Volume13,Issue4

1. A Case Control Study to Determine the Frequency and Severity of Vitamin D Insufficiency in People with Type 2 Diabetes.
Anil Kumar Mahto
Abstract
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.

2. Effect of Dietary Habit and Physical Activity on Over Nutrition of School Going Adolescents
Bhagraj Choudhary
Abstract
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.

3. The Radiological Assessment to Determine the MRCP’s Accuracy over USG and CT in Diagnosing the Patients Suffering from Obstructive Jaundice
Chandan Kishore, Ratna Priya
Abstract
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.

4. Establishing the Metrical Factors for Estimating Height from the Long Bones of the Superior Extremities in Humans
Premjeet Kumar Madhukar, Mani Bhushan Yadav, Praveen Kumar
Abstract
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.

5. To Assess the Usefulness of Non-invasive Ventilation (NIV) in the Treatment of Acute Respiratory Failure (ARF) in Patients with Bronchiectasis Caused by Cystic Fibrosis (CF)
Ranjeet Kumar, Shashi Kant
Abstract
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.

6. Assessment of the three Different Dexmedetomidine Doses and their Effects on the Duration of Spinal Anaesthesia: A Comparative Research
Shashi Chandra Bhurer, Shreya Saurav, Binod Kumar Kashyap
Abstract
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.

7. Prospective Cross Sectional Assessment of the Pattern of Antimicrobial Use in an Indoor Ward of A Tertiary Care Hospital’s Surgery Department
Vikram Jha, Anil Kumar
Abstract
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.

8. Management and Visual Outcome in Lens Induced Glaucoma: Prospective Clinical Study
Mrityunjay Kumar, Binod Kumar
Abstract
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.

9. A Clinical Evaluation of the Levels of High-Sensitivity C-Reactive Protein in People with Type 2 Diabetes
Sunil Kumar, Surendra Kumar
Abstract
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.

10. Forced Expiratory Flow FEF 25-75 % and Body Mass Index among Young Adolescents
Akshay Berad, Jyoti Mehta, Charu Mishra, Yogesh Kumar Yadav
Abstract
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.

11. Knowledge about Safe Patient Handling in Radiology Department Among Radiography Students
Gulistan Bi, Niraj Kumr Sah, Raushan Kumar, Navreet Boora
Abstract
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.

12. Various Dermatological Lesions and their Prevalence in Diabetic Retinopathy: An Observational Research
Priyanka Sharma, Vinay Kumar, Vishal katiyar
Abstract
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%.

13. Study to Evaluate the Pattern of Thyroid Disorder (TD) in Patients with Met S in Comparison to Healthy Controls.
Ramakant Prasad
Abstract
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.

14. An Observational Study to Assess if Depression and Disability are Co-Morbid in People with Alcoholism.
Vinay Kumar, Priyanka Sharma, Satish Kumar Sinha
Abstract
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.

15. Prospective Observational Research to Assess the Efficacy of Thrombolytic Therapy with IV Streptokinase in Patients with Acute ST-Elevation Myocardial Infarction.
Ashutosh Kumar Sinha, Sonali Suman, V.P. Sinha
Abstract
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.

16. A Cross-Sectional Analysis to See how Common Aerobic and Fungal Infections are in Post-Operative Wound Infections.
Babita, Sanjeev Suman, Sanjay Kumar, Rajesh Kumar, Hira Lal Mahto
Abstract
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.

17. An Observational Study to Evaluate Dermatological Manifestations of Beta Thalassemia Major Children Aged 2 to 12 Years and their Connection to Serum Ferritine Levels
Sanjeev Kumar Sinha, Sonali Suman, Hemant Kumar
Abstract
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.

18. Multiparametric Ultrasonography to Assess the Parenchymal Thyroid Conditions: A Prospective Study
Sanjeev Suman, Babita, V.S. Prasad
Abstract
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.

19. A Prospective Research to Determine the Clinico-Etiologic and Echocardiographic Profiles of Patients with Atrial Fibrillation
Ashutosh Kumar Sinha, Sonali Suman, V.P. Sinha
Abstract
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.

20. A Prospective Evaluation of Maternal and Foetal Outcome in Cases of Oligohydramnios at PMCH
Priyadarshini, Chandra Kiran
Abstract
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.

