Aim: The aim of the study to assess the prevalence and severity of vitamin D deficiency in type 2 DM. Methods: A case-control study was conducted in the Department of General Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India, for 15 months. Total 220 participants were including in the study out of which 110 healthy people were include as case (Group A) and 110 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: The mean age of group A (case) was 51.88±11.36 years while that of group B (control) was 49.92±11.26 years. Total 115 males and 105 females were enrolled in study. 64.55% of group A were male and 35.45% female. Group B (control) had 59.10% males and 40.90 female. Prevalence of low vitamin D level in healthy population was only 22.73 % in my study, while prevalence was 86.36 % in Diabetic group. Among diabetic patients having abnormal Vitamin D level, majority (66.36%) were having insufficiency, only 22% were having overt 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 20.41%, 69.39% and 16.33% respectively, where in patients with uncontrolled diabetes it was 8.20%, 68.85% and 22.95% respectively. More number of diabetic patients with uncontrolled status (22.95%) was having overt vitamin D deficiency in comparison to controlled status (16.33%). 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. Hypertension was most common co-morbidity found in diabetic group (18.18%) followed by ischemic heart disease (4.54%). Conclusion: We concluded that the control of diabetic status is mandatory in order to prevent vitamin D deficiency.

Aim: To estimate and compare the effects of different dietary habits and habits related to physical activity in the development of overweight and obesity among rural school going adolescents. Methods: The prospective cross-sectional study which was carried in the Department of Community Medicine, Netaji Subhas Medical College and Hospital, Amhara, Patna, Bihar, India for 12 months. A prospective follow-up study was conducted among adolescents (14–18 years) studying at secondary and higher-secondary level (Classes IX to XII) in four selected school. The participants, who were permanent residents of the rural areas, were surveyed at the beginning, and a follow-up assessment was done after 6 months. Thus, two repeated measures were taken on each individual participant. A total of 200 participants (80 male and 120 female respondents) were ultimately included in this study. Results: Among the dietary habits, the students reported that 12% went hungry most of the times, 50% were eating fruits less than once a day, and 25% were eating vegetables less than once a day. Regarding frequent intake of soft drinks and fast foods, the prevalence was 46% and 54%, respectively, at the time of initiation. However, on follow-up visit, all the prevalence were seen to be higher except frequent intake of junk foods, which fell down to 50%. Infrequent intake of vegetables was prevalent among 30% of the participants on follow-up. Now, this difference was statistically significant. While the prevalence of unhealthy dietary habits overall was noted to be 70% at the baseline, there was a marginal decrease to 68%. However, this difference also was not significant statistically. Risk factors pertaining to physical activity among adolescents, for example, usually not walking or cycling to school increased to 33% on follow-up compared to 30% at the baseline. However, there was a marginal decrease in prevalence of sitting activities from 15% at the baseline to 14%. Similarly, for inadequate other daily physical work, the prevalence decreased from 25% to 24%. Conclusion: Strong evidence was generated of dietary practices being more rigidly related to overweight among the adolescents. Healthy dietary practices coupled with physical activity should be promoted to mitigate the risk of obesity.

Aim: The aim of the radiological Study to Establish the Accuracy of MRCP over USG & CT in Diagnosing the Case of Obstructive Jaundice. Methods: A cross-sectional prospective study was conducted in the Department of Radiology, Narayan medical college & Hospital, Jamuhar, Sasaram, Bihar, India, for 15 months. 50 patients clinically diagnosed as suffering from   obstructive jaundice and total Bilirubin greater than 5mg/dl were included in this study.  All the patients in the study underwent USG examination first followed by MRCP and finally CT. Results: Of the 50, seventeen patients had benign lesions while 26 patients had malignant lesions. While MRCP and CT had diagnosed 48 of the seventeen lesions, USG could diagnose all the benign lesions. However, USG had diagnosed several of the malignant lesions as benign. MRCP has 98% accuracy in detecting the site of obstruction followed by CT and USG. The sensitivity of MRCP and CT is the same for both modalities while it is 98%forUSG. In spite of the high sensitivity for USG, the specificity for the same is very low at 64% when compared to that of CT’s 64% and MRCP’s 98%. Thus, USG is a very good screening tool for benign lesions for obstructive jaundice while CT and MRCP are the specific investigations. The MRCP is again the most accurate investigation with an accuracy up to 98%. The sensitivity and specificity of MRCP is high making it more accurate while USG and CT have high sensitivity their specificities are low. The MRCP has the largest area among the three investigations, proving it to be the most efficient investigation in the detection of malignant lesions. Conclusion:  In the diagnosis of obstructive jaundice and to know the cause, site and extent of the lesion MRCP being a non-invasive, non-ionizing procedure seems to be a better choice over other radiological procedures like USG, CT or ERCP.

Aim: To establish the metrical factors for estimating height from the long bones of the superior extremities in humans. Methods: This prospective observational study was carried out in the Department of Anatomy, JNKTMCH Madhepura, Bihar, India, for 10 months, Asymptomatic 200 healthy students (adult males and females) and staffs between 18 to 50 years of age were included in this study. For height measurement “anthropometer” was utilized and for measuring lengths of humerus, radius and ulna “spreading calipers”. Results: The Standard Error of Estimate works out to be 18.99 for male humerus and 9.55 for females humerus, 16.01 for male radius and 8.65 for female radius, 15.03 for male ulna and 6.78 for female ulna. Correlation coefficient (r) for length of long bones with stature was 0.57 for male humerus, 0.47 for female humerus, 0.55 for male radius, 0.49 for female radius, 0.65 for male ulna and 0.57 for female ulna. ‘t’ test applied for testing the statistical significance of the obtained values was found to be significant. The regression equations for approximation of stature were formulated using length of humerus, radius and ulna. Conclusion: The simple regression equations derived from this study can be used to determine the stature of individuals belonging Bihar population). This fact can be of practical use in medicolegal investigations and anthropological and archaeological studies where the stature of a person can be found out if the length of upper arm and or forearm long bones is known.

Aim: To evaluate the role of   noninvasive ventilation (NIV) for treatment of acute respiratory failure (ARF) among patients with noncystic fibrosis (CF) bronchiectasis. Methods: This was a retrospective study conducted in the Department of Anaesthesia, Netaji Subhas Medical College and Hospital, Bihta, Patna, India for 1 year. We included 130 patients with bronchiectasis and ARF who required either NIV or invasive mechanical ventilation (IMV). Results: Out of 250,130 patients who required either NIV or IMV. The most common etiology of bronchiectasis was post-tuberculosis (52%) followed by idiopathic (22%), ABPA (16%), and immunodeficiency (6%). NIV was initiated as first line of ventilator support for 100 patients. Among these, 65(65%) were managed successfully with NIV. 35 (35%) patients failed NIV and required endotracheal intubation during the hospital stay.  Reasons for NIV failure were worsening or non-improvement of ventilatory or oxygenation parameters (n=15), hypotension (n = 7), worsening of sensorium (n = 5), and intolerance (n = 6). NIV failure occurred after a median duration of 2.69(95% confidence interval [CI]-1.47–4.32) days after the initiation. There was total 15 deaths in the study group. Among patients who failed NIV, total days (median [range]) spent on ventilator (6.8 [2–63] vs. 6.2 [3–17] days; P = 0.31), duration (median [range]) of hospital stay (7.5 [4–63] vs. 12 [5–16] days; P = 0.29), and mortality (11 [11%] vs. 4 [13.33%]; P = 0.21) were comparable to the IMV group. The causes of death among patients who failed NIV were septic shock (n=7) and ventilator-associated pneumonia (n = 4). Predictors of noninvasive ventilation failure: For identification of the early predictors of NIV failure univariate and multivariate regression analysis was performed using various baseline clinical and laboratory parameters of patients managed successfully with NIV and who failed NIV. Conclusion: NIV is feasible for management of ARF with non‑CF bronchiectasis. High APACHE may predict NIV failure among these patients.

Aim: The aim of the present study to comparison of 3 Different Dexmedetomidine Doses and Their Effect on the Duration of Spinal Anesthesia. Methods: Any gender between 18 and 65 years with American Society of Anesthesia physical state I or II (ASA I or II) with body mass index (BMI) 40 kg/m² or below were included in this study. All patients that were included were randomized, using computer generated random number table, to four groups: control group (group C) and three experimental groups (groups D1.5, D3 and D5). At the site of local anesthesia, a spinal needle 25G was advanced till reaching the intrathecal space and cerebrospinal fluid (CSF) flows through the needle, and then the following were injected according to the groups: Total 100 Patients were included in this study 25 in each group. Results: Regarding the onset of the sensory block, there were statistical differences among groups as group C showed onset after 1.7 ± 1.7 min while group D1.5 showed onset of sensory block after 2.5 ± 1.88 min while in group D3 it was 3.12 ± 2.54 min and in group D5 it was 2.63 ± 3.34 min. The previous results showed a dose-response prolongation to the Dexmedetomidine; this prolongation shows a statistically significant between the control group C and the other three groups (p-value 0.001). On the other hand, there were no statistical differences among the study groups (p-value 0.57). Moreover, this prolongation has no clinical significance. Regarding the duration of the sensory block there is, again, a dose- related prolongation with a crescendo pattern (group C 217.21 ± 81.69 min), group D1.5 (221.22 ± 50 min), group D3 (303.56± 43.01 min), group D5 (367.75 ± 97.68 min)). However, there was no statistical significance between the control group and group D1.5 (p-value was 0.24). On the contrary, there was a prolongation in both groups D3 and D5 which have achieved a statistical significance (p value was<0.001) in comparison with the control group. The same pattern was achieved in the duration of the motor block as it was (207.25 ± 45.26min) in group C, (250.27 ± 82.69 min) in group D1.5, (269.67 ± 33.61 min) in group D3 and (320.64 ± 93.12 min) in group D5.  Conclusion: The Dexmedetomidine can prolong the duration of the spinal anesthesia with a high safety profile and no complications in both doses 3 and 5 μg but not with a dose of 1.5 μg.

Aim: To evaluate the pattern of antimicrobial utilization in indoor ward of surgery department. Methods: This prospective cross sectional study which was carried in the Department of General Surgery, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. For 10 months. 100 patients admitted in male and female indoor fulfilling inclusion criteria were included in the study. Antimicrobial utilization pattern among male and female patients was evaluated using quality indicators of drug use, recommended by WHO. Average number of antimicrobials per prescription, Percentage of antimicrobials prescribed by generic name, percentage of antimicrobials prescribed from essential drug list, and average dose of antimicrobial per prescription were calculated. Results: Out of 100 patients included, 55 (55%) were male and 45 (45%) were female patients. Most of the patients 40-50 years age group. Clinical diagnosis for which antimicrobials were prescribed among surgical indoor patients were GIT disorder 33(33%), Genito-urinary disorders 15 (15%), trauma 10 (10), Carcinoma 9 (9%), Lump 8 (8%), Plastic surgery 7 (7%), Hernia 6 (6%), Gangrene 5 (5%), Liver disease 3(3%), Cellulites 2 (2%), Cyst 1 (1%), Sarcoma 1 (1%). Total number of antimicrobials used was 13. Ceftriaxone was the maximally utilized antimicrobial, given to 120 patients. Mean number of antimicrobials prescribed per patient was 3.81±1.18. Total number of antimicrobials administered by IV route was 325 (81.25%), and by oral route 75 (18.75%). No severe ADR was reported during the study ADRs reported were headache (30%), nausea (25%), vomiting (10%) and rashes (3%). Conclusion: Prescribing indicators provide useful information in understanding general medicines prescribing patterns. Prescribing injectables was not common in surgery OPD in our institute and is a good practice. Prescriptions writing in generic name needs to be promoted and encouraged.

Aim: Clinical study of management and visual outcome in lens induced glaucoma. Methods: This prospective study was conducted in department of ophthalmology, JanNayak Karpoori Thakur Medical College & Hospital, Madhepura (JNKTMCH), Bihar, India for six months . 50 Patients visiting the Hospital with classical symptoms of Lens induced Glaucoma were taken into study. The diagnosis of phacomorphic glaucoma was based on the presence of the classical signs and symptoms such as pain and redness, shallow anterior chamber (AC), cornea oedema and increased IOP with intumescent lens. Phacolytic glaucoma was diagnosed clinically based on the presence of the hyper mature cataract with intact capsule, presence of lens protein and flare in AC. Results: A Total of 50 patients were taken into this study in which 19(38%) were male patients and 31(62%) were Female. Among different LIG patients maximum patients had Phacomorphic Glaucoma accounting 60% (30 patients). Phacolytic Glaucoma was present in 18 patients which accounted 36%. Subluxated Glaucoma was seen in 2 patient in our study (4%) and phacoanaphylactic Glaucoma was not seen in our study. Other eye of the patients was without any Glaucomatous changes or pressure. Pseudophakic were seen in 12 patients (24%), mature cataract was seen in 3 patients (6%) and Immature cataract was seen in 35patients (70%). Intra Ocular pressure was measured on admission before any medication and noted. Highest percentage was among 30-39mmHg (40%) followed by 40-49mmHg (34%) and 50-59mmHg (14%). Highest patients were between 10-19mmHg (88%). Rest were <10mmHg (6%) and 20-29mmHg (6%) making it clear that eyes were out of danger. Similarly Visual acuity were measured at three intervals using Snellens Chart and readings were noted. On admission, highest patients were seen in Hand movements positive (40%) followed by Perception of Light positive (32%). On the day of Discharge, highest patients (40%) were seen in 6/24-6/36 visual acuity followed by 6/60-1/60(30%). 6/12-6/18 was noted in 24%. On the day of follow up after 1 week of surgery and 6 weeks of surgery maximum patients were seen between 6/12-6/18 (42%) followed by 6/24-6/36 (40%) and 6/6-6/9 (6%). Conclusion: LIG is an important vision-threatening disease presenting as a painful red eye. It is remaining as one of the important cause of Blindness not only because of Senile cataract but even after cataract surgery due to Glaucoma caused by neglected cataractous lens.

Aim: To determine the high-sensitivity C-reactive protein levels in subjects with type 2 diabetes mellitus. Methods: This prospective observational study was carried out in the Department of General Medicine, Patna Medical College and Hospital, Patna, Bihar, India, for 1 year. The study was undertaken on 80 type Diabetes mellitus and 80 normal healthy controls. All the patients were advised to fast overnight. Blood samples were collected in fasting condition. 5ml venous blood was collected from each subject and it was transferred to the Plain tube and serum is separated by centrifugation and stored at -20⁰C for measured. Estimation of Plasma Glucose by the Glucose Oxidase and Peroxidase (GOD POD) method and estimation of hs-CRP by turbidimetric immunoassay using commercially available kit. Results: Fasting blood glucose, post prandial blood glucose, and hs-CRP levels was measured in 80 T2DM cases and 80 age matched healthy controls. The mean and standard deviation were calculated for all the Biochemical parameters. The significance between the groups was determined using Student t- test for Equality of means. The p-value of < 0.05 was considered significant. Conclusion: we concluded that high hs-CRP levels in T2DM cases compared with controls. hs-CRP is an inflammatory marker and has role in atherosclerosis. From this study it is observed that there is moderate correlation between hs-CRP levels, and it increases the risk of atherosclerosis.

