Volume13,Issue5

1. Study of Micro-Organism’s Isolation from Acute Bacterial Conjunctivitis: Study of Bacteriological Profile
Pragya Rai, Sujata Kumari, Kumar Nishant, Nageshwar Sharma
Abstract
Aim: The aim of the present study to determine the bacteriological profile of acute conjunctivitis. Methods: This prospective observational study was done the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India, for 10 months This is prospective observational study with evaluation of demographic factors, associated comorbid conditions and finding causative organism i.e., bacteria gram staining culture methods and biochemical reaction. Results: All 90 patients underwent Gram stain and bacterial culture out of 90, 65 patients were culture positive and other was negative. In the present study, the most common organism isolated Coagulase positive staphylococci 44.44% followed Klebsiella pneumoniae with 12.22%, Pseudomonas 5.56%, Diptheroids 3.33% and least Alkaligenes fecalis was 2.22%. Out of 90 patients 40 patients had a involvement of both eyes which is 44.44% and 50 patients had involvement of only one eye which is 55.56%. Complications like Petechial haemorrhages were seen in 78(86.67 %) of the cases while Punctate keratitis was seen in 7(7.78%). All the cases presented with red eyes, conjunctival congestion is seen in all the cases, lid oedema in 80(88.89%) cases, matting of eyelashes in 34(37.78%) cases and preauricular lymphadenopathy in 39(43.33%) cases, Conjunctival follicles 75(83.33%) cases and Corneal sensation was present in 80(88.89%) cases. Conclusion: The bacteriological evaluation of conjunctivitis provides to the ophthalmologist a working knowledge of the causal microbes, their common presentations, clinical course and antibiotic sensitivity patterns along with confirming the clinical diagnosis.

2. Intraocular Pressure Assessment and Comparison in Diabetes Mellitus and Non-Diabetics
Sujata Kumari, Pragya Rai, Kumar Nishant, Nageshwar Sharma
Abstract
Aim: The aim of the present study was to compare the intraocular pressure in diabetes mellitus and non-diabetic’s individuals. Methods: This prospective observational study was done in the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India for 1 year, all the Patients having diabetes mellitus on treatment and non-diabetic individuals was included in this study. Two groups were formed which includes Group A constituting diabetes mellitus patients and Group B constitutes non-diabetic individuals. Detailed history of diabetes mellitus patient was taken regarding duration of diabetes, treatment, fasting, post prandial blood sugar levels and HbA1c was 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: 160 patients were included in our study. 68 patients had Type 2 diabetes mellitus (all were non-insulin dependent) and 12 patients had Type 1 diabetes mellitus (all were insulin dependent), and 80 patients were non-diabetics subjects. Mean age of non-diabetics was 47.98±10.33 years and that of diabetics 50.88±10.36 years (p valve 0.24) statistically not significant. In those 80 diabetic patients 55 were male and 25 were female. Mean age of male subjects was 52.88±10.69 years and that of female was 51.87±10.67 years in diabetic group which was not statistically significant (p value 0.27). Mean intra-ocular pressure higher (18.33±3.02 mmHg) in diabetic patients as compared with (16.12±2.97 mmHg) in non-diabetic, p value < 0.0001 which is statistically significant. Mean intra ocular pressure was (19.88±2.77mmHg) in diabetic patients with duration greater than 10 years as compared with (19.03±3.03mmHg) in diabetic patients with duration less than 10 years, p value <0.27which is not significant. Mean intra-ocular pressure (20.37±2.99 mmHg) higher in diabetic patients with HbA1c value >6.5% as compared (19.02±2.59 mmHg) with 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 ocular morbidity due to glaucoma can be reduced.

3. The Effect of Health Education and Screening Site on Diabetic Retinopathy Screening Compliance in A Rural Bihar Population: An Analytical Research
Prashant Kumar, Anurag Verma
Abstract
Aim: Effect of health education and screening location on compliance with diabetic retinopathy screening in a rural population of Bihar. Methods: The present study was conducted in the Department of Ophthalmology, Anugrah Narayan Magadh Medical College Hospital (ANMMCH), Gaya, Bihar, India for 1 year. The population is predominantly rural. The blocks were grouped as facilities A and B: screening for DR in CHCs. Health education was not imparted in A but was imparted in B. Facilities C and D: screening in PHCs. Health education was not imparted in C block but was imparted in D. The health education intervention in the two settings was delivered by Village Level Health Workers (VHWs). Blindness and visual impairment were classified as per the WHO International Classification of Diseases. Results: A total of 1154 people with diabetes out of 6910 registered (16.70%) were screened for DR in the four blocks over the 3‑month period. The mean age of those screened was 56.9 ± 12 years and 52% were male. The uptake of screening varied by facility, the highest uptake was in the block with PHC level screening with health education and provision of transport to PHCs from villages (29.78%) while the lowest was in the block with CHC level screening without health education (9.78%). The uptake was significantly higher in the facilities with health education than in those without (17.62% and 16.06%, respectively, P < 0.01), and was significantly higher in blocks with PHCs level screening with provision of transport to PHCs from villages than CHCs level screening (22.35% and 12.10%, respectively, P = <0.001). A third of those screened had some degree of visual impairment: 7.97% (92) were blind, 6.85% (79) had severe visual impairment, 20.45% (236) had moderate visual impairment, and 64.73% (747) had mild or no visual impairment. There was not much difference in visual status between the people who did or did not receive health education. Fundus images were gradable in 87% (1004/1154) of those screened. In the gradable images, 9.18% (106/1154) had any DR and 3.81% (44/1154) had STDR. Conclusion: Conducting DR screening closer to the place of living at PHCs with the provision of transport and health education was more effective, resulting in an increase in the uptake of DR screening by people with known diabetes in rural Bihar.

4. Diabetic Retinopathy Awareness Assessment Among Type 2 Diabetes Mellitus Patients in Bihar
Anurag Verma, Sharfuddin Ahmad
Abstract
Aim: The aim of the present study was to assess the awareness of diabetic retinopathy among Type 2 diabetes mellitus patients in Bihar region. Methods: This was a descriptive, cross sectional, non-randomized, questionnaire-based study conducted in the Department of Ophthalmology Vardhman Institute of Medical Sciences, Pawapuri, Bihar, India, for 1 year. A knowledge, attitude, practice questionnaire was prepared and pretested in a sample group of representative population. The response was analyzed as to whether the questions were understood or not. Social workers were trained in administering questionnaire. Diabetic patients were given questionnaires at primary health centres and filled in the presence of social workers. Results: Out of the 140 patients, 76(54.29%) had no knowledge of diabetic retinopathy compared to 64(45.71%) who had knowledge. This was statistically significant with p value <0.001. Knowledge was more in age group less than 25 years (68.75%) and least in 35 to 45 age group (48.84%) which was statistically significant with p value <0.001. There was no significant association between duration of diabetes and knowledge of diabetic retinopathy. About 73.44 % of individuals in knowledge group had right attitude which was significantly higher than non-knowledge group (56.58%) with a p value <0.001. Regarding source of information, 51.43% of patients in knowledge group got information about diabetic retinopathy from physicians, 12.14% from eye specialists, 10.71% from reading books, 10.71% from various media and 15% from other sources like family and friends. Conclusion: We concluded that increasing knowledge about diabetic retinopathy through awareness campaigns can improve attitude & practice. Early detection & timely intervention can help in preventing sight-threatening complications.

