001. The overall success rate of IOP control at the comple- tion of 12 months follow-up was 90%, Complete 70% and qualified 16%. In the first three months of postoperative period, 88(88%) of the operated eyes were without hypotensive medication. And at one-year follow-up, 70 (70%) of the eyes were free of medication. The mean number of hypotensive medications lowered from 2.75 + 0.53 preoperative to 1.42 +0.72 at 12 months follow up. At the last visit, filtering bleb was present in 75% and flat bleb was recorded in 25% eyes. Conclusion: Combined manual small incision cataract surgery and trabeculectomy is effective in terms of IOP control and vision restoration in treating patients with coexisting cataract and glaucoma.

6. Comparative Assessment of the Characteristics Features of Desflurane with Isoflurane under Low Flow Anaesthesia using Equilibration time: Prospective Trial
Chhabindra Kumar, Narendera Kumar
Abstract
Aim: to compare characteristics of Desflurane with Isoflurane under low flow anaesthesia using equilibration time. Material and Methods: This prospective observational study was done in the Department of Anaesthesiology, Government Medical College, Bettiah (West Champaran) Bihar, India, for 1 year. 120 healthy patients of either sex scheduled for routine surgeries, American Society of Anesthesiologists (ASA) physical status I and II, age 20–65 years, and hemoglobin more than 10 g/dL were include in this study. Patients were randomly allocated to two groups. Group I received desflurane as the inhalational anesthetic agent with minimal flow anesthesia (n=60). Group II received isoflurane as anesthetic agent with minimal flow anesthesia (n=60). Results: Out of 120 adult patients were randomly divided into two groups of 60 patients each. There was no significant clinical and statistical difference in hemodynamic parameters in between the two groups. Mean of time taken for equilibration of the volatile anesthetic agent in the desflurane group was 5.77 ± 1.58 min and in the isoflurane group was 16.98±8.95 min, and the difference was statistically significant (P <0.001). Mean end-tidal volatile anaesthetic partial pressure (MFe) was calculated at 5, 20, 60, and 120 min intervals, i.e. in wash-in period (5, 20 min) and steady state (60 and 120 min). At 5, 20, 60, and 120 min, mean end-tidal concentrations (in kPa) of desflurane were not changed much and were 4.59 ± 0.77, 4.68 ± 0.57, 4.47 ± 0.63 and 4.09 ± 0.65, respectively. In the isoflurane group, variation was significant over time and were 0.82 ± 0.15, 0.95 ± 0.13, 0.69 ± 0.22 and 0.67 ± 0.17 at 5, 20, 60 and 120 min intervals, respectively. The nitrous oxide concentration tended to fall over time. It ranged between 40.70 ±4.85 and 63.10 ± 4.80 vol.%. The oxygen level varied between a minimum of 34.11 ± 3.12% and a maximum of 47.22 ± 4.33%. In both the groups, end-tidal to inspired nitrous oxide ratio was found to be 0.82 ± 0.15 in 5 min duration and 0.92 ± 0.07 by 12 min. Conclusion: with availability of agents like desflurane we can use minimal flow anaesthesia more efficiently, with less drift in anaesthetic gases and a clear-headed recovery and minimum operating room pollution.

7. A Study to Assess how Effective Extravascular Lung Water Measurement is in Controlling Lung Damage in Critical Care Units
Ranjeet Kumar, Shashi kant
Abstract
Aim: To evaluate the use of extravascular lung water measurement in managing lung injury in intensive care unit. Methods: This was a prospective observational study conducted in the Department of Anaesthesia, Netaji Subhas Medical College and Hospital, Bihta, Patna, India for 12 months. 50 critically ill patients between 18 and 65 years of age with an admission diagnosis of septic shock with or without ARDS with Acute Physiology and Chronic Health Evaluation II ≥20 requiring mechanical ventilation were included in this study. EVLW indexed to the predicted body weight, EVLWI, was measured by injecting 20ml of ice-cold saline through the central venous catheter, through thermistor manifold three times, and the average of the three readings was noted. Simultaneously with EVLWI measurements, PaO2:FiO2 and alveolar‑arterial gradient of oxygen (AaDO2) were also recorded. EVLWI values with corresponding PaO2:FiO2 and AaDO2 readings were obtained for correlation. Results: Mean baseline EVLWI and PVPI were higher in ARDS patients, but the difference was not statistically significant (P > 0.05). 30 patients died during their ICU stay, 20 patients were successfully treated and shifted out to the ward. There was no statistically significant difference in mean EVLWI (P = 0.81) and PVPI (P = 0.61) between the two groups. The chest radiograph scores from both radiologists strongly correlated with EVLWI (r = 0.69 and 0.64 for observers 1 and 2, respectively, P < 0.0001 for both observers). A moderate correlation between chest radiograph scores and PVPI was obtained (r = 0.57 and 0.55 for observers 1 and 2, respectively, P < 0.0001 for both observers). Conclusion: EVLWI and PVPI may have a prognostic significance in the assessment of lung injury in septic shock patients with ARDS. Further research is required to reveal the usefulness of EVLWI as an end point of fluid resuscitation in the management of septic shock with ARDS.

8. Clinical Characteristics of Individuals Having Spinal Anaesthesia with Intrathecal Bupivacaine and Clonidine, as well as Intrathecal Bupivacaine and Fentanyl
Shreya Saurav, Shashi Chandra Bhurer, Binod Kumar Kashyap
Abstract
Aim: The aim of this study is to assess the clinical profile of patients undergoing spinal anesthesia with intrathecal bupivacaine with clonidine and intrathecal bupivacaine with fentanyl. Methods: A prospective double blind randomized controlled study was conducted in the Department of Anaesthesiology and Critical Care, Patna Medical College and Hospital, Patna, Bihar, India for a period of 1 year. 100 adult patients were randomly divided on an alternative basis into two groups of 50 each. Group A-Bupivacaine plus clonidine group. Group B– Bupivacaine plus fentanyl group. Patients with ASA grade 1and 2 and age group of 18–70yrs were included in the study. Those patients scheduled to undergo elective lower abdominal, lower extremity, gynaecological or urological surgeries under subarachnoid block were included in this study. Patients in group ‘A’ received 3 ml (15 mg) of hyperbaric bupivacaine 0.5% plus 1 µg.kg-1 of clonidine. Patients in group ‘B’ received 3 ml (15 mg) of hyperbaric bupivacaine 0.5% plus (25 µg) of fentanyl. After injection, patient was immediately turned to supine position. Results: Majority of patients in both the groups belonged were in the age group of 35 to 45 years. The number of males was 45% and females 55%. Majority of female patients in the both the groups have the heights in the range of 160 to 170 cms and males 171 to 175 cms. Samples were height matched. 42 percent of the patients underwent gynaecological surgery followed by lower limb surgeries 34 percent and Lower Abdominal Surgeries 24 percent. Conclusion: The administration of local anaesthetics in combination with opioids intrathecally is an established technique for managing postoperative pain following abdominal, pelvic, thoracic, or orthopaedic procedures on lower extremities. Local anaesthetics with opioids demonstrate significant improvement in the post-operative pain and decrease the requirement of rescue analgesia.

9. The Timing of Nephrogenic Processes in Staged Aborted Human Embryos and Foetuses: An Observational Study
Premjeet Kumar Madhukar, Praveen Kumar, Mani Bhushan Yadav
Abstract
Aim: To evaluate chronology of nephrogenic events in staged aborted human embryos and foetuses. Methods: Total 65 aborted embryos and dead foetuses of 5 weeks gestational age to full term were include in this study. The study was done in Department of Anatomy, JNKTMCH Madhepura, Bihar, India for 1 year. The entire specimens were preserved in formalin after recording the weight, CR length and CH length. Kidneys were removed from the foetuses of more than 8 weeks gestational age by opening the abdominal cavity. The specimens were subjected to routine tissue processing and H&E staining. 10 embryos of less than 8 weeks gestational age were processed as a whole and were serially sectioned. The histological sections were observed for the time of appearance of various nephrogenic components and photographed. Results: Less than 12 weeks GA group: In this group a total of 10 embryos (less than 8 wks GA) and 3 fetuses were observed for renal histogenesis. 5 wks. Embryo: The youngest embryo observed in this group was that of 5 wks. GA with a CRL of 0.9 cms. In this embryo urogenital mesentery, degenerating pronephros and pronephric tubule could be identified. Pronephric tubule was opening in to the coelomic cavity. There was no glomerulus at this stage. 6 wks. Embryo: In the 6 wks. GA (1.5 cms CRL) embryo urogenital mesentery containing developing mesonephric kidney and gonad were identified. 8 wks. embryo: At 8 wks. GA (1.8 cms CRL) differentiating renal corpuscles, proximal and distal convoluted tubules and collecting ducts could be identified. Up to 8 weeks gestational age the sex of the embryo could not be identified. 12 weeks foetus: At 12 week (2.3 cms CRL, male foetus) mesonephric components could not be identified. There is central to peripheral progression in metanephric kidney development and there is no cortico-medullary differentiation of functional components. 13-24 wks GA group: In this group a total of 11 foetuses were observed for renal histogenesis. Sections from a specimen of 16 weeks and that of 24 weeks were compared for the developmental progression. Conclusion: Detailed findings of this study could aid the embryologists, neonatologists and nephrologists to understand the chronology of nephrogenic events and related consequences of developmental abnormalities.

10. Real-Time Ultrasonography for Gallbladder Volume Assessment in Type 2 Diabetes Mellitus Patients
Chandan Kishore, Ratna Priya
Abstract
Aim: The aim of the present study to evaluate the Gall Bladder Volume in Type 2 Diabetes Mellitus Patients Using Real Time Ultrasonography. Methods: A cross-sectional prospective study was conducted in the Department of Radiology, Narayan medical college & Hospital, Jamuhar, Sasaram, Bihar, India, for 1 year. Among 110, 55 were type 2 diabetes mellitus patients with duration of 5 years or more, with diabetic complications are included as cases and 50 age and sex matched healthy controls. Autonomic neuropathy was assessed by the presence of symptoms like dysphagia, abdominal fullness, nausea, vomiting, diarrhea, fecal incontinence, urinary incontinence, gustatory sweating, impotence etc. Under aseptic conditions, 3ml fasting blood samples were collected from all the subjects and used for the estimation of fasting blood sugar, post prandial blood sugar. Results: The mean age of the T2DM patients was 43.88±4.98 and in the healthy controls 49.88±5.69 (p=0.42). In the cases, 36 were males and 19 were females and in the control group 38 were males and 17 were females. In the present study, BMI (25.88±2.41kg/m2), FBS (161.88±28.09 mg/dl), PPBS (245.41±39.01mg/dl), Fasting gall bladder volume (34.43±6.52cm3), post fatty meal gall bladder volume (16.31±6.49cm3), ejection fraction (50.44±18.39cm3) were significantly increased in type 2 diabetes mellitus patients compared with healthy controls. T2DM patients were also subdivided broadly into without complications and those with diabetic complications. T2DM patients without diabetic complications were reported in 28 (50.91%) patients. Peripheral neuropathy was observed in 12(21.82%), peripheral neuropathy & Autonomic neuropathy was reported in 10 (18.18%) cases. In the present study, fasting GB Volume (cm3), post fatty meal GB Volume (cm3) and ejection fraction (%) were compared between the T2DM patients without complications and with complications. The fasting GB Volume (cm3) was not statistically significant between two groups (p=0.223). The post fatty meal gallbladder volume (cm3) was statistically significant between the two groups (p<0.001). Conclusion: Ultrasound evaluation of gall bladder volume (fasting and post-prandial) and Ejection Fraction are efficient parameters to evaluate gallbladder function. Gallbladder function should be evaluated routinely in T2DM patients as incomplete gallbladder emptying may lead to gallstone formation and associated complications. Further studies with large sample size are recommended.

11. To Investigate the Causes and Consequences of Acute Pancreatitis, as well as to Evaluate the Clinical Profile of Acute Pancreatitis
Vikram Jha, Anil Kumar
Abstract
Aim: To study aetiology and complications of acute pancreatitis, to assess the clinical profile of acute pancreatitis. Material and Methods: The study was a cross sectional study which was carried in the Department of General Surgery, Darbhanga Medical College and Hospital, Laheriasarai, India for 15 months. Total 100 patients who were diagnosed for acute pancreatitis were include in this study and data collection on admission included age, sex, address and clinical presentation with respect to pain vomiting, gallstones trauma and drugs was noted. Results: Out of 100 patients, 56 were males and 44 were females. Majority of patients at the age group of 30-40 (42%) and followed by 40-50 years (33%). All the patients (100%) presented with pain abdomen, 84% of them presented with nausea/vomiting, 45% of them presented with fever and 28 % of them with jaundice. 46% patient’s biliary pancreatitis was found to be the most common cause for acute pancreatitis. Alcoholism was the second most common cause (35%). Hyperlipidemia (4%) and traumatic (4%) pancreatitis was found in 4 patient each. Patients where no cause was found were labelled as idiopathic (11%). In males alcoholism induced pancreatitis was most common with a second commonest as biliary aetiology. Diabetes mellitus was most prevalent in the study population 59%. Obesity as defined by the current definition was prevalent in 41%. Conclusion: Acute pancreatitis is one of the leading causes for increase morbidity and mortality to society. Cinical assessment along with lab markers correlated well with the mortality and morbidity.

12. An Observational Study to Assess the Lipid Profile Abnormalities in Newly Diagnosed Type 2 Diabetics.
Ramakant Prasad
Abstract
Background: India is fast becoming the diabetes capital of the World. A direct atherogenic effect of triglyceride rich particles has been noted. This study assesses the lipid profile abnormalities in newly diagnosed type 2 diabetes mellitus. Since dyslipidemia is a risk factor for cardiovascular disease, such assessment will enable better recognition, prevention and management of cardiovascular mortality and morbidity. Aim and objective: The aim of this study was evaluating the lipid profile abnormalities in newly diagnosed type 2 diabetics. Material and Methods: This was a cross-sectional study was done in the Department of Medicine, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India it will be retrospective study for one year. A total of 100 newly diagnosed type 2 diabetes mellitus within the last 3 months using the ADA (American Diabetes Association) criteria and both males and females were including in this study for determine the lipid profile levels. Results: Among 100, 38 (38%) were males, and 62(62%) were females. The maximum number of patients belonged to the age group of 40-50 years (54%) and the least number belonged to the age group 20-30 years (3%). According to ATP III classification 46 (46%) participants had normal serum triglycerides levels which is <150 mg/dl whereas 54(54%) participants had an abnormal level of serum triglycerides. Among the 54 (54%) participants with abnormal triglycerides, 32% had borderline high levels (150-199mg/dl), 22% had high levels (200-499 mg/dl). 53% participants had low HDL and 47% participants had normal HDL. Conclusion: Hyperlipidaemia is the commonest complication of the diabetes mellitus, and it can predispose patients to premature atherosclerosis and microvascular complications. Good glycemic control can prevent the development and progression of common lipid abnormalities in diabetes like raised triglycerides, LDL, serum cholesterol and low HDL.