In India, undernutrition coexists with obesity, thus demonstrating a double burden of the disease. The effect of the increased BMI and the body fat percentage on the pulmonary functions has been studied extensively. The effect of undernutrition on the pulmonary functions needs attention. FEF 25-75 (L/S) describes the amount of air expelled from the lung during the middle half of the forced vital capacity test. The study was conducted over 300healthy students (13-19 yrs.), 155 male subjects and 145 female subjects. Medspiror, computerised spirometer was used to record lung function parameter Forced expiratory flow (FEF25-75%). Pulmonary function parameter in different Body Mass Index (BMI) groups was tabulated. 262 subjects had BMI less than 18.5 (underweight), 36 subjects and BMI between 18.5-25 (normal weight), and 2 subjects had BMI more than 25 (overweight). Majority subjects (262) were underweight. subjects who were having low BMI had low Forced expiratory flow (FEF25-75%) as compared to normal BMI subjects. Our study also showed a marked reduction in FEF25-75% in the underweight group. This could be due to malnutrition. It is observed that PFT value FEF25-75% were significantly reduced in underweight young individuals, compared between males and females this study showed fall is more in female than males. Under nutrition should be identified as early as possible and should be corrected in order to ensure health of young individuals.

Background: The interventional radiology processes along with the features of medical imaging have come across a long way during the last few years which is basically due to the the experiments that took out in various technological breakthroughs, and it gave a steep rise in the workload of the the patients besides creating a deficit in the overall globalisation apart from work force. Aim: Access the knowledge about safe patient handling in radiology department among radiography students Material and Methods: A questionnaire based Cross Sectional study was carried out in college of paramedical sciences at Teerthanker Mahaveer University, Delhi Road Moradabad, Uttar Pradesh, India. 120 students were being taken between the age group of 18 to 31 years from the department which was: radiological imaging techniques. Results: The distribution of knowledge from the overall participants according to the chosen options show that the majority of the students were without knowledge which accounted for 61.2 % and only 38.8% of the students had knowledge regarding their subject. The gender wise difference regarding the distribution of knowledge shows that the female participants had more knowledge than the male participants which is 41.4 % vs 37%. It has no significant value because p>0.05. The distribution of knowledge regarding the individual questions of the overall participant showed that the majority of the participants had given the right answer for question number 10 which accounted for 71.7 % while compared to the other questions of the study. Conclusion: The study concluded that the knowledge among radiography students about safe patient handling in transfer technique occurring in radiology department increases according to year of education completed. The students from post-graduation have more knowledge to safe patient handling in radiology department rather students of under graduation.

Aim: The purpose of this study to determine the prevalence of dermatological lesions in patients with diabetic retinopathy. Methods: This cross-sectional study was done the Department of Ophthalmology, King George’s Medical University (KGMC), Lucknow, UP, India, for 10 months. 130 patients with diabetic retinopathy having diabetes mellitus of at least 5 years duration, aged between 30-67 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: Among 130 diabetic patients, 12(9.23%) had Very Mild Non-Proliferative Diabetic Retinopathy (NPDR), 42(32.31%) had Mild NPDR, 49(37.69%) had Moderate NPDR, 16(12.31%) had Severe NPDR, 11(8.46%) had Proliferative Diabetic Retinopathy (PDR) and 52(40%) had Clinically Significant Macular Edema (CSME). 102 among 130 DR patients had different types of dermatological lesions, the prevalence being 78.46%. Dermatological lesions among poor glycemic control DM patients had a prevalence of 55.38% which was higher as compared to 34.62% among good glycemic control DM patients. 55(42.31%) patients had diabetic dermopathy, 40(30.77%) had Xerosis, 34(26.15%) had IGH, 30(23.84%) patients had Icthyosis, 9(6.92%) patients had Intertrigo, 7(5.38%) patients had Tinea Versicolor, 6(4.62%) patients had Chronic Paronychia and 4(4.62%) patients had Tinea Unguium. Conclusion: Prevalence of Dermatological lesions in Diabetic Retinopathy patients was 42.31%.

Background: Thyroid disease and the metabolic syndrome are both associated with cardiovascular disease. Aim: to evaluate the pattern of Thyroid disorder (TD) in patients with Met S in comparison to healthy controls and to correlate the relationship between the components of MetS and Thyroid disorder. 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 18 months .100 patients with metabolic syndrome (MetS) who fulfilled the National Cholesterol, Education Program, Adult Treatment Panel III (NCEP-ATP III 2001) criteria were included in the study group (MetS group). Results: our of 300 patients study group (MetS group) consist of 200 subjects (102 female, 98 male, mean age 52.74±9.21) and control group (Non-MetS) included 100 subjects (35female and 65 male, mean age 50.21±10.88).The two groups were not significant different with respect to dietary habits and life style (P>0.05) while significantly greater number of subjects in the metabolic group had sex, education level and thyroid dysfunctions (P<0.001). Of the 200 metabolic subjects, 52 (26%) had SCH, 26(13%) had clinical hypothyroidism, 8 (4%) had subclinical hyperthyroidism, and 114 (57%) were euthyroid. The overall prevalence of the thyroid dysfunctions was 86(43%) in study group. In the healthy non metabolic group, only 10(10%) had SCH, 5(5%) had clinical hypothyroidism and 85(85%) were euthyroid. The overall prevalence of thyroid dysfunctions was 15% among non-metabolic subjects. Conclusion: We concluded that the prevalence of TD in patients with MetS was high, indicating a possible interplay between thyroid status and MetS. Hypothyroidism was the most common TD in Indian patients with MetS.

Aim: The aim of the present study to determine the co-morbidity of depression and disability in patients with alcohol dependence syndrome. Methods: This cross-sectional observational study was conducted in the Department of Psychiatry, Jannayak Karpoori Thakur Medical College and Hospital (JNKTMCH), Madhepura, Bihar, India for 10 months. 100 Patients of age 18 years and above, who met the criteria for alcohol dependence syndrome according to ICD- 10 and having informant available. Patients were screened for depression through clinical interview using ICD-10 criteria and severity was assessed using HAM-D rating scale (Score on HAM-D: 0-7 is normal, 8-16 is mild depression, 17-23 is moderate depression, 24 and above is severe depression). Disability was assessed using WHODAS 2.0 rating scale. Results: The prevalence of depression in alcohol dependence patients was found to be 82%. In terms of severity (11%), Moderate (31%) and very severe depression (21%) was more common. Among the individual domains, life activities (32%), which include both household and work activities was most affected, followed by participation in the society (28%). p-value between alcohol dependant patients without depression and their disability was found to be <0.0001 which was significant. In terms of severity, most of the patients had moderate (40%) to severe (35%), mild (23%), and extreme (2%), disability. Correlation was assessed between patients with alcohol dependence syndrome with co morbid depression and their disability using Mann- Whitney U test.p-value between alcohol dependant patients with depression and their disability was found to be <0.0001 which was significant. Disability was assessed using WHO DAS 2.0 Scale. It was found that disability is present in 91% of the sample. Conclusion: Alcohol abuse leads to negative impact on social, occupational and economic aspects of an individual, leading to impairment of various role functions, ultimately contributing to poor QoL. Furthermore, psychiatric co morbidity in alcohol dependence leads to more impairment in QoL.

Aim: To determine the efficacy of thrombolytic therapy with IV streptokinase in acute ST elevation myocardial infarction patients. Methods: A prospective observational study was conducted in the Department of Cardiology Patna Medical College and Hospital, Patna, Bihar, India for 1 year. Total 120 Patients with diagnosis of acute ST segment elevation before and after thrombolysis with Streptokinase Were included in this study. Based on values obtained, study population divided into three categories. Category A: <30% resolution of the sum of ST segment elevation. Category B: 30%-70% resolution of the sum of ST segment elevation. Category C: >70% resolution of the sum of ST segment elevation. Results: Mean age of present study is 50.77±10.02. Male patients were significantly increased (75%) when compared with Female patients (25%). In this study chest pain was the most common mode of presentation, present in 111 (92.5%) patients associated with sweating in 103(85.83%) patients, breathlessness seen in 31 (25.83%) patients. Syncope was seen in 13 (10.83%) patients and palpitation in 7 (5.83%) patients. In this study Ratio of anterior wall myocardial infarction (61.67%) to inferior wall MI (38.33%).  Complete ST resolution seen among 41.67% cases, partial resolution seen among 43.33% and no resolution among 15% cases (Table 5). Thrombolysis time of <3 hours, 3-5 hours and more than 5 hours was noted in a, b and c categories patients. B and c categories patients were significantly increased when compared with a category patients. The mortality is 9.17%. Conclusions: In the present study we conclude that the efficacy of IV streptokinase for thrombolysis in acute STEMI is 41.67%. Patients with no resolution of ST segment 90 minutes following thrombolysis associated with more frequent adverse events and increased mortality compare to partial and complete resolution group.

Aim: To determine the incidence of aerobic and fungal infection in post-operative wound infection. Methods: The study was a cross sectional study which was carried in the Department of Microbiology, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. Total 220 patients with post operative wound infection either sex or any age, who had surgical wound pus, discharge, or signs of sepsis were include in this study. Using sterile cotton swabs, two pus swabs/ wound swabs were collected aseptically from each patient suspected of having post operative wound infection. 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. Results: Out of 220 samples, 100 samples were culture positive (45.45%) (Table1). Among 100 positive samples 55(55%) were males. Maximum no. of culture positive samples in age 25-35 years (32%) followed by 35-45 (17 %) and then followed by 45-55 (16%) of age group respectively. The predominant bacterial isolates S. aureus (36%), P. aeruginosa (23%), E. coli (14%), Proteus spp. (7%), K. aerogenes (7%), Streptococcus spp. (4%) and one fungal isolate C. albicans (9%). Conclusion: It has been concluded that wound infections in this were polymicrobic in nature and, in most cases, associated with S. aureus, E.coli and Pseudomonas aeruginosa. A continuous inspection should be carried out to monitor the susceptibility of these pathogens and chose appropriate regimens both for prophylaxis and treatment of surgical wound infections.

Aim: The aim of the present study to evaluate the dermatological manifestations in beta thalassemia major patients between 2 to 12 years and their relation with serum ferritine level. Methods: The descriptive observational study was conducted in the Upgraded Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India for 12 months. 100 children with beta thalassemia between 2 to 12 years age already diagnosed by HPLC or Hb electrophoresis already transfused 10 units of blood were included in this study. Results: xerosis was the most common (67%) dermatological change amongst the study subjects, followed by skin hyperpigmentation (55%). Acanthosis nigricans was also found in 10% patients, pityriasis versicolor and alba, accounted for 14% of all the skin changes seen. Urticaria was another important skin change noted in 6% study children. dermatological changes were present in all children amongst the study group who were having a serum ferritin level more than 1000 mcg/dl and in 85.71% children having less than 1000mcg/ dl. This finding is found statistically significant (p<0.05). dermatological changes and amongst the age group of 5 to 8 years and <5years, dermatological changes were found in 93.33% and 92.5% cases respectively. dermatological changes amongst them (100%) but 94.44% children who were having malnutrition were found to have dermatological changes amongst them. amongst the study children 71.43% whose serum ferritin level were below 1000mcg/ dl had Xerosis and those children whose serum ferritin level were between 1000-2000 mcg/dl and more than 2000 mcg/dl, Xerosis was found in 64.44% and 55% respectively.  Hyperpigmentation was found more commonly in those study children who had serum ferritin level in the higher side i.e. 65% who had serum ferritin level more than 2000 mcg/dl, 53.33% who had between 1000 to 2000 and 45.71% who had less than 1000 mcg/dl.   Pityriasis were found more (15%) amongst the study children who had Serum Ferritin level more than 2000 mcg/dl than who had Serum Ferritin between 1000 to 2000 (13.33%) and who had less than 1000 mcg/dl. Conclusion: The Beta-thalassemia major is equally distributed amongst male and female subjects in the present study. A relationship also found between hyperpigmentation and Pityriasis with serum ferritin level, but it was statistically insignificant. Further study with larger sample size is needed.

Aim: To evaluate of Parenchymal Thyroid Diseases with multiparametric Ultrasonography. Methods: This study was conducted in the department of Radio- diagnosis, Patna Medical College and Hospital, Patna, Bihar, India for 12 months. 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 GE LOGIQE P3 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 300, 65% were male and 35% female most of the patients between 30-40 years 44% and followed by 40-50 years was 29.33%.  The Distribution of patients based on diseases and each group had 60 patients show in table 2. The mean RI in group I was 0.61, in group II was 0.64, in group III was 0.49, in group IV was 0.55 and in group V was 0.57 mean AT in group I was 28.8, in group II was 27.7, in group III was 72.4, in group IV was 48.7 and in group V was 47.4, mean SWV in group I was 1.62, in group II was 1.81, in group III was 1.31, in group IV was 1.55 and in group V was 1.80. The difference was significant (P< 0.05). Conclusion: we concluded that the resistivity index, acceleration time and shear wave velocity together are reliable for differential diagnosis of parenchymal thyroid diseases.

Aim: The clinical and echocardiographic assessment of patients with atrial fibrillation. Methods: The present study was conducted in the Department of Cardiology, Patna medical college and Hospital, Patna Bihar, India for 15 months. Total 120 patients were evaluated clinically, and detailed Cardiovascular, Neurological examination was done to evaluate etiology and for any evidence of thromboembolism. Echocardiography was also done. Results: Among the total 120 patients, males were predominant in this study as 66.67 % and females were 33.33 %. 110 patients (91.67%) in this study were hypertensive, 26 patients (21.67%) were diabetic, 41 patients (34.17%) had a significant history of Alcohol consumption and history of smoking was present in 13 patients (10.83%). Metabolic Syndrome was present in 17 patients (14.17 %). The most predominant presenting symptom was dyspnea that was class IV in 75 patients (62.5%) followed by pedal edema in 41 patients (34.17%), Stroke in 23 patients (19.17%), Palpitations in 20 patients (16.67%), Typical Chest Pain in 7 patients (5.83%) and in 20 patients (10 %) AF was discovered incidently during work up of some intercurrent illness. It was seen in 73 patients out of 107 (68.22%) followed by Coronary artery disease (CAD) in 21 patients (19.63%), Dilated Cardiomyopathy (DCM) in 5 patients (4.67%) and 2 patient (1.87%) each of congenital heart disease (CHD), Hypertrophic Obstructive Cardiomyopathy (HOCM), Chronic Obstructive Pulmonary Disease (COPD) and Lone AF. Among the cases of valvular AF of 13 patients, Mitral stenosis with Mitral regurgitation was the most common lesion found in 11 patients (84.62%). 11 patients (84.62%) out of 13 had severe Mitral Stenosis having valve area of <1.5 cm2. Mean LA Size in this study was 48.15±10.05 mm. Ejection Fraction (EF) was found to be more than 44% in 87 patients (72.5%) and less than 44% in 33 patients (27.5%) as evaluated in the study. Left ventricular hypertrophy (LVH) was seen in 91 patients. Diastolic Dysfunction was seen in 19 patients (15.83%) out of 120. Conclusion: we concluded that the hypertensive heart disease was the most common etiology in elderly age group. Presence of LVH or left atrial enlargement in patients with hypertensive heart disease requires early management to improve the outcomes.