5. Recovery of Smell and Taste Loss in COVID-19 Patients
Akshay Berad, Arvind Kumar, Charu Mishra, Yogesh kumar Yadav
Abstract
A significant proportion of people infected with SARS-CoV-2 report a new onset of smell or taste loss. The duration of the chemosensory impairment and predictive factors of recovery are still unclear. We aimed to investigate the recovery of smell and taste loss in COVID-19 patients who suffered from varying disease severity and chemosensory impairment severity. Subjects above age of 18 years who were infected with covid 19 virus and recovered from Covid 19 infection were included in this study. This was questionnaire-based study. Questions   regarding features of loss of smell and taste sensations in covid 19 patients were asked with help of Google forms.102 subjects participated in this study. 33.33% subjects regained smell sensation in 7 days, 51.38% regained smell sensation in 8-14 days and 15.27% had taken more than 14 days to regain smell sensation. 30.18 % subjects had taste recovery in less than 7 days.  58.49% subjects had recovery of taste in 8 to 14 days. 11.32 % subjects had regained of taste in more than 2 weeks. Recovery of chemosensitive dysfunction occurred within 1–3weeks; most of them recovered within 2 weeks. This means the dysfunction is transient in most of the cases and reversible.

6. Histopathological Study of Endometrium in Abnormal Uterine Bleeding Patients in Tertiary Care Hospital of South West Bihar
Manjari, Rajendra Kumar
Abstract
Background: Endometrium is sensitive to sex hormones and abnormal uterine bleeding is prevalent in all age group females which cause anemia and affects quality of life. Pattern of endometrial pathology diagnosis is vital to know the proper cause of bleeding to maintain clinicians conversant in making their management strategy. Methods: Study of endometrial biopsy was done retrospectively for a period of 1 ½ years. After processing of tissues, slides stained with hematoxylin & eosin by conventional method was examined microscopically. A statistical analysis between endometrial histopathology and mean age of presentation was done using Chi square test. Results:  After exclusion due to various reasons, 197 samples were enlisted for reviewing and final diagnosis was made. Endometrial hyperplasia emerged the commonest with 29.4% mostly in reproductive age group, followed by proliferative endometrium 20.3%, atrophy endometrium 16.24%, chronic endometritis 9.64%, endometrial polyp 8.63%, disordered proliferative endometrium 7.61% and secretory endometrium 6.6%. The endometrial carcinoma was diagnosed in only 1.52% of cases mostly in postmenopause females. The menorrhagia was the most common complaint overall (48.2%). Conclusion: The D & C method is suitable, but a newer technique has more scope. The commonest endometrial pathology in this study came out to be endometrial hyperplasia. For that unplanned use of hormone therapy is to be avoided.

7. Dual Channel Brachial AVF- A Case Series of Six Patients
Aandrei J Jha, Tushar Kumar, Madhav Kumar, Sheil Avaneesh, Ruchi Singh
Abstract
Background: Vascular access for Hemodialysis is the commonest mode of renal replacement therapy for end stage renal failure patients. Such fistulae have significant access related complications that translate to reduced durability. This paper reviews a new technique of a “dual channel” brachial arteriovenous fistula creation that provides used both basilic and cephalic veins thereby providing greater area for access and potentially reduced complications. Objectives: To study technical feasibility of creation and immediate patency of “dual channel” arteriovenous fistula in patients of end stage renal disease. Materials and Methods: All patients found anatomically suitable for creation of “dual channel arteriovenous fistula” were included in the study. Results and conclusions: The “dual channel” arteriovenous fistula is an acceptable alternative to the traditional single channel variant in anatomically suitable patients and provides excellent immediate patency. Summary:   An arteriovenous fistula is by far, the commonest and the most durable vascular access for hemodialysis in patients with End stage renal disease.  Antecubital fossa has been long recognized as an alternative site for AVF construction but local complication at this site is higher than the classical Bresica- Cimino fistula at radial or forearm location. This case series describes a new technique of making a forearm fistula where two venous channels are available for hemodialysis access instead of one.

8. Home Management of Acute Watery Diarrhoea and Its Impact on Dehydration: Perceptions and Practices
Abu Irfan, Baibhav Prakash Sahay
Abstract
Aim: The aim of the present study to evaluate the perception and Practices of Home Management of Acute Watery Diarrhoea and Its Impact on Dehydration. Methods: This prospective and descriptive analysis study was done in the Department of Pediatric, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 1 year. A total of 100 cases with acute diarrhea were included in this study. Prior to the initiation of any rehydration therapy, investigator performed a clinical evaluation, with particular attention to the dehydration and illness, degree of dehydration, purging rate, physical characteristics of stool and nutritional status. Investigator questioned each mother with the help of a preformed questionnaire. Results: In 100 cases 25% were aged 5-10 months, 8% were under 5 months and rest were over 10 months. The age range was 2 – 59 months, Mean ± SD = 19.78± 12.56. Male comprised 60% of the studied subject. Most of the parents used closed latrine and all the parents used tube well water in the studied population. Most of the patients had both increased frequency and fluidity of stool according to the parent’s perception (82%). Only 3% parent initially thought about taking the patient to the hospital. Regarding treatment more than half of the patients (55%) were treated at home with both ORS and drugs, while 42% were treated with only ORS and 3% patients were not treated at all. The drugs received by the patients were metronidazole (15%), cotrimoxazole (13%), erythromycin (17%), nalidixic acid (4%), zinc (9%) and antiemetics (11%). Regarding perception of ORS intake, about two third had appropriate perception, only 20% took adequate amount of ORS, all the patients continued breast feeding during ORS. Most of the parents had the perception of returning back to hospital when the child got sicker (55%). Regarding dehydration status, only 3% had severe dehydration, 17% had some dehydration and 80% had no sign of dehydration. Conclusion: This study held in India, provides important information about perception and practices of home management of diarrhea in children. Most of the caregivers used ORS at home yet they had wrong idea regarding the preparation.

9. Study to Determine the Infectious Skin Disorders Encountered in Children Attending A Tertiary Care Hospital in Bihar Region:  Retrospective Observational Study
Anjula
Abstract
Aim: To determine the infectious Skin Disorders Encountered in Children Attending a Tertiary Care Hospital in Bihar region. Methods: This retrospective study was done the Department of skin & V D, Nalanda Medical College and Hospital, Patna, Bihar, India, from December 2019 to November 2020. 250 children aged less than 18 years were included in this study. Diagnosis of skin diseases in the clinic were made by trained dermatologists. The diagnoses were mainly clinical, but laboratory confirmation was done where necessary. The infectious skin diseases diagnosed were categorized into bacterial, fungal, viral disorders and infestations. Results: A total of 250 children aged less than 18 years were seen in the Dermatology clinic over the 1-year period. The mean age of children with ISDs was 8.12±6.3 years with a male to female ratio of 1.22:1. ISDs were diagnosed in 100 (40%) of these children. Types of ISDs Fungal skin infections were seen in 45 (45%) patients. Parasitic skin infections were diagnosed in 30 (30%) patients. Viral and Bacterial skin infections were observed in 15 (15%) and 10 (10%) children respectively. The most frequent ISDs according to aetiologic group were: Scabies in 30 (30%), Verruca Vulgaris in 12 (12%), Tinea corporis in 12(12%) and Impetigo in 5 (5%). 3.1.7 Relationship of age and gender occurrence of ISDs Age and Gender showed no significant association with the occurrence of skin diseases. Conclusion: ISDs are common in children with a prevalence of 40%. Scabies was the leading   ISDs   in   our   study. Age and gender showed no significant association with the occurrence of ISDs among the children studied.