21. A Case-Control Study to Assess Procalcitonin Serum Levels in Children Under the Age of Five with UTI
Anil Kumar, Rajnish Chandra Mishra
Abstract
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.

22. An Anatomical and Topographic Study to Discover the Nutrient Foramen of the Clavicle
Barun Kumar
Abstract
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.

23. A Case Control Study to Assess of Glycated Haemoglobin, Total Protein and Albumin Levels in Patients with Type 2 Diabetes Mellitus
Sujeet Kumar Mandal, Pankaj Kumar Suman
Abstract
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.

24. Evaluating the Frequency, Risk Factors, Clinical Characteristics, Diagnosis, Treatment, and Outcome of Ectopic Pregnancies: Observational Research
Sangeeta Kumari, Seema Kumari, Raj Rani Chaudhary, Renu Rohatgi
Abstract
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.

25. Assessment of COVID-19-related new onset of Depression and Anxiety: A Comparative Cross-Sectional Study
Rakesh Kumar Singh, Pragati Pragya, Seema Singh
Abstract
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.

26. The Relationship Between Glycosylated Haemoglobin (Hba1c) Levels and Diabetic Retinopathy in Type 2 Diabetes: A Cross-Sectional Study
Kumar Nishant, Pragya Rai, Sujata Kumari, Nageshwar Sharma
Abstract
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.

27. Comparative Research on the Effectiveness and Safety of Long-Acting Antihistamines in Allergic Conjunctivitis in Indian Patients: An RCT Trial
Prashant Kumar, Anurag Verma
Abstract
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.

28. Awareness of Patients about Dental Implants as Treatment Modality of Missing Tooth Among Patients Visiting Government Medical College in Madhepura
Ahtasham Anwar, Shagufta Syreen, Bimleshwar Kumar
Abstract
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.

29. Intraocular Pressure (IOP) in Diabetics and Non-Diabetics: A Comparative Assessment
Anurag Verma, Prashant Kumar
Abstract
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.

30. To Assess the Clinico-Epidemiological Characteristics of Children with Urinary Tract Infection.
Abu Irfan, Baibhav Prakash Sahay
Abstract
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.

31. Comparing the Outcomes of Laparoscopic (TAPP Mesh Repair) and Open Hernia Repair.
Md Faizul Hassan, Mohammad Tarique
Abstract
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.

32. Olecranon Fracture Treated with Locking Plate for Functional Evaluation: A Prospective Study.
Neeraj Kumar
Abstract
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.

33. The Impact of Prescription Zinc Sulphate on Relieving Clinical Symptoms of Pneumonia in Children Aged Below 5 Years.
Renu Bharati, Sweety Rani
Abstract
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.

34. Clinical And Biochemical Characteristics of Newborn Seizures Admitted in NICU of A Tertiary Care Hospital in Bihar.
Shilpi Golwara, Md Nasim Ahmed, Devanshu Kumar, Rashmi Agrawal, Binod Kumar Singh
Abstract
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.

35. Variation in Total and Differential Leukocyte Count, As Well As Oxygen Saturation of Haemoglobin, Between Healthy Smokers and Non smokers.
Sunil Kumar, Bharat Kumar, Richa Kumari, Malti Kumari
Abstract
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.

36. Assessment Of Knowledge, Attitude and Practice Towards Emergency Contraception Among Women of Reproductive Age Group Working in Hospital Premises Other Than Health Professional.
Anuja Pritam, Priyanka Raj, Monika Anant, Surbhi
Abstract
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.

37. Early Failure of Arteriovenous Fistula: Association with Mortality in Patients on Hemodialysis-A Retrospective Study at A Single Centre.
Aandrei J Jha, Tushar Kumar, Sheil Avaneesh, Ruchi Singh, Madhav Kumar, Abhishek Kumar
Abstract
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.

38. An Estimation of The Incidence of Dengue Virus Infection among Clinically Suspected Patients WHO Attended A Tertiary Care Centre.
Barun Kumar Kundu, Shashi Kant Kumar, Rajnish Kumar
Abstract
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.