Aim: To evaluate the fetal outcome in cases of oligohydramnios after 34 weeks of pregnancy at tertiary care hospital in bihar region. Materials and methods: A prospective case control study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. 120 antenatal cases with >34 weeks of gestation with AFI ≤5 cm by sonographic estimation were included as study group and 120 women with normal AFI (8-24 cm) were included as control group. Induction of labour was done for women with high risk factors like PIH, by PGE 2 gel and accelerated with oxytocin. Labour outcome of the women were recorded includes, spontaneous /induced, nature of Amniotic Fluid, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery. Perinatal findings such as APGAR score <7 at 1 minute 5 minutes , birth weight, admission to NICU, perinatal morbidity and mortality were noted. Results: In the present study oligohydramnios was observed in 48.33% in primigravida and 51.67 % in gravida 2 and above. AFI 2-3 was seen in 35.83%, 3-5 in 64.17%. The nature of the amniotic fluid was clear in 30.83% in study and 81.67% in control group. Amniotic fluid was thin meconium stained in 31.67% in study, 14.17% in control group and was thick meconium stained in 42.5% in study and 12.5% in control group (Chi square=21.37, p<0.0001). Incidence of LSCS in the study group was 54.17% and 19.17% in control group. This study shows that incidence of intervention is significantly more in the study group than control group with p<0.001. APGAR score <7 in 30.83 % at 1 minute, 13.33% at 5 minutes in study group and 10.83% at 1 minute, 3.33% at 5 minutes in control group. Birth weight <2.5 kg was found in 61.67% in study group and 17.5% in control group with mean of 2.4 and 2.9 in study and control group respectively (p <0.001) statistically significant.12.5% of babies required NICU admission in study group in view of meconium aspiration, birth asphyxia and seizures. Neonatal death was 2.5% in study group. None of the babies admitted to NICU and no perinatal mortality in Control group. The p value showed strong significance <0.001. Conclusion: Pregnancies with isolated oligohydramnios (AFI ≤ 5) at or beyond 34 weeks is associated with increased rates of non reactive NST, FHR deceleration during labor, development of fetal distress, caesarean delivery and low birth weight.

Aim: The aim of the present study to evaluate the Procalcitonin Serum Levels in Children Younger than Five Years Old with Urinary Tract Infection. Methods: This case-control was done the Department of Paediatrics, Government Medical College, Bettiah, West Champaran, Bihar, India for 1 year. The 100 (100 case and 100 control) children less than 5 years of age were included in this study. The children in the case group suffered from UTI based on a positive urinary culture test.  They also were undergone VCUG and accordingly were divided into two groups: having VUR and not having VUR. Their serum levels of PCT were measured before starting antibiotic therapy using the chemiluminiscence immunoassay (CLIA). They had negative results for both urine culture (UTI) and urinary analysis tests that the serum levels of PCT were measured for them. In both groups children under 5 years without genetically diseases and chronic kidney diseases included in the study. Results: Of the samples, 130 children (65%) were female. The median age of the samples was 23.7 months with an interquartile range between 11.5 and 36.5 months. Accordingly, both the evaluation methods diagnosed 90 children to be healthy, while 92% of children with VUR positive simultaneously were PCT positive. The odds of one positive and two positive for one way 1.714 (P=0.015) times and 1.212(P=0.785) times were higher than the group without reflux. However the odds of 4 positive for one way 0.239 (P=0.3) times was lower than control group. The positive and negative predictive values of the serum level of PCT were 40% and 90%, respectively. In this respect, 50% of the samples diagnosed by serum level of PCT were false positive and 12% were false negative. It meant that sensitivity and specificity of PCT measurement were 90% and 50%, respectively. The kappa score for the level of serum PCT was 0.5 (P < 0.0001). The positive predictive value of serum PCT for the female and male samples was 42% and 54% respectively. Conclusion: No statistically significant relationship between vesicoureteral reflux and the serum level of PCT.

Aim: The aim of the present study was to determine the nutrient foramen of clavicle an anatomical and topographic. Methods: The study material consisted of 120 dry human clavicles of unknown age and sex, without any deformity or fracture, which were collected from the Department of Anatomy, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. All the bones were macroscopically observed using magnifying hand lens for the number, position and direction of the nutrient foramina. The nutrient foramina were identified by the presence of a well marked groove and often with slightly raised edge at the commencement of the canal. The distance of foramina from the sternal end & the total length of the clavicle were measured in millimetre, ignoring curves of clavicle. Results: The foramina were single in 51(42.5%) clavicles, double in 61 cases (50.83%), and more than two foramina in 8 clavicles (6.67%). Most of the right clavicles contained single foramina (56.67%) whereas left clavicles contained double foramina (63.33%). Three foramen were found in 3 clavicle of right side and 5 clavicles in left side. Total 130 number of nutrient foramen was found, out of which, 36.15% foramen were on inferior surface and 63.85% foramen were on posterior surface of the clavicles. Percentage of clavicle containing nutrient foramina on inferior surface was 45.56% and on posterior surface was 54.44%. Total number of clavicles considered was 90 as some clavicles contained nutrient foramen on both posterior and inferior surfaces .We found 20.77% foramens at the medial 1/3 region, 70% at the middle 1/3 region and 9.23% at the lateral 1/3 region of the shaft of the clavicles. In our study 61.11% of clavicles contained nutrient foramen in middle one third regions, 27.78% contained on medial one third and 11.11 % on lateral one third. Average distance of the foramina from the sternal end was found to be 65.78 mm and the average total length of clavicles was 13.74 cm resulting in the mean foraminal index of 50.97. Conclusion: Nutrient foramina vary in their position, number and distribution on the bone surface. Knowledge of nutrient foramen is helpful in surgical procedures like bone grafting and in microsurgical bone transplantation.

Aim: The aim of the study to assessment of glycated haemoglobin, total protein and albumin levels in patients with type 2 diabetes mellitus. Methods: This case control study was done the Department of Pathology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, for 2 years. A total of 140 subjects comprising of 70 diabetic subjects and 70 controls aged between 35 and 75 years were recruited for the study. 5mls of blood sample was collected from each patient and 1ml was dispensed into EDTA for the estimation of glycated haemoglobin, and 4ml was dispensed into plain containers for estimation of serum albumin and total protein levels. Determination of glycated haemoglobin level, estimation of serum albumin level and estimation of total protein done by standard methods. Results: The mean level of HbA1c was significantly higher in the diabetic subjects when compared with control group (11.36±1.59Vs 7.01±0.88; p=0.00). There were no significant differences observed between the age, the serum levels of Albumin and Total protein in the test and control subjects (p>0.05). Conclusion: We concluded that the present study showed significantly higher mean levels of HbA1c in the diabetic patients compared with the control subjects.

Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar India for 15 months. Total 50 cases were diagnosed with ectopic pregnancy. Results: The mean age of the patients was 27.97±5.25years. Majority of the patients 26 (52%) belonged to 20-25 years. Most of the patients 32 (64%) belonged to lower class socioeconomic status. Majority of the patients 37 (74%) were multiparous and 7 (14%) of the patients were nulliparous. The most common site of ectopic pregnancy was fallopian tube 46 (92%). The most common risk factor was pelvic inflammatory disease 24 (48%) followed by H/o previous abortion 11 (22%) and H/o previous abdomino pelvic surgery including tubal ligation 8 (16%) and LSCS 4 (8%). Almost 95% patients in our study came with H/O variable period of amenorrhoea. 44 (88%) cases complained of abdominal pain. 66% of the patients had bleeding or spotting per vaginum. The other symptoms noted in our study were syncope 15 (30%), nausea / vomiting 19 (38%) and urinary symptoms 11 (22%). In our study, 48 (96%) of patients had severe pallor. The most important signs which guided in the diagnosis of ectopic pregnancy were cervical excitation pain 36 (72%), abdominal tenderness 33 (66%), adnexal mass or fullness 30 (60%) and tenderness in the fornix 34 (68%). Urine pregnancy test was positive in 95% of patients. Culdocentesis was positive in 42% of patients.97% patients underwent laparotomy (unilateral or bilateral salpingectomy or salpingoophrectomy). Conclusion: Early diagnosis, timely referral, improved access to health care, aggressive management and improvement of blood bank facilities can reduce the maternal morbidity and mortality associated with ectopic pregnancy.

Aim: The aim of the present study assessment of new-onset depression and anxiety associated with COVID-19. Methods: This analytical, cross-sectional study was done the Department of Psychiatry Adesh Medical College Hospital Ambala Haryana, India for 10 months. By using Google Form platform contained validated online survey among Indian population which includes all adult males and females during or post COVID-19 infection and compared to the non-COVID-19 population as a control group. Results:  38% of participants were male while 62% are females. 26% of participants were married while 70% were single. 60% of participants are students and 38% are employed while 2% are retired. Regarding the COVID-19-positive and COVID-19-negative participants, 25% of participants reported having been diagnosed with COVID-19. Scores of PHQ-9 ranged from 0 to 27 (the mean is and the standard deviation is 6.12). Depression prevalence in our sample was 40%. Scores of GAD-7 ranged from 0 to 21 (the mean of 8.99 and the standard deviation is 5.33). Anxiety prevalence in our sample was 41%. The model shows a significant overall effect of gender [F(489) = 39.02, p<0.001], a non-significant effect of  COVID-19  infection [F(489)=1.88, p=0.177] and  a trending  effect  of the interaction between gender  and  COVID-19  [F(489) = 3.25, p=0.069]. Since the effect is not significant, we did not run any post hoc analyses. Conclusion: Significant levels of depression and anxiety were observed among the study population. The high levels of depression and anxiety may have masked the differences between those with or without COVID-19.

Aim: Association of glycosylated hemoglobin (HbA1C) level with diabetic retinopathy in type 2 diabetes patients at tertiary care hospital in Bihar region. Methods: The present study was cross sectional descriptive observational conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. Participants diagnosed to have type 2 diabetes mellitus with retinopathy changes in the fundus are included in this study. Results: The present study constituted 15% mild NPDR, 19% moderate NPDR, 50% severe NPDR, 12% PDR and 4% high risk PDR. The above table reveals that there were 93.33% of mild NPDR cases, 55% of moderate NPDR cases and 14.29% of PDR cases in 6.5% – 8.5% range of HbA1c.Whereas in HbA1c range of 8.6 % – 10.5%, mild and moderate NPDR cases reduced to 6.67% and 30% respectively and severe NPDR cases increased to 55.10%. Early PDR cases raised from 50% in 6.5% – 8.5% range of HbA1c to 25% in 8.6 % -10.5%. And high-risk PDR cases raised from 25% to 50% when HbA1c raises from 6.5% – 8.5% to 8.6 %- 10.5%. This revealed an increasing trend of severity of retinopathy with raise in HbA1c levels. The means of HbA1c in each level of severity of diabetic retinopathy. The mean of HbA1c in mild NPDR was 8.01±0.52. In moderate NPDR it was 9.02±1.66. In severe NPDR 10.25±1.77.  In Early PDR 9.22±1.25 and in High-risk PDR 9.69±2.36. Conclusion: The value of glycosylated haemoglobin (HbA1c) showed an increasing trend as severity of diabetic retinopathy increases. The poor metabolic control as demonstrated by high HbA1c is significantly associated with severity of retinopathy and presence of CSME.

Aim: The aim of the present study was to compare the safety and efficacy of Alcaftadine 0.25%, Olopatadine hydrochloride 0.2% and Bepotastine besilate 1.5% in allergic conjunctivitis. Methods: A total of 90 patients with mild or moderate allergic conjunctivitis were randomized into three groups with an allocation ratio of 1:1:1 using computer-generated random number sequence to receive topical anti-allergic medication for 14 days as Group 1: Topical 0.25% Alcaftadine eye drops OD, Group 2: Topical 0.2% Olopatadine eye drops OD and Group 3: Topical 1.5% Bepotastine besilate eye drops BID. Patients were examined and their baseline symptoms and signs (TOSS) were recorded. Results: The 4 major complaints recorded by patients were itching (30 patients, 100℅), redness (22 patients, 73.33%), tearing (25 patients, 83.33%), and swelling (13 patients, 43.33%). The total ocular symptom score (TOSS) showed a consistent decrease in subsequent visit in all the Groups and it was statistically significant, when compared from baseline to 14th day in all the groups (p=0.0008). The difference in mean TOSS between (Group A) Alcaftadine and (Group C) bepotastine treatment groups was observed at the third day of follow-up. This showed early relief of allergic conjunctivitis symptoms by bepotastine (5.57 ± 1.26) compared to Alcaftadine (mean (6.31 ± 1.47) and olopatadine (6.31 ± 1.47) but this was not statistically significant. Total ocular symptom score at 14th day visit with post hoc Tukey HSD test showed mean of Alcaftadine group vs mean of olopatadine group – p < 0.05, mean of olopatadine group vs mean of bepotastine group – p<0.01, which were statistically significant whereas mean of Alcaftadine group vs mean of bepotastine group showed no significant difference. Alcaftadine was found to be better than olopatadine in reducing the Allergic Conjunctivitis symptoms using TOSS score at 14th day visit (p < 0.5). Although there is no significant difference between bepotastine and Alcaftadine groups, bepotastine showed a better reduction of symptoms compared to Olopatadine group using TOSS score at 14th day visit (p<0.1). Conjunctival hyperaemia had reduced in all the treatment groups but there was a significant reduction in Alcaftadine and Bepotastine treatment groups at 14th day compared to olopatadine group (p = 0.0023). Conclusion: All three topical ophthalmic medications used in the study are safe and effective in the treatment of allergic conjunctivitis. However, Bepotastine and Alcaftadine appear to outweigh Olopatadine in resolving the symptoms of allergic conjunctivitis.

Background: Loss of tooth is quite common among general population and it is due to various reasons either due to caries, or trauma or developmental. With the advancement of technology and aesthetic consideration of patients increasing no of patients opt for dental implant as prosthesis for lost tooth. Materials and Methods: Surveys of 100 patients were conducted among patients visiting the government medical college, Madhepura for rehabilitation of lost tooth. This is questionnaires based survey provided in Hindi as well as English for better understanding. Results: Out of 100 patients surveyed only 29% of patient knows about dental implant however 67% knows that missing tooth is replaced where as 0nly 13% knows that missing tooth is replaced with dental implant and only 9% aware that dental implant is placed in jaw bone. However 46% wants dental implant if cost is low. Conclusion: there is need of improving education and socioeconomic condition of masses to understand the restoration of lost dental structure. First of all we have to educate about importance of dental and oral structure. Continuing education programs for dentist practicing in peripheral areas and small town is necessary. Dental education and implants advantages must be in local dialect for better understanding.

Aim: The aim of the present study was to compare the intra-ocular pressure in diabetes mellitus and non-diabetic individuals. Methods: This prospective observational study was done in the Department of Ophthalmology, Anugrah Narayan Magadh Medical College Hospital (ANMMCH), Gaya, Bihar, India for 1 year. All the patients having diabetes mellitus on treatment and non-diabetic individuals were included in this study. Two groups were formed which included Group A constituting diabetes mellitus patients and Group B constituting non-diabetic individuals. Detailed history of diabetes mellitus patient was taken regarding duration of diabetes, treatment, fasting, post prandial blood sugar levels and HbA1c were recorded. Intra-ocular pressure was compared between Group A and Group B to correlate intra-ocular pressure in relation to duration of diabetes mellitus and different stages of diabetic retinopathy. Results: 140 patients were included in our study. 60 patients had Type 2 diabetes mellitus (all were non-insulin dependent) and 10 patients had Type 1 diabetes mellitus (all were insulin dependent), and 70 patients were non-diabetics subjects. Mean age of non-diabetics was 49.22±9.12 years and that of diabetics 52.36±9.63 years (p value 0.26) statistically not significant. In those 70 diabetic patients 50 were male and 20 were female. Mean age of male subjects was 54.26±9.38 years and that of female was 53.74±9.36 years in diabetic group which was not statistically significant (p value 0.31). Mean intra-ocular pressure was higher (18.96±2.66 mmHg) in diabetic patients as compared to (15.87±2.69 mmHg) non-diabetics, p value <0.0001 which is statistically significant. Mean intra-ocular pressure was (19.11±2.49mmHg) in diabetic patients with duration greater than 10 years as compared with (18.98±3.23mmHg) in diabetic patients with duration less than 10 years, p value <0.31 which is not significant. Mean intra-ocular pressure (19.96±2.78 mmHg) was higher in diabetic patients with HbA1c value >6.5% as compared (18.87±2.26 mmHg) to diabetic patients with HbA1c value <6.5%, p value < 0.0005 which is statistically significant. Conclusion: Diabetes mellitus is a risk factor for raised IOP. Tight glycemic control prevents the rise in IOP. Patients with poor glycemic control were found to be more prone to raised IOP. Diabetic patients should be regularly screened for IOP so that burden of ocular morbidity due to glaucoma can be reduced.