13. A Case Control Study to find out Whether there is Any Sexual Dysfunction in Male Patients with Alcoholism.
Vinay Kumar, Priyanka Sharma, Satish Kumar Sinha
Abstract
Aim: The aim of this study to determine the sexual dysfunction in male patients with alcohol dependence syndrome. Methods: This cross-sectional case-control study was conducted in the Department of Psychiatry, Jan Nayak Karpoori Thakur Medical College and Hospital (JNKTMCH), Madhepura, Bihar, India. Married men (currently having a stable heterosexual sexual partner) were included in this study. The socio- demographic and clinical variables were recorded in a specific form prepared for the clinical study. They were further administered the ICD-10-AM (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) Symptom Checklist for mental disorders screened by a trained clinician. Results: In this study 77.5% of the patients in the case group initiated drinking alcohol before 25 years of age, with 30% of them started before 18 years of age. However, only 7.5% developed dependence before 25 years of age. The duration of dependence exceeded five years in 40% of patients by the time of de-addiction. The quantity of alcohol consumed per day was 15.2 (± 6.97) standard drinks. The predominant brand used was whisky (80%). More than half 57.5%) of the patients had alcoholic liver disease. 70% of patients were having nicotine use compared to 24% in controls with significant difference (p=0.00). 3/4th of the patients in the case group had a family history of alcohol use, with half of them amounting to dependence. This finding was also significantly different from controls (p<0.04). 40% of men with alcohol dependence had SD, whether situational or global. On ignoring temporary or situational complaints, 28% had SD. 12% of controls had global SD. Conclusion: Sexual dysfunction is common in male patients with alcohol dependence.

14. A Prospective Observational Study to Assess the Clinico-Microbiological Profile of Children Suspected with Pulmonary Tuberculosis.
Sanjeev Kumar Sinha, Sonali Suman, Hemant Kumar
Abstract
Aim: To evaluate the relation of clinical features with microbiological findings in children of suspected pulmonary tuberculosis. Methods: The prospective observational study was conducted in the Upgraded Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India for 13 months 80 children aged between 6 months to 18 years presenting with constitutional symptoms like persistent fever >2 weeks without a known cause and/or unremitting cough for >2weeks and/or weight loss of 5% in three months or no weight gain in past three months along with any one of the following findings i.e., history of contact or Mantoux positive. Chest X-ray was done and reported by the radiology department and findings suggestive of TB like hilar and paratracheal lymphadenopathy, parenchymal lesions, cavitatory lesions were included in this study. Results: A total of 80 paediatric inpatients with mean age of 11.24±5.01 years were included in the study. The median age was found to be higher (12.5 years). A total of 58.75% subjects in the study belonged to more than 12 years of age. There was a female preponderance in the study. Only 35 (43.75%) male patients were present in the study compared to 45(56.25%) female patients. Fever 67 (83.75%) was found to be the most common complaint followed by cough 61(76.25 %). Other prominent symptoms, in the beginning of the illness, consisted of weight loss (87.5%), loss of appetite (86.25%), and breathlessness (16.25%). Haemoptysis, chest pain and breathlessness were relatively less prevalent. Out of 80 subjects, 20% of the patients tested positive for Mycobacterium tuberculosis and remaining 80% tested negative both by ZN staining and CBNAAT. The proportion of CBNAAT positive patients with cavitation on chest X-ray were 65% and were significantly higher (p-0.0022). Conclusion: Females were more likely to suffer from TB disease as compared to the males. The study also found out that the patients with clinical finding suggestive of pulmonary Koch’s do not always have sputum CBNAAT positivity.

15. A Case-Control Investigation to Determine the Amount of Serum Zinc in Children Who had an Acute Lower Respiratory Tract Infection
Sonali Suman, Sanjeev Kumar Sinha, Ashutosh Kumar Sinha, Hemant Kumar
Abstract
Aim: The aim of this study to evaluate the serum zinc level in children with acute lower respiratory tract infection. Methods: This Case-Control study was done the Upgraded Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India for 14 months. Among 210 patients divided into two equal groups. 105 Children between the age of 2 months to 59 months and children with Acute Lower Respiratory Tract infection were include in case group and 105 children for control group. The details of blood investigations and imaging for confirmation of clinical diagnosis were also noted during the stay of the patient in the hospital. The serum zinc estimation was done by using colorimetric test. Results: The mean age of cases was 1.83±1.39yrs and that of controls was 1.89±1.64 yrs. The Sex wise distribution of the cases and controls consisted of 74(59.20%)of cases being male and 51(40.80%) being female as compared to 69(55.20%) of controls being male and 56(44.80%) being female. The Mean serum zinc levels in the cases and controls, after comparison,  were found to be significantly different [p=0.0001], with mean value for the cases being 56.06 ± 10.11 ug/dl as compared to 82.36 ± 11.26 ug/dl for the controls. A total of 25 cases and controls (23.81%) were found to have deficiency of zinc, of which majority (85.71%) were cases      (normal range of 60 to 150ug/dl). Severe Pneumonia group (Mean=41.23 ± 5.63 ug/dl) having significantly lower value than that of Pneumonia group (Mean=60.22 ± 5.96 ug/dl).This is also reflected when we see serum zinc levels according to oxygen requirements, with cases managed on room air having mean of 63.63 ± 8.06 ug/dl, cases requiring supplemental oxygen by nasal prongs having mean of 60.74 ±9.11 ug/dl and cases requiring mechanical ventilation having mean of 39.49 ±8.67 ug/dl. Conclusion: we concluded that the zinc deficiency occurs in the majority of recurrent respiratory infection in children and therefore a decreased serum zinc level is considered an additional risk factor for recurrent respiratory infection.

16. An Observational Study of Diabetes Patients’ Awareness and Understanding of Diabetic Retinopathy
Priyanka Sharma, Vinay Kumar, Vishal katiyar
Abstract
Aim: The aim of the present study was to assess the awareness and knowledge of Diabetic retinopathy among Diabetic patients. Methods: This was a descriptive, cross sectional, non-randomized, questionnaire-based study conducted in the Department of Ophthalmology, King George’s Medical University (KGMC), Lucknow, UP, India, for 1 year. A knowledge attitude practice questionnaire was prepared and pretested in a sample group of representative population. The response was analyzed as to whether the questions were understood or not. Resident doctors were trained in administering questionnaire. Diabetic patients were given questionnaires at retina clinic and filled in the presence of residents. Results: Out of the 150 patients, 82(54.67%) had no knowledge of diabetic retinopathy compared to 68 (45.33%) who had knowledge. This was statistically significant with p value <0.001. Knowledge was more in age group less than 25 years (66.67%) and least in 35 to 45 age group (47.83%) which was statistically significant with p value <0.001. Patients in the upper socioeconomic group had more knowledge about diabetic retinopathy (57.14%) which was statistically significant with a p value of 0.001. About 73.53 % of individuals in knowledge group had right attitude which was significantly higher than non-knowledge group (57.32%) with a p value <0.001. Regarding source of information, 50% of patients in knowledge group got information about diabetic retinopathy from physicians, 12% from eye specialists, 10.67% from reading books, 10.67% from various media and 26.67% from other sources like family and friends. About 20.59% in knowledge group had practice of visiting ophthalmologist for eye check-up which was significantly higher than non-knowledge group with a p value <0.001. Conclusion: we concluded that the Increasing knowledge about diabetic retinopathy through awareness campaigns can improve attitude & practice. Early detection & timely intervention can help in preventing sight threatening complications.

17. Prospective Comparative Study of Laparoscopic Appendectomy Versus open Appendectomy
Alok Kumar Niranjan, Sanjeet Kumar
Abstract
Aim: The aim of the present study to compare laparoscopic appendectomy versus open appendectomy. Methods: This Prospective and observational study was done in the Department of Surgery, JJNKTMCH, Madhepura, Bihar, India, for 1 year. Totally 160 Patients with clinical diagnosis of acute or recurrent appendicitis with necessary investigations were included in this study. Post operative pain using a visual analogue pain scale and duration of analgesic used in number of days and post operative complications like vomiting, ileus, abdominal abscess and wound infection were compared in both the group. Results: In this study 55(68.75%) patients of open appendicectomy and 35(43.75%) patients of laparoscopic appendicectomy were males. 25(31.25%) patients of open appendicectomy and 45(56.25%) laparoscopic appendicectomy were females. The mean age of the patients in two groups was 24.8 ± 8.77 years and 23.5 ± 7.61 years, respectively. Open appendicectomy is less time (45.3 ±10.63) consuming than laparoscopic appendicectomy (65.6 ± 20.69). The average pain score was 2.7 ±0.25 in open group as compared to 1.5 ±0.39 in laparoscopic group with p value <0.05 which was statistically significant. There is significant reduction in incidence of post operative wound infection in laparoscopic group. The laparoscopic appendicectomy significantly reduced the hospital stay (P<0.05). Conclusion: The laparoscopic appendicectomy was better than the open appendicectomy with respect to pain score, lesser use of analgesics and post operative complications.

18. Platelet Parameters in Neonatal Bacterial Sepsis with Different Isolated Organisms: Prospective Observational Study
Anil Kumar, Rajnish Chandra Mishra
Abstract
Aim: The aim of the present study to determine the Platelet Parameters with Different Isolated Organism in Neonatal Bacterial Sepsis. Methods: This cross sectional prospective observational was done the Department of Paediatrics, Government Medical College, Bettiah, West Champaran, Bihar, India for 12 months. Neonatal with presence of more than 2 clinical features suggestive of sepsis with positive C – reactive protein (CRP). Baseline neonatal characteristics like gestational age, birth weight, gender, mode of delivery, APGAR score was noted for all enrolled babies. Neonates were examined clinically for primary illness according to standard format. CBC was done by automated cell counter. Blood culture was done by BACTEC method. Platelet parameters studied were platelet count at baseline & at onset of sepsis; degree of thrombocytopenia; duration of thrombocytopenia; mean platelet volume (MPV) and platelet nadir. The platelet count at the onset of sepsis was considered as platelet count coinciding with blood sample showing positive culture report. Results: Total 120 babies with culture positive sepsis were analyzed. Mean gestational age of study group was 34.78 ± 4.02 weeks; mean birth weight was 1.912 ± 0.85 kg; male: female ratio was 1.4: 1. Mode of delivery was normal vaginal delivery (NVD) in 66.67% neonates. Mean APGAR score of study group was 7.91 ± 1.43. Our study observed early onset sepsis in 70% babies and Gram-negative sepsis in 75% babies. Overall thrombocytopenia was observed in 87.5% babies with 54.17% having moderate to severe degree of thrombocytopenia. The proportion of severe degree of thrombocytopenia (20% Vs 4%), higher MPV (76.67%) Vs (56.67%) and longer duration of thrombocytopenia (3.98 ± 0.75Vs 3.22 ± 0.81) was observed more with Gram negative sepsis than with Gram positive sepsis, but statistical significance was not found. We observed statistically significant platelet nadir with Gram negative sepsis. The proportion of isolated organisms was: 30.83% klebsiella, 26.67% pseudomonas, 19.17% Coagulase- negative Staphylococci (CONS), 12.5% Citrobacter, 5.83% S. Aureus & 6.67% Acinetobacter. Conclusion: Thrombocytopenia is a frequent occurrence in neonates with sepsis especially with Gram negative organism.

19. A Questionnaire Survey to Examine Married Rural Women’s Knowledge of Various Contraceptive Methods
Priyadarshini
Abstract
Aim: The aim of the present study is to assess the awareness towards various contraceptive devices among married rural women. Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India for 12 months. A total of 200 women of the age group of 16 – 45 years were included in the study. The preformed questionnaire was prepared by the two qualified personal. All the study included participants were asked a series of question from the preformed questionnaire. All the questions were asked in the local language. The questionnaire did consist of two parts. The first part of questionnaire consists of detail demographic history and the second part consists of awareness related to emergency contraceptives.  Results: Of the total 200 women, the literacy rate was found in 170 women and rest of the 30 women were found to be illiterate. Those who were aware or had the knowledge related to the EC, only those women were further questioned for the depth of knowledge and awareness related to emergency contraceptives. The present study states that around 88.5% women have heard and had some or the other knowledge related to the emergency contraceptives. The reason for this is the main source of information was found to be television and friends and social media. When the question related to the source of knowledge and information was asked television was found to be the main source of information followed by friends and husbands and social media. In context to the questions related to the time of consumption of Emergency contraceptive pills, majority of them had no idea about the ideal time for the taking Emergency contraceptive pills. Conclusion: Based on the findings, it is concluded that on an average majority of women have adequate knowledge of emergency contraception as a whole. Majority of them are likely to have mix attitude towards Emergency contraception.

20. A Study to Assess the Prevalence of Primary Caesarean Section and the Feto-Maternal Indications: An Observational Study.
Seema Kumari, Sangeeta Kumari, Swati, Minu Sharan
Abstract
Aim: The aim of the present study to evaluate the incidence and feto-maternal indications for primary caesarean section. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar India for 15 months. The study includes 200 subjects planned for primary cesarean section. Patients were followed up in the ward till they are admitted and thereafter till 6 weeks for any complications. Neonatal status was followed up in the ward or Neonatal ICU and later on till 6 weeks of neonatal life. Results: Out total 700 institutional deliveries the incidence of primary cesarean section calculated was 28.57%. The mean age of the patients was 26.98±2.36. Majority of the subjects belonged to below 25 year age (58.5%) followed by 25-30 year age (22.5%), 30-35 years age (15%) and >35 years age (4%). Fetal indications comprises Non-reassuring or Abnormal CTG (54%) followed by Malpresentation (24%), Abnormal umbilical artery colour Doppler (15%), Macrosomia (7%). Under maternal indications for primary caesarean; maternal request CDMR (47.5%), Abnormal placentation (25%), Maternal cardiac disease (8.75%), Genital tract obstructive mass (8.75%), Pelvic deformity (5%), Failed operative vaginal delivery (5%). Under the category of other indications, the most common was Cephalo-pelvic disproportion (60%) followed by Arrest disorders (40%). Conclusion: Even though the cesarean is of the most commonly performed surgical procedures today; it is not without risks. Our study confirmed the cesarean section rate of 28.57% and it is above the 15% recommended by World Health Organization (WHO) for developing countries.

21. A Retrospective Study to Find Correlation Between Clinical and Pathological Factors of Gastric Cancer.
Sujeet Kumar Mandal, Pankaj Kumar Suman
Abstract
Aim: The aim of this study was to find correlation between clinical and pathological factors of gastric cancer in Bihar region, India. Methods: This retrospective study was carried out in the Department of Pathology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, for 1 year. Results: Of these 80 patients, 50(62.5%) male and 30 (37.5%) female, 50(62.5%) underwent distal gastrectomy, 5 (6.25%) proximal gastrectomy via abdomen and 15 (18.75%) via thorax, and 10(12.5%) underwent total gastrectomy. Distal and total gastrectomy had more numbers of clearances of lymph nodes than the other operational approaches. The postoperative complications occurred in 8 patients, 10%, including gastric retention in 20(25%), anastomotic leakage in 10(12.5%), infection of incision in 9(11.25%), disruption of wound in 5(6.25%), and thoracic cavity effusion in 5(6.25%). The complication was most common in proximal gastrectomy via abdomen (30%patients). The overall mortality was 1.25% (1/80). The diameter of the neoplasm was positively correlated with the depth of infiltration and lymphatic metastasis rate while hemoglobin was the opposite. 12(15%) of 80 were early gastric carcinoma (EGC) with metastasis of lymph nodes in 12patients (15%). The frequency of positive lymph nodes in these patients was 4%-5% less than in advanced gastric cancer (Table 2). In linear regression analysis, age and diameter of the tumor were negatively correlated with the preoperative hemoglobin (P<0.001). The diameter of the tumor was positively correlated with age and the frequency of positive lymph nodes (P<0.01). The patients with tumor of bad differentiation were younger than the other groups, who had larger tumor diameter and higher frequency of positive lymph nodes. The degree of differentiation was not related with the depth of tumor invasion on the gastric wall. The tumor diameter on the corpus and fundus was larger than the others, which had higher frequency of positive lymph nodes. The proximal gastric cancer, bad differentiation and frequency >36% positive lymph nodes were more common in female than in male. Conclusion: This retrospective study has shown that clinic-pathological characters in gastric cancer varied with sex, location, and diameter of the tumor.