10. The Relationship Between Blood Group Types and Haemoglobin Levels in Bihar’s Rural Population
Bharat Kumar, Sunil Kumar, Richa Kumari, Malti Kumari
Abstract
Aim: Study of association between blood groups and blood hemoglobin levels in rural Population of 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 Jan 2020 to December 2020.100 adults (males and females) who are in the age group of 18-30 years were included in this study. Blood sample is taken using finger prick, under aseptic conditions and blood group is determined using glass slide method using antisera A, B and D. Hemoglobin concentration is estimated using Sahli’s method. Results: In this study, adults with hemoglobin concentration less than 10g/dl were taken as anemic. Total 30 adults are anemic, while remaining 70 adults are non-anaemic. 41 adults are females out of which 59 are anemic whereas 59 adults are males where only 10 males were found to be anemic. 29 adults with Hb less than 10g/dl were Rh positive and 1 adult Rh negative. 67 adults and 3 adults were Rh positive and Rh negative respectively with Hb more than 10g/dl. Also 27 adults are blood group A, 5 with blood group AB, 35 with blood group B and O blood group adults are 33. Among the A blood group, 5 adults were anemic, among blood group B, 14 were anemic, among blood group AB, 2 were anemic and 9adults with O blood group were anemic. Conclusion: Individuals with blood group B are more prone to anaemia followed by blood group O, AB and least is with blood group A. Based on their blood groups, we can advise regular intake of diet rich in iron and vitamins or also their supplements to the individual who are more susceptible to anaemia.

11. Prospective observational study to evaluate the association of various parameters associated with severity of acute pancreatitis
Md Faizul Hassan, Syed Aakif Faridi, Mohammad Tarique
Abstract
Aim: The aim of this study was to evaluate the parameters associated with severity of acute pancreatitis. Methods: This Prospective observational study was done in the Department of General Surgery, Madhubani Medical College and Hospital, Madhubani, Bihar, India, for 1 year. Total 80 patients diagnosed as acute pancreatitis on the basis of clinical signs, biochemical markers and radiological signs were included in this study. they were investigated by various blood investigations like haemoglobin, total leukocyte count, differential count, haematocrit, calcium, Blood urea nitrogen (BUN), arterial blood gas analysis, serum electrolytes, Random blood sugar (RBS), liver function tests, Lactate dehydrogenase (LDH), serum amylase, serum lipase, ultrasound abdomen and contrast Computed tomography (CT) for those indicated. The two commonly used scoring systems in our institution were also analysed viz. Ranson’s score and modified Glasgow score. Results: Majority cases were seen in between 40 to 50 years 30(37.5%). In our study the 56 cases were mild acute pancreatitis (70%), 15 cases were moderately severe acute pancreatitis (18.5%) and 9 cases severe acute pancreatitis (11.25%). In our study the majority of cases who presented with acute pancreatitis were of alcohol induced type, 56 (70%). Gall stone pancreatitis accounted for 14 (17.5%) cases. In our study 50 (62.5%) patients had diabetes mellitus, 32 (40%) had hypertension and 40 (50%) had dyslipidemia. Major co-morbidity was diabetes mellitus among the studied population.  In our study the 38 cases were having a Body mass index (BMI) of 18.5 to 24.9 (47.5%) and 8 (10%) were having a BMI of above 30 and 34 (42.5%) had BMI between 18.5 to 19.9. Majority of the cases 56 (70%) who presented were having habit of consuming alcohol. 4 (5%) patients in our study died due to complications of severe acute pancreatitis. The mean BMI in those with mild acute pancreatitis was 25.47±0.21 (Standard error (SE)), moderately severe acute pancreatitis was 29.54±0.62 and severe acute pancreatitis was 29.87±1.67. Conclusion: One should not wait for any single scoring system to get scored for effective treatment. A diagnosis of pancreatitis should be made using clinical, laboratory and radiological means and treatment in the form of aggressive crystalloid resuscitation should be started with intensive care monitoring at the earliest.

12. A Prospective Clinical Research to Compare the Notion of A Heated Sitz Bath Verses Standard Room Temperature Sitz Bath in Perineal Wound Healing
Md Faizul Hassan,Syed Aakif Faridi, Mohammad Tarique
Abstract
Aim: The aim of this retrospective study is to compare the effect of warm versus regular room temperature sitz bath. Method: This was a prospective clinical study conducted in the Department of General Surgery, Madhubani Medical College and Hospital, Madhubani, Bihar, India for 1 year. Total 80 patients comprising cases of haemorrhoids, fissure, perianal fistula, pilonidal sinus, perianal abscess and episiotomy wounds in the age group of 18 years to 58 years were include in this study. A set protocol of medical line of management was made for all the patients in the form of 5 days course oral antibiotics, metronidazole, H2 blocker along with 3 to 5 days course of analgesic and ointment for local application. All the patients were asked to practice seitz bath of their choice by warm water or regular room temperature seitz bath with added povidone iodine solution 3 to 4 times in a day till the wound heals completely and the patient gets the desired pain relief. Results: out of 80 patients, 45 patients (56.25%) in the study group opted for warm water seitz bath as compared to 35 patients (43.75%) of regular water seitz bath from the 3rd day of surgery onwards. All the 35 patients operated for pilonidal sinus, perineal abscess and perianal fistulectomy were found to have significant discomfort in the initial 15 days to 21 days due to discharge from the wounds. But all the patients got satisfactory results with respect to the reduction in the amount of smell and discharge from wound after a period of 15 days to 21. Adequate wound healing was achieved over a period of 8 to 10 weeks in all the 35 patients of fistulectomy, perineal abscess and pilonidal sinus excision depending upon the size of the tissue defect and severity of infection. Conclusion: The frequency of seitz bath and subsequent improvement in the local hygiene definitely give comfort to the patient and speeds up wound healing.

13. Identify the Bacterial Pathogens Causing Hospital Acquired Septicemia and the Antibiotic Sensitivity Profile of the Bacterial Isolates
Ashan Hamidi, Ram Naresh Sharma, Ram Shankar Prasad
Abstract
Objective: The objective of this study was to determine the bacterial agents responsible for hospital acquired septicemia and to determine the antibiotic sensitivity profile of the bacterial isolates. Methods: This was a prospective observational study conducted in the Department of Microbiology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 1 year. A total of 550 patients with suspected blood stream infection were included for this study. The sample collected was inoculated immediately into culture bottle containing 70 ml to Brain Heart infusion (BHI) broth. The culture bottle was incubated at 35-37oC aerobically. After 24h incubation, the sample was sub-cultured on to Blood agar, MacConkey agar, Chocolate agar and special media which were suitable for isolation and identification of the species. Antimicrobial susceptibility test antimicrobial sensitivity was determined by Kirby Bauer’s disc diffusion method on Mueller Hinton agar (MHA). Results: Out of 550, 100(18.18%) were culture positive. Out of 100 positive cultures (65%) were male while (35%) were female. The positive samples belonged to maximum from infants 52(52%) followed by adults 48 (48%). Out of 100 positive cultures, 50 (50%) were gram-positive, 44 (44%) were gram-negative and 6 (6%) were Candida spp. Among the 100 isolates, the most predominant organism was Klebsiella species 35(35%), followed by Staphylococcus aureus 20(20%) and the least was Escherichia Coli 2(2%). Among Gram positive sepsis, Staphylococcus aureus was found to be most sensitive to vancomycin (95%) & linezolid (95%) followed by amoxyclav (70%), Amoxacillin (70%), tetracycline (55%), ciprofloxacin (55%) & netilmycin (50%). Low sensitivity to clindamycin (35%), cotrimoxazole (35%), gentamycin (45%) & least sensitive to erythromycin (10%), ampicillin (10%) and penicillin (0%). (Table 2). Klebsiella spp. showed 88.57% sensitivity for imipenem followed by amikacin (62.86%), tetracycline (45.71%), aztreonam (42.86%), gentamycin (37.14%), netilmicin (37.14%) and ciprofloxacin (37.14%). Imipenem showed 90% efficacy against the Pseudomonas aeruginosa. Conclusion: The most predominant organism was Klebsiella species followed by Staphylococcus aureus. Imipenem was the most effective drug for gram negative isolates while Vancomycin & Linezolid were most effective against gram positive isolates.