Aim: The aim of this study was to evaluate the clinico-epidemiological profile of children suffering from urinary tract infection. Methods: This retrospective observational study was done at the Department of Pediatric, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 15 months. Total 100 children with culture positive UTI were included in this study. Clinical examination was done, and the findings were recorded. Blood sampling was done for all patients and sent to a laboratory to measure total count, differential count, ESR. Results: Among 100, 62 children belonged to 2-5years of age constituted 62% and 38 children belonged to 5-14 years of age constituting 38%. 100 children 32 were male and 68 were female constituting 32% and 68% respectively. 15 children had <3 days fever which is around 25.42% of total children and 3 to 5 days history was in 18 children constituting 30.51% and fever was present for >5 days in 26 children constituting 44.07%. Total fever cases summed up to 59% and are the most common symptom observed in the study. Chills and rigor were present in 42 patients with fever. Burning micturition history was present in 42 children which are around 42%. Increased frequency of micturition with small voids every time was present in 53 children constituting 53%. The third common symptom was abdominal pain which constituted 45%. Vomiting was present in 23 patients which are around 23% of the total. History of preputial bulging while urinating was present in 6 boys out of 32 boys which are around 18.75%. E. coli was grown in the urine culture of 62 children which was 62% of the total. This was the most common causative organism in the study group. This was followed by Klebsiella spp. in 18 children which are around 18%. 11 children’s urine culture grew Proteus mirabilis which is around 11% of the total. Pseudomonas was grown in 5 children constituting 5%. Staph epidermidis growth is seen in 2 children which come around 2%. Enterococci faecalis was grown in 1 child which constitute 1%. Citrobacter growth was seen in 1 child, and this constitutes 1%. Conclusion: UTI is a common childhood illness. This study shows age and gender distribution in accordance with available literature. Females were more commonly affected than males. Fever being most common presenting symptom followed by vomiting and pain abdomen.

Aim: The aim of the study at comparing the outcome of laparoscopic (TAPP mesh repair) and open hernia repair with respect to the duration of surgery, intra and postoperative complications, postoperative pain, recurrence, stay in the hospital and resumption of daily activities. Methods: A comparative study was conducted in the Department of General Surgery, Madhubani Medical College and Hospital, Madhubani, Bihar, India, for 11 months to compare laparoscopic hernioplasty and Lichtenstein’s open mesh repair. The study consisted of 110 patients with unilateral or bilateral inguinal hernia, and they were randomly allocated into either group. Various parameters like duration of surgery, intra and post-operative complications, post-operative pain, recurrence, stay in the hospital and resumption of daily activities were compared. Results: Out of the 110 patients, 25 had bilateral inguinal hernia and the rest 85 had unilateral. 17 patients with bilateral hernia underwent laparoscopic repair and 8 underwent open mesh repair. 38 patients with unilateral hernia underwent laparoscopic hernioplasty and 47 underwent open mesh repair. The mean operative time for unilateral open hernioplasty was 48.45 mins and bilateral was 89.16 mins whereas, for unilateral laparoscopic hernioplasty it was 65.38 mins and bilateral was 123.35 mins. post-operative complications, like wound infection was noted in 12.73% (7 out of 55 patients) and 20% had seroma formation (11 out of 55 patients) in the open hernioplasty group. In laparoscopic hernioplasty group, 3.63% (2) had wound infection but, seroma formation was noted in 14.55% (8 out of 35 patients). Urinary retention was noted 21.82 % of open hernioplasty group (12 out of 55) and 7.27% of laparoscopic hernioplasty group (4 out of 55 patients). Mean pain score was noted on post-operative day (POD), POD 0, POD 3 and POD 7 as show in. The mean pain score for; laparoscopic hernioplasty (LH) and open hernioplasty (OH) were POD 0: LH– 5.8 and OH–6.5 and POD 3: LH– 4.5 and OH– 5.5 but, on POD 7: pain score for LH was 2.1 and OH was 3.4. The mean duration for resumption of day-to-day activities was 5.3 days following laparoscopic hernioplasty and 9.1 days following open hernioplasty. Conclusions: Laparoscopic hernia repair is safe and provide less postoperative morbidity in experienced hands compared to open hernia repair.

Aim: To evaluate the functional outcome assessment of olecranon fracture treated with locking compression plate. Methods: The prospective clinical study was conducted in the Department of Orthopaedics, All India Institute of Medical Science, Patna, Bihar, India for 18 months. 50 patients operated at a tertiary care centre for olecranon fracture. The mean age was 31.5 years and minimum follow up was 1 year.  Patients with isolated olecranon fracture, age >18 years and trauma < 10 days of admission were included in this study. Polytrauma Patients excluded from this study. The Mayo Elbow Performance Index (MEPI) consists of four domains: pain (one item, maximum score 45 points), range of motion (20 points), stability (one item, 10 points), and function (5 items, 5 points each). Each domain is transformed into a 100-point scale with higher score representing better outcome. Maximum possible score can be 100, and the results are graded as excellent for scores >90; good for scores 75-89; fair for 60-74 and poor for scores less than 60. Results: In our study of 50 patients, 42 were males and 8 were females. Mean Age of the patient was 31.5 years (range 18 years to 50 years). There were 42 right sided fracture (84%). There were no bilateral cases. 39 patients (78%) had transverse fractures and 11 (22%) had oblique fractures. Comminuted fractures were seen in 7 patients. Most common mode of injury was fall on ground (92%), other being assault (8%). All the cases were operated in 1-7 days following injury. Mean operative time of tension band wiring was 47 minutes (range 28 minutes to 64 minute). The mean range of motion after 1 year was 108 degrees (range 79- 139 degrees). Average radiological union was seen at 8 weeks (range 5 weeks to 14 weeks). Hardware impingement was seen in 9 cases at 1 year follow up, infection was seen in 4 patients. Out of the 27 excellent outcomes, 15 Good, 4 fair and 4 show poor results. 39 had transverse fractures and 11 oblique fractures. The entire 4 poor outcome had comminuted fractures and large proximal fragment of olecranon. Conclusion: Tension band wiring is an effective method for treatment of transverse olecranon fractures and yields excellent to good functional outcomes in good percentage. Radiological union too is achieved in satisfactory duration.

Aim: This study was investigating the effect of prescribing zinc sulphate on improving the clinical symptoms of pneumonia in 2 to 59 months of children. Methods: This Case-Control study was done in the Department of Pediatrics, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India for 1 year. Among 160 patients divided into two equal groups. 80 Children between the age of 2 months to 59 months and children with Acute Lower Respiratory Tract infection were include in case group and 80 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 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 59.12± 10.85 ug/dl as compared to 83.88 ± 10.26 ug/dl for the controls. A total of 20 cases and controls (25%) were found to have deficiency of zinc, of which majority (92%) were cases (normal range of 60 to 150 ug/dl). Pneumonia group (Mean=40.67± 7.55 ug/dl) having significantly lower value than that of Pneumonia group (Mean=62.75±6.32 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 62.34 ± 5.69 ug/dl, cases requiring supplemental oxygen by nasal prongs having mean of 58.64 ±10.25 ug/dl and cases requiring mechanical ventilation having mean of 37.36 ±6.78 ug/dl. Conclusion: We concluded that the serum zinc levels were found to be lower in risk factors of LRTI like poor nutritional status, anemia, vitamin A deficiency, low birth weight and formula fed patients. Zinc supplementation had no overall effect on the duration of hospitalization or of clinical signs associated with severe infection in young children hospitalized for severe pneumonia in India. This finding differs from the results of 2 previously reported trials wherein zinc supplementation was associated with a shorter period of recovery from severe pneumonia.

Aim: Clinical and biochemical profile of neonatal seizures admitted in neonatal intensive care unit of a tertiary care hospital in Bihar region. Methods: This was a retrospective, observational study conducted in the Department of Pediatrics, Nalanda medical College and Hospital, Patna, Bihar, India, from January 2020 to January 2021.All neonates with seizure before 28 days of life were included in the study. The neonatal seizures were classified according to Volpe’s classification into subtle, focal clonic, multifocal clonic, tonic and myoclonic. Metabolic abnormalities and infections were noted. Hypoglycemia was defined as blood sugar < 40 mg/dl, and hypocalcaemia when total serum calcium was less than 7.0 mg/dl. Total 100 cases of neonatal seizure presenting before 28 days of life were included in the study. Results: Total admission during the study period was 1000 live births, out of which 100 neonates presented with seizure. The incidence of neonatal seizure was 10/ 1000 live births. The seizures were more common in male babies observed in our study. 71 (71%) neonates were born to multiparous women while 40 (40%) were born to primigravidas.  In birth asphyxia (n= 50), the most common type of seizure observed was subtle seizure 24 (48%), followed by focal clonic 12 (24%) and multifocal clonic 6 (12%). Tonic type of seizure was observed in 5 (10%) and myoclonic in 3 (6%). Meningitis and septicemia were the second most common cause of neonatal seizure observed in our study. Among metabolic abnormalities hypoglycaemia was found in 20 (20%) and hypocalcaemia in 10 (10%). The commonest cause of seizure was birth asphyxia presenting within 72 hours. Among infection septicaemia and meningitis was the most common infection leading to neonatal seizure. Among biochemical abnormalities the most common cause of seizure observed in our study was hypoglycaemia and hypocalcaemia. Conclusion: Birth asphyxia was the commonest cause of neonatal seizure that can be managed by resuscitation and providing intensive care. Meningitis and septicaemia also contributed to neonatal seizure, which needs aggressive management.

Aim: To evaluate the total and differential leukocyte count and oxygen saturation of hemoglobin changes in healthy smokers and non-smokers in Bihar region. Methods: The present Prospective study was conducted in the Department of Physiology, Jan Nayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India from February 2019 to feb 2020. A total of 140 clinically healthy volunteers of Bihar, in the age group of 20–60 years participated in the present study. Individuals with a history of smoking cigarettes/bidis daily for at least 1 year were considered as smokers. Results: The mean values of TLC (P < 0.001), lymphocyte count (P < 0.001), monocyte count (P = 0.03), and granulocyte count (P = 0.01) were significantly higher in smokers as compared to non-smokers, while the mean values of SpO₂ (P = 0.03) were significantly lower in smokers as compared to non-smokers. A significant difference was observed (P < 0.001) in TLC between non-smokers and smokers (103/mm3). Smoking builds an inflammatory environment in the human body which, in turn, triggers immune response in general, subsequently raising the leukocyte count. Conclusion: We concluded that the total and DLC were altered in smokers and thus should be considered during diagnosis, interpretation of result, and treatment of patients. Tobacco smoking has a negative impact on oxygen saturation of hemoglobin. Reduction in smoking can improve the changes which are sensitive to change in smoking intake.

Aim: Assessment of Knowledge, Attitude and Practice towards Emergency Contraception among women of reproductive age group working in hospital premises other than health professionals. Methods: This was a descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Patna, Bihar, India. The questionnaire covered the following demographic points like age, age at marriage, address, religion, education, total family income, socioeconomic status, no of living children, no of abortions and its reason, menstrual history. Results: 76 of 100 (76%) knew that it should be taken within 72 hours. 40% knew that it can be obtained without prescription and 10% said that it cannot be obtained without prescription and 60% had no idea about it at all. 50% did know about the exact dose. 24% of them had no idea in which conditions are ECPs used. 35% believed that it should not be given to lactating mother and 65% had no idea whether to given to breastfeeding mother or not. No single women found safe to breastfeeding mothers. Only 4% said that they might use it in future if required. When asked whether it should be included in orientation Programme 86 were neutral about it and 4 said no and only 10% of them wanted to know more about ECPs. 70% did not prefer ECPs as they had no clear-cut knowledge of dose and timings and 30% feared of its side effects. 30% said that it should not be available without prescriptions 62% were neutral and 8 told that it should be freely available. Conclusion: Awareness among the public through mass media is likely to generate public demand for EC and also needed to be adequately educated and informed about ECPs to make this method successful.

Background: Arteriovenous fistula (AVF) has many post-operative complications. One of it is failure to mature, prone to early dysfunction which relates to poor outcome. Though it is not sure that whether early AVF failure is linked with death in CKD patients on hemodialysis. Material and methods: A retrospective cohort study was performed using data of patients who underwent initial AVF surgery at our institution at IGIMS PATNA from April 2018-March 2020. Demographic, clinical, biochemical and AVF parameters were noted from the logbook records, and the association between these variables and mortality was analysed. The Inclusion criteria were 1. Patient aged between 20-60 years who underwent avf creation within given time period. 2. Only native avf creation patient was selected 3. Patient with brachiocephalic avf were selected. Exclusion criteria   were Patient in whom av graft was done 2. Patient who was seriously ill 3. Patient with Radiocephalic avf. A total of 620 patients on hemodialysis (68% male) were included, and the median observation period was 2 years. Out of them 68 patients had failure of AVF. Out of which 48 had early failure within   8 weeks of avf creation. Out of 48, 42 died within a year of AVF creation but none had mortality linked or associated with AVF creation. The cause of mortality in most of them were linked to cardiovascular causes as evident from their death records. Conclusion: Mortality in CKD patient is an independent variable and does not relate with early failure of arterio-venous fistula, though it definitely raises the morbidity.

Aims and objective: To estimate the prevalence of dengue viral infection among clinically suspected patients attending a tertiary care centre in Bihar state. Material and methods: This was a prospective observational study conducted in the Department of General Medicine, Madhubani Medical College and Hospital, Madhubani, Bihar, India, from March 2020 to Dec 2020. A total of 554 serum samples from suspected dengue cases attending OPD or admitted in the hospital were tested for the confirmation of Dengue. We have received blood samples in our microbiology laboratory, the blood samples were allowed to clot at room temperature and then we centrifuged the samples and serum samples were separated. From the serum samples we have done NS1 Ag and IgM Ab testing by ELISA. Results: Out Of 554, 100 samples were positive for dengue. Seroprevalence of Dengue was 18.05%. Out of 100 dengue patients 65(65 %) were male patients and 35 (35 %) were female patients. Out of 100 dengue patients, 69(69%) patients were from urban area and 31(31%) from rural area. All dengue positive patients in our study had fever of 2 to 7 days. The most common presenting symptoms of dengue were fever with body ache (45%), headache (37%), nausea (33%) and vomiting (22%). Out of 100 dengue cases fever with rash was observed in 7 cases (7%). Conclusion: The present results revealed that the study region is epidemic for dengue viral infection and there is an urgent need for the constant monitoring to control further spreading of the infection in the community, hence serological test has important role in the early diagnosis. Therefore, IgM ELISA is recommended in all the suspected dengue patients so as to instigate essential treatment and assessment of morbidity and mortality rate during an outbreak.