22. Assessment of the Dermatological Lesions in Diabetic Retinopathy Patients: Cross Sectional Study.
Anurag Verma, Prashant Kumar
Abstract
Aim: The purpose of this study was to determine the prevalence of dermatological lesions in patients with diabetic retinopathy. Methods: This cross-sectional study was done at the Department of Ophthalmology, Anugrah Narayan Magadh Medical College Hospital (ANMMCH), Gaya, Bihar, India for 10 months. 90 patients with diabetic retinopathy having diabetes mellitus for at least 5 years duration, aged between 28-62 years, were included in this study. The dermatological examination was done by a dermatologist under proper day light and if needed, using handheld magnifying lens. Examination of the retina was done by an Ophthalmologist using indirect ophthalmoscopy of dilated fundus, fundus photo, fundus fluorescein angiography and optical coherence tomography of the macula. Results: Of the 90 diabetic patients included in this study, 8(8.89%) had Very Mild Non-Proliferative Diabetic Retinopathy (NPDR), 29(32.22%) had Mild NPDR, 35(38.89%) had Moderate NPDR, 11(12.22%) had Severe NPDR, 7(7.78%) had Proliferative Diabetic Retinopathy (PDR) and 39(43.33%) had Clinically Significant Macular Edema (CSME). 71 among 90 DR patients had different types of dermatological lesions, the prevalence being 78.89%. Dermatological lesions among poor glycemic control DM patients had a prevalence of 56.67% which was higher as compared to 33.33% among good glycemic control DM patients.39(43.33%) patients had diabetic dermopathy, 28(31.11%) had Xerosis, 24(26.67%) had IGH, 22(24.44%) patients had Icthyosis, 6(6.67%) patients had Intertrigo, 5(5.56%) patients had Tinea Versicolor, 4(4.44%) patients had Chronic Paronychia and 4(4.44%) patients had Tinea Unguium, 4(4.44%) patients had Eczema, 3(3.33%) had Melasma, 3(3.33%) had Lichen Amyloidosis, 3(3.33%) had Varicose vein, 2(2.22%) had Fissure feet, 2(2.22%) had Pigmented Purpuric Dermatosis (PPD), 2(2.22%) had Dermatosis Papulosa Nigra (DPN), 2(2.22%) had Sclerodactyly, 1(1.11%) had Plain warts, 1(1.11%) had Macular Amyloidosis, 1(1.11%) had Cherry Aneurysm, 1(1.11%) had Xanthelasma Palpebrarum, 1(1.11%) had Photodermatitis, 1(1.11%) had Skin tags, 1(1.11%) had Onychomycosis, 1(1.11%) had Onychogryphosis and 1(1.11%) had Prurigo. Conclusion: Prevalence of Dermatological lesions in Diabetic Retinopathy patients was 78.89%, the most common being Diabetic Dermopathy (shin spots) which was 43.33%.

23. Prospective Assessment of the Electrocardiographic Changes Associated with Subclinical Hypothyroidism.
Bharat Kumar, Sunil Kumar, Richa Kumari, Malti Kumari
Abstract
Aim: To evaluate the electrocardiographic changes in subclinical hypothyroidism. Methods: The present Prospective study was conducted in the Department of Physiology, Jan Nayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India from December 2018 to December 2019. We studied 40 patients with newly diagnosed and untreated primary SCH with non-specific complaints such as fatigue, mild weight gain, dry skin, and depressive feelings but without overt symptoms and signs of thyroid hormone deficiency. ECG was done to determine the electrical changes in functioning of the heart using 12-lead ECG machine. Then, reports were examined manually using magnifier. PR interval, QRS interval, QT interval, and QRS axis were recorded and tabulated. Results: A total of 80 subjects (40 in the study group and 40 in the control group) were included in the study. The clinical and biochemical parameters are tabulated in Tables 1 and 2. Both groups were well matched with regard to age and BMI. Heart rate and blood pressure were comparable in both the groups. TSH levels were significantly higher in SCH patients than controls, but fT4 and fT3 were comparable. Mean QTc interval of the study group was significantly longer   than   those   of   the   control   group (P = 0.041). Other parameters in ECG were comparable in both the groups. Conclusion: The present study concludes with the following important finding that patients of SCH have prolonged QTc interval, which predisposes to the potentially life-threatening ventricular arrhythmias. Therefore, it may present as a useful tool in monitoring the cardiovascular risk.

24. The Role of C-Reactive Protein and Gastric Aspirate Polymorphs in Newborn Sepsis.
Devanshu Kumar, Rashmi Agrawal, Shilpi Golwara, Md Nasim Ahmed, Binod Kumar Singh
Abstract
Aim: To evaluate the role of C-reactive protein and gastric aspirate polymorphs in early onset neonatal sepsis. Methods: This was a prospective observational study conducted in the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India, from January 2020 to Feb 2021. 80 babies, who had the clinical symptoms and signs of suspected neonatal sepsis/high risk factors for developing sepsis, were included in the study. Each patient was subjected to detailed history and physical examination. Blood sample was taken at admission and subjected to TLC and CRP. The blood sample for blood culture and sensitivity was collected at the same time. Following this the decision to start antibiotic therapy was based on combination of clinical signs, obstetric risk factors and sepsis screen. Results: A total number of 80 subjects were included in the study with 61 (76.25%) as out born neonates. Most of the neonates had presented with tachypnea followed by difficulty in feeding and lethargy. Sepsis screening was done at admission for all neonates enrolled in the study. Only 20 patients (25%) had TLC more than 25000 /dl. Maximum TLC value in the study was 41300 /dl. 60(75%) patients showed positive CRP values, whereas 55 patients (68.75%) had polymorphs in the GA more than 5 per high power field. Only 48 (60%) patients had positive blood culture and sensitivity report. By combination of any CRP and TLC specificity increased to 81.25%. While sensitivity approached 100% when TLC with GA polymorphs and CRP with GA polymorphs were combined with significant p values of 0.001 and 0.014 respectively. When all the three parameters were combined together, both the sensitivity and specificity increased to 100% and 91.25% respectively with p values of 0.001. In this study the most common organism grown in blood culture was Klebsiella followed by Staphylococcus aureus and Pseudomonas. Conclusion: CRP showed high sensitivity while GA polymorphs showed high specificity. GA cytology as a screening tool for neonatal sepsis with intermediate sensitivity, specificity, positive predictive value and negative predictive values serves as good tool, added to a detailed antenatal history and clinical examination of the neonate.

25. Prospective Observational Study to Assess the Incidence of Double Cystic Artery.
Md Faizul Hassan, Syed Aakif Faridi, Mohammad Tarique
Abstract
Aim: The aim of this study was to find out the prevalence of double cystic arteries. Methods: The study was a prospective observational study conducted in the Department of General Surgery, Madhubani Medical College and Hospital, Madhubani, Bihar, India, for 15 months. Total 520 patients with symptomatic gallstones with benign gallbladder diseases, gallbladder polyps, previously known gallbladder inflammation, patients without bleeding clotting disorder, being over the age of 18, and patients who can be given general anesthesia induction and underwent laparoscopic cholecystectomy operation were include in this study. The characteristics and complications of the patients with double cystic artery were recorded and examined. Results: 520 laparoscopic cholecystectomy performed in 1 years. 129 male and 391 female patients were included in the study. The average age was 21-71(53.26). The double cystic arteries were detected in the operation of 4 males (0.77%) and 16 female patients (3.07%). The average age of these patients was 53.4±10.85. It was discovered from ultrasound reports that the indication for operation in 3 of the 20 patients with double cystic arteries was gall bladder polyp while it was multiple stones in the gallbladder for the rest of the patients. An epigastric hernia was detected in 4 patients other than gallstones and an epigastric hernia correction was performed simultaneously laparoscopically. 4 of the 20 patients (20%) with double cystic arteries were switched from laparoscopic to conventional cholecystectomy due to bleeding during surgery. The average duration of hospital stay of patients with a double cystic artery is 5.9 (4-12) days, and (3.2 days) for patients without a double cystic artery. The incidence of a double cystic artery was found to be 3.84 on average. Conclusion: Cystic artery variations and other variations can coexist. Awareness of cystic artery variations can reduce the possibility of uncontrolled intraoperative bleeding, extra hepatic biliary injury, and switching to conventional cholecystectomy.

26. A Comparison of the Effectiveness of Platelet-Rich Plasma Therapy and Corticosteroid Injection in the Treatment of Plantar Fasciitis.
Neeraj Kumar
Abstract
Aim: The aim of this study to compare the efficacy of platelet-rich plasma therapy and corticosteroid injection in the treatment of planter fasciitis. Methods: The present prospective clinical study was conducted in the Department of Orthopaedics, All India Institute of Medical Science, Patna, Bihar, India for 15 months. Total of 50 patients were included for the study and were randomly allotted into two groups, PRP group (n=25) and Steroid group (n=25). For preparation of platelet-rich plasma, 27 ml of blood was withdrawn from the cubital vein and placed in a glass tube containing 3 ml of citrate dextrose solution (ratio 9:1). Citrate dextrose solution was used to prevent clotting. The blood was centrifuged at 3200 rpm for 12 minutes. 3ml PRP preparation was obtained from the upper buffy coat. Results: Both groups were similar in terms of age, gender and side involvement as shown in table 1. The mean initial or Pre injection VAS and AOFAS scores in the steroid and PRP group was 7.9±1.5, 61.2±10.5 and 8.1±1.5, 62.4±9.9 respectively and were comparable (p≥0.05). Post injection, the score improved considerably in each group on each follow-up; however, no significant difference could be detected between the scores of the two groups at the 1, 3 and 6-month follow-ups. Conclusion: The observations made in the present study suggest that the treatment of plantar fasciitis with steroid or PRP injection is equally effective.

27. Assessment of Cord Clamping in Preterm Infants Less Than 37 Weeks and its Impact on the Outcomes.
Renu Bharati, Sweety Rani
Abstract
Aim: The aim of our study is to compare between immediate and delayed cord clamping in preterm infants less than 37 weeks, and its effect on the outcomes of such babies. Methods: This study was conducted at Department of Pediatrics, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India for 11 months. The total number of babies included in the study was 200 preterm, where the protocol of DCC was applied on 100 preterm. All infants born at less than 37 weeks’ gestation were eligible for DCC and Eligible infants were left attached to the placenta for 45 seconds after birth. Neonatal process and outcome data were collected until discharge. Results: Mean gestational age was 34.3 weeks in the ICC group compared with 34.1 weeks in the DCC group; mean birth weight was 2330 g in the ICC cohort compared with 2415 g in the DCC cohort. Male infants represented 48 (48%) in DCC group, compared to 47 (47%) in the ICC group. There were no significant differences in 1 and 5-minute Apgar scores, admission temperature or Ph, PCO2, PO2 done at birth from the umbilical cord. Phototherapy in first week of life was significantly higher in the DCC, but none of the infants in either groups received intensive phototherapy or exchange transfusion. Incidence of RDS and surfactant administration was significantly lower in the DCC cohort. Our study showed significantly lower number of pt with IVH 22 suspected NEC 8% in DCC group. In our study, the number of babies who needed phototherapy in the DCC group (73%) was significantly higher than ICC group (51%). One analysis found a very slight (3%) increase in jaundice among babies who received delayed cord clamping. Conclusion: The DCC, as performed in our hospital, was associated with a significant reduction in IVH and early red blood cell transfusion. Further clinical studies are needed to optimize the timing and technique of DCC and to report the impact of this potentially valuable procedure on long term neuro developmental outcomes of the preterm infants.

28. Executive Functions and Glutamate Levels in the Prefrontal Cortex in Major Depressive Disorder
Ankit Saxena, Arvind Kumar, Santosh Kumar, Lokesh Singh Shekhawat, Subash Khushu, Pankaj Kumar
Abstract
Background: Executive functions are most commonly impaired cognitive functions in Major depressive Disorder. The executive dysfunction can lead to impairment in judgement, organization, planning and decision-making. The prefrontal cortex has been found to be the primary site for these functions. Glutamatergic theory of depression postulates that depression may result due to disruption in the glutamatergic neurotransmission in the brain. Magnetic Resonance Spectroscopy (MRS) has provided opportunity to study these neurotransmitters to find out the etiopathogenesis of major depressive disorder and associated cognitive impairment. Trail Making test is one of the most widely used assessment tool to study the executive functions. This study was planned to study association of executive dysfunctions as assessed on trail making test (TMT-A and B) and glutamate levels in the prefrontal cortex. Method: This cross-sectional observational study was carried out in the Department of Psychiatry, PGIMER and Dr. RML Hospital, New Delhi and NMR Research Centre, INMAS, DRDO, Ministry of Defence, Government of India between November 2014 to February 2016. 25 adult patients with major depressive disorder without treatment from last 6 weeks and 24 healthy controls were included in the study. The patients and controls were interviewed using the Hindi version of diagnostic interview for genetic studies for diagnosis. Patients were further assessed on Hamilton depression rating scale and Hamilton anxiety rating scale to measure the severity of depressive and anxiety symptoms. Trail Making test part A and part B were administered to both patients and controls to assess the executive functions. Neuro-metabolites of glutamate in the prefrontal cortex of both the groups were measured on Magnetic Resonance Spectroscopy. Results: The analysis also showed that the mean age at onset of the depressive episode was 32.56 years and mean total lifetime duration was 25.8 months for the cases. Controls performed significantly better than cases on Trail Making Test Part A and part B (p – value < 0.0001). After adjusting for age and sex as covariates for analysis of glutamate and other metabolites in cases and controls, no significant difference was found. The severity of depression as measured by HAM-D scores was not correlated to either the TMT scores or glutamate levels as measured by MRS in the prefrontal cortex. Conclusion: Though the cases and control were not matched on education, but the executive dysfunction did not significantly correlate with glutamate and it’s neuro-metabolites level in prefrontal cortex.

29. Role of L-Arginine in Borderline Oligohydramnios
Vinita Sahay
Abstract
Aim and objective: To study the effect of L-arginine in optimizing fetal outcome in case of borderline oligohydramnios(BO). Material and Method: A retrospective study was conducted in NSMCH Bihta in Dept of Obs & Gynae between June 2019 to March 2021 consisting of 100 antenatal patients diagnosed with BO- AFI < 8cm remote from term. Patients were evaluated for all antenatal risk factors and were started on L-arginine sachets (1 sachet twice daily). The treatment was continued till an adequate improvement in liquor was noted. However, patients were considered for delivery if the liquor remained <5. Further, mean increase in AFI, intervention delivery interval and neonatal outcome were studied. Results: The mean gestational age at the time of recruitment was 32.4 weeks. The mean AFI noted was 5.6 cm. These patients were delivered at a mean of 35.5 weeks and thus pregnancy could be prolonged by 3.1 weeks. The mean AFI at the end of therapeutic intervention was 8.8 cm and thus an AFI increase of 3.2 cm could be obtained. Significant improvement in liquor volume was obtained in these patients after supplementation with L-arginine sachets. There was no significant neonatal morbidity in these patients. Discussion and Conclusion: L-arginine supplementation is promising in improving volume of amniotic fluid in case of BO and prolonging pregnancy by a mean of 3.1 weeks, allowing better fetal maturation and neonatal outcome.