14. Co-Morbidities in Severe Acute Malnutrition, Including Unanticipated Dyselectrolytemia in Diarrhoea: An Observational Study
Md Nasim Ahmed, Shilpi Golwara, Rashmi Agrawal, Devanshu Kumar, Binod Kumar Singh
Abstract
Aim: The aim of the study is to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Methods: The study was an observational study which was carried in the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India, from January 2020 to May 2021. Total 150 children below 6 years of age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: Majority of children with SAM were having co-morbidity in the form of Anaemia (84%), Diarrhoea (66.67%) followed by pneumonia (26.67%), Rickets (26%), Tuberculosis (15.33%), Otitis media (11.33%), UTI (9.33%), Celiac (5.33%), Hypothyroidism (2.67%), & HIV (2%). Mean age (SD) of the diarrheal cases was 4.1 months (95% C.I. 24.5- 27.6) of which 56 were male (56%). Mean age (SD) of non-diarrheal cases was 2.1. (95% C.I. 19.2 – 22.7) of which 78% were male. 100(66.67%) SAM children presented with diarrhea of which hyponatremia was seen in 75 cases (72.11%) & hypernatremia in 3 cases. No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.09). It was found that 23.33% SAM children were having hypokalemia. Potassium levels of diarrheal & non diarrheal children with SAM was estimated. Hypokalemia was found in 25% of diarrheal cases & 20% in non- diarrheal cases.  A statistically significant difference was found with hypokalemia in SAM (P value of 0.027) between diarrheal & non diarrheal cases. Conclusion: Co-morbidities identification and treatment in SAM children is the key step in reducing morbidity and mortality associated with SAM.

15. Impact of Yoga on the Human Body’s Parasympathetic Nervous System
Sunil Kumar, Bharat Kumar, Richa Kumari, Malti Kumari
Abstract
Aim: Effect of yoga on parasympathetic nervous system of human body. Methods: The present Prospective study was conducted in the Department of Physiology, Jan Nayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India from June 2019 to June 2020. Case group (N=40): subjects who were performing regular yoga asanas and relaxation techniques for at least 5 years. Control group (N=40): age and gender matched subject who were not performing yoga asanas and relaxation techniques or were not engaged with any other type of physical exercises. Results: Amongst the sympathetic nervous system parameters, statistically significant difference existed between cases and controls for the Resting Heart Rate, Resting Diastolic Blood Pressure, Hand grip systolic blood pressure and Hand grip systolic blood pressure (p<0.05) respectively. Conclusion: The yogic activity significantly alters the sympathetic activity like heart rate and blood pressure. With expanded mindfulness and enthusiasm for wellbeing, one ought to embrace the non-pharmacological strategies like Yoga exercise, reflection and way of life alteration to control the modifiable hazard factors responsible for cardiovascular morbidity and mortality.

16. Type 1 Tympanoplasty in the Middle Ear with and without Gelfoam: A Comparative Assessment of the Outcome
Sanjeev Kumar, Rajeev Ambastha, R. P. Thakur
Abstract
Aim: The aim of this study is to compare the type 1 tympanoplasty with and without gelfoam in the middle ear. Methods: The present study was conducted in the Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India from January 2020 to January 2021. 100 patients admitted for type 1 tympanoplasty for chronic suppurative otitis media (quiescent and inactive) were considered for the study. Patients were age group of 10-60 years. All cases of CSOM (quiescent and dry) undergoing type 1 tympanoplasty without any contraindication, all cases of traumatic perforation undergoing type 1 tympanoplasty were included in this study. Patients with age group <10 years and >60 years, CSOM with active disease, patients with comorbidities were not included in the studies. Results: In our study, 60 patients were male of which 27 were in group 1 and 33 were in group 2. 40 patients were female of which 23 were in group 1 and 17 in group 2. There was no significant difference between the two groups in sex distribution as p value was more than 0.05. In our study, in group 1, 41 (82%) patients had complete graft uptake and 9 (18%) patients had failure of complete graft uptake following surgery. In group 2, 42 (84%) patients had complete graft uptake and 8 (16%) patients had failure of complete graft uptake following surgery. Thus, according to our study, graft uptake is comparable and good in surgical technique with gelfoam and without gelfoam. The T value based on paired t test was 11.6 in group 1 and 7.3 in group 2 with a p value of <0.001 in both groups which is statistically significant. Significant postoperative hearing gain was present in both the study groups (Table 3) In our study, median of hearing gain in group 1 was 13.63 with an interquartile range of 11 and median of hearing gain in group 2 was 14.25 with an interquartile range of 20. The p value based on Mann Whitney u test was 0.77 which is not statistically significant. Conclusion: Graft uptake is equally good in cases with gelfoam and without gelfoam. Hearing gain is comparable in both groups of patients. No significant complications occurred in our study. ‘Ad’ is the most common type of impedance curve after surgery. Long term follow up is important in these patients.

17. A Comprehensive Investigation of the Relationship Between Symptom Complex and Magnetic Resonance Imaging in Lumbar Disc Herniation: A Prospective Study
Neeraj Kumar
Abstract
Aim: To study the correlation between symptom complex and magnetic resonance imaging in lumbar disc herniation. Method: The present Prospective study was conducted in the Department of Orthopaedics, All India Institute of Medical Science, Patna, Bihar, India for 1 year. A total of 90 patients were studied. The patients with lumbar disc prolapse, diagnosed clinically, are included in the study. Patients with a pathological fracture in lumbar spine, post- traumatic low back pain, failed back syndrome or lower limb radiculopathy due to other causes and Age <20yrs and >80yrsare all excluded from the study. Results: Total number of patients studied was 90, out of which 50 were males and 40 were females. 10 patients were in the age group of 20-30 years, 28 were between 30-40 years, 24 were between 40-50 years, 22 were between 50-60 years and 6 patients were more than 60 years old. The mean age was found to be 45.9 years. Total levels of disc herniation were 110. Out of the 90 patients, 40 had specific dermatomal distribution and 50 had nonspecific dermatomal distribution. Among the 40 patients, 4 had L3 radiculopathy, 3 had L4 radiculopathy, 5 patients had L5, and 3 patients had S1 radiculopathy. Patients with L4 and L5 and L5 and S1 radiculopathy were 12 and 8 respectively. 5 patients had multiple level radiculopathy. Total number of patients presented with sensory deficits was 5. 18 patients suffered from motor deficits. Out of 110 levels of disc herniation, 30 levels had motor deficits. Out of 90 patients, 88 patients had positive SLRT and 70 had positive crossed SLRT test. Out of 110 levels of disc herniation, 52 showed disc bulge, 35 showed protrusion, 20 showed extrusion and 3 levels were with sequestration. Out of 110 levels of disc herniation, 27 showed anterior thecal sac compression, 49 showed nerve root contact and 34 showed nerve root compression. Conclusion: The disc bulge/ protrusion/ extrusion with central presentation were not significantly correlating with clinical features. But, independent of type of herniation, if there is PC/FL presentation of disc with neural foramen compromise, there is significant correlation with clinical features.

18. Comparative Assessment of Two Different Techniques in the Management of Unstable Senile Intertrochanteric Fractures
Niraj Narain Singh, Diksha Chaudhary
Abstract
Aim: To comparative study of PFN antirotation vs bipolar hemi arthroplasty in unstable senile intertrochanteric fractures. Methods: The present Prospective study was conducted in the Department of Orthopaedic, Katihar Medical College and Hospital, Katihar, Bihar, India for 1 year. 50 patients each were included in PFNA group and hemi arthroplasty group. Patients with age > 70 years, unstable intertrochanteric fractures Patient mobile before the fracture and medically fit for surgery. Results: In hemi arthroplasty group 38 patients underwent cemented bipolar replacement, 12 patients underwent uncemented bipolar replacement. PFNA group scored significantly better with respect to intraoperative blood loss, surgical time, hospital stay compared to hemi arthroplasty group. (P<0.05) There were less intraoperative complications in PFNA group as compared to hemi arthroplasty. (P=0.041). In hemi arthroplasty group three patients had hypotension with bradycardia following cementing. Two patients had symptomatic fat embolism with hypotension, desaturation and tachypnea. All patients were immediately resuscitated and shifted to ICU for further management. In PFNA group none of the patients had intraoperative complications. Hemi arthroplasty group definitely had better functional outcome using Harris hip score till first three months (P<0.05) as compared to PFNA group. But both groups had similar score at 6 month and 1 year (P>0.05). There was significant difference in the incidence of wound complications in both groups (0% vs 26%, P= 0.045). In PFNA group none of the patients had wound infection or post operative wound drainage following DVT Prophylaxis. In Hemiarthroplasty group 6 patients have superficial wound infection. Wound debridement and through lavage done in both cases and antibiotics was given as per culture and sensitivity for 6 weeks. Conclusion: The PFNA definitely provide advantage for senile intertrochanteric fracture being less invasive, quick surgery, and less disruptive to normal physiology. It allows early weight bearing similar to Hemiarthroplasty which has more risk of cementation, hypotension, wound related complications.