Aim: The aim of this study to determine the intramedullary Nailing Versus Plate Fixation for the Treatment Displaced Midshaft Clavicular Fracturesn Methods: A prospective randomised trial was conducted in the Department of Orthopedics, MGM Medical College Jamshedpur, Jharkhand, India from Feb 2020 to February 2021. Those consenting to participation were randomised to open reduction and plate fixation with a 3.5 mm superior clavicular plate or a 2.0 mm to 3.5 mm titanium elastic nail in the second group. Patients with Age 18 to 58 yrs, Mid-shaft fracture, Displacement by one bone width, Tenting/compromised skin, Initial shortening of more than 15 mm, Angulation exceeding 30 were included in this study. Total of 100 fractures of the clavicle were included in this study and divided into 2 equal groups. Demographic data were recorded at presentation and patients completed a baseline Disabilities of the Arm, Shoulder and Hand (DASH) score to describe their shoulder function the week before injury. Standard standing radiographs with 15° caudal and 15° cephalad and a ‘panorama’ view of both clavicles were performed. Results: There were no demographic differences between the groups (Table 1) and they had the same baseline mean DASH score of 0.5 (0 to 6.8 for plate versus 0 to 15.9 for ESIN, p = 0.7). The duration of surgery was shorter for ESIN (mean 52.4 minutes, 21 to 119) than for plate fixation (mean 68.7 minutes, 34 to 105; p < 0.001, independent samples t-test). After 12 months, there was no difference in DASH score between the plate fixation and ESIN, with both approaching their DASH baseline values   of 0.5. Individual  differences between baseline data and the DASH score after one year showed no statistical difference (1.5, -4.3 to 12.2 for plate versus 2.1, -14.3 to 28.4 for ESIN; p = 0.5, independent samples t-test). Compared with baseline values, 1 patient (2%) with plate fixation had a DASH score which worsened by ten points compared with 4 patients (8%) in the ESIN group.  Both groups demonstrated similar satisfaction with their shoulder at 12 months as measured by VAS (9, 0 to 10 for plate fixation versus 9, 3 to 10 for ESIN; p = 0.87, independent samples t-test). Conclusion: Fixation with plate or ESIN in completely displaced midshaft fractures of the clavicle produce equally excellent functional results at 12 months. In addition, nailing should not be undertaken with implants less than 2.5 mm in diameter.

Aim: To evaluate the Aetiological factors and clinical profile of neonatal jaundice from Bihar, India. Methods: This prospective observational study was done the Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, from March 2020 to January 2021. Total of 100 cases were enrolled for the study. Jaundice was ascertained by clinical methods. This was confirmed with the help of biochemical tests. Serum bilirubin was estimated by Van den Bergh method. All babies with serum bilirubin value of >10mg/dl were included in the study. Results: Out of 100 jaundiced neonates, 91 were born at term (91%) and the remaining 9 were preterm babies (9%). Among 100 neonates studied, majority had birth weight between 2501g and 3000g (51%). Only 11 babies had birth weight <2.5kg (11%). Here maximum number of cases was due to physiological Jaundice 35 (35%). This was followed by ABO incompatibility which constituted 18%. Of these 50% were due to OA incompatibility and 50% due to OB incompatibility. Other common causes were sepsis (11%), Rh incompatibility (9%), idiopathic (9%) and prematurity (7%). Neonatal jaundice was attributed to cephalhematoma and breast feeding in 5 cases each (5%). There was one case of haemolytic anaemia diagnosed as hereditary spherocytosis. Of the 100 neonates 64 were males (64%) and 36 were females (36%). Conclusion: The physiological jaundice is the most common cause of neonatal jaundice in our hospital and followed by ABO incompatibility, sepsis, Rh incompatibility and idiopathic cases.

Aim: To evaluates the changing Trend of Neonatal Septicemia and Antibiotic Susceptibility Pattern of Isolates. Methods: The present Prospective study was conducted in the Department of Paediatrics Vardhman Institute of Medical Science, Pawapuri Nalanda, Bihar, India for 15 months after taking the approval of the protocol review committee and institutional ethics committee. The blood cultures and the sensitivity reports of 100 newborns who were admitted with symptoms of sepsis to the NICU were studied. One to two ml of blood was collected from each neonate with aseptic precautions and inoculated into brain-heart infusion broth and incubated at 37ᴼC for 24 hrs. Results: Among the 100 significant culture-positive cases, there were 62 (62%) male and 38 (38%) female neonates with the male to female ratio of 1.63:1. Out of 180 cases, those of early-onset septicemia (EOS) were 120 and late-onset septicemia (LOS) was 60. Blood culture positivity was seen in 65 cases of EOS and 35 cases of LOS. Early-onset sepsis was more common than late-onset. 50 (50%) of the 100 bacterial growths were gram-negative bacilli (GNB) while 32 (32%) were gram-positive cocci (GPC) and 8 (8%) were candida isolates. 30% of the GNB were Klebsiella pneumoniae, thus making it the predominant GNB. Acinetobacter species constituted 21%, while Escherichia coli and Pseudomonas aeruginosa made up 4% each of the GNB. Conclusion: Multi-drug-resistant organisms were isolated from septicemia in neonates. Therefore, great caution is required in selection of antibiotic therapy.

Aim: Pharmacoepidemiological study of the usage of caripill for the dengue patients in an urban health setup among the registered medical practitioners. Methods: The observational study was conducted in the Department of Pharmacology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India from January 2020 to October 2020. The data collected from the registered medical practitioners who are doing their general practice in Darbhanga. For this study, the data of the dengue patient found positive, and the treatment modalities were collected. Results: In our study based on the proved efficacy of carica papaya leaf extract, the prescription pattern and usage of the drugs were common among many practitioners. It is evident from the below table 1 that around 7 out of 10 clinics have prescribed caripill tablet than the conventional pain killer regimen. The tablet was given for a period of five days, and they recovered after week duration. Conclusion: From this study it is evident that the tablet caripill is very much popular for its efficacy and hence many practitioners are prescribing caripill in dengue fever patients to prevent the progression of the disease to the next level of dengue heamorrhagic fever.

Aim: The aim of this study to determine the maternal and perinatal outcome in eclampsia at a tertiary care center. Methods: The retrospective study was carried out in the Department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 18 months. A total of 115 patients with eclampsia were included in this study. Information such as detailed patient profile, obstetric history, blood pressure (BP) at the time of admission, mode of delivery, duration of hospital stays including intensive care unit (ICU) admission, maternal complications and fetal outcome were noted. Results: The prevalence of eclampsia came out to be 18.75 per 1000 deliveries. Eclampsia was found to be more common in young patients with age 20-25 years (61.73%). 86.95% of women managed for eclampsia were unbooked. Maximum patient 77.39% were primigravida in our study. 89.56% patient had antepartum eclampsia and only 10.43% had postpartum eclampsia. Conclusion: This study reveals that eclampsia is still an important obstetric emergency in the community contributing to significant maternal and perinatal morbidity and mortality. Certainly, the high incidence of eclampsia can be reduced by proper antenatal care, diagnosing, admitting and treating the mild and severe pre-eclampsia cases.

Aim: Evaluate the Role of Vitamin D in pre-hypertension and its association with cellular senescence. Methods:  This cross-sectional comparative   study   conducted in the Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India, for one year. Inclusion criteria for the pre-hypertensive group (pre-HTN) (n = 50) were both genders between 18 and 27 years of age with SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg in apparently healthy individuals. The controls (n = 50) population were healthy individuals with 18–27 years of age with SBP between 100 and 119 mmHg and DBP between 60 and 79 mmHg. Results: The study population included 100 apparently healthy individuals. 50 of 100 were pre-hypertensives with the age of 19.11±0.40 and the age of controls was 19.05±0.78. A significant difference was not found between-group differences in height and waist-hip ratio. However, pre-HTN group subject’s BMI (P < 0.0001) and weight (P < 0.0001) was more compared to controls. Mean and standard deviation of various cardiovascular parameters are given in Table 2. In pre-HTN group, significantly higher HR (P < 0.0001), SBP (P < 0.0001), DBP (P < 0.0001), MAP (P < 0.0001), and RPP (P < 0.0001) were seen when compared to controls. No significant difference was seen in PP but it was slightly high in pre-HTN group and negatively associated with Vit-D (r: ‒0.388).  The values of Vit-D, telomerase in both groups. Significantly low levels of Vit-D (P < 0.0001) and high telomerase (P < 0.0001) were seen in pre-HTN group when compared to controls. Table 4 shows the correlation of Vit-D and other parameters in pre-HTN group. Low levels of Vit-D have no correlation with BMI, waist-hip ratio, DBP, and MAP. However, significant correlation was seen with HR (r: ‒0.312), SBP (r: ‒0.554), PP (r: ‒0.388), RPP (r: 0.487), and telomerase (r: ‒0.388). Further, as shown in Table 5, high telomerase levels have correlation with waist-hip ratio (r: 0.337), SBP (r: 0.479), DBP (r: 0.446), MAP (r: 0.659), and RPP (r: 0.329) but no   significant correlation was seen with BMI, HR, and PP. Conclusion: The reduced Vit-D levels in pre-HTN may cause derangements of cardiovascular homeostatic mechanism, enhance the speed of cellular senescence measured by telomerase.

Aim: Awareness of diabetic retinopathy among Type 2 diabetes mellitus patients in North Bihar region. Methods: This was a descriptive, cross sectional, non-randomized, questionnaire-based study conducted in the Darbhanga Medical College and hospital, Laheriasarai, Darbhanga, Bihar, India, for 1 year, after taking the approval of the protocol review committee and institutional ethics committee. Participants were asked to answer questions from a structured questionnaire developed in English and hindi, which included questions about awareness of DR due to DM and compliance with DM and DR management. All interviewed patients were with Type 2 DM and were randomly selected using multistage random cluster sampling from the general population in and around Darbhanga.  100 study subjects having Type 2 diabetes mellitus were selected.100 Patients with Type 2 diabetes mellitus who had normal cognitive ability and could speak hindi and resided in and around Darbhanga was selected. Result: Of 100 randomly selected Type 2 diabetes mellitus patients, 56(56%) were women and 44 (44%) were males. 33% of them were illiterates, 30% had only primary education and 37% had education above middle school. 65% of the selected patients wore glasses for refractive error and they were aged from 18 yrs to 75 yrs. 79% of these people had awareness about diabetes mellitus causing a condition called diabetic retinopathy. But only 35% knew that Diabetic Retinopathy can cause blindness. 87% of them are aware that Diabetic retinopathy can be prevented. Only 14% are aware that laser treatment for DR does not improve vision but reduces further deterioration in vision. 80% feel regular eye check-ups are required in DM patients and nearly 80% patients are fairly frequent with their eye check-up. Conclusion: Nearly 3/4^th of this urban population are aware about diabetic retinopathy and feel blood glucose control and regular eye check-ups are necessary in reducing the risk of diabetic retinopathy, less than 1/4^th know about blindness caused by DR, that laser treatment does not improve the vision but only reduces further deterioration and when a Diabetic patient should first visit the eye doctor-therein suggestive that most are aware of the disease but are not well informed about the complications and treatment of the disease.

Aim and Objective: To study the effect of Mifepristone on the symptoms and size of fibroids, specially using a low- dose regimen for 6 months. Material and Methods: It was an observational prospective “Before-After” study. 50 women attending OPD of Dept of Obs and Gynae, NSMCH Bihta between June 2019-May 2021 with diagnosis of uterine fibroid were selected according to the inclusion criteria to study changes in various parameters after 6 Months treatment with Mifepristone 50mg once a week. Baseline investigations were done,50mg Mifepristone weekly was used and patients re-assessed at 1 and 6 months. They were also further followed up till 3 months after stopping the drug to observe changes in menstrual pattern, fibroid volume, haemoglobin and liver function tests. Baseline endometrial biopsy and another at 6 months on cessasation of drug therapy were done for all patients. Results: Majority of the study population comprised of perimenopausal women i.e 41-45 yrs. 50% were Para 2. The dominant presenting symptom was menorrhagia associated with dysmenorrhoea and pelvic pain. After 6 months of treatment with Mifepristone, the mean fibroid volume reduced 45%. Immediate reduction in bleeding per vaginum was observed in 100% and 90% attained amenorrhoea. The mean haemoglobin increased from 9.18 to 10.82 gm/dl. There was transient rise in SGPT/ SGOT levels at 6 months which reverted to normal at 9 months follow up. Discussion and Conclusion: To conclude, 6 months therapy with 50mg Mifepristone weekly is efficacious and acceptable for the treatment of symptomatic fibroid, specially in select group of patients.

Aim: To evaluate the outcome of operative fixation of acute scaphoid fractures with those of non-operative treatment. Materials & Method: This clinical study was carried out among 26 patients with an acute nondisplaced or minimally displaced scaphoid fracture reported to the OPD of Department of Orthopedics Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. Patients were non-randomly allocated to group A (non-operative) and group B (operative). Results: The average age of the participants in the sample was 40.11 years. The majority of them were men, with 21 (80.7%) being male and 5 (19.3%) being female. 16 (61.5%) of the 26 scaphoid fracture cases were found on the right side, with the other 10 (38.5%) on the left. The most frequent site of fracture was the waist (B2) in 10 cases. In group B, there was complete union. Conclusion: Cast therapy has the drawbacks of a longer immobilisation duration, joint instability, decreased grip power, and a longer time to return to work, while operative fixation of acute scaphoid fractures results in a predictable satisfactory union performance and strong functional outcome, according to the report.

Aim: The aim of the study to determine the Functional outcome of open latarjet procedure for recurrent anterior shoulder instability. Methods: 50 patients with Bony Bankart’s lesion representing ≥ 25% of glenoid lesion, Hill Sacs lesion, On track lesion with glenoid bone loss of ≥ 25%, Off track lesion with glenoid bone loss < 25%, Lesions requiring Remplisage correction along with Latarjet procedure were included in this study. Functional scoring of the patient was determined by ASES (The American Shoulder and Elbow Surgeons) score, Quick DASH (The Disabilities of Arm, Shoulder and Hand) score, Rowe score, ISIS (Injury Severity Index Score score) and Visual analogue scale (VAS) for pain to get a baseline reference. The case was treated with open Latarjet repair after the criteria were met. In which coracoid process along with the conjoint tendon is transferred and fixed with screws to the margin of glenoid. Results: A total of 50 patients were evaluated in the study whose mean age was 33.22 (+/-8.12) years. 20 patients were less than 25 years (40%); 27 were between 25-40 years (54%) who were the majority and 3 were above 40 years (6%). All the patients in my study were males except for 2 females. Of total 50 patients 45 were male (90%) with a female (10%). Among 50 patients, 30(60%) patients had their dominant shoulder affected and remaining 20 (40%) had recurrent instability in their non-dominant shoulder. Mean VAS (Visual analogue scale) for pain among the patients in the study also reduced from pre-op value of 5.3 to 2.8, 1 and almost 0 at 1 month, 3 months and 6 months post- op respectively and this reduction in pain was found to be highly significant. The American Shoulder and Elbow Surgeons (ASES) Shoulder Score which is both a physician-rated and patient- rated scoring system showed a significant improvement at post-op follow ups. The post-op scores at 1 month, 3 months and 6 months were 67.9 (+/-8.1), 82.4 (+/-5.1), and 92.3 (+/- 5.3) respectively. The mean pre-op ASES score was 46.6 (+/- 5). The Quick DASH (The Disabilities of Arm, Shoulder and Hand) score also showed good improvement in patient satisfaction and ROM, with postop scores at 1 month, 3 months and 6 months being 31.8 (+/-8), 20.1 (+/-7.3), and 12.5 (+/-6.9) respectively. The mean pre-op Quick DASH score was 44.2 (+/-9.6). Conclusion: The Open Latarjet repair for anterior shoulder instability is a useful and successful procedure for patients with significant glenoid bone loss and heavy work demand such as contact athletes and manual labourers.

