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
Nishant Kumar, 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.