19. A Comparison of Pregnancy-Related Problems in Women with and Without Polycystic Ovarian Syndrome was Conducted (PCOS)
Priyanka Raj, Anuja Pritam, Monika Anant
Abstract
Aim: To comparative study of pregnancy- related complications of women with and without polycystic ovary syndrome (PCOS). Methods: The present Prospective study was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Science, Patna, Bihar, India for 1 year. The study population consists of two groups Test group (100 Pregnant woman with polycystic ovarian syndrome) and Control group (100 Pregnant woman without polycystic ovarian syndrome). Woman with pre-existing medical conditions like Hypertension, Diabetes Mellitus, Hyperprolactinaemia, Antiphospholipid antibody syndrome, Systemic Lupus Erythematosus, thyroid disorders and those with twin gestation were excluded from the study. Results: The participants with overweight/obesity were 35% among the women with PCOS when compared to 25% among the women without PCOS (p=0.47). Proportion of primigravida among women with PCOS was 88% and among women without PCOS was 52%. Mode of conception was spontaneous in 58% and 80% among women with and without PCOS, respectively. IUI/IVF was the method of conception in 24% of women with PCOS, whereas only two women adopted IUI/IVF among the non-PCOS group. Gestational diabetes was reported in 25% women with PCOS as against 15% women without PCOS. the women who are overweight and obese/morbid obesity were found to have increased risk of GDM by 6.90 times and 10.89 times when compared to the normal women and it was found to be statistically significant. Similarly, GDM was found to be 1.35 times higher in Primigravida compared to multigravida women. Similarly, pre-eclampsia was found to be higher among the women with PCOS when compared to the women without PCOS (28% VS 11%). Women with PCOS were having 2.75 (1.12-6.96); p=0.039] times the higher risk of having pre- eclampsia. Conclusion: The risk factors for PCOS, Primigravida was significantly associated with the occurrence of PCOS after adjusting for the confounder. On the maternal complications front, PCOS was significantly associated with GDM and pre-eclampsia after adjusting for the confounders.

20. Assessment and Connection to the Neurologic Outcome of Severe Hyperbilirubinemia in Term Infants
Renu Bharati, Sweety Rani
Abstract
Aim: Evaluation of risk factors for severe hyperbilirubinemia and its relationship with neurological outcome in term infant. Methods: This prospective observational study was conducted Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 1 year. All consecutive neonates more than 35 weeks of gestation admitted in the NICU with a serum bilirubin >20 mg % in first 72 h of life or >25 mg% after first 72 h formed the study subjects. Results: A total of 80 neonates were enrolled. Both the study groups were comparable with respect to age (125.21±77.85h vs 135.54±75.19 h; p = 0.63), sex (male/female 2.1:1 vs 1.39:1; p = 0.74), presence of SGA babies (4[13.33%] vs 4 [8%]; p = 1.22), socioeconomic status (p = 0.48), and antenatal care (p = 1.2). However, neonates with ABE weighed less on admission than those without ABE (2324.87±429.69 g vs 2531.87±382.91 g; p = 0.027) and the causes of hyperbilirubinemia (p = 0.033) were significantly different of 30 neonates with ABE, 19 presented in stage II and 11 presented in stages III of ABE. Table 2 shows the risk factors associated with development of ABE. A lower weight on admission (2331.886 397 g vs 2511.87 379g; p = 0.023), ABO/Rh incompatibility (odds ratio 4.20; 95% CI: 1.23–14, p = 0.037), a positive Coomb’s  test  (odds ratio 6.1; 95% CI: 1.64–22.7, p = 0.0088), culture-proven sepsis (odds ratio 17; 95% CI: 0.92–322, p = 0.072), and normal vaginal delivery (odds ratio 6.5; 95% CI: 1.7–25.4, p = 0.032)  were  found  as  statistically significant risk factors for development of ABE. Conclusion: Nearly half of the neonates admitted in a tertiary care NICU with severe hyperbilirubinemia had features of ABE on admission. The risk was more if they were born vaginally, had a lower weight on admission, had blood group incompatibility with positive Coomb’s test, and had sepsis.

21. Effect of Weekly Iron Therapy, Health Nutrition on Prevalence of Anemia in Adolescent Girls in Rohtas District, Bihar
Narayan Kumar Joshi, Kumari Veena Sinha
Abstract
Objective: To assess prevalence and reduce the incidence of anemia among the adolescent girls (10-19 years) by imparting health nutrition and with weekly iron folic acid under supervision to empower them to address their own nutrition and health issues. Design: Supervised community intervention of health nutrition and   with weekly iron folic acid in Sasaram and Dehari community Development block of   Rohtas, District in   Bihar, through a network of specially trained community workers. Settings: Anganwadi centers and schools in rural Sasaram and Dehari community Development block of   Rohtas. Methods:  Services were rendered to adolescent girls, to assess the impact a sample size of 375 (250 school going girls and 125 non-schools going) was taken for baseline and after 6 months repeat assessment. The Hemoglobin levels were estimated, and Health Nutrition of adolescent girls was assessed before and after the intervention. Weekly supplementation of iron folic acid (IFA) tablets and biannual supplementation of Albendazole tablets was provided. The girls were also counselled on benefits of the right age of marriage on their health. Results:  The impact of the interventions reveal a significant reduction in severe anemia from 16.0% to 8.6 %; while there was a slight increase in mild anemia from 36.0 % to 38.0 %; and a significant increase in the number of girls (47.4 % to 56.8 %) with hemoglobin level more than 12 gm/dl. Conclusion: The study revealed that proper counseling and implementation of   with weekly supplementation of IFA tablets coupled with Albendazole tablets biannually are highly effective in reducing the prevalence of anemia among the adolescent girls.

22. Assessment of Cardiac Autonomic Dysfunction Among Patients with Diabetes Mellitus and its Associated Factors
Dheerendra Kuber, Himanshu Mathur, Pankaj Kumar Jain, Anshumali Singh
Abstract
Background: Autonomic neuropathy was only generally recognized as part of the spectrum of nerve damage in diabetes following the work of Jordan in 1936 and Rundles in 1945. Autonomic neuropathy is the ‘needle in the haystack’ in the complete evaluation of a diabetic patient. Most clinicians tend to neglect these symptoms even though their patients present only with them. It is indeed a curse for a person to have diabetes, but the superimposed impotence or postural syncope may actually worsen his morale on the whole. Material & methods: the present prospective study including 100 diabetic patients which were selected by simple random sampling. institutional ethics committee clearance was obtained and written informed consent was obtained from all the patients. Strict confidentiality was maintained with patient identity and data and not revealed, at any point of time. Results:  Majority 17% of patients had early cardiac autonomic dysfunction, followed by 7% patients had definite, 3% patients had atypical and severe cardiac autonomic dysfunction respectively. Mean age in cases with autonomic dysfunction was 46.25 (S.D.±6.24) and 38.42 (S.D.±7.38) with no autonomic dysfunction. Z value worked out to be 3.38 which is statistically significant (p<0.05). Mean duration of diabetes in cases with autonomic dysfunction was 6.83 (S.D.± 2.01) and 5.24 (S.D.± 2.48) with no autonomic dysfunction. Z value worked out to be 2.43 which is statistically significant (p<0.05). Mean BMI in cases with autonomic dysfunction was 27.61 (S.D.±2.53) and 24.16 (S.D.±2.90) with no autonomic dysfunction. Z value worked out to be 3.52 which is statistically highly significant (p<0.05). Among 52 cases with >7 HbA1c, 22 had autonomic dysfunction and 30 cases did not have autonomic dysfunction. Among 48 cases with ≤7 HbA1c, 8 had autonomic dysfunction and 40 did not have autonomic dysfunction, which is statistically significant (p<0.05). Conclusion: We concluded from the present study that incidence of cardiac autonomic dysfunction among patients of Diabetes Mellitus was more prevalent in age group 40 to 50 years. Other associated factors were high body mass index, increased duration of diabetes and raised HbA1c value for occurrence of cardiac Autonomic dysfunction secondary to Diabetes Mellitus.