Aim: Evaluate the Prevalence of Acute Abdomen in General Surgery in Teaching Hospital. Methods: This cross-sectional study was done the Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi, India from January 2018 to June 2019. Total 2544 patients were admitted through emergency, out of which 336 patients were admitted with pain abdomen. Out of 336 pain abdomen patients 100 of them were admitted with surgical causes of pain abdomen and 236 were admitted with medical and gynecological causes. Results: During study period, 2544 patients were admitted through emergency. 336 (13.21%) of them were admitted with complains of pain abdomen. Out of 336 pain abdomen patients, 236 were due to non surgical causes and 100 were due to surgical causes. The frequency of surgical pain abdomen requiring emergency hospitalization was 3.93%. The most common symptom was pain abdomen and was present in all 100 (100.0%) of study subjects. Vomiting was present in 75 (75%) study subjects. 58 (58%) of study subjects reported abdominal distention. Fever was present in 46 (46%) of study subjects. Constipation and diarrhea were present in 55 (55%) and 2 (2%) of the study subjects respectively (Table 3). Most consistent sign was abdominal tenderness, which was present in all 100 (100.0%) of the study subjects. Abdominal guarding was present in 63 (63%) of the study subjects. Absent bowel sounds and tachycardia was present in 53 (53%) and 49 (49%) study population respectively. In this study most common cause of surgical acute abdomen was acute appendicitis. Acute appendicitis was present in 40(40%) of study subjects. Gall bladder pathology was the 2^nd most common cause of surgical acute abdomen in 22 (22%) of the study subjects. Renal/ureteric colic, perforation peritonitis, intestinal obstruction, and bowel ischemia was the cause of surgical acute abdomen in 13 (13%), 13 (13%), 7 (7%), and 5 (5%) of the study subjects respectively. Conclusion: The most common cause of surgical acute abdomen was acute appendicitis. Adequate health infrastructures at the primary and secondary health care level may be an important step forward to address common causes of acute abdomen.

Aim: The comparative analysis of the functional outcome of arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft fixed with bio-absorbable interference screw against titanium interference screw. Methods: The Present comparative study of 100 patients treated with arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring graft with endobutton as the femoral fixation device and titanium interference screw (no=50) and bio-absorbable interference screw (no=50) as tibial fixation device respectively.  Patients with closed growth plate, Primary ACL surgery, no evidence of multiple ligament injury, No previous knee surgeries and No ligamentous injury to contralateral knee were included in this study. Results: Our study is to evaluate the functional outcome of arthroscopic single bundle ACL reconstruction with quadrupled Hamstring graft with transtibial and transportal techniques using endobutton as femoral fixation device and titanium interference screw in 50 patients and bio absorbable interference screw in 50 patients as tibial fixation device. In our study fall and road traffic accidents predominated as the cause of injury accounting for 36% and 46% respectively. Sports injuries accounted for only 18% in contrary to all international studies. In our study 28% of patients had meniscal injury at presentation and medial meniscus injury predominated lateral meniscus injury like other studies. None of our patients had significant chondral damage at diagnostic arthroscopy. In our study we used transtibial or transportal single bundle reconstruction with quadrupled hamstring graft placing the femoral tunnel between 10 30 and 11’o clock position in the right knee and between 1’o clock and 1 30 position in the left knee.Our study shows that there is no significant difference in the outcomes associated with the use of titanium and bio absorbable interference screws used for anterior cruciate ligament reconstruction. Conclusion: Our study shows that there is no difference in functional outcome whether bio absorbable or titanium interference screw was used.

Aim: The aim of this study to determine the rate of sight restoration as a useful indicator to measure impact of cataract surgery. Methods: This study conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India, from July 2017 to June 2018. All of the eye examinations were performed by the same operator. Pre- and post-BCVA were categorized into four categories according to WHO classification. The categories are 6/6-6/18, 6/18-6/60, 6/60-3/60, and 3/60-No Light Perception. Result: Our study included 230 eyes 20 lost follow-up 10 had comorbidities in form of corneal opacities, optic nerve atrophy, retinal detachment, congenital anomalies. Total 200 patients were included in this study. Out of 200, 53% were male and 47% were female. The average age of the patients 37.5 years. Most of the patients 40-50 years.  5 of the visual impairments could not be cured due to co- morbidities. The SRR of the surgery in our study 50%. SRR is an indicator to determine the impact of conducting cataract surgeries on people’s productivity. In measuring SRR, the best visual acuity of either eye in a patient before the surgery is used. If the best visual acuity of either eye is already more than 3/60, then the cataract surgery is not considered as having an effect on people’s productivity. This is the key difference which differentiates SRR from other indicators which are used to determine the success of cataract surgery. Visual outcome <3/60 in 10 eyes (0.5%). Conclusion: SRR of the surgery in this research is 50%, while our poor surgical outcome is 5%. High SRR means that a lot of these patients can return to work, while poor surgical outcome means that the surgeries have very good standard.

Aim: The aim of this study to evaluate the role of noninvasive ventilation (NIV) for treatment of acute respiratory failure (ARF) among patients with noncystic fibrosis (CF) bronchiectasis. Methods: This was a retrospective study conducted in the Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India, from May 2018 to December 2018. We included 130 patients with bronchiectasis and ARF who required either NIV or invasive mechanical ventilation (IMV). Results: There were a total of 200 patients with bronchiectasis who were admitted during the above specified period. Among these, 130 patients were admitted with ARF.  Totally 130 patients who required either NIV or IMV. The most common etiology of bronchiectasis was post‑tuberculosis (54%) followed by idiopathic (22%), ABPA (18%), and immunodeficiency (6%). NIV was initiated as first line of ventilator support for 100 patients. Among these, 66(66%) were managed successfully with NIV. 34 (34%) patients failed NIV and required endotracheal intubation during the hospital stay.  Reasons for NIV failure were worsening or non-improvement of ventilatory or oxygenation parameters (n=16), hypotension (n = 7), worsening of sensorium (n = 5), and intolerance (n = 6). NIV failure occurred after a median duration of 2.73(95% confidence interval [CI]‑1.52–4.42) days after the initiation. There was total 15 deaths in the study group. Among patients who failed NIV, total days (median [range]) spent on ventilator (6.9 [2–61] vs. 6.3 [3–15] days; P = 0.27), duration (median [range]) of hospital stay (7.1 [4–61] vs. 13 [5–16] days; P = 0.25), and mortality (11 [11%]  vs. 4 [13.33%]; P = 0.21) were comparable to the IMV group. The causes of death among patients who failed NIV were septic shock (n=7) and ventilator‑associated pneumonia (n = 4). Conclusions: NIV is feasible for management of ARF with non-CF bronchiectasis. High APACHE may predict NIV failure among these patients.

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, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 15 months. 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 was 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.

Aim: The study on HbA1c levels in patients without GDM and its correlation with pregnancy outcome. Methods: The prospective analytical study was conducted in the Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, from February 2020 to February 2021. 50 Healthy antenatal women who are neither previously overt diabetic nor having gestational diabetes in the previous pregnancies were selected. A total of 50 antenatal mothers between the age group of 18 and 35 years and with gestational period more than or equal to 24 weeks, who were willing to participate were included in the study after getting proper informed and written consent. Results: A total of 50 non diabetic pregnant were taken in the study. The mean age of the population was 25.09 years. All of them were belonging more or less to same socioeconomic status. The majority of participants presented in their 2^nd trimester and few in third trimester. Congenital anomalies were ruled out by anomaly scan. At the time of sample collection for HbA1c all the foetuses of the participating mothers were in cephalic presentation and the liquor was adequate on clinical examination. The mean Hba1c was found to be 5.19%. Among the study population 36 (72%) had normal vaginal delivery, 1(2%) had forceps assisted vaginal delivery and the remaining 13 (26%) had caesarean section for various reasons. 48(96%) of the study subjects came with labour pains, 1 (2%) among them had foetal distress and meconium stained liquor each respectively for which they were taken up for emergency caesarean section. Remaining 1 (2%) antenatal mother had oligohyramnios during her last trimester. About 90% participants had normal birth weight babies and the mean glycaemic status of the neonate was 55.75 mg/dL. Among the subjects 2 new-borns (4%) had NICU admission, one for 1 day for phototherapy and the other was born with congenital icthyosis for which the baby was admitted and was on continuous monitoring. Conclusion: Our study showed no significant association between the maternal HbA1c levels in non-diabetic mothers and the adverse pregnancy outcome.

Aim: The aim of the study clinical and echocardiographic assessment of patients with atrial fibrillation. Methods: The present study was conducted in the Department of cardiology, Patna Medical College and Hospital, Patna, Bihar, India for 10 months. Total 120 patients were evaluated clinically, and detailed Cardiovascular, Neurological examination was done to evaluate etiology and for any evidence of thromboembolism. Echocardiography was also done. Results: Among the total 120 patients, males were predominant in this study as 66.67 % and females were 33.33 %. 110 patients (91.67%) in this study were hypertensive, 26 patients (21.67%) were diabetic, 41 patients (34.17%) had a significant history of Alcohol consumption and history of smoking was present in 13 patients (10.83%). Metabolic Syndrome was present in 17 patients (14.17 %). The most predominant presenting symptom was dyspnea that was class IV in 75 patients (62.5%) followed by pedal edema in 41 patients (34.17%), Stroke in 23 patients (19.17%), Palpitations in 20 patients (16.67%), Typical Chest Pain in 7 patients (5.83%) and in 20 patients (10 %) AF was discovered incidently during work up of some intercurrent illness. It was seen in 73 patients out of 107 (68.22%) followed by coronary artery disease (CAD) in 21 patients (19.63%), Dilated Cardiomyopathy (DCM) in 5 patients (4.67%) and 2 patient (1.87%) each of congenital heart disease (CHD), Hypertrophic Obstructive Cardiomyopathy (HOCM), Chronic Obstructive Pulmonary Disease (COPD) and Lone AF. Among the cases of valvular AF of 13 patients, Mitral stenosis with Mitral regurgitation was the most common lesion found in 11 patients (84.62%). 11 patients (84.62%) out of 13 had severe Mitral Stenosis having valve area of <1.5 cm2. Mean LA Size in this study was 48.15±10.05 mm. Ejection Fraction (EF) was found to be more than 44% in 87 patients (72.5%) and less than 44% in 33 patients (27.5%) as evaluated in the study. Left ventricular hypertrophy (LVH) was seen in 91 patients. Diastolic Dysfunction was seen in 19 patients (15.83%) out of 120. Regional wall motion abnormalities (RWMA) were present in 25 patients and LA (left atrial) clot was seen in 11 patients (9.17%) and that too in cases of Valvular AF. The most common complication was found to be as Congestive cardiac failure in 69 patients (57.5%) followed by stroke in 23 patients (19.17%), early death occurred in 13 patients (10.83%) and no major complication was documented in 15 patients (12.5%). Conclusion: The hypertensive heart disease was the most common etiology in elderly age group. Presence of LVH or left atrial enlargement in patients with hypertensive heart disease requires early management to improve the outcomes.

Aim: study of Vitamin C Deficiency and Oxidative stress Levels in Children with Transfusion- Dependent -Thalassemia. Methods: A cross-sectional study was conducted in the Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar India for 18 months. All children (below 18 years of age), with TDT and receiving regular transfusions at the centre were included in the study group. Any child who was already receiving vitamin C prior to enrolment was excluded. In the control group, 50 asymptomatic children    were included in this study. Results: Plasma vitamin C levels were low in 84 (84%) children in the study group, while all children in control arm had normal plasma vitamin C levels despite comparable dietary deficiency of vitamin C (P<0.001). The correlation of dietary deficiency with low plasma vitamin C levels in the 2 groups. Age (P=0.76), number of transfusions received (P=0.57), chelation (P=0.74), and associated infections (HIV, P=0.61, anti-HCV antibody positive, P=0.53) did not have any correlation with vitamin C levels, while increasing serum ferritin values correlated with vitamin C deficiency (r=0.4, P= 0.03). There was a correlation between higher serum ferritin values and MDA levels done prior to administration of vitamin C (r=0.37, P=0.04). On administration of vitamin C, the mean (SD) levels of vitamin C rose from 0.2 (0.1) mg/dL to 0.7 (0.2) mg/dL in those with low plasma levels of vitamin C (P<0.001). The mean (SD) level of MDA dropped from (7.5) nmol/mL to 8.5 (2.7) nmol/mL after 15 days of administration of vitamin C (P<0.001). Conclusions: Low levels of vitamin C are common in children with thalassemia. Dietary counselling along with supplementation with vitamin C, in those with low levels may prevent oxidative stress.

Background: The human foot is studied for various reasons in forensic sciences. It is of value in the crime scene in establishing the personal identity and can be a useful link for the perpetrators of crimes. The present study aimed to estimate the height of an individual based on their footprint lengths. Methods: This cross-sectional study was conducted in the Department of Forensic Medicine, Kakatiya Medical College, and MGM Hospital, Warangal, Telangana State. A total of n= 50 male and n=50 female students were included for the study aged from 18 to 23 years. Glass plate of (2 X 2 Feet) cleaned and smeared uniformly with painter ink will be kept on the floor. Students with dry feet will be asked to stand on the smeared glass plate first and then, on two separate white sheets so that prints of the right foot and left foot will be transferred on these white sheets separately. Height is measured with a stadiometer. Results: The average footprint length of the right foot was slightly larger than the left foot in males. A relevant correlation (r) value was found to be positive for the right footprint (+ 0.560). In females, the average footprint length of the right was also slightly larger as compared to the left footprint length. The correlation coefficient (r) values were however strongly positive for left foot + 0.712 versus right foot + 0.614. The relevant regression equations have been developed and depicted in tables 3 and 4. Conclusion: it can be concluded that the footprint length in males, as well as females, shows a good correlation with body height. Therefore, footprint length can provide better reliability and accuracy in the estimation of body height. In males, the right footprint gives a better correlation and in females, both right and left footprints are equally reliable.

Aim: Norepinephrine versus phenylephrine for maintenance of blood pressure during spinal anaesthesia for caesarean delivery. 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 11 months. After written informed consent to participate in study, 100 patients of 18-32 years of age group, having singleton, full term pregnancy, American Society of anaesthesiologist physical status (ASA) II posted for elective caesarean section under spinal anaesthesia were included in the study.Results: 100 patients were included in this study. Patient characteristics and surgical time were similar between the two groups. Both the drugs were able to maintain the systolic blood pressure following spinal anaesthesia throughout the surgery (p=0.37).  In group N, no changes observed in CO while in group P, it decreased from 3 minutes to 15 minutes, with maximum fall after 5 minutes and then after maintained till the end of surgery (p<0.05). Comparing both the groups, CO remained less in patients with phenylephrine group than norepinephrine group for 3 to 15 minutes after spinal anaesthesia (p=0.016). Then after, it was comparable in both the groups. Requirement of total intermittent bolus doses were comparable (1.8± 0.74 vs 1.44 ±0.53) in both the groups (p=0.078). In group N, no difference in mean pulse rate was observed. While, in group P, significant decrease in mean pulse rate was observed from the preoperative value till the end of surgery (p<0.01). On inter group comparison, the mean pulse rate remained lower in group P as compared to group N from 1 min till 20 minutes, then after it was comparable between both the groups (p=0.001). Conclusion: Norepinephrine is as effective as phenylephrine for maintenance of blood pressure during spinal anaesthesia for caesarean delivery with stable cardiac output and heart rate. It can be used as an alternative vasopressor to phenylephrine for managing intra operative hypotension during spinal anaesthesia for caesarean delivery.

