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%.