23. Assessment of Thyroid Profile Among Pre and Postmenopausal Women
Pradeep Jain
Abstract
Background: Thyroid disorders are reported in higher magnitude among women than men. Various reports have shown an increasing trend of thyroid disorders with an increase in age. Occurrence of thyroid disorders such as hypothyroidism, autoimmunity, nodular goiter, and cancer was the most often reported in post-menopausal and elderly women than younger women. Material & Methods: 100 post-menopausal women of age group 50-55 years according to inclusion and exclusion criteria and 100 pre-menopausal women of age group 34-49 years according to inclusion and exclusion criteria were enrolled in the present study. Study participants were enrolled by simple random sampling. Clearance from the hospital ethics committee was taken before the start of the study. Written informed consent was taken from each study participant. Results:  In the present study, out of total study participants, based on the thyroid function test status, the mean value of total T3 among pre-menopausal group was 142.4±10.9 and the mean value of total T3 among post-menopausal group was 169.4±11.8. the mean value of total T4 among pre-menopausal group was 8.1±1.3 and the mean value of total T4 among post-menopausal group was 9.3±1.2. the mean value of TSH among pre-menopausal group was 12.4±4.8 and the mean value of TSH among post-menopausal group was 20.4±5.1. the mean value of free T3 among pre-menopausal group was 286±13.4 and the mean value of free T3 among post-menopausal group was 312±15.6 the mean value of free T4 among pre-menopausal group was 1.23±1.1 and the mean value of free T4 among post-menopausal group was 1.38±1.2. Conclusion: We concluded from the present study that thyroid dysfunction suggesting from the thyroid profile in post-menopausal women. We recommend the thyroid profile of all post-menopausal women to diagnose and treat the thyroid dysfunction early.

24. Effect of Yoga Asana on Glycemic Variability Monitored by Biosensors in Type 2 Diabetes Mellitus
Chandika Surya Teja, A Jamuna Rani, B Shanthi, Chittooru Chandra Sekhar
Abstract
Introduction: The 8th edition of International Diabetic Atlas states that South Asian region ranks second among all the IDF regions. As per census in 2015, 69.1 million adults are diabetic in India. One in eleven is a diabetic patient. Even worse finding is that 1 among 2 diabetic is undiagnosed. Exercise and lifestyle modification haven proven to be of great use in management of Diabetes Mellitus. However, autonomic failure can occur with association of hypoglycemia in secretagogue dependent type 2 diabetes mellitus populations when exercising. It is well understood that severe hypoglycemia can results in seizure, coma, and fatality. Evidence suggest that acute mild hypoglycemia may adversely affects cardiovascular parameters as well as endothelial function. Fear of hypoglycemia is prevalent among individuals with diabetes reliant upon exogenous insulin or insulin secretagogues. This fear is a big threat in achieving glycemic treat. Keeping this in mind the study is proposed to understand the glycemic variability when practicing the 6 asana in yoga (kapal bhati pranayama, supta matsyendrasana, dhanurasana, paschimottanasana, ardhya matsyendrasana, shavasana) of importance in stimulating the pancreas among the type 2 diabetes mellitus patients. Objectives: To understand the dynamics of insulin secretion in response to kapal bhati pranayama, supta matsyendrasana, dhanurasana, paschimottanasana, ardhya matsyendrasana, shavasana among type 2 diabetic mellitus patients. Methodology: After ethical approval from the institutional ethical committee, we propose to recruit 20 type 2 diabetic volunteers. After obtaining informed consent they would be fitted with biosensors marketed by Abbott laboratories over a period of 1 week. At the end of the week, we would monitor the glycemic variability. Parallel 20 healthy volunteers will also be fitted with biosensors and perform the same set of asanas. Implications: A comparison of glucose variability among diabetic subjects and healthy volunteers will help us to understand the body insulin secretions in response to performance of asanas. On learning the intricacies in glucose levels, the diabetic subjects could very well encourage to perform the asanas. This study will help to overcome fear of exercise induced hypoglycemia and achieve favorable glycerin status.

25. Pets During Covid-19 Pandemic: Significant Role as Stress Buster for their Owners
Ifrah Ahmed, Vijaya Lakshmi
Abstract
Background: COVID-19 pandemic has affected everyone’s lives in many different ways since January 2020 globally. COVID-19 pandemic has revealed the vulnerability of humans to disorders related to loneliness due to physical distancing measures and it has also highlighted the positive aspects of the relationship between animals and humans. Apart from physical wellbeing, psychological wellness has also been a matter of concern during lockdown. Animal assisted therapy aims at improving physical, mental and emotional aspects of human life. Aim & Objective: To evaluate the Role of pets in an individual’s life during Covid -19 Pandemic. Methodology: Questionnaire on PSS-10-C and a questionnaire on human animal relationship with relevant demographic data was distributed electronically via social media to subjects of age group more than 18 years after taking consent for participation in the study during April-May 2021. Subjects having any psychiatric disorder or taking any medication were excluded from the study. Result: Out of 230 participants 69 (30%) had pets amongst which dog was the most preferred pet. Many pet owners were concerned about their pet during lockdown, reason being restriction to veterinary treatment, etc. Stress of non-pet owners was significantly high as compared to pet owners. Regardless of owning a pet, 82% participants agreed that pets act as stress busters. Conclusion: Human-animal bond has beneficial effect on human’s physical and mental health. Animal assisted therapy utilises this interaction to promote the health of patients. Animals as pet played an important role in reducing stress among their owners during COVID-19 pandemic. Animal assisted therapy therefore can be promoted in certain ailments which will not only cure the patients but improve the well-being of animals too.

26. Assessment of the Outcome of Conservative Therapy for Acute Type 3 Acromioclavicular Joint Dislocations
Aditya Kumar Jha, A K Baranwal, Surya Prakash
Abstract
Aim: The aim of the study evaluate functional outcome of conservative treatment of acute type 3 acromioclavicular joint dislocations. Methods: A retrospective study was conducted in the department of Orthopedics, MGM Medical College Jamshedpur, Jharkhand, India from Jan 2020 to December 2020. 60 patients with acromioclavicular dislocation type III treated conservatively were included in this study. These patients were then followed up at 6 weeks, 3 months and 6 months interval. patients with AC joint dislocation type I and II, Men or women >60 yrs age, Open dislocation, Dislocation in a poly trauma patient and Fracture of ipsilateral coracoid process of scapula, fracture of the clavicle were excluded from the study. Results: Out of total 60 patients 44 had excellent results having no pain or limitation of movements. 12 had good results, had mild pain only on excessive activity and terminal restriction of abduction. 4 had fair results and there were no poor results. At final follow up, the mean score was 11.15. There was improvement in the mean score from 9.13 at 6 weeks to 11.25 at 6 months. Improvement in subjective and objective symptoms were highly significant as per Freidman test value (p<0.01). At final follow up, mean score for pain was 3.98 at final follow up. Reduction of pain was found to be highly significant (p<0.01) at final follow up and also between each follow up. Mean score for abduction was 4.11 at final follow up. Improvement in the range of abduction was found to be highly significant (p<0.01) at final follow up and also between each follow up. At final follow up only 7 patients had restriction of abduction (less than one third of normal side) and 53 patient’s regained full range of movements. Follow up x-rays at the end of 6months showed that 48 Acomioclavicular joints were still subluxed and 12 joints were dislocated. Mean score was 2.98 at final follow up. Conclusion: Conservative treatment of acute Type 3 Acromioclavicular joint dislocation with short periods of immobilization by bandages and slings and early rehabilitation of shoulder gives good short-term results clinically although not correlated radiographically.