39. Assessment of the Outcome after Treatment of the Displaced Midshaft Clavicular Fractures Using two Different Approaches.
Aditya Kumar Jha, A K Baranwal, Surya Prakash
Abstract
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.

40. A Prospective Investigation of the Aetiology and Clinical Characteristics of Newborn Jaundice in Bihar, India.
Dipak Kumar, B.B. Singh
Abstract
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.

41. A Change in the Pattern of Antibiotic Susceptibility of Isolates: A Prospective Evaluation.
Shobha Kant Choudhary
Abstract
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.

42. Pharmaceutical Investigation of Caripill Use by Certified Medical Practitioners in an Urban Health Setting for Dengue Patients.
Swetabh Verma, S. N. Sachit, Kumar Devashish, V. K. Mishra
Abstract
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.

43.A Retrospective Study to Determine the Maternal and Perinatal Outcome in Eclampsia at A Tertiary Care Facility.
Suman Kumari, Madhuri Choudhary, Neha Singh, Anisha Buddhapriya
Abstract
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.

44.Analyze the Role of Vitamin D in the Development of Prehypertension and the Connection with Cellular Ageing
Jai Ram Singh, Rajni Kant, Krishna Kant Prasad Singh
Abstract
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.

45. A Descriptive Cross-Sectional Questionnaire Based Study to Assess the Awareness of Diabetic Retinopathy Among Type 2 Diabetes Mellitus Patients
Asif Shahnawaz, Randhir Kumar, Anunay Narain, Sweta Kumari, Alka Jha
Abstract
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 3/4th 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 1/4th 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.

46. Use of Long Term Low Dose Mifepristone in Treatment of Fibroid: Its Efficacy
Vinita Sahay
Abstract
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.

47.A Non-randomized Clinical Trial Comparing the Results of Surgical and Non-Surgical Scaphoid Fracture Treatment
Abhas Kumar, Kumar Gaurav, Manish Kumar, N.P. Sinha
Abstract
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.

48.A Prospective Evaluation of the Open Latarjet Surgery for Recurrent Anterior Shoulder Instability
Anshu Anand, Ajoy Kumar Manav
Abstract
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.

49. Cross-Sectional Study to Assess the Prevalence of Acute Abdomen in Tertiary Care Hospital
Arvind Kumar, Ashok Kumar Sharma
Abstract
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 2nd 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.

50.The Functional Outcome Assessment of Arthroscopic Anterior Cruciate Ligament Reconstruction using Quadrupled Hamstring Graft Fixed with Bio-absorbable Versus Titanium Interference Screw
Navin Chandra, Utkarsh Bhardwaj, Rajesh Tiwary
Abstract
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.

51.Sight Restoration Rate (SSR): Measure of Cataract Surgery Success
Navin Chandra, Utkarsh Bhardwaj, Rajesh Tiwary
Abstract
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.

52.Non-Invasive Ventilation (NIV) for Acute Respiratory Failure (ARF) in CF Bronchiectasis Patients
Prashant, B.K. Kashyap
Abstract
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.

53.A Prospective Study of the use of a Locking Compression Plate to Treat Tibial Plateau Fractures in Adults
Ram Sagar Pandit, Ramashish Yadav, Nand Kumar
Abstract
Aim: To study of management of tibial plateau fractures by locking compression plate in adults. Methods: A prospective study was conducted in the Department of Orthopaedics, 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.

54.A Prospective Research on HbA1c Levels in Individuals without GDM and its Association with Pregnancy Outcome
Sushma Shikha, Preeti Pushpam, Kumar Devashish, Seema
Abstract
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 2nd 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.

55.Atrial Fibrillation Patients’ Clinical and Echocardiographic Evaluation: A Prospective Study
Virendra Prasad Sinha, Ashok Kumar, Upendra Narayan Singh
Abstract
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.

56.A Cross Sectional Research Study on Vitamin C Deficiency and Oxidative Stress Levels in Children with Transfusion-Dependent Thalassemic Disorders
Shivani Nivedita, Kaushalendra Kumar Singh, Anil Kumar Tiwari, Anil Kumar Jaiswal
Abstract
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.

57.Estimation of Height from Footprint Length in MGM Warangal
Mohd Raza Malik Khan, Mohd Inayatulla Khan
Abstract
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.