30. Assessment of the Subjective, Objective and Radiographic Outcome of the Different Treatment Approaches for the Management of Radius and Ulna Fractures in Adults
Abhas Kumar, Kumar Gaurav, Manish Kumar, Rajeev Anand
Abstract
Aim: To determine relationship of the subjective, objective and radiographic method of treatment. Material and methods: A prospective study were conducted in the Department of Orthopaedics Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India.for 1 year. Three different treatment approaches were utilized: open reduction and internal fixation (ORIF), closed reduction and casting (CR), and external skeletal fixation with pins-in-plaster (PIP). The method of treatment was chosen by the attending surgeon based upon his experience and the type of injury. Results: Overall, 82 percent of patients reported no pain, with no difference between patients with open and those with closed fractures. While 85 percent of patients treated with ORIF were pain free at their last examination, only 55 percent treated with CR and 50 percent treated with PIP were painless. There was no significant difference in the loss of forearm rotation between closed and open fractures: 67 percent of each group lost less than thirty degrees of forearm rotation. 75 percent of patients treated with ORIF lost less than thirty degrees of forearm rotation, while only 48 percent treated by CR and 27 percent by PIP lost less than thirty degrees. Union occurred in 91 percent of radius fractures and 94 percent of ulna fractures, with an average time to union of 15.1 weeks for the radius and 16.5 weeks for the ulna. Union was more frequent after closed than after open fractures. This difference was most apparent in radius fractures where 14 percent of open fractures developed nonunion, compared to only 3 percent of closed injuries (p = 0.142). Also, the average time to union was 17 percent longer for open than for closed fractures of the radius (p = 0.035), and 33 percent longer for open fractures of the ulna (p = 0.014). Neither the frequency of nor the time to union varied significantly with the method of treatment. The amount of forearm rotation lost was directly proportional to the loss of normal alignment, reaching a mean of 38 degrees when the combined malalignment of the radius and ulna exceeded thirty degrees (p = 0.06). 80 percent of patients treated with ORIF had less than twenty-degree combined malalignment of the radius and ulna on the final radiographs, a result seen in only 55 percent and 11 percent of patients treated with CR and PIP respectively. Conclusion: The results of open and closed fractures were somewhat similar, with the exception of a longer period to union and a higher infection risk. A weakened end outcome was strongly predicted by the occurrence of subsequent casualties.

31. Tibial Plateau Fractures Treated with Locking and Non-locking Plates: A Retrospective Analysis
Anshu Anand, Ajoy Kumar Manav
Abstract
Aim: Functional outcome of tibial plateau fractures treated with locking and non locking plate fixation: A retrospective study. Methods: A retrospective study was conducted in the Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India from September 2017 to August 2018. Total 30 patients managed by internal fixation were evaluated for their functional outcome. The patients were assigned into two groups; those treated with locking plate and another being the Non locking group. The injured patients were initially stabilized haemodynamically in Emergency room and concomitant injuries ruled out. Patients’ radiography of the limb with full length anteroposterior (AP) & Lateral views taken and fracture pattern assessed initially. Results: The locking plate group was better as for results obtained; Out of 10 (66.6%) patients had range of 100- 130 degrees of flexion, 3(20%) had a range of 90-100 degrees and in 2 (13.3%) patient had a flexion range between 90- 80 degrees 13 patients (86.6%) had excellent and 2 patients (13.3%) had good objective knee society score in locking group as compared to 8 (53.3%) and 7(46.6%) respectively.11 patients (73.3%) had excellent, 4 patients (26.6%) had well and 1 patient (6.6%) had a fair functional knee society score in locking group. In non-locking group 8 patients (53.3%) had excellent, 3 patients (20%) had good, and 4 patient (26.6%) had a fair functional knee society score 12 patients (80%) had excellent, 2 patients (13.3%) had good and 1 patients (6.6%) had fair radiological outcome in locking group. 8 patients (53.3%) had excellent, 3 patients (20%) had good, and 4 patients (26.6%) had fair radiological outcome in non-locking group The functional outcome using Oxford knee score was 12 cases had scored between 40 and 48, 2 cases had scored between 30 and 39, 1 case had scored between 20 and 29 in locking group. 7 scored between 40 and 48, 3 cases between 30 and 39, 5 cases had scored between 20 and 29 in non- locking group. Conclusion: The management of complex tibial plateau fractures is an ever-remaining challenge. Choice of the procedure/implant should be based on the fracture pattern, bone quality and intraoperative fracture reduction. The development of locking implants and biological fixation with minimally invasive technique and proper handling the soft tissues influence the final outcome.

32. Randomized Controlled trial Comparing Laparoscopic Cholecystectomy with and without Drains
Arvind Kumar, Ashok Kumar Sharma
Abstract
Aim: The aim of this study to compare the laparoscopic cholecystectomy with and without drains. Methods: This randomized controlled trial single-blind study was done the Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi from January 2019 to December 2019. 200 patients were included in this study. Patients were divided into 2 groups; A with drain and B without drain. A complete history, physical evaluation, the relevant investigations were done, and the post-operative period and complications were assessed. Patients were grouped by simple random sampling.  Results: Amongst cholelithiasis patients 42% had drain and 42% without drain. Amongst acute cholecystitis patients, 27% had drain and 11% without drain and amongst chronic cholecystitis patients, 31% had drain and 47% without drain. The difference was not statistically significant. VAS (Visual analogue scale) grade in patients with drain was G4 (49%), G3 (47%) then G2 (5%). VAS grade in patients without drain was G2 (49%) followed by G3 (30%) then G1 (15%). P<0.05, there was statistically significant difference observed between the two groups. Wound infection is noted in 12(12%) with drain and 1 (1%) without drain group, hence p value was 0.006. So, there was statistically significant difference noted between the two study groups. Mean hospital stay in patients with drain was 9.15±2.03 days and a patient without drain was 4.11±1.36 days. P<0.05, there was statistically significant difference noted between two study groups. Nausea and vomiting were noted in 45 (45%) with drain and 3 (3%) without drain group, hence p value was less than 0.05. Conclusions: An uncomplicated gall stone disease can be treated by laparoscopic cholecystectomy without need for drain with reasonable safety by an experienced surgeon. With no usage of drain, it is significantly advantageous in terms of post-operative pain, use of analgesics and hospital stay.

33. A Prospective Research to Compare the Functional Results of Medial Patellofemoral Ligament (MPFL) Reconstruction v/s Graft Tissue Implantation
Bibek Kumar Rai, Ajoy Kumar Manav
Abstract
Aim: study of functional outcomes of MPFL reconstruction vs. graft tissue placement. Methods: This prospective study   was carried out in the Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India from January 2017 to December 2017. 40 subjects who underwent MPFL reconstruction were retrospectively analyzed for MFPL graft tissue placement relative to the anatomic ideal. The total distance from anatomic ideal was determined trigonometrically by first measuring the two distances (anterior or posterior, and proximal or distal to ideal), then determining the actual geographic distance from anatomic ideal using the Pythagorean theorem. Results: The study population was comprised of 17 males and 23 females, with a mean age of 24.48 ± 7.31, an average height of 171.2 cm ± 10.15, and an average weight of 78.83 kg ± 18.5. 21 patients had their surgery on the right knee, and 19 on the left. All patients had both Fulkerson Osteotomy procedures involving MPFL reconstruction with intraoperative femoral nerve stimulation. A significant post-operative difference was found between groups in the following parameters: WOMAC pain (anatomic mean = 86.71 ± 11.34, non-anatomic mean = 76.00 ± 25.35 p = 0.015), function (anatomic mean = 86.85 ± 8.96, non-anatomic mean = 80.09 ± 23.45, p =0.021) and in KOOS symptom (anatomic mean = 76.63 ± 10.79, non-anatomic mean = 68.83 ± 21.40, p = 0.029), pain (anatomic mean = 78.54 ± 7.61, non-anatomic mean = 72.39 ± 24.18, p = 0.01), ADL (anatomic mean = 86.85 ± 8.97, non-anatomic mean = 80.09 ± 23.45, p = 0.014) and overall (anatomic mean = 75.61 ± 9.33, non-anatomic mean = 70.41 ± 23.25, p = 0.01) scores. No significant difference was observed for post-op instability, improvement in WOMAC or KOOS, 2-week, 6-week, or final 1-year range of motion, WOMAC stiffness, or KOOS sport/recreation or QOL. Conclusion: Within the range of graft placement values considered by this study, while no reduction in range of motion was seen, non-anatomic placement of MPFL graft tissue in MPFL reconstruction operations caused increased pain and decreased function, evidenced by post-operative KOOS and WOMAC scores.

34. Astigmatism Correction Following Various Incisions in Manual Small Incision in the Management of Cataract Surgery
Navin Chandra, Utkarsh Bhardwaj, Rajesh Tiwary
Abstract
Aim: The aim of this study to compare the laparoscopic cholecystectomy with and without drains. Methods: This randomized controlled trial single-blind study was done the Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi from January 2019 to December 2019. 200 patients were included in this study. Patients were divided into 2 groups; A with drain and B without drain. A complete history, physical evaluation, the relevant investigations were done, and the post-operative period and complications were assessed. Patients were grouped by simple random sampling. Results: Amongst cholelithiasis patients 42% had drain and 42% without drain. Amongst acute cholecystitis patients, 27% had drain and 11% without drain and amongst chronic cholecystitis patients, 31% had drain and 47% without drain. The difference was not statistically significant. VAS (Visual analogue scale) grade in patients with drain was G4 (49%), G3 (47%) then G2 (5%). VAS grade in patients without drain was G2 (49%) followed by G3 (30%) then G1 (15%). P<0.05, there was statistically significant difference observed between the two groups. Wound infection is noted in 12(12%) with drain and 1 (1%) without drain group, hence p value was 0.006. So, there was statistically significant difference noted between the two study groups. Mean hospital stay in patients with drain was 9.15±2.03 days and a patient without drain was 4.11±1.36 days. P<0.05, there was statistically significant difference noted between two study groups. Nausea and vomiting were noted in 45 (45%) with drain and 3 (3%) without drain group, hence p value was less than 0.05. Conclusions: An uncomplicated gall stone disease can be treated by laparoscopic cholecystectomy without need for drain with reasonable safety by an experienced surgeon. With no usage of drain, it is significantly advantageous in terms of post-operative pain, use of analgesics and hospital stay.

35. To Compare Isobaric Levobupivacaine with Fentanyl and Dexmedetomidine for Spinal Blockade Onset, Duration, Hemodynamic Parameters, and Adverse Effects
Prashant, B.K. Kashyap
Abstract
Aim: The aim of the study to compare a combination of isobaric Levobupivacaine with fentanyl and dexmedetomidine for the characteristics of spinal blockade with respect to onset, duration and hemodynamic parameters and side effect. Methods: This was a prospective, randomized, and double blinded clinical comparative study conducted in the Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India, from Jan 2018 to July 2018. The study population consisted of 150 adult patients who were classified as American Society of Anesthesiologists (ASA) physical status I or II, undergoing elective lower limb orthopaedic surgery under spinal anesthesia. The study participants were randomly divided into three groups.Group A: 0.5% Levobupivacaine Isobaric 2.5ml+ 0.5ml normal saline (total volume is upto 3.0 ml). Group F: 0.5% Levobupivacaine Isobaric 2.5ml + 25mug fentanyl (test solution will diluted with normal saline to total volume of 3.0ml). Group D: 0.5% Levobupivacaine isobaric 2.5ml +5 mcg dexmedetomidine (test solution will diluted with normal saline to total volume of 3.0 ml. Result: The mean time for onset of sensory block was 10.69 ±4.16 min in the saline group and 8.41±2.93 min in the dexmedetomidine group and 2.31±1.19 min in the fentanyl group. The mean time taken to achieve maximum sensory block in group A was 15.72±4.91 min, in group D was 13.28±3.51 min and in group F it was 5.38±1.92 min so maximum sensory block was achieved earlier in group. The mean duration of sensory block in group A was 114.47±7.12min, and in group F was 162.11±12.74min., and in group D was 205.12±6.41 min. The mean onset time of motor block in group A was 11.14±3.98 min, in group D it was 8.97±3.31 min, in group F it was 3.41 ±1.33 min. Onset of motor block occurred earlier in the fentanyl group. In the present study there was a significant difference in duration of motor block across the three groups with p value <0.001. In group A mean duration of motor block was 162.04±6.30 min, and in group D was 254.26±6.59 min and in group F it was 187.74±11.64 min. Conclusion: Dexmedetomidine group has longer onset of and duration of sensory block and effective postoperative analgesia and fewer side effects as compared to fentanyl group.

36. To Evaluate the Functional Result of Intertrochanteric Femur Fractures Managed with a Proximal Femoral Locking Compression Plate
Ram Sagar Pandit, Ramashish Yadav, Nand Kumar
Abstract
Aim: Evaluation of functional outcome of intertrochanteric femur fractures treated with proximal femoral locking compression plate. Methods: A prospective study was conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 1 year. A total of 50 patients with intertrochanteric femur fractures were studied. All the patients who were brought to casualty and outpatient department with intertrochanteric fractures were selected for the study. Adults with intertrochanteric fractures, patients willing to give consent to participate in the study, patients with isolated intertrochanteric fractures confirmed on radiographs, patients with fractures less than two weeks old and patients who were medically fit for surgery were included in the study. Results: Mean age in years was 60.12±20.22 years. The fractures were classified according to AO-OTA classification and most of the cases in our study belonged to 31A2-2 (24%) followed by 31A2-1 (18%). The mean duration of surgery was found to be 88.36±20.39 minutes. The average blood loss was 212.5±21.51ml of blood. The average period of hospitalization was found to be 11.02±2.14 days in our study. Majority of the patients had no complications (82%). Complications seen were superficial infection (4%), varus collapse (6%), and screw cut-out (4%) and non- union (4%). The evaluation was done using the Harris hip score and 72% of patients had excellent outcomes, 16% patients had good outcome, 8% of patients had a fair outcome and only 4% of patients had a poor outcome. The mean Harris hip score at 1 month was 70.38±5.30, at 3 months was 78.69 ±6.55 and at 9 months was 88.6 ±6.96. The average time required for fracture union in our study was 15.76 weeks. Conclusion: Intertrochanteric femur fractures are one of the most frequently encountered fractures by orthopedic surgeons all over the world. Various fixation methods are available for treatment of intertrochanteric femur fractures which range from DHS to intramedullary devices, but these are associated with many complications.