27. A Hospital Based Research to Evaluate the Incidence and Severity of Vitamin D Insufficiency in type 2 Diabetes Patients
Barun Kumar Kundu, Rajnish Kumar, Shashi Kant Kumar
Abstract
Aim: The aim of the study to assess the prevalence and severity of vitamin D deficiency in type 2 DM. Methods: The present study was conducted in the Department of General Medicine, Madhubani Medical College and Hospital, Madhubani, Bihar, India, from January 2020 to June 2020. Total 180 participants were including in the study out of which 90 healthy people were include as case (Group A) and 90 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: Frequency Distribution of Participants according to Severity of Vitamin D level noted. Prevalence of low vitamin D level in healthy population was only 22.22% in my study, while prevalence was 85.56 % in Diabetic group. Among diabetic patients having abnormal Vitamin D level, majority 68.59%) were having insufficiency, only 16.67% 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%, 67.5% and 12.5% respectively, where in patients with uncontrolled diabetes it was 8%, 74% and 18% respectively. More number of diabetic patients with uncontrolled status (18%) was having overt vitamin D deficiency in comparison to controlled status (12.5%). There is a significant association between the maintenance of euglycemia and severity of Vitamin D level in diabetic patients, as the p value is less than 0.05. Conclusion: We concluded that the control of diabetic status is mandatory in order to prevent vitamin D deficiency.

28. Comparison of Efficacy of two Different Doses of Glycopyrrolate Pretreatment on Hemodynamics Changes Associated with Phenylephrine Infusion During Cesarean Section Under Spinal Anaesthesia
Vikash Bansal, Kirti Nath Saxena, Bharti Wadhwa
Abstract
Background and aims:  Phenylephrine infusion is the drug of choice for hypotension following spinal anaesthesia in caesarean section but is associated with a dose related reflexive slowing of maternal heart rate (HR) and a corresponding decrease in Cardiac output. Methods: A prospective, randomized study was performed on 60 parturients (30 in each group), undergoing elective caesarean section. All parturients were administered SAB with 2.2ml of 0.5% bupivacine (hyperbaric) in left lateral position and phenylephrine infusion was started at the rate of 50µg/min. Parturients were randomly allocated to receive either 0.1mg (group G1) or 0.2 mg glycopyrrolate (group G2) intravenously with the start of infusion. The maternal systolic blood Pressure (SBP) and HR were recorded every 5 min till delivery of baby (taken at clamping of cord). Results: Neither of the groups had significant hypotension but HR and SBP were better maintained in group G1 than G2 while the change in SBP from the baseline SBP was significantly higher in G2 up till 20 min (p<0.05). There were no episodes of nausea and vomiting, and the level of spinal blockade achieved was similar in both the groups. The umbilical cord pH was higher in group G1 as compared to group G2, but the Apgar score was similar in both the groups. Conclusion:  Pretreatment with 0.1 mg glycopyrrolate maintains better haemodynamics and fetal umbilical pH as compared to 0.2mg when given with phenylephrine infusion.

29. Comparison of Lipid Profile between Patients with Liver Cirrhosis & Matched healthy controls at SMS Medical College & Hospital, Jaipur
Ajay Saxena, Mahesh Bairwa, Nivedita Gupta, Balveer Singh Gurjar, S K Vardey
Abstract
Background: Cirrhosis is considered as generalized involvement of liver by concurrent parenchymal necrosis, regeneration and diffuse fibrosis resulting in disorganization of the lobular architecture. Liver cirrhosis is defined as the diffuse process characterized by fibrosis and conversion of the normal liver architecture into structurally abnormal nodules. Cirrhosis in anatomical point of view is a diffuse process with fibrosis and nodule formation. Aims & Objectives: The aim of this study was to assess the serum lipid profile in liver cirrhosis patients and Comparable control groups and to find out association of serum levels of lipids (TG, Cholesterol, HDL, LDL, VLDL) with severity of liver cirrhosis based on Child Pugh Classification. Methods: This study was a cross sectional study in which clinically diagnosed cases of liver cirrhosis from OPD/IPD of Gastroenterology department of S.M.S. Medical College and Hospital, Jaipur were taken as cases. Results: 45 cases of liver cirrhosis and matched controls between age group of 35-65 years were analyzed in this study. In this study Mean age in cases group was 49.58 + 5.63 years while that of controls group was 48.82 ± 9.23 years. The mean cholesterol for cases was 144.51 + 28.21 mg/dl and for Controls was 170.20 + 23.12 mg/dl, mean HDL for cases was 36.11 + 4.88 mg/dl and for Controls was 44.44 + 5.01 mg/dl and mean LDL for cases was 85.72 + 26.58 mg/dl and for Controls was 104.45 + 22.43 mg/dl which was statistically significant (p value < 0.001). However, the mean TG and mean VLDL were statistically non- significant. Mean Cholesterol and HDL levels were significant when compared with Child Pugh Grades. Conclusion: Dyslipidemia exists in patients with liver cirrhosis and screening for the same is important for intervention with appropriate therapy to prevent cardiovascular events so it would be recommendable to provide laboratory analysis of Lipid profile as a routine. The total cholesterol, HDL and LDL cholesterol levels decrease gradually with progression of cirrhosis that can help in understanding disease prognosis.

30. Neonatal Small Bowel Obstruction: Pattern, Symptoms and Diagnostic Evaluation: A Prospective Study
Ade Gangadhar
Abstract
Background: Neonatal intestinal obstruction is a most common surgical emergency. Surgery in neonates is a challenging issue especially in developing countries. Early diagnosis and treatment lead to better outcome. It is observed that there are very few studies available on small bowel obstruction in neonate. Aim: To observe the pattern, Symptoms and diagnosis of neonatal small bowel obstruction. Material and Method: This observational prospective study conducted among 210 cases for the duration of two years, December 2014 to January 2017 at Department of Paediatric Surgery, Institute of Child Health, Niloufer Hospital, Hyderabad. All the neonates who presented with neonatal small bowel obstruction included in the study. Qualitative data was presented in percentage. Results: A total of 210 patients were admitted, average age of the patient was 2.3 Days (1-7 Days) and male to female ratio was 1.8: 1, it means that male newborn were more affected by small bowel obstruction. Intestinal Atresias observed among 52.38% of the patients, followed by malrotation, Meconium ileus, Bands and obstructed Hernia. We observed Vomiting and Abdominal Distension was most common symptoms among the patients, also alone vomiting was most common clinical presentation observed, most of the patients nearly 39% of the patients observed with multiple fluid level and thumb size loop Conclusion: Intestinal atresia was found one the most common cause small bowel obstruction among neonates with common symptoms of Vomiting and Abdominal distension. Immediate surgery and post operative care can be made by collaboration of pediatrician as well as pediatric surgeons to ensure better outcome in newborns with small bowel obstruction.