Aim: The aim of the study was to determine the maternal and perinatal outcome in GDM among Low Socioeconomic Status. 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 June 2020.  Total 220 patients were included into the study. Out of 110 GDM patients who were managed and delivered and another 110 women with normal profile patients without GDM who delivered during the same time were taken as controls. The baseline characteristics (age, body mass index, religion, and socioeconomic status) were noted in all cases. Diagnosis of GDM was made using oral glucose tolerance test with 75 g glucose. GDM patients were started on diet following which insulin or oral hypoglycemic agents were given if required. Maternal and perinatal outcome was noted in all women. Results: The prevalence of GDM was 4.23% (110/2600) total of 89(80.91%) were controlled on diet, whereas 12(10.91%) required insulin and 9(8.18%) were treated with oral hypoglycemic agent. Family history of diabetes was observed in a significantly higher number of GDM patients 31(28.18%) as compared to control group 17(15.45%) (P = 0.001). Gestational hypertension and preeclampsia were seen in a significantly higher number of 22(20%) cases in GDM patients as compared to controls 9(8.18%), whereas polyhydramnios was also seen in higher number in GDM it was 3(2.73%) and Prevalence of other antenatal complications such as UTI 14(12.73%) and candidiasis 6(3.64%) was higher in GDM patients as compared to non GDM patients groups. There was no significant difference in the mode of delivery between the two groups. Mean birth weight was significantly higher in GDM group 2887.61±542.57 as compared to control  group 2763.59±646.12. There was no significant difference in Apgar score at 1 and 5 min in two groups. There was a significantly higher number of large-for- date babies in GDM group as compared to control group. Conclusion: The prevalence of GDM was 4.23% in this study. Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can achieve near‑normal maternal and neonatal outcome.

Aim: Assessment of the prevalence and associated risk factors of post dural puncture headache (PDPH) after cesarean section delivery under spinal anesthesia. Methods: This Cross Sectional study conducted in the Department of Anaesthesiology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 13 months.  The entire procedures were performed at sitting position. The backside of the patients was cleaned with Iodine and alcohol. Spinal anaesthesia was done using a midline approach at the L2-3 or L3-4 interspaces by using different size of spinal needles and 0.5 % isobaric bupivacaine 2.5-3.0ml was injected. Results: The 100 Patients were included in this study with fulfilling the criteria. 8 patients had a previous history of spinal anesthesia exposure and 3 of them complained a PDPH like headache after the procedure. All patients had given spinal anesthesia on sitting position. 21 G needle is the most frequently used spinal needle which is 45% of total patients whereas 20 G is used as 3%. There were 1 case (1%) diagnosed as failed block which were converted to general anesthesia.  Hosmer-Lemeshow test of goodness of fit was performed to check the appropriateness of the model for analysis. Variables found to be significant at a binary logistic regression were needle size and number of attempts. After analysis with multivariate logistic regression needle size and number of attempts were found to be significant at p-value<0.05. Size of the needle used to administer spinal anesthesia is significantly associated with the development of PDPH.  In this study PDPH was present in 43 patients (43%). Conclusion: In conclusion, the prevalence of PDPH was higher, 43% compared with most other studies.

Aim: The aim of this study was the assessment of lipid profiles mainly triglycerides in diabetic patients from bihar region. Methods: This was a cross-sectional study was done in the Department of General Medicine, Madhubani Medical College and Hospital, Madhubani, Bihar, India from November 2019 to November 2020. 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. The Gender distribution showed that 20 male participants (37.74%) and 33 female participants (62.26%) had low HDL. Among the 100 participants, 69(69%) participants   had   desirable total   Cholesterol levels of <200mg/dl, 25(25%) had borderline high levels of 200- 239mg/dl and 6 (6%) had high total cholesterol levels of ≥240mg/dl. 30 (30%) participants had an optimal level of LDL of which 12 (40%) participants were males and 18 (60%) were females. 35 (35%) had near optimal levels of LDL and 14(40%) participants were males and 21(60%) were females. 21 (21%) had borderline high levels of LDL out of which 7 (33.33%) participants were males and 14(66.67%) were females. 12(12%) had high levels of LDL of which 4 (41.67%) were males and 8 (58.33%) were females. 2 (2%) participants had very high levels of LDL of which 1 (50%) was male and (50%) was female. Conclusions: Hyperlipidemia 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.

Aim: Evaluate the Intraoperative Anaesthesia Management and Postoperative Pain Scores after Caesarean Section. Methods: This cross-sectional study conducted in the Department of Anaesthesiology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 15 months. All patients either receiving GA or spinal anaesthesia for CS receive IV tramadol infusion for post-operative pain control, which is started either at the request for first analgesia in the PACU or at 60 min, whichever comes first. Patients are assessed for pain using numerical rating scale (NRS) immediately in the PACU and at regular intervals. Any patient having NRS >4 is given rescue analgesia. Results: Percentage of patients having NRS >4 and who required rescue analgesia on immediate assessment (time zero) was 15 (15%). After that, 13 patients (13%) at 30 min, 10 (10%) patients at 45 min and 5 (5%) patients at 60 min had NRS of >4 and required first rescue analgesia. There was no statistically significant difference among patients in PACU having NRS >4 from those having NRS <4 in terms of the type of incision, ASA grading and duration of surgery. Patients receiving RA had a statistically significant (P-value < 0.01) low percentage of patients with NRS >4 and need for first rescue analgesia at time zero and at 30 min when compared to the percentage of patients operated under GA. The difference became insignificant after 30 min. Overall, 18% of patients received some sort of co-analgesia, mainly in the form of IV paracetamol 15% and only two patients received TAP block. Conclusion: The pain management in the PACU was adequate as all patients were given rescue analgesia if they had NRS of >4 and no patient was shifted from PACU with NRS of >4.

Aim: Study of variations in the reported haemophilia prevalence around the Bihar Region in Tirhut. Methods: The present Observational study was conducted in the Department of General Medicine, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for 1 year. Patients with clinically suspected bleeding disorder, who were referred to us either from departments of our tertiary care hospital or from Hemophilia Society were included in this study. Complete Blood Count (CBC), General Blood Picture (GBP), tests for coagulation: Prothrombin time (PT), Activated partial thromboplastin time (APTT), Thrombin time, Correction experiment to know the specific factor deficiency or inhibitors present by Normal Plasma, Normal aged serum, Al(OH)₃ adsorbed plasma, Specific Factor Assay, Inhibitor Assay. Results: 100 patients diagnosed as suffering with Hemophilia A or B were included in study. The age of patients ranged from 3 months to 50 years. In our study, maximum number of patients was in age group 10-15 years. All patients were male. In our study, family history was present in 64% of patients, consanguinity was present in 5% of patients, 3% consanguineous patients were positive for family history. In our study, most common presenting clinical feature was prolonged bleeding after cut (79%). More than 3 joints were involved in 22% of haemophilia-A patients. Arthropathy/deformity was present in 19% of patients. Bilateral knee joints were involved in 15% of Hemophilia B patients. Arthropathy/deformity was present in 8% of patients. The mean for PT was 15.06 ± 1.06 while mean for APPT was 81.33 ± 19.20. Out of 100, 86(86%) were Haemophilia A and 14 were (14%) Hemophilia-B patients. The Mean Factor VIII value was 48.58 ± 29.33 (P value < 0.001). Factor IX assay was done in 50 patients. Mean Factor IX value was 109.60 ± 23.93 (P value < 0.001). 58.14% patients of Haemophilia A were having <1% factor VIII concentration. In our study 71.43% cases of Haemophilia B were having <1% factor IX. 37% patients were having transfusion ≥3 times, 38% were having <3 times. 4% cases of treated Hemophilia A patient develop inhibitor. Conclusion: The prevalence of hemophilia and incidence of inhibitors in these patients is varies in different regions of India. This variation may be due to the type of product used as treatment, intensity of treatment or the genetic characteristics of the patients.

Background: Enteric fever, also known as typhoid, is a common worldwide bacterial disease caused by the ingestion of contaminated food or water which contains the bacterium Salmonella enterica, serovar Typhi. It disproportionately affects children with varied clinical presentations ranging from a mild illness with low grade fever to severe life-threatening complications. Aim: To evaluate clinical and laboratory profile of typhoid fever in children of Bihar region. Materials and Methods: Total 150 children aged below 18 years who presented in 2 years to the Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India with history of fever of more than 7-10 days duration were included in this study. In each case, age, sex, presenting complaint, past medical history, laboratory investigations including Widal test and antibiotic sensitivity pattern are collected and analyzed. Results: Out of sample population of 150, 90 (60 %) were males and 60 (40 %) were females. Out of all these patients, maximum cases (58 %) were from age group of 7-12 years of age. The most common symptoms were fever (100 %), followed by anorexia (71.33 %). We observed high incidence of typhoid fever in lower class (28.67 %) and lower middle class (48 %), lesser in upper middle-class society (14 %) and least in upper class (9.33 %).]. The most common physical findings found in our study was toxic look (68.67 %) followed by coated tongue (62.67 %) and hepatomegaly (40 %). Conclusion:  Typhoid fever should be suspected and investigated in all children with short and long duration fever without localizing signs. Early diagnosis and institution of appropriate antibiotics therapy is of paramount importance in the management of typhoid fever.

Aim: The aim of the present study to determine the bacteriological profile of acute conjunctivitis. Methods: This prospective observational study was carried out in the Department of ophthalmology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, for 1 year. This is prospective observational study with evaluation of demographic factors, associated comorbid conditions and finding causative organism i.e., bacteria gram staining culture methods and biochemical reaction. Results: All 100 patients underwent Gram stain and bacterial culture out of 100, 69 patients were culture positive and other was negative. In the present study, the most common organism isolated Coagulase positive staphylococci 42% followed Klebsiella pneumoniae with 12%, Pseudomonas 6%, Diptheroids 3% and least Alkaligenes fecalis was 2%. Out of 100 patients 45 patients had a involvement of both eyes which is 45% and 55 patients had involvement of only one eye which is 55%. Complications like Petechial haemorrhages were seen in 83(83 %) of the cases while Punctate keratitis was seen in 8(8%). All the cases presented with red eyes, conjunctival congestion is seen in all the cases, lid oedema in 85(85%) cases, matting of eyelashes in 41(41%) cases and preauricular lymphadenopathy in 45(45%) cases, Conjunctival follicles 79(79%) cases and Corneal sensation was present in 85(85%) cases. Conclusion: We concluded that the bacteriological evaluation of conjunctivitis provides to the ophthalmologist a working knowledge of the causal microbes, their common presentations, clinical course and antibiotic sensitivity patterns along with confirming the clinical diagnosis.

Aim: Epidemiological analysis of traumatic spinal injuries in Bihar, India. Methods: This Observational study conducted in the Department of Neurosurgery, IGIMS, Patna, Bihar, India for 1 year. All the 100 patients of traumatic spinal injuries admitted in our hospital were included in this study. Detailed history with respect to age, sex, occupation, education, socio-economic status and mode of trauma was taken, followed by a clinic-radiological examination to ascertain the exact spinal and associated injuries. Results: Total 100 patients with traumatic spine injury included in study. Out of these there is 68(68%) were male and 32 (32%) were female. Male to female ratio was 2.12:1. In our study most common mode of injury was fall from height like unprotected roof, uncovered well, construction work, tree, electric pole in 45cases (45%), followed by road traffic accident in 42 cases (42%). other cause of injuries were assaults in 7 cases (7%) and sports in 6 cases (6%). In our study lumber spinal column was fractured in 56cases (56%) followed by thoracic spine in 22 cases (22%). Cervical spine injuries noted in 20cases (20%). Sacral spine injuries noted only in 2 cases (2%) but it associated with abdominal and pelvic injuries. Out of 100 cases of Traumatic Spinal Injuries 32 cases (32%) found to be had other associated injuries. Most common of them was head injuries in 10 cases (10%) and extremities injuries 10 cases (10%) followed by chest injuries 6cases (6%), abdominal injuries 3 cases (3%) and pelvic injuries 3 cases (3%). Conclusion: TSI is major source of morbidity and mortality in Bihar, India like throughout the world. Accidental fall and RTA are major cause of TSI. Prevention remains the most effective way to reduce the burden of the traumatic spinal cord injuries.

Aim: Study of drug utilization pattern of analgesics among post-operative patients in a tertiary care hospital. Methods: This prospective, observational study was conducted in Department of Pharmacology Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India for 1 year (1 Sep 2020- 31 Aug 2021). Patients aged >18 years who underwent operative procedure in Departments of Orthopedics, General Surgery and Obstetrics & Gynecology and who were willing to participate in the study were included after taking informed consent in a pre-designed consent form. The data regarding analgesics prescribed during day 0, 1st, 2nd & 3rd post-operative days, their dose, route of administration, mono/combined therapy were collected from case sheets. Results: All the patients were prescribed with injectable analgesics (Parenteral) on the day of surgery (Day O) and also on 1st post-operative day (day1). Diclofenac was the most commonly prescribed among the injectable analgesics (49%), followed by Paracetamol (30%), Tramadol (17%) and Pentazocin (4%). On 3rd post-operative day (Day 3), number of patients prescribed with different oral analgesics has increased to 83(83%). Combination of Aceclofenac + Paracetamol (34%) was again the commonly prescribed oral analgesic followed by Paracetamol as a single drug and Tramadol + Paracetamol (13%) combination. Repeated measure ANOVA and post hoc tests showed that the overall difference in mean pain scores on VAS scale measured at 0hr post operatively were not significant between the groups with a p-value of 0.541. However Mean pain scores measured at 2 hours and 6 hours were significantly higher in Group A compared to Group B and C (VAS scale p value 0.001 and 0.041) which shows that maximum reduction in the mean pain scores in group C at 2 hrs and group B at 6 hrs respectively. Conclusion: The post operative cases can be managed with conventional NSAIDs and non NSAIDs like Tramadol to little extent. These are relatively safe drugs for short course therapy (<10days), with minimal side effects. Single analgesic was used parenterally in maximum number of cases in the early post-operative period. The prescription of drugs in brand name could be changed to Generic name.

Aim: The aim and objective of this retrospective study is to compare the effect of warm versus regular room temperature seitz bath. Methods: This was a clinical retrospectively study conducted in the Department of General Surgery, Government Medical College, and Hospital, Bettiah, Bihar, India for 15 months.  Total 85 patients comprising cases of haemorrhoids, fissure, perianal fistula, pilonidal sinus, perianal abscess and episiotomy wounds in the age group of 18 years to 55 years were include in this study. A set protocol of medical line of management was made for all the patients in the form of 5 days course oral antibiotics, metronidazole, H2 blocker along with 3 to 5 days course of analgesic and ointment for local application. All the patients were asked to practice seitz bath of their choice by warm water or regular room temperature seitz bath with added povidone iodine solution 3 to 4 times in a day till the wound heals completely and the patient gets the desired pain relief. Results: out of 85 patients, 50 patients (58.82%) in the study group opted for warm water seitz bath as compared to 35 patients (41.18%) of regular water seitz bath from the 3^rd   day of surgery onwards. All the 35 patients operated for pilonidal sinus, perineal abscess and perianal fistulectomy were found to have significant discomfort in the initial 15days to 21 days due to discharge from the wounds. But all the patients got satisfactory results with respect to the reduction in the amount of smell and discharge from wound after a period of 15 days to 21. Adequate wound healing was achieved over a period of 8 to 10 weeks in all the patients of fistulectomy, perineal abscess and pilonidal sinus excision depending upon the size of the tissue defect and severity of infection. Conclusion: The frequency of seitz bath and subsequent improvement in the local hygiene definitely give comfort to the patient and speeds up wound healing.