37. An Investigation of Surgical Site Infection in Obstetrics and Gynaecological Surgeries at a Tertiary Care Hospital
Sushma Shikha, Preeti Pushpam, Kumar Devashish, Seema
Abstract
Aim: To Study of surgical site infection in obstetrics and Gynaecological surgeries in a tertiary care hospital in Bihar region. Methods: The prospective analytical study was conducted in the Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, from December 2019 to July 2020. A total of 100 females undergoing abdominal surgeries at our hospital were selected for study after informed consent. Patients with SSI occurring within 30 days after operation involving only skin and subcutaneous tissue were included. Patients who are not operated in our hospital or coming with surgical site infection after getting discharge from the hospital were excluded. Results: Mean age of the study subjects was 37.8 years with over half of them (58%) were between 20-40 years of age. Out of total 100 cases, 43% were gynaecological procedures while rests 57 were obstetric cases. Most common obstetric surgery was LSCS (52%) while most common gynaecological surgery performed was total abdominal hysterectomy (26%) cases while TAH BSO was performed in 14% cases. Exploratory laparotomy and tubal ligation were done in 4% cases each. Prevalence of Surgical site infections in present study was 9%. Most common organism isolated from SSI site was Staph. Aureus (5 cases) followed by E. coli (2 cases) and Klebsilla (2 cases). Prevalence of SSI was 11.63% in gynaecological procedures while it was 7.02% in obstetric procedures (p-0.67). No difference was observed between subjects with and without SSIs with respect to mean age, haemoglobin and leucocyte count (p>0.05). However, mean hospital stay was significantly higher in cases with SSIs (7.8 vs 4.52 days). Conclusion: The incidence of SSI was same for Obstetric as well as Gynaecological surgeries. The multiple risk factors identified in the present study can be helpful for SSI risk stratification and prioritizing interventions in low-middle income countries.

38. A Retrospective Research Assessing the Rising Risk Factors of Acute Myocardial Infarction
Virendra Prasad Sinha, Ashok Kumar, Upendra Narayan Singh
Abstract
Aim: A study focusing emerging risk factors in patients of acute myocardial infarction in Bihar region. Methods: A retrospective study was conducted in the Department of Cardiology, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. Patients with acute ST elevation Myocardial Infarction (STEMI) and typical rise of cardiac biomarkers either in the form of Creatine Kinase-MB (CKMB) or Troponin were included in this study. Baseline characteristics like age, sex, clinical history, conventional risk factors, duration of symptoms, type of thrombolytic agent used, and coronary angiogram results were analyzed in detail. Results: In this study, 70% patients were males, and 30% patients were females indicating high prevalence of Acute Coronary Syndrome in men. 60 (%) patients had AWMI indicating high prevalence of AWMI in STEMI. 37% patients had inferior wall MI. In our study 35% patients had diabetes indicating Diabetes is one of the most common risk factors. The prevalence of diabetes in our study was 35%. Diabetes is one of the common risk factors still need to be controlled in India. In our study patients 45% had hypertension indicating it’s the one of the common causes for acute coronary syndrome. In our study 55% of the patients were smokers most (90%) of them were men indicating high prevalence of ACS in smokers. Smoking accelerates the atherosclerotic process and provoke myocardial infarction in young patients. In this study, patients had BMI 5% patients had BMI <25 kg/m2, 65% patients had BMI between 25-30 kg/m2, 30% of the patients had BMI between 30-40 kg/m2 indicating CAD is more common in overweight patients than obese patients. In this study, 10 patients had depression even though it’s not a significant factor treating depression lowers the ACS risk. Conclusion: The modifying risk factors such as smoking, increased levels of body fat, consuming too much fat and salt, and a sedentary lifestyle together with the use of accessible and affordable preventive medicines, can lower the risk of CAD.

39. Utility of Urine Protein Creatinine Ratio and Proteinuria as an early Indicator to Predict the Disease Severity and Outcome in Paediatric Dengue Fever: Prospective Study
Ankur Priyadarshi
Abstract
Objective: The study was undertaken to establish early predictors of disease severity viz urine protein creatinine ratio (UPCR) and proteinuria in children with dengue. Material and Methods: A prospective study was conducted in the Department of Paediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 15 months. Children aged less than 14 years, hospitalized with clinical features of dengue and testing positive serology (NS1, IgM) were included in the study. All enrolled children were assigned according to urine protein creatinine ratio into 4 groups viz< 0.5, 0.5-1, 1-3, 3. Results: All of the 100 children with dengue fever were classified according to UPCR into 4 groups. It was observed that 37 % had UPRC <0.5, 23% had 0.5-1.0, 27% had 1-3 and 13% children had UPRC >3. UPRC was inversely proportional to age and had no association with gender. There was a positive correlation between UPRC and the severity of illness in dengue fever. Conclusion: The usage of both UPCR as well as proteinuria estimation in all children afflicted with dengue fever as a screening device for hospitalization, management and prognostication.

40. Topical Amorolfine, Luliconazole, Sertaconazole, and Terbinafine Effectiveness in Tinea Corporis and Tinea Cruris: A Comparative Study
Iftekhar Khan
Abstract
Aim: The main aim of the study is to compare the efficacy of newer antifungals like Luliconazole, Amorolfine, sertaconazole and terbinafine cutaneous mycoses. The study also aims to evaluate the effectiveness and safety of these newer topical antifungals. Materials and Methods: It is a Prospective parallel study and a randomized comparative study done at Department of Skin and VD, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar to evaluate the efficacy of newer antifungal drugs. Study population as a total 300 patients, needed to be enrolled in the study based on the inclusion and exclusion criteria. All the patients are aged between 18 to 70 years. Patients will receive the newer antifungals randomly and the test product needed be applied once daily for 1 week in patients with Tinea cruris/ Tinea corporis. Follow up as the first follow up will be at 1 week and all the patients will be evaluated for clinical parameters and global clinical response. The second follow up is at 4 weeks and all the patients are again needed to the assessed for the parameters. Adverse events were recorded at each visit. Results: A study population included 186 (62.0%) male patients and 114 (38.0%) female patients, the youngest patient was 18 years and the oldest was 69 years. The efficacy was higher in Sertaconazole (93.3%) group followed by Luliconazole, Amorolfine, Terbinafine. Conclusion: The efficacy was higher in Sertaconazole (93.3%) group followed by Luliconazole, Amorolfine and Terbinafine. And the Adverse events order as follows Luliconazole >Terbinafine >Amorolfine >Sertaconazole.

41. Prospective Evaluation of the Clinical and Functional Outcome of Total Knee Replacement in Patients with Primary Knee Osteoarthritis
Kanhaiya Lal Gupta
Abstract
Aim: Observational study to evaluate functional out-come of total knee replacement in primary osteoarthritis of knee joint. Methods: A prospective study was conducted in the Department of Orthopaedics, Jawaharlal Nehru Medical College, Hospital, Bhagalpur, Bihar, India from June 2020 to February 2021. 25 patients were included in this study. Scoring system formulated by the Knee Society Knee Score was used to evaluate the patients before and after surgery. Both knee scores and functional scores are calculated with each amounting to a total of 100 points. Results: There were 5 patients who underwent in bilateral TKR, in both group and 20 patients underwent in unilateral TKR. Out of 5 Patients who underwent in bilateral TKR, among them 3 patients developed post op complications. One patient developed post op deep surgical site infection, for that wound debridement done and antibiotics were given as per culture and sensitive report. Second patient developed knee joint stiffness. For the same patient followed up with physiotherapy reference. Which was gradually improved with time. Third patient who had good functional outcome post operatively but developed difficulty in walking after systemic illness, which includes liver cancer. The average pre-op knee Functional score was 65.8 which improved to an average post-op score of 83.68 At 6 month follow up, 19 patients (76%) had excellent, 2 patients (8%) had good, 2 patients (8%) had fair, and 2 patients (8%) had poor results as per KFS. The average pre op knee Clinical score was 47.4, which improved to a post op score of 83.84. At 6 month follow up, 18 patients (53%) had excellent, 5 patients (20%) had well, 1 Patient (4%) had fair and 1 patient (4%) had poor results as per KCS. Conclusions: Primary Total Knee Arthroplasty improves the functional ability of the old patient above 70 years and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post- op Knee Clinical Score and Knee Functional Score.

41. Stress Management Knowledge, Attitude, and Behaviour Among Medical Students
Kapil Kumar Singh, Jeetendra Kumar, Saurabh Kumar
Abstract
Aim: Evaluation of knowledge, attitude and practice regarding stress management among undergraduate medical students at Bihar region. Methods: A cross-sectional, questionnaire-based study was conducted in the Departmen of Pharmacology, JLNMCH Bhagalpur, Bihar, India for 12 months. A total of 260 undergraduate students of first year, second year and third first year of MBBS were briefed on the aims and objectives of the study and written informed consents were obtained from those who were willing to participate in the study. The questionnaire consisted of age, study year and gender of the participating students which was followed by 12 questions regarding knowledge, attitude and practice on stress management. The students were asked to fill the questionnaire by themselves within 30 minutes of time. Results: The most common condition related to stress is depression (57.6%), followed by anxiety (36.3%). Only 35.7% of students could answer the correct clinical features confronted by a person under stress. 11.9% of students strongly agreed and 45.7% of students fairly agreed that they have faced difficulties in adapting to the new environment and away from home, these observations were particularly founded in first-year students. Socio-behavioural problem was the most common non-academic cause of stress faced by 41.1% of students. 64.6% students of all years of MBBS had confronted stress because of study performance anxiety among colleagues. Most commonly used stress coping strategy by the students was listening to music especially in female students, followed by watching internet videos particularly in male students. A total of 12.3% students thought that a balanced and healthy diet can make mind healthier, 68.1% of students indulged themselves in various hobbies when felt stressed out and listening to music and singing (32.7%) and playing outdoor games (23.1%) were the most common hobbies. Only 19.7% of students worked harder and faster when under stress, 13.8% of students behaved irritably and took out their stress on surrounding people and 24 (9.2%) third-year male students became addicted to smoking and alcohol. Conclusion: The significant level of perceived stress among majority of medical undergraduates owing to various stressors such as academic, environmental, psychological and socio-economical factors.

43. An Open Labelled, Randomized Controlled Trial to Evaluate Acute Antidepressant Activity of Ciprofloxacin and Levofloxacin by Using Tail Suspension Test in Swiss Albino Mice
Khursheed Anwar, Saurabh Kumar, Jeetendra Kumar
Abstract
Aim: Acute antidepressant activity of ciprofloxacin and levofloxacin by using tail suspension test in swiss albino mice. Methods: The study was an open labeled, randomized controlled trial conducted in the Department of Pharmacology, J.L.N.M.C.H. Bhagalpur, bihar, India for 15 months, after taking the approval of the protocol review committee and institutional ethics committee. Swiss albino mice weighing 20-25 gm were divided randomly in to six groups. Group I: 1% Gum acacia, 10ml/kg (Control), Group II: Imipramine (Standard), 10mg/kg, Group III and IV, Ciprofloxacin 25 & 50 mg/kg respectively, Group V & VI, Levofloxacin, 25 & 50 mg served as test groups respectively. Results : Immobility duration based on mean± SD was 86.67 ± 2.61 sec for control, 52.50 ± 5.95 sec for Imipramine, 63.50 ± 19.00 sec and 67.17 ± 10.21 sec for Ciprofloxacin 25mg/kg and 50mg/kg respectively. Similarly, immobility duration for Levofloxacin was 68.67 ± 14.41 sec and 69.00 ± 18.85 sec respectively. Conclusion: This study did not show any antidepressant activity of both the drugs by tail suspension test in Swiss albino mice which is a contrary result compared to our previous study of forced swim test with significant antidepressant effect.

44. A Study to Evaluate the Clinical Outcome of RTA-Related Head Injuries Treated at Tertiary Care Hospital : A Retrospective Study
Manoj Kumar, Radha Raman Singh, Kumar Saurav
Abstract
Aim: A clinical analysis of outcome in management of head injury in patients with highway road accidents. Methods: A retrospective study was conducted in the Department of Forensic Medicine and toxicology, Nalanda Medical College and Hospital, Patna, Bihar, India for 15 months. The data was collected regarding demography, mode of injury, clinical presentation, and condition at admission, treatment given, hospital stay and outcome of these patients. All patients were clinically evaluated by a team comprising of doctors from surgical, medical and orthopedics specialties in the emergency department and subsequently admitted and treated at Neurosurgery. Plain CT scan head along with X-ray of cervical and for dorsolumbar spine were carried out to rule out other injuries. Whenever necessary, CT scans of spine, USG abdomen (FAST). Results: According to the data collected 38 (41%) patients were under alcoholic influence, 87(97%) patients had history of LOC, 47 (50%) patients had ENT bleed and 7 (7.5%) had CSF leak at the time of admission. At the time of admission glasgow coma scale (GCS) score of less than 8 was seen in 31 (33%) cases. GCS between 9 to12 was seen in 47 (52%) cases and GCS between 12 to 14 was seen in 12 (15%) patients (Table 2). Plain CT scan of head revealed, 39 (42%) patients had EDH, 33 (35%) patients had SDH, 10 (11%) patients had cerebral contusion, 5 (6%) patients with SAH and 3 (3%) patients with DAI. Thirty three (33%) patients were managed conservatively using anti-epileptics, diuretics and osmotic agents. In patients with less than 8 GCS, ICP monitoring was done initially, 35 (39%) patients underwent craniotomy and evacuation, 2 (2%) patients underwent craniotomy and decompression and 23(26%) patients underwent burr hole and evacuation of clot. Associated injuries were seen in total 18 (20%) of patients. 5 (5%) patients had limb fractures, 7 (8%) patients had fasciomaxillary fractures and 6 (7%) patients had chest injuries. At the time of discharge, 70 (70%) patients had GCS of 13, 18 (17%) patients had GCS of 14 and 4 (3%) patients had GCS of 13. Conclusion: RTA is an unfortunate economic burden for our nation. Head injury due to RTA is a recognized major public health problem causing death and disability among the population.

45. A Retrospective Investigation of the Current MMR and the Cause of Maternal Mortality Study
Kumari Nutan, Rajendra Prasad
Abstract
Aim: To assess the existing MMR and the causes of maternal mortality. Materials and Methods: The present retrospective hospital based study was conducted in the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar over a period of 1 years. Results: A total of 56 deaths were analyzed. The mortality rate in study period was 333 per 1,00,000 live births. Maximum maternal deaths (60.7%) were reported in the age group 21-25 years. More deaths were reported in multiparous women (67.9%) as compared to primiparous women (32.1%). Most of them were unbooked cases (60%). Hemorrhage (30.4%), eclampsia (16.1%), sepsis (12.5%) and embolism (7.1%) were the major direct causes of maternal death. Anemia (16.1%) was the major indirect cause of death. Conclusions: Hemorrhage is the leading cause of maternal death followed by hypertensive disorders and sepsis. Anemia continues to be the most common indirect cause. Majority of maternal deaths were preventable by proper antenatal care, early detection of high risk pregnancies and their timely referral to tertiary care centre.

46. A Retrospective Research to Determine the Incidence of Hypocalcaemia in Patients Receiving Complete Thyroidectomy for Papillary Cancer
Pankaj Kumar, Kumar Ratnesh, Anamica Arya
Abstract
Aim: Study of incidence of hypocalcaemia in patients undergoing total thyroidectomy for
papillary carcinoma. Methods: The prospective study was conducted in the Department of general surgery J.L.N.M.C.H. Bhagalpur, Bihar, India for 12 months. A total 30 patients who underwent bilateral thyroidectomy for papillary carcinoma were analysed. Data was collected from the patients undergoing total thyroidectomise by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigations including serum calcium and serum albumin, operative findings and follow-up of the cases will be done after surgery for post-operative hypocalcaemia. Results: In this study 30 patients underwent total thyroidectomy for papillary carcinoma were studied. Patients with altered calcium before surgery were excluded. 27 female patients and 3 males’ patients were included. According to age distribution higher incidence of hypocalcemia occurred in patients between 20 to 35 years. During surgery, all precautions were taken recurrent laryngeal nerve and parathyroid glands. Recurrent laryngeal nerve was identified in 12 (93.33%) patients on right side and 13 (96.67%) patients on left side. In post-operative period, all the patients were thoroughly examined and evaluated for signs and symptoms of hypocalcemia like paresthesia’s, carpopedal spasm, convulsions, Chvostek’s sign and Trousseau’s sign. Post-operative progress of the patients showed that paresthesia was observed in 18 (60.0%) patients, Chvostek’s sign in 10 (33.33%), Trousseau’s sign in 3 (10%) and convulsion in one patient. In none of the patients, authors found carpopedal spasm. Conclusion: Post-operative hypocalcemia remains a frequent complication which can be avoided by identification of risk factors, by following proper meticulous surgical technique.

47. To Compare Clinical and Histopathological Diagnosis, Taking into Account History, Clinical Features, and Differential Diagnosis
Prem Prakash Pravakar
Abstract
Background: The pattern of skin diseases varies from country to country and even region to region within a country. The histological diagnosis is used by clinicians to aid in the management of patients & most appropriate clinical interventions. Aim: The study aims to compare clinical diagnosis with histopathological diagnosis and find factors that affect their correlation, taking cognizance of history, clinical details and differential diagnosis. Materials and Methods: The study included a total of 500 skin biopsies for 2 years in Department of skin and VD and Department of Pathology, Anugrah Narayan Magadh Medical College, Gaya, Bihar. Data collection was by convenience sampling, and recordings of clinical notes and results of skin biopsies of suitable cases seen at the out patient clinic were collated. Details of patient’s age, gender, folder number, clinical history and diagnosis, histologic report as well as histologic diagnosis were documented. The results were seen as correlating when the provisional clinical diagnosis or any of the differential diagnosis agreed with the histopathological diagnosis and discordant when the provisional clinical diagnosis or differential diagnosis varied with the histopathological diagnosis. Results: The majority of the patients were in the age group of 31-40 years. The most common skin disease is non-infectious vesicobullous and vesicopustular disease (28.6%), followed by non-infectious erythematous papular and squamous disease (25.9%). The most common vesicobullous disease is spongiotic dermatitis (84.8%). Erythema dyschromicum perstans (31.8%) is the commonest non- infectious erythematous papular and squamous disease. The most common microbial disease is fungal infection, followed by leprosy. Among the neoplastic diseases of skin, tumors of epidermis are commonest diseases and the most common epidermal tumor is basal cell carcinoma. The commonest tumor of skin is melanocytic nevus. The most frequent site is upper extremities. Conclusion: Eczema is predominating non-infectious vesicobullous and vesicopustular disease. A relatively higher, prevalence of fungal infections was observed. Basal cell carcinoma is the commonest epidermal tumor and melanocytic nevus is commonest of all skin tumors.

48. Serum Prolactin Levels and Toxoplasma Infection: A Prospective Observational Study
Ram Dayal Singh
Abstract
Aim: To study the of serum prolactin levels and Toxoplasma infection in humans. Methods: A prospective study was conducted in the Department of General Medicine, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. A total of 343 blood samples were collected from individuals who had been referred for PRL measurement in medical diagnostic laboratories. Demographic characteristics such as sex, age, marital status, and current pregnancy status were recorded through questionnaires. ELISA was designed to detect anti-Toxoplasma IgG antibody in blood sera. Results: Of the total participants, 70% were women and 30% men. The highest frequency of participants 43% were found in the age group of 30–40years. Of 343 blood serum samples, 110 samples (32%) had anti-Toxoplasma IgG. Participants were divided into five age groups of below 19, 20–30, 30–40, 40–50, and above 50 years. According to the age of participants, the prevalence of anti- Toxoplasma IgG in 343 blood serum samples was as follows: <19 age group, (18.7%); 20–30, (29.8%); 30–40, (34.9%); 40–50 age group, (31.6%); and >50 age group, (38.5%). Of 240 serum samples of women, 68 (28.3%) had anti-Toxoplasma IgG while of 103 serum samples of men 42 (40.8%) had anti- Toxoplasma IgG antibody .In total, of 343 serum samples, 171 (49.8%) were considered as normal range of PRL, 16 (4.7%) and 156 (45.5%) samples were considered as hypoprolactinemia and hyperprolactinemia, respectively. Conclusion: The results of the current study confirmed the previous studies based on immuno regulatory role of PRL and indicated that high levels of PRL could be related to T. gondii seronegativity in women.

49. A Prospective Evaluation of the Utilisation of a Locking Compression Plate in the Treatment of Tibial Plateau Fractures in Adults
Rajendra Prasad, Kumari Nutan
Abstract
Aim: To study of management of tibial plateau fractures by locking compression plate in adults. Methods: A prospective study was conducted in the Department of Orthopaedics, NMCH, Patna, Bihar, India, for the period of 1 year. 50 patients with tibial plateau fractures above 18 years of age were included in the study. Age group adults (>18 years), radiologically diagnosed tibial plateau fractures and open fractures Gustillo Anderson type I and II. All tibial plateau fractures were graded preoperatively using Schatzker classification. The functional outcome of the patients were assessed using knee society score (KSS). Results: Majority of the patients was males and in the age group of 30-50 years with right sided predominance. Schatzker type V and VI were the most common fracture patterns observed. Good results were obtained in 44% and excellent results in 38% of the patients. Fair results in 14% and Poor results were obtained in only 4% of the patients. Mean union time was about 4.6 months with 86% patients showing radiological union within 6 months. 4 patients showed delayed union with 3 showing non-union. Mean range of flexion was found to be 116 degrees, with 82% of the patients showing functional range of flexion (110 degrees or more). 4 patients showed an extension lag of 5 degrees while 1 other patient had an extension lag of 10 degrees. 4 % (2 patients) had knee stiffness. Conclusion: Locked compression plates in tibial plateau fractures has revolutionized the way these fractures are managed. It has the following advantages- Anatomic reduction of the articular surface is of utmost importance.

50. A Case Control Study to Examine Vitamin D Insufficiency in type 2 Diabetes and the Impact of Hyperglycemia on Blood Vitamin D Levels
Shachindra Kumar Astik, Bindu Arya
Abstract
Aim: The aim of the study to assess the prevalence and severity of vitamin D deficiency in type 2 DM as well as to record the effect of hyperglycaemia on serum vitamin D level. Material and methods: A case-control study was conducted in the Department of General Medicine ,Nalanda Medical College and Hospital, Patna, Bihar, India from August 2019 March 2020. Total 240 participants were include in the study out of which 120 healthy people were include as case (Group A) and 120 type 2 diabetic patients as controls (Group B). Routine laboratory Investigations like CBC, FBS, RBS, PP2BS, HbA1C, blood urea, serum creatinine, lipid profile, urine albumin and Vitamin D3 levels were done by standard methods in central laboratory of Institute. Results: Prevalence of low vitamin D level in healthy population was only 23.33 % in my study, while prevalence was 85.83 % in Diabetic group. Among diabetic patients having abnormal Vitamin D level, majority (65%) were having insufficiency, only 20.83% were having over vitamin D deficiency in Diabetic patients. In patients with controlled diabetes as per HbA1C criteria, the prevalence of sufficient, Insufficient and Deficient Vitamin D was 18.51%, 61.11% and 16.67% respectively, where in patients with uncontrolled diabetes it was 10.60%, 68.18% and 24.24% respectively. More number of diabetic patients with uncontrolled status (24.24%) was having overt vitamin D deficiency in comparison to controlled status (16.67%). There is a significant association between the maintenance of euglycemia and severity of Vitamin D level in diabetic patients, as the p value is less than 0.05. Conclusion: control of diabetic status is mandatory in order to prevent vitamin D deficiency.

51. An Open Labeled, Randomized Controlled Trial to Study the Effect of Drugs Modulating Serotonergic Systems on the Analgesic Action of Paracetamol in Mice
Saurabh Kumar, Kapil Kumar Singh, Jeetendra Kumar
Abstract
Aim: Effect of drugs modulating serotonergic systems on the analgesic action of Paracetamol in mice. Methods: The study was an open labeled, randomized controlled trial conducted in the Department of Pharmacology, J.L.N.M.C.H. Bhagalpur, Bihar, India for 1 year. Thirty adult albino mice weighing 25–30 g of either sex were used in our study. Housing was done in standard cages (6 animals per cage) with food (standard chow) and water ad libitum and maintaining a 12-h light-dark cycle. Animal coding was done according to standard protocol and animals were randomly allocated to different experimental groups. All tests were performed between 09:00 a.m. and 04:00 p.m. to minimize the confounding effects of circadian rhythms. The mice were divided into five groups of six animals each as follows: Group 1: Control – PCT alone, Group 2: PCT + buspirone, Group 3: PCT + ondansetron, Group 4: PCT + fluoxetine, Group 5: Negative control: Distilled water. The drugs were administered to the various groups as PCT: 200 mg/kg intraperitoneally, Buspirone: 10 mg/kg orally, Ondansetron: 4 mg/kg orally, Fluoxetine: 10 mg/kg orally. Animals in Group 2 and 3 were administered respective drugs 30 min before PCT. Group 4 animals were pre-treated with fluoxetine for 7 days and 30 min before PCT on the day of the experiment. Exactly 45 min after PCT injection the animals were evaluated for analgesic effect. Results: Reaction time in PCT treated group was significantly increased (P < 0.0001) as compared to the Control group. The most effective group found was fluoxetine + PCT group, with reaction time of 10.33 ± 0.614 s, whereas the buspirone + PCT showed a decrease in reaction time than PCT group (P < 0.0001). Ondansetron + PCT group also showed decrease in reaction time in comparison to PCT group (P = 0.013). In this model, PCT was found to cause a significant reduction in the licking time compared to control group (P = 0.009) suggesting analgesic activity in the early phase (0–5 min). Co-administration of fluoxetine + PCT showed more analgesic effect than PCT alone, however this increase was not statistically significant (P > 0.05). The paw licking and shaking time following the administration of buspirone + PCT was significantly increased as compared to PCT group (P = 0.0122). Analgesic effect in the ondansetron + PCT group was less than PCT alone, however this decrease was not statistically significant (P > 0.05) . During the late phase, the injection of PCT showed significant reduction in the duration of paw licking as compared to Control group. PCT + buspirone and PCT + ondansetron group also showed analgesic action comparable to PCT (P > 0.05). On the other hand, the PCT + fluoxetine group exhibited total nonexistence of the late phase as shown by lack of paw licking post the formalin injection (P < 0.001) . Conclusion: Pain threshold of mice who were administered PCT + buspirone was decreased suggesting involvement of 5HT1 receptors in mechanism of nociception. Whereas higher analgesia is produced by co-administration of SSRI (fluoxetine) + PCT. These findings support the hypothesis that there is an underlying role of central serotonergic system in the mechanism of analgesic action of PCT. It can further be explored, if this action of PCT is increased by 5-HT1A and 5HT1B antagonists or SSRI and SNRI. If so, this combination might lead to development of new strategy in therapeutics of pain.

52. An Observational Research to Determine the Co-morbidities Associated with Severe Acute Malnutrition
Sushil Kumar Pathak, Saroj Kumar
Abstract
Aim: To evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Material and Methods: The study was an observational study which was carried in the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India, for the period of 1 year. Total 300 Children below 6 year age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: out of 300, 94% were associated co-morbid conditions in SAM. Majority of children with SAM were having co-morbidity in the form of Anaemia (85%), Diarrhoea (63%) followed by pneumonia (30%), Rickets (28%), Tuberculosis (15%), Otitis media (14%), UTI (10%), Celiac (5%), Hypothyroidism (3%), & HIV (2%). Mean age (SD) of the diarrheal cases was 37(6) months (95% C.I. 23.7- 26.5) of which 37 were male (58.73%). Mean age (SD) of non-diarrheal cases was 28(6). (95% C.I. 16.6 – 19.4) of which 75.67% were male. Among 300, 189 (63%) SAM children presented with diarrhea of which 184 had dysnatremia in the form of Hyponatremia & Hypernatremia. No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.08). Serum Potassium levels of 100 SAM children were analysed. It was found that 22% SAM children were having hypokalemia. Hypokalemia was found in 13% of diarrheal cases & 9% in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.023) between Diarrheal & Non diarrheal cases. Conclusion: we conclude that dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions. Hence, we recommend that due care is to be given for management of dyselectrolytemia in complicated SAM children.

53. Clinico-etiological and Demographic Profile of Children Presenting with Seizures: A Cross Sectional Study
Vinay Kumar, Sanjeev Kumar, Bibha Kumari, Binod Kumar Singh
Abstract
Aim: To study the clinic-etiological profile and use of antiepileptic drugs in children presenting with seizures. Methods: The present prospective observational study was conducted in the Department of Pediatric, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. A total of 120 children with acute symptoms and signs of seizures were studied. History was obtained to determine the possible cause of the seizure and type of epilepsy. The data obtained was analyzed with SPSS version 20. Results: out of total 120 children majority were found in the age group of 1-4 years and males had higher prevalence compared to female. Primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen. Unconsciousness’ 51.7%, fever 40.8%, vomiting 26.7%, and headache 20% were the leading presenting complaints in seizure patients. Conclusions: The study showed primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen, followed by focal seizures. Effort should be intensifying to eradicate the preventable causes of the disease.

54. Treatment of Type I and Type IV Capitellar Fractures by Open Reduction & Internal Fixation – A Series of 16 Cases
Ajoy Kumar Manav, Kumar Shashikant, Abhinav
Abstract
Objectives: The purpose of the present study was to evaluate clinical, radiographic, and patient-based functional outcomes following the open reduction and internal fixation of capitellar fractures. Material and Methods: An observational study of 9 years duration was conducted on 16 patients admitted in the Department of Orthopaedics of Patna Medical College & Hospital in the age group of 20 to 58 years. The patients were treated by open reduction and internal fixation of type 1 & type 4 capitellar fractures. An extensile lateral approach was used, and fractures were fixed by K-wires (5), cannulated cancellous screws (6), or headless screws (5). Patients were followed up to an average of 36 months. Evaluation of the patients post operatively was done according to the Mayo elbow performance index (MEPI). Results: Union occurred in all the cases. There were no case of instability or AVN. The mean MEPI was 87 points with 6 excellent outcomes, 7 good outcomes, 2 fair outcomes and one poor rating. The mean range of movements at elbow in flexion\extension was 1250 (1150– 1350) while range of movements in pronation\supination was 1700 (1200– 1800). Conclusion: Open reduction and internal fixation is preferred mode of treatment for type 1 and type 4 capitellar fractures. Radiological and functional outcomes are good to excellent in most of the cases using the extensile lateral approach for surgery.