Aim: To study the prevalence of patients with anal fistula due to chronic anal fissure. Methods: This was an analytical observational study conducted in the Department of Surgery, Madhubani Medical College and Hospital, Madhubani, Bihar, India, for 1 year. The patients were examined on the 8th postoperative day and at 1, 2 and 6 months postoperatively. Objective healing was defined as complete epithelization of the fissure base and if present, all raw areas created by sentinel pile excision or fistulotomy. Time of relief of pain and complications were also analyzed in the group of patients who underwent surgery. At 6 months’ follow up, successful clinical outcome was defined as the lack of anal symptoms and objective healing of the fissure. The Cleveland clinic incontinence score (CCIS) was also noted at 6 months. Results:  Of the 171 surgically treated patients, 120 (70.2 percent) underwent LIS (LIS-only group) as no additional sequels were detected. Two complications (1.7 percent) percent) were noted. A single case had bleeding that required additional hemostasis and a second one developed infection on the LIS incision. Time of relief of pain was 1.82±1.02 days. Objective healing was achieved in 114 (95 percent) of the patients at one month’s follow up and in 118 (98.3 percent) at two months. At 6 months, three patients were lost for follow up, the rest healed, but a single patient developed recurrence and he was treated with Botox® injection (successful clinical outcome in 96.7 percent). The parameters investigated are shown in Table 1. Sentinel piles were detected in 56 patients (22 percent). Of the 171 patients who underwent surgery, 46 (26.9 percent) had sentinel piles. Sentinel piles were removed in 44 patients (95.7 percent) with their will and consent (LIS+sentinel pile excision group). The remaining two patients were excluded from further analyses. A single case developed abscess and subsequent fistula on the sphincterotomy site, and another patient developed bleeding on the raw area of the sentinel pile excision (complication rate of 4.5 percent). Conclusion: In conclusion, at least 3 percent of the patients with CAF harbor a coexistent abscess or fistula around the fissure. This fact, which may sometimes be disguised, needs to be seriously considered by practitioners of this field and appreciated by hospitals and insurance companies.

Aim: The aim of this study to evaluate the surgical outcome in chronic otitis media with cholesteatoma. Methods: This prospective observational study was carried out in the Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 1 year. All patients of chronic otitis media with cholesteatoma – new cases, and previously operated cases with residual or recurrent disease. A written informed consent was taken from all patients included in the study. Detailed history-taking, thorough clinical examination was done for these patients. The data collected was entered into a specially designed case record form. Results: The mean preoperative ABG was 36 dB and the mean postoperative ABG was 22 dB with an improvement in mean ABG of 14 dB. 57% of the study population underwent ICW mastoidectomy and 43% underwent CWD mastoidectomy. The mean improvement in ABG in ICW mastoidectomy was 16dB whereas it was 11.4dB in CWD mastoidectomy showing a statistically significant difference. All patients in the study population underwent ossicular reconstruction of which 52% underwent myringo platinopexy (MP) and 48% underwent myringo- stapedopexy (MS). The mean improvement in the ABG in subjects who underwent MP was 13.5dB and in MS was 14.6 dB. Postoperative complications were noted in 15% of the study population. Our study had 6 patients undergoing revision surgery, all of which were after a period of 1 year from the previous surgery undergone by the patients for cholesteatoma. From this the recurrence rate for cholesteatoma can be determined at 14%. Conclusion: The controversy of ICW vs. CWD surgery is here to stay for long. However, it can be noted that both procedures have their own advantages and disadvantages and when performed meticulously both serve the purpose of rendering the patient a safe ear.

Aim: The aim of this study evaluates the echocardiographic and radiological profile of clinically diagnosed congenital heart disease in children. Methods: The Prospective, Observational study was conducted in the Department of Pediatrics, Darbhanga medical college and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 15 months. 100 Children up to 12 years of age with clinically suspected cases of CHD were included in this study. All children up to 12years of age with complaints of recurrent chest infection, respiratory distress, cyanotic spells, squatting episodes, poor feeding, failure to thrive and other relevant history and examination findings suggestive of CHD were included in this study. Informed consent was taken from parents or caregivers. Results: Out of 4700 patients (both IPD and OPD) 115 patients were found to have CHDs and the hospital incidence of CHD is 2.45%. Cough (81%) and breathlessness (66%) were major symptoms. Acyanotic CHD comprises 69% of total cases. Cardiomegaly 74%and hypertrophy 52% were major findings. Echo also suggested ACHD in 63% of cases. Conclusion: The most common presenting symptoms in CHD were cough and breathlessness. Chest X-ray is important corroborative evidence in the diagnosis of CHD and was abnormal in 80% of cases with the presence of cardiomegaly in 74% of all cases.

Aim: The aim of this study was to evaluate the sonographic morphology of pelvic masses and to correlate with the histopathological diagnosis of the patients who underwent surgical intervention. Material and Methods: A cross-sectional prospective study was conducted in the Department of Radiology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India for 12 months. Total 100 female patients with gynecological masses using high resolution ultrasonography and findings correlated with histopathology or serial sonographic examination. Results: Majority of the patients were in the age group of 40-50 years with mean age of 36.3 years. The minimum number was in the age group of below 20 years. The most common chief complaint of female patients enrolled in our study was pain in pelvic cavity 36 (36%) followed by pain and palpable mass 16(16%).  Menstrual    irregularity,    menorrhagia,  post-menopausal bleeding, infertility, and amenorrhea were the other less common complaints in the female patients of our study. Out of 100 patients evaluated by ultrasonography 25 (25%) were having ovarian pathologies and 45(45%) were having uterine pathologies. 11(11%) patients presented with localized collection in to the fallopian tube pathologies. Few cases there were involvement 8(8%) of vagina. Fibroids were the most common uterine masses. Conclusion: The USG is most commonly preferred imaging tool to evaluate gynecological masses. It’s important to differentiate gynecological and non-gynecological masses on sonography for accurate management of the patient.

Aim: To evaluate the outcome of three dimensional osteotomy for cubitus varus deformity. Methods: This prospective study conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 12 months. A total of 40 patients attending at the department of orthopaedic surgery for the treatment of cubitus varus deformity within the defined period were enrolled in this study. Patients with cubitus varus deformity after malunited supracondylar fracture of the humerus, patients who will voluntarily give consent to be enrolled in the study, in case of minors, the consent of the guardians was taken, age between 8 to 20 years and duration of fractures >1 year. Results: Among 40 subjects, the duration of injury was <35 months in 22 (55%) subjects and ≥35 months in 18 (45%) cases. Among 40 subjects, majority of the patients 30 (75%) was previously treated with closed reduction (CR) and cast immobilization, only 6 (15%) patients were treated with CR and percutaneous pinning and 4 (10%) patients were initially maltreated by Bonesetters. The distribution of study population according to duration of bone union after osteotomy. In 30 (75%) cases, duration of union was 8- 10 weeks, in 6 (15%) cases duration of union was 10-12 weeks while only in 4 (10%) cases duration of union was >12 weeks up to 16 weeks according to radiology. Before 15 years of age, duration of bone union following corrective osteotomy took 8-10 weeks in 26 (65%) cases and 10-12 weeks in 2 (5%) cases. On the other hand, in age >15 years’ group, duration of union was 8-10 weeks in 4 (10%) cases, 10-12 weeks in 4 (10%) cases and 12-16 weeks was in 4 (10%) of patients. The pre- and post-operative means (±SD) carrying angle were -18.55°±3.46° and 9.50°±1.77° respectively. This indicated a significant difference between the two groups. Again, the preoperative means (±SD) range of motion were 117.50°±6.98° (flexion), 18.75°±3.41° (extension) and 29.65°± 5.97° (internal rotation) respectively. The post-operative means (±SD) range of motion were 130.00°±4.90° (flexion), 5.00°±3.57° (extension) and 3.2±1.83° (internal rotation) respectively. In current study, only 4 (10%) patients had under correction of deformity, 2 (5%) patient developed nerve injury that was neurapraxia type of radial nerve injury, which was improved within 8 weeks and 2 (5%) patients developed infection that led to stiffness of elbow joint. The outcome of the subjects was graded according to Mayo elbow performance score: excellent were 16 (40%), good were 18 (45%), fair was 4 (10%) and poor were 2 (5%) patients. Conclusion: Cubitus varus usually presents as a cosmetic problem rather than functional one. After analyzing the results of the present study, it can be concluded that three dimensional osteotomy is a safe technique with satisfactory outcome in the treatment of cubitus varus deformity.

Aim:  Comparative study of functional and radiological outcome in management of type IIIB tibial fractures by AO and ilizarov external fixator. Methods: This Randomized, comparative study conducted in the Department of Orthopedics, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, for 1 year. 50 patients satisfying the inclusion criteria have been treated by Ilizarov technique and 50 patients treated by AO external fixator in the previous 1 years. Results: In our study ASAMI bone results & functional results was Excellent (24%), Good (72%) & Poor (4%) in AO group, whereas in Ilizarov group Excellent (64%), Good (32%) & Poor (4%). Conclusion: Ilizarov external fixator being minimally invasive procedure interferes less with the blood supply. The construct is ring fixator, safe, stable (three dimensional stability) and enable the patient early Weight bearing after surgery and high union rates, even in highly comminuted fractures.

Aim: The relationship between the mandibular foramen and numerous landmarks on the ramus of the mandible, as well as its clinical importance. Material and methods: The present study was done in the Department of Anatomy, Nalanda Medical College, Patna, Bihar, India, for 15 months. The material for the present study consists of 120 adult dry human mandibles of unknown sex. All measurements were recorded using a sliding vernier caliper. Results: A total of 120 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 statistically 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 57.66± 3.67% and on the left side it is 63.22 ± 2.52%. The percentile of distance MF-MN in relation to MF – MN+ MF-MB is 50.61 ± 3.69% on the right side and 47.51± 5.30% 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: 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.

Aim: Prospective analysis of post-operative pain management in elective Laparotomies in a tertiary care centre.  Methods: This prospective observational study conducted in the Department of Surgery, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, for 1 year. 100 patients who underwent elective Laparotomy were provided details about the study and method. Informed written consent was obtained. Detailed history of the patient, condition, surgery performed, analgesics used were documented. NRS score was calculated. Results: A total of 100 patients were included among which 41(41%) were female and 59 (59%) were the male patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine in 48 (48%) patients followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural in 32(32%) patients (p=0.88). By the second day 53(53%) patients were shifted to oral analgesics most common drug used was the combination of aceclofenac, paracetamol and serratiopeptidase. 7(7%) patients were on transdermal patch on post-operative day 2 and 2 (2) patients were on diclofenac patch and 5 (5%) patients were on fentanyl patch. The use of analgesics was shifted from parenteral to oral route from post-operative day 2. All the patients received analgesics within 6 hours of surgery (p=0.75). NRS score was recorded for all the 100 patients on postoperative days 1, 2 and 3. Severity of pain gradually reduced from post-operative days 1-3 with the use of various analgesics. Conclusion: Multimodal analgesia was used in most of the patients for management of post -operative pain combined analgesia was better mode of pain management method than a single analgesic. For 48(48%) of patient’s opioid with epidural was used for post-operative pain and for 32 (32%) of patients NSAID with epidural was used for post -operative pain.

Aim: To study the distribution of the initial site of infection in diabetic foot and associated initiating etiologies. Methods: This cross sectional study conducted in the Department of Surgery, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, for 2 years. 100 Patients who initially presented to the investigator and those who could be processed through well enough for identification of necessary data were included in the study. Results: Of 100,61% of the patients were above 60 years and 39% were below 60. 45% of the patients were male and 55% were females. 63% of them had duration of diabetes of more than 10 years and 37% had duration of less than 10 years. 41% had evidence of peripheral vascular occlusive disease and 59% had no clinical evidence of vascular occlusion. 29% had previous history of diabetic foot infection and 71% did not have. These patients are already predisposed and added with the scarring of previous infection if they were drained using plantar incisions or excisions. 41% of the patients were smokers and 59% non- smokers. Incidence of peripheral vascular disease and amputations is particularly high in smokers. 65% had a body mass index (BMI) above 30 and 35% had a BMI below 30. In addition to predisposing to diabetes, a greater body weight adds to the demand on the foot. 9% of these patients had chronic kidney disease and 91% did not have it In our study, 29% affected the big toe, 18% the other 3 toes, 15% were in the interdigital spaces, 22% in metatarsal regions, 5% in mid foot, and 11% in heel. Trauma, callosities and foot deformities are some of the predominant causes in the big toe, other 3 toes interdigital spaces, metatarsal heads, mid foot and heel. Fungal infection is common in the interdigital space. Cracks and fissures are common in metatarsal heads, interdigital space and heel. Conclusion: With this study, we are recommending that, during each visit, in addition to routine neural, and vascular clinical examination, the health care personnel should focus on the sites of foot, that has high chance of involvement and the associated risk factors that most commonly contribute to infection at the specific site to help prevent delay of detection of problems and thus save functional feet and limb.

Aim: The aim of the present study was to determine the morphometrical and topographical variations of nutrient foramina in human clavicles. Methods: The study material consisted of 80 dry human clavicles of unknown age and sex, without any deformity or fracture, which were collected from the Department of Anatomy. All the bones were macroscopically observed using magnifying handlens for the number, position and direction of the nutrient foramina. The nutrient foramina were identified by the presence of a well marked groove and often with slightly raised edge at the commencement of the canal. The distance of foramina from the sternal end & the total length of the clavicle were measured in millimeters, ignoring curves of clavicle. Results: The foramina were single in 35(43.75%) clavicles, double in 40 cases (50%), and more than two foramina in 5 clavicles (6.25%). Most of the right clavicles contained single foramina (28.75%) whereas left clavicles contained double foramina (31.25%). Three foramen were found in 2 clavicle of right side and 3 clavicles in left side. Total 130 number of nutrient foramen was found, out of which, 39.23% foramen were on inferior surface and 60.77% foramen were on posterior surface of the clavicles. Percentage of clavicle containing nutrient foramina on inferior surface was 46.67% and on posterior surface was 53.33%. Total number of clavicles considered was 90 as some clavicles contained nutrient foramen on both posterior and inferior surfaces. We found 19.23% foramens at the medial 1/3 region, 71.54% at the middle 1/3 region and 9.23% at the lateral 1/3 region of the shaft of the clavicles. Percentage-wise calculation of clavicles containing these foramens at different regions was also done. Total number of clavicles were 90 as some clavicles contained more than one foramina at different regions (medial, middle or lateral). In our study 62.22% of clavicles contained nutrient foramen in middle one third region, 24.44% contained on medial one third and 13.33% on lateral one third. Conclusion: Nutrient foramina vary in their position, number and distribution on the bone surface. Knowledge of nutrient foramen is helpful in surgical procedures like bone grafting and in microsurgical bone transplantation.