55. Incidence of Facial Nerve Canal Dehiscence in Primary Cholesteatoma Surgery: A Prospective Clinical Study
Preeti Sharma, Ratnesh Kumar, Vineet Sinha
Abstract
Background: Chronic otitis media surgery is the most prevalent operation in the field of otology, particularly in developing countries with one of the ominous intra-temporal complications being facial nerve paralysis. Material and Methods: After written informed consent, this prospective clinical study was carried out in a tertiary care hospital in Bihar. Inclusion criteria was all canal wall down tympanomastoidectomy in patients who suffers from chronic otitis media. All patients with bells palsy, tumours, history of traumatic fracture of temporal bone and patients with any documented congenital anomaly were excluded from the study. Results: Intra-operative findings under high magnification microscope examination revealed dural plate dehiscence in 29 patients (36.25%). In 6 patients (7.5%) we encountered labyrinthine fistula. Sigmoid sinus dehiscence was seen in 7 patients (8.75%). Facial canal dehiscence was seen in 13 (16.25%) patients. Among these 13 patients, most common site was horizontal segment of facial canal (11 patients). Conclusion: Otorrhea (90%) is the most common finding in patients with long standing disease for more than 10 years followed by hearing loss (73.7%). facial nerve paralysis was associated in only 2 patients as relatively rare findings. external auditory canal polyp was present in 18.7% and postauricular abscess / postauricular fistula in 27.5% cases. Facial canal dehiscenece was seen in 16.25% cases with horizontal part being the most common site.

56. A Prospective Study to Evaluate the Impact of Breast Feeding and Bottle Feeding Babies on Maternal and Fetal Health
Anuradha Singh, Manoj Kumar Singh, Chandra Bhushan Kumar
Abstract
Background: In the first days of life, breast-fed infants consume minimal amounts of milk; this may be explained by substrate limitation (limited milk output) and/or by self-limitation (through low appetite and/or suck-swallow competency). It is important to ensure the optimal growth and development of children so that they can effectively contribute towards progress of the nation. Children in their early life are completely dependent for their nutritional requirements on their person both in terms of quantity and quality. This, in term, is influenced by the customs, traditions and beliefs as well as socioeconomics and education status of their parents. Aim: To study the impact of breast feeding and bottle-feeding babies on maternal and fetal health. Materials and Methods: A prospective study was undertaken with 150 breast- and bottle-fed babies and their mothers. They were selected for this study from our OPD using Multistage Stratified Random Sampling Techniques. Results: Out of the 122 babies, majority (46.91%) were suffered from diarrhea, followed by 38.68% from fever and minimum (6.59%) were suffered from jaundice. Out of the 53 breast fed babies, majority (57.14%) were suffered from fever, followed by 22.86% for diarrhea and minimum (9.52%) were suffered from jaundice while out of 69 bottle bed babies, majority (50.72%) were suffered from diarrhea, followed by 39.13% from fever and minimum (4.35%) were suffered from jaundice. Conclusion: Formula-feeding places mothers and infants at increased risk of a broad spectrum of adverse health outcomes, ranging from infectious morbidity to chronic disease. Given compelling evidence for differences in health outcomes, breast-feeding should be acknowledged as the biological norm for infant feeding.

57. A Cross-Sectional Investigation of Paediatric Tuberculosis Cases Diagnosed by CBNAAT in A Tertiary Care Centre was Conducted
Chandra Bhushan Kumar
Abstract
Background: Pediatric tuberculosis (TB) is different than that in adults in several ways. The diagnosis of TB is more difficult in children due to non-specific or complete absence of symptoms and difficulty in confirming the diagnosis microbiologically. Newer diagnostic methods like Cartridge based nucleic acid amplification tests (CBNAAT) can rapidly identify Mycobacterium tuberculosis with improved sensitivity over the smear testing. Aim: To analyze the in-hospital prevalence of Pediatric tuberculosis in children up to 18 years of age. Material & Method: This observational record based cross-sectional study was done 1 year in Department of Pediatrics, Patna Medical College & Hospital, Patna, Bihar, India. The study was carried out by analyzing the clinical & laboratory data of 320 patients treated with ATT. Results: Data of a total of 320 patients was analyzed. In 21.2% of cases gastric aspirate was sampled and Sputum sample was taken in 78.8 % of cases. Out of them, 146 (45.6%) turned reactive for tuberculosis by CBNAAT. 69.4% of children completed treatment and 30.6% were declared cured. Conclusion: This study concludes with 45.6% positivity after CBNAAT testing for tuberculosis infection in collected samples of sputum and gastric aspirate.

58. Early Discontinuation of Antibiotics in Patients with Suspected Early Onset Sepsis Based on A Negative Blood Culture and Their 7-Day Outcome
Shivani Nivedita, Anil Kumar Tiwari, Anil Kumar Jaiswal
Abstract
Aim: the aim of this study to evaluate the early stoppage of antibiotics in blood culture negative term suspected early onset sepsis and their 7 days outcome. Materials and methods: A cross-sectional study were conducted in the Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar India for 12 months. Symptomatic babies >37 weeks of gestation with possible EOS and Gestational age ≥37 weeks with suspected early onset sepsis were included in this study. Results: Out of 186, 178 (95.7%) were symptomatic and 8 (4.3%) were asymptomatic at the time of admission. Maximum death occurred on day 1 of life i.e., 19 (67.8%), on day 2 6 (21.4%) and on day 3, 3 (10.7%). Mortality of culture positive sepsis was found to be 58.4 % (28 deaths out of 48 cultures positive). Among various risk factors studied in relation to suspected early onset sepsis, low birth weight led the list in the present study with 80 (43%) cases, followed by perinatal asphyxia 45(24.2%) and prolonged rupture of membranes 37 (19.9%).A significant association was noted between the incidence of blood culture positivity with 2 risk factors namely, low birth weight and prolonged rupture of membranes (p<0.05).Among 186 cases, 64 (34.4%) had no perinatal risk factors at the time of admission whereas 77(41.3%) had single risk factor. 2 risk factors were noted in 34 (18.3%) of the study population, >2 risk factor 44 (23.7%), ≥ 3 risk factors were seen in 11 (5.9%) of the cases. However, 16 (8.6%) babies had foul smelling liquor. Out of the 64 cases which had nil perinatal risk factor, all were symptomatic at admission. Conclusion:  it was observed that along with evaluation of clinical condition of the baby and 48-hour BacT/Alert blood culture report, antibiotics can be safely discontinued in those babies who are clinically asymptomatic and 48-hour blood culture negative.

59. A Quantitative Questionnaire Based Study to Assess the Effectiveness of Introduction to Early Clinical Exposure as Learning Tool
Bharat Kumar, Vijay Kumar Singh, Sheela Kumari
Abstract
Aim: study of introduction to early clinical exposure as learning tool in physiology. Methods: A quantitative questionnaire-based study was conducted in the Department of physiology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India from January 2021 to July 2021. The 1st year MBBS students were sensitized to ECE by taking a lecture. The meaning of ECE, the purpose, and the methods of conducting ECE were explained to the students. After the session, students feedback was taken by a questionnaire. The questionnaire consisted of student’s perception and feedback on ECE sessions. Results:  Analysis of the open feedback showed that the program had significant impact on the building concept (28%), retention of topic (38%), interactive (28%), and correlating physiology to clinical (50%). Conclusion: To conclude, ECE though challenging, is a way to motivate the students and help in better retention of the knowledge.

60. An Investigation to Assess the Clinical Relationship Between Glaucoma and systemic Hypertension as well as its Impact on Visual Morbidity
Shreya, Binod Kumar Sharma, Priyanka, Srishti Sharma
Abstract
Aim: The aim of present study is to evaluate the clinical correlation of glaucoma with systemic hypertension and its effect on visual morbidity. Methods: This was a prospective study conducted in the Department of Ophthalmology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India, for 10 months. It was performed on 120 patients between the age group of 30 to 65 years which included newly diagnosed hypertensive and previously diagnosed hypertensive receiving treatment and on follow up now. Patients are classified as hypertensive based on elevated BP readings of >120/80 mm Hg on two separate occasions according to current American Heart Association. The oral hypotensive medication taken by patients were categorized into 5 groups as calcium channel blockers (CCB), diuretics, angiotensin converting enzyme inhibitors (ACE), angiotensin receptor blockers and beta blockers. Glaucoma was defined as progressive optic neuropathy associated with visual field loss in which IOP is a modifiable factor according ICO Glaucoma Guidelines. Results: Among the 120 hypertension patients involved in the study, 50 patients (41.33%) were found to have glaucoma. 70 patients (58.33%) were female and 50 patients (41.67%) were male. Age group affected was 15.83% between 30-40 years, 31.67% between 40 to 50 years and 52.50% above 50 years, the mean age being 56.2 years. Decreased IOP was highest among patients taking CCB in 25 patients (46.30%), followed by beta blockers in 4 patients (40%), ACE inhibitors 13 patients (38.24%), ARB 7 patients (43.75%) and diuretics in 1 patient (16.67%). The range of IOP in the treated population was between 10-16 mmHg and this difference in those on hypertension medications was statistically significant with p-value = 0. 01. Conclusion: Hypertension can cause both reduction and elevation in IOP. Treatment of hypertension does lower the IOP and prevent further progression of glaucoma and prevent any visual loss.

61. Susceptibility Pattern of Microorganisms Implicated in the Development of Surgical Site Infection to Antimicrobial Agents
Rajeev Ranjan, Manish Kumar Sinha, Arvind Kumar, Prem Sagar Chaudhary, Neelam Kumari
Abstract
Aim: The aim of the present study to evaluate the antimicrobial susceptibility pattern of microorganisms involved in the pathogenesis of surgical site infection. Methods: The study was a cross sectional study, which was carried in the Department of Microbiology, Vardhman Institute of Medical Sciences Pawapuri Nalanda, Bihar India from August 2020 to June 2021. Using sterile cotton swabs, two pus swabs/ wound swabs were collected aseptically from each patient suspected of having SSI. Gram-stained preparations were made from one swab for provisional diagnosis. The other swab was inoculated on nutrient agar, 5% sheep blood agar (BA) and MacConkey agar (MA) plates and incubated at 37°C for 24-48 hours before being reported as sterile. Growth on culture plates was identified by its colony characters and the battery of standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by Kirby Bauer disk diffusion technique on Muller Hinton Agar. Results: Out of 400 samples, 210 samples were culture positive (52.5%). Out of 210 culture positive samples S.aureus (23.80%) was the most common pathogen isolated followed by Escherichia coli. (23.80%), Citrobacter spp. (14.28%) and Pseudomonas aeruginosa (12.86%) respectively. Among gram negative bacilli, E. coli was most sensitive to Imipenem 90%) followed by Amikacin (78%) and Piperacillin Tazobactam (74%) whereas for Citrobacter spp., Imipenem (83.33%) followed by Gentamicin (53.33%), Ciprofloxacin (46.67%) was the drug of choice then for Klebsiella spp., Imipenem (75%) followed by Gentamicin (45%), Amikacin (45%) was the drug of choice. For Pseudomonas aeruginosa, Imipenem (62.96%) followed by Piperacillin Tazobactam (59.26%), Gentamicin (51.85%) was the drug of choice and for Enterobacter spp., Imipenem (80%) followed by Amikacin (70%), Piperacillin Tazobactam (80%) showed maximum sensitivity. Among gram positive organism, S.aureus showed maximum antibiotic sensitivity to Linezolid (94%) followed by Vancomycin (90%), Amikacin (82%) whereas CONS was sensitive to Linezolid (100%) followed by Vancomycin (93.75%), and Gentamicin (87.5%). Conclusion: The increasing resistance to antimicrobials increases the risk of morbidity and mortality; therefore, there is urgent need of implementation of measures to restrict the health care associated infection.

62. Clinical Study of Efficacy and Safety of Oral Pilocarpine in the Treatment of Severe Dry Eye Disease
Sudhir Kumar, Vineeta Laxmi, Ravi Ranjan
Abstract
Introduction: Dry eye disease is a multi-factorial disease with varied presentation of foreign body sensation with or without visual disturbance. When its presentation is severe and refractory to conventional tear substitution treatment, it maybe it can lead to compromised quality of life. Aim & Objective: The purpose of this study is to effectively treat aqueous deficient, severe dry eyes with oral Pilocarpine, which is conventionally refractory to conventional tear substitute ocular instillation. Material & methods: 32 continuous cases of bilateral dry eye disease with severe symptoms, refractory to the conventional tear film substitute treatment and fitted in our inclusion criteria. All the patients were given oral Pilocarpine tablet of 5 mg once a day. Results: There were mean improvement of 4.37 mm in Schirmer’s value and mean improvement of 3.03 seconds in TBUT. The result was analysed by using two tailed t- test and found to highly significant (p<0.001) for both TBUT and Schirmer’s test. A few patients complained of sweating after taking the medicine which was relieved in few minutes. Discussion: Pilocarpine is widely used as sialagogue. Oral Pilocarpine is approved for management of dry eye in Sjögren’s syndrome and has been ascertained to be effective in dry eye (6-11). Our study shows similar effect of improvement who were otherwise refractory to tear film substitutes without significant adverse effects. Though we do not rule out that many of them may be cases of Sjögren’s syndrome. Conclusion: Oral Pilocarpine (5 mg OD) is safe and effective in otherwise healthy individuals in relieving symptoms of severe dry eye disease in cases who are refractory to various tear film substitutes.

63. A Prospective Research to Investigate the Link Between Serum C-reactive Protein and Disease Severity in COPD Patients
Pramod Kumar Sinha, Md. Nasar Zubair
Abstract
Aim: Evaluating serum C-reactive protein level in patients with chronic obstructive pulmonary disease and its correlation with disease severity. Methods: A prospective study was conducted in the Department of General Medicine, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. for the period of 1 year. 100 COPD patients and 100 asymptomatic individuals were selected as the control group. COPD patients underwent spirometry tests, and the severity of disease was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The main inclusion criteria for COPD patients were having symptoms or history of COPD with FEV1/FVC below 70% after using a bronchodilator. Results: In this study, 200 subjects were investigated (100 patients with COPD and 100 individuals as controls). In the COPD group, 58 subjects (58%) noted cigarette smoking during the study, 18 subjects (18%) reported cigarette smoking in the past, and 34 subjects (34%) mentioned a history of baking. In the control group, 16 subjects (16%) noted cigarette smoking during the study; 8 subjects (8%) mentioned cigarette smoking in the past, and five subjects (10%) reported a history of baking. In this study, hsCRP was measured in 98 patients with COPD and 94 control subjects. The mean hsCRP was 7519±417 ng/mL in the COPD group and 2874±393 ng/mL in the control group. In the comparative study of the two groups using t-test, a significant difference was observed (p<0.001). The COPD group underwent spirometry and blood gas measurements, and then FEV1, FEV1%, FVC, and FEV1/FVC parameters were measured. The severity of the disease was determined by the GOLD criteria, where 32 subjects (32%) were GOLD II, 48 subjects (48%) were GOLD III, and 20 subjects (20%) were GOLD IV. There was no case of GOLD I found among the subjects because patients were hospitalized. Mean FEV1 was 1.25 L/s, mean FVC was 2.126 l, and mean FEV1/FVC was 57%. Conclusion: The findings of the present study demonstrated that plasma CRP is not only effective in the evaluation of inflammation in COPD, but also useful as a marker in monitoring inflammation during COPD treatment. CRP is decreased during treatment by inhaled corticosteroids.

64. A Study to Determine the Early Pregnancy BMI, the Prevalence of Various Levels of BMI, and the Correlation in Order to Analyse the Influence of Low Weight, Overweight, and Obesity on Mother and Foetal Outcomes
Anupam Kumar Chaurasia, Lata Shukala Dwedi
Abstract
Aim: To evaluate the effect of BMI and maternal weight gain during pregnancy on maternal and fetal outcome. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India from July 2019 to March 2020. Pregnant women with viable singleton pregnancy with 1st antenatal visit in 1st trimester (<12 wks) were included in this study. During antenatal period – Gestational hypertension, antepartum haemorrhage, preeclampsia, gestational diabetes. Period of gestation at delivery – abortion (<24weeks), Preterm (24 to 37 weeks), Term (37 to 40 weeks) and post- term (>40 weeks). Onset of labor-Induced or spontaneous. Mode of delivery- vaginal delivery, instrumental or C- section. Perineal trauma and Post partum haemorrhage were studied. Results: A total of 100 pregnant women were include in this study.  Most of the patients age group were 20-25 years (48%) followed by 25-30 years (25%), below 20 years (22%) while only 5% cases were in the age group above 30 year.  In present study, 2 patients were of socioeconomic status of grade I, while only 3% patients were socioeconomic status II. 35%, 36% and 24% patients had their socioeconomic status III, IV and V respectively. Table 3 shows distribution of cases according to BMI group. 10 cases were in group A(≤18.5). 50 cases were in group B (18.51-24.99). 35 cases were in group C (25- 29.99) and 5 cases were in group D (≥30). The mean weight gain in group A is 10.64 ± 5.62, group C is 9.12 ± 1.16, group D is 8.95 ± 1.65 on comparing with group B mean weight gain 10.35 ± 6.0 significantly less mean weight gain in group C and group D (P<0.001,<0.001) respectively. But there is no difference in mean weight gain between group A and B (p=0.81). The incidence of live births, stillbirths and IUD were comparable in all the groups. It was observed that there were 9 (90%) subjects in group A, 48 (96%) women in group B, and 33 (94.29%) subjects in group C and 3 (60%) women in group D who had live births. There were three (2%) stillbirths in group B and zero (0%) in group A, 1 (2.86%) in group C and 1(20%) in group D. In group B there were 1 (2%) IUD and 1 (10%) IUD in group A. 1 (2.86%) and 1 (20%) cases in group C and group D respectively. Conclusion: The study has shown an association between maternal weight (underweight, overweight and obese) and pregnancy outcome. There is importance of prepreg Nancy counselling in maintaining weight of women during pregnancy to avoid maternal and fetal outcomes.

65. Prospective Randomized, Double Blind Controlled Study to Evaluate the Effect of Fentanyl and Tramadol as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block
Md Imran Mehdi, Ambar Khan, Garima Chaurasia, Surendra Singh
Abstract
Aim: To study the effect of fentanyl and tramadol as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Methods: This prospective randomized, double blind controlled study conducted in the, Department of Anaesthesiology and critical care, Era’s Lucknow Medical college and Hospital, Lucknow, Uttar Pardesh, India, for 1 years. 70 patients of either sex aged 20-60 years, belonging to ASA physical status I or II undergoing upper-arm surgery were recruited for this study. Pre-operative visit were performed one day prior to surgery. All the patients were clinically assessed, evaluated and investigated as per proforma. The patients were randomly allocated into 2 groups of 35 patients each. Group RT: Patients were given 0.5% Ropivacaine 30ml + tramadol 50mg [1ml]. Group RF: Patients were given 0.5% Ropivacaine 30ml + fentanyl 50mcg [1ml]. Results: Mean interoperative VAS score of Group RT and Group RF at 5 minute was 5.10 and 6.15, at 10 minutes it was 2.50 and 4.07 in both the study groups. Mean VAS score at 15 minutes was 0.84 and 1.92 in Group RT and RF, at 20 minutes mean VAS score of Group RT was 0.32 and that of Group RF was 0.88. Mean interoperative sedation score of Group RT and Group RF at 5 minute was 2.97 and 3.11, at 10 minutes it was 1.97 and 2.11 in both the study groups. Mean sedation score at 15 minutes was 1.06 and 1.20 in Group RT and RF, at 20 minutes mean sedation score of Group RT was 1.09 and that of Group RF was 1.14. Mean sedation score at 25 minutes in Group RF and RF was 1.03 and 1.09, while as it was 1.03 and 1.06 at 30 minutes in both the study groups. Mean time (min) to achieve complete block in Group RT was 20.6 and in Group RF it was 26.1 minutes. Mean time (hours) of sensory block in Group RT was 13.7 and in Group RF it was 7.8 hours. Mean duration (hours) of motor block in Group RT was 13.1 and in Group RF it was 7.2 hours. Mean postoperative VAS score of Group RT and Group RF at 3 hours was 0.43 and 1.31, at 6 hours it was 0.57 and 2.77 in both the study groups. Mean VAS score at 9 hours was 1.40 and 3.97 in Group RT and RF, at 12 hours mean VAS score of Group RT was 2.60 and that of Group RF was 2.46. Mean postoperative VAS score at 15 hours was 3.43 and 2.97 in Group RT and RF, at 18 hours mean VAS score was 1.26 in RT group and 2.89 in RF group. At 21 hours mean postoperative VAS score was 1.94 and 2.71 in both the study groups, while as at 24 hours mean VAS score was 2.14 in Group RT and 2.94 in Group RF. Conclusion: We concluded that the brachial plexus block is essential for effective surgical anaesthesia and analgesia. It not only eliminates stress response to surgery but also helps in smooth transition of patient from surgery to routine preoperative state. High satisfaction scores were reported by patients in both groups of our study.

66. Study of Anaemia Profile in A Tertiary Care Hospital in Bihar State
Barun Kumar Kundu, Shashi Kant Kumar, Rajnish Kumar
Abstract
Aim: Study of anaemia profile in a tertiary care hospital in Bihar, India. Methods: This was a prospective observational study conducted in the Department of General Medicine, Madhubani Medical College and Hospital, Madhubani, Bihar, India from August 2019 to feb 2020. In all 100 patients thorough history was taken, general physical examination and systemic examination were done. Patients were subjected to routine blood investigations including complete blood count, peripheral smear study and serology for viral markers. Results: 50 (50%) were easy fatiguability and generalised weakness the most common symptoms of anaemia in our study. Incidentally detected patients constituted 33% of patients and were the second most common in occurrence. This was followed by breathlessness seen in 21% of patients. Pallor was noted in all patients. Platonychia/koilonychia suggesting iron deficiency anaemia was seen in 28(28%) of patients, whereas knuckle pigmentation suggestive of megaloblastic anaemia was observed in 19(19%) of patients. 16 (16%) patients presented with anaemia in failure as evidenced by elevated jugular venous pulse and pedal oedema. None of the patients in this study was due to hemolysis. Hence icterus seen in 8(8%) patients was due to ineffective erythropoiesis seen in patients with megaloblastic anaemia. On systemic examination haemic murmurs on CVS examination were detected among 24(24%) patients. Bibasilar crepts not attributable to other diseases were found among 6 patients. Isolated hepatomegaly was found in 13(13%), splenomegaly in 8(8%) and hepatosplenomegaly was found in 8 patients. Whereas severe anaemia showed 86 (86%) highest occurrences. Microcytic hypochromic anaemia 48(48%) attributed to iron deficiency unless proved otherwise was the most common form of anaemia in our study. Dimorphic anaemia 28(28%) was the second most common suggesting that nutritional anaemia continues to predominate in our part of world. Conclusion: we conclude that some extensive steps taken by WHO and Government bodies in educating and treating people about the disease.

67. To Assess the Impact of Internet Use on Adolescent’s Mental and Physical Health
Tulika, Sanjeev Kumar Sinha
Abstract
Background: Social media is the most prominent communication tool of choice for adolescents. Therefore, it is important to understand the relationship between the frequency of social media use and health behaviors among this population. Objective: To determine the effect of internet use on the psychosomatic and physical health of adolescent children. Materials and Methods: This cross-sectional study was carried out by the Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India, during the period of June 2019 to May 2020. “Young people’s internet usage questionnaire” was handed over to everyone to enquire internet use practices. We measured frequency of social media use using a Likert-like scale. A structured interview accommodating various factors and statements from the internet addiction test was used to find the level of internet addiction. Results: Out of 390 participants, only 94 (24.10%) were the normal users; 112 (28.20%) had mild prevalence of internet addiction, 147 (37.70%) had moderate and 37 (9.49%) had severe prevalence for internet addiction. Conclusion: The internet addiction scores in adolescents have a significant relationship to the various types of illnesses and the duration of illness of their parents. Excessive use of the Internet undesirably affects one’s physical and mental health and social wellbeing.

68. A Hospital Based Prospective, Observational, Cohort Study to Determine the Association Between Type of Arrhythmias and Site involved Along with Mortality in Consecutive Cases After Thrombolysis by Streptokinase within 24 Hours
Nilashish Dey
Abstract
Aim: To determine the association of type of arrhythmias and site of myocardial infarction. Materials and methods: A hospital based prospective, observational, cohort study was conducted with 90 patients in the Department of General Medicine, Bokaro General Hospital, in Bokaro district of Jharkhand, India, during January 2018- December 2018. Detailed history regarding chest pain, palpitation, sweating, vomiting, dyspnea, giddiness was asked, past personal and family history was asked. General and systemic examination was done. Information was collected through a pre tested and structured proforma for each patient. Cases was studied for arrhythmias complicating AMI, in terms of their incidence, timing, duration, severity, type, relation to the involved site, reperfusion and end result. Patient who showed arrhythmias on monitor, but whose arrhythmias couldn’t be recorded on ECG paper due to the transient nature of the arrhythmias, was included in the study as a positive case. Patient having VF or any other arrhythmias, who died before recording could be done or in whom urgency of the situation prohibited the recording, was considered as positive cases of arrhythmias. Results: There was no significant association of ventricular arrhythmias, Bundle branch block (BBB), Sinus tachycardia, Iº and IIº AV block (AVB), Complete Heart Block (CHB) (IIIº), Sinus bradycardia and site of myocardial infarction as per Chi-Square test (p>0.05). There was no significant association of mortality and type of arrhythmias. Conclusion: The most common arrhythmia after reperfusion with STK is ventricular tachycardia (24.4%) and least common is atrial ectopics (1.1%). Other common arrhythmias are AIVR (12.2%), VPB (7.8%), bundle branch blocks and first degree AV blocks. The most common mode of termination is pharmacological.

69. A Hospital Based Prospective, Observational, Cohort Study to Determine the Association Between Type of Arrhythmias and Site involved Along with Mortality in Consecutive Cases After Thrombolysis by Streptokinase within 24 Hours
Nilashish Dey
Abstract
Aim: To analyze the incidence of various types of arrythmias, site involved and mortality in consecutive cases after thrombolysis by streptokinase within 24 hours. Materials and Methods: A hospital based prospective, observational, cohort study was conducted with 90 patients in the Department of General Medicine, Bokaro General Hospital, in Bokaro district of Jharkhand, India. Detailed history regarding chest pain, palpitation, sweating, vomiting, dyspnea, giddiness was asked, past personal and family history was asked. General and systemic examination was done. Information was collected through a pre tested and structured proforma for each patient. Cases was studied for arrhythmias complicating AMI, in terms of their incidence, timing, duration, severity, type, relation to the involved site, reperfusion and end result. Patient who showed arrhythmias on monitor, but whose arrhythmias couldn’t be recorded on ECG paper due to the transient nature of the arrhythmias, was included in the study as a positive case. Patient having VF or any other arrhythmias, who died before recording could be done or in whom urgency of the situation prohibited the recording, was considered as positive cases of arrhythmias. Results: The mean age of male and female patients was 54.39 ± 13.37 years and 56.55 ± 13.44 years respectively. The most common symptom was Chest pain (77.8%) followed by Sweating (61.1%), Dyspnea. 22 (24.4%) and 18 (20%) patients had hypertension and acute coronary syndrome respectively. The site of myocardial infarction in majority of the patients (57.8%) was anterior wall. The incidence of supraventricular arrhythmias was 6.6%. The incidence of ventricular arrhythmias was 44.4%. There were 10 (11.1%) cases of Right bundle branch block (RBBB). On analysis it was observed that in our study 25 (27.8%) patients died. Conclusion: AMI occur in patients above 60 years of age and they are more common in males than in females. The most common arrhythmia after reperfusion with STK is ventricular tachycardia and least common is atrial ectopics.

70. Clinical Significance of the Association between Mandibular Foramen and Various Landmarks on the Ramus of the Mandible: An Observational Research
Amrendra Prasad Sinha, P.K. Verma, Rajendra Prasad
Abstract
Aim: To evaluate the clinical significance of the association between mandibular foramen and various landmarks on the ramus of the mandible. Methods: The present study was done in the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for 1 year.The material for the present study consists of 110 adult dry human mandibles of unknown sex.  All measurements were recorded using a sliding vernier caliper. Results: A total of 110 adult human mandibles were studied for the location of mandibular foramen. The minimum, maximum, average and standard deviation values of the different parameters were studied on both the sides of the mandible. There was no significant difference statatically between the values obtained on the right and left sides (P>0.05). The percentile of the distance from anterior border of ramus to midpoint of mandibular foramen in relation to the distance from anterior to posterior border of ramus on the right side is 57.69± 3.70% and on the left side it is 63.25 ± 2.55%. The percentile of distance MF-MN in relation to MF – MN+ MF-MB is 50.64 ± 3.72% on the right side and 47.54± 5.33% on the left side. There is no statistically significant difference in the location of mandibular foramen on the right and left sides according to value of P>0.05 in both the anteroposterior axis and super inferior axis. Conclusion: We concluded that the data may also be useful in reconstructive surgery and anthropological assessments. The present study gives knowledge of the position of mandibular foramen and provides useful information regarding site of inferior alveolar nerve block which is routinely used by dental surgeons in performing various procedures like tooth extraction, removal of ramus of mandible by maxillofacial surgeon.

71. Use of Multiparametric Ultrasonography in Determining Parenchymal Thyroid Diseases
Sanjay Kumar Choudhary
Abstract
Aim: The aim of the study was to evaluate of Parenchymal Thyroid Diseases with multiparametric Ultrasonography. Material and Methods: This study was conducted in the Department of Radiology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India for one year. Patients were divided into five groups such as group I (normal); group II had first detected, early untreated Hashimoto disease (EH); group III comprised of chronic Hashimoto patients that are under treatment and/or follow up (H); group IV had multinodular parenchymal hyperplasia (M); and group V had nodular hyperplasia with Hashimoto (HM). They underwent spectral Doppler ultrasound and acoustic radiation force impulse using Siemens ACUSON S 2000 machine. Quantitative spectral doppler parameters such as resistivity index (RI), acceleration time (AT) and quantitative elastography such as shear wave velocity (SWV) was recorded. Results: Out of 250, 60% were male and 40% female most of the patients between 30-40 years 42% and followed by 40-50 years was 32% shows in table1.  The Distribution of patients based on diseases and each group had 50 patients show in table 2.The mean RI in group I was 0.59, in group II was 0.62, in group III was 0.47, in group IV was 0.53 and in group V was 0.55 mean AT in group I was 27.9, in group II was 26.8, in group III was 71.5, in group IV was 47.8 and in group V was 46.5, mean SWV in group I was 1.53, in group II was 1.72, in group III was 1.22, in group IV was 1.46 and in group V was 1.71. The difference was significant (P< 0.05). Conclusion: The resistivity index, acceleration time and shear wave velocity together are reliable for differential diagnosis of parenchymal thyroid diseases.