31. Comparison of Ondansetron and Metoclopramide for Prevention of Nausea and Vomiting in Elective LSCS under Spinal Anaesthesia
Amol Hendre, Rameshwar Bhale
Abstract
Background: Post Operative Nausea Vomiting (PONV) is the most unpleasant and distressing consequence in the immediate post operative period. The problem of PONV has become challenging through appear small problem, tough to control postoperatively. Many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to compare the efficacy and safety of IV Metoclopramide and IV Ondansetron as prophylaxis for postoperative nausea and vomiting in lower-segment caesarean section (LSCS) under spinal anaesthesia. Materials: After institutional approval and informed consent 100 ASA I & II patients undergoing non emergent LSCS taken for study. The patients were divided randomly into 2 groups of 50 each. Group I received IV Metoclopramide 10mg and Group II received IV. Ondansetron 4mg. Anaesthetic management was standardised. The incidence of vomiting and retching as number of episodes was studied. Nausea was graded depending on the severity and data derived. Results: The mean age, weight and duration of surgery was not significantly different when compared group-1 parturients with group-2. The mean episodes of emesis, nausea and retching at different postoperative duration were significantly decreased in Ondansetron group when compared to metoclopramide group as postoperative time progresses. Conclusions : Injection ondansetron 4mg provided decrease in the incidence of PONV than Metoclopramide as the side effects with these drugs were minimal.

32. A Study of Thyroid Dysfunctions in cases with Abnormal Uterine Bleeding Reporting to RIMS, Adilabad
Numi Anjum, Kranti Porika, Godipelli Laxmi
Abstract
Introduction: Dysfunctional uterine bleeding is the term used to describe abnormal bleeding from the uterus in absence of organic genital tract disease or extragenital causes. It is a common presentation in Gynecology practice. This study aimed to evaluate the association of thyroid dysfunctions in cases of abnormal uterine bleeding reporting to RIMS Adilabad. Methods: This cross-sectional study was done in the Department of Obstetrics and Gynecology, Rajiv Gandhi Institute of Medical Sciences, RIMS, Adilabad. Retrospective case records of patients reported to RIMS with Abnormal uterine bleeding were analyzed. N=80 cases with abnormal bleeding were included in the study. Results: The incidence of thyroid dysfunctions were found in n=15(18.75%) out of which n=12 were found to be hypothyroid and n=3 were diagnosed as hyperthyroid cases. the average FT3 was 4.5 ± 0.65 pmol/L the average FT4 was 18.66 ± 1.54 pmol/L and TSH was 4.22 ± 0.87 µIU/L. Most patients had menorrhagia n=34(42.5%) followed by Polymenorrhea n=14 (17.5%), Amenorrhea n=12(15%), Oligomenorrhea n= 10(12.5%), Polymenorrhagia n=8(10%) and Hypomenorrhea n=2(2.5%). Conclusion: Thyroid dysfunctions remain one of the critical causes associated with abnormal uterine bleeding disorders. The most common menstrual abnormalities seen are menorrhagia followed by polymenorrhoea in hypothyroid patients. Since thyroid dysfunction is a crucial cause of menstrual disorders, estimation of thyroid status should be done in all women with menstrual disorders.

33. Risk of Benzodiazepine induced fractures in Elderly Using Cronbach’s α-Coefficient
Praveen Khairkar, Andem Meghana Reddy, Edwin Luther, Vishwak Reddy, C Kamraj, Sumera Yasmeen, Pustakaala Dharneedhar, Ashwini Kamble
Abstract
Objective: Our primary objective was for naturalistic evaluation of benzodiazepine use in elderly using Cronbach’s alpha, odd’s ratio and attributable risk of benzodiazepines for propensity of fractures. Methods: We used the naturalistic case-control qualitative as well as quantitative (mixed) study design and recruited 216 elderly patients above 60 years of either gender. We specifically included those who were prescribed with any benzodiazepines over last 6 months or more and we enquired if any of them had sustained a fracture of any nature or visited the emergency setting for any other medical purpose. Results: Out of 216 patients, only 31% patients had history of fractures who were using benzodiazepines. Fracture of femur neck (38%) was the most common site followed by tibia (17%), while the fracture of radius and humerus were least common 6% and 4% respectively. We observed the odd’s ratio (1.117), Attributable risk (0.0239), Population Attributable risk (0.0206), Relative Risk (1.079), Cronbach’s alpha (0.066) for propensity of risk of benzodiazepines induced fractures. Conclusions: We naturalistically evaluated the multiple risk ratios like odd’s ratio to Cronbach’s alpha and from sensitivity to specificity for association of benzodiazepines and bone fractures allowing the clinicians to have necessary vigilance.

34. A Study of the Status of Ovarian Reserve in Infertile Women Attending Tertiary Care Centre
Kalpana Singh, Shubhanti Kumari, Kumari Shashi, Bhawana Tiwary, Huma Nishat, Sangeeta Kumari
Abstract
Background: As infertility has been not only a medical but a psychosocial problem, it necessitates the complete evaluation of ovarian reserve in an infertile couple. Infertility may be caused by various factors like tubal, uterine, hormonal, age-related factors, ovarian like endometriosis, polycystic ovarian syndrome, premature ovarian failure and decreased ovarian reserve in elderly patients. WHO data suggest that worldwide about 48 million couples and 186 million individuals have to deal with infertility. The various tests include hormonal assays e.g., basal FSH, Inhibin B, AMH, LH/FSH ratio and ultrasonographic evaluation of AFC. Of all AFC and AMH have proven to the most accurate in estimating the ovarian status in infertile women. Objective: To assess the ovarian reserve status in infertile women by different markers for ovarian reserve. Materials and Methods: It is a hospital based prospective study, done in the department of Reproductive Medicine, IGIMS, Patna in 100 infertile women for one year (April 2018-April 2019), Results: In our study, ovarian reserve decreased with increasing age and of all markers for ovarian reserve, AMH alone or along with AFC is the most accurate method. Conclusion: In our study we found a linear co relation between increasing age and AMH. Day 2 AFC and AMH together prove to a better indicator of ovarian status than AMH alone in infertile women.

35. A Prospective Study of Women to Establish a Link Between Pap Smear and Colposcopy Findings in Relation to Histopathological Findings
Suman Kumari, Madhuri Choudhary, Anisha Budhpriya, Neha Singh
Abstract
Aim: To evaluate the correlation of Pap smear and Colposcopic findings in relation to histopathological findings among sexually active women. Methods: The present prospective cross-sectional study was carried out in the department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year. 100 women between 20-60 years of age with H/o abnormal vaginal discharge, pain abdomen and unhealthy cervix were included in this study. After detailed history and examination, Pap smear was taken and Colposcopic examination was done using Colposcope model 150 FC with magnification between 10X to 12.5X followed by Colposcopy guided biopsy. Results: Out of 100, 40% of cases were in 30-40 years age group followed in order by 20-30 years (25%), 40-50 years (18%) and 50-60 years (17%). Majority were (52%) multiparous (Para 3 or more) and 35% with para 2 and 13% with para 1. White discharge associated with unhealthy cervix and H/o contact bleeding was the most common clinical symptom (62%) among the cases and others were low backache (19%), pain abdomen (11%) and menstrual disorders (13%). Pap smears were stained and examined, and the findings were recorded as NILM with 67%, ASCUS (Atypical squamous cells of undermined significance) with 13%, LSIL (Low grade squamous intra epithelial lesion) with 10%, HSIL with 6% and carcinoma as 4%. Colposcopic findings were reported as benign inflammatory (RCI:0-2, 60%), low grade (RCI:3-5, 21%), high grade (RCI:6-8, 13%) and carcinoma (RCI:>8,6%).  Histopathology reports showed that56% of study cases had chronic cervicitis with or without metaplasia, 19% with CIN1, 15% with CIN2 and CIN3 and 10% with carcinomas. Conclusion: The result on current study give support to the fact that Pap smear is an easy screening tool to identify premalignant and malignant lesions of cervix early in the stage of disease and Colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management. Colposcopy and cytology are not competitive method, but complementary to each other.

36. To Investigate the Patterns and Prevalence of Distinct ABO Blood Types in Dengue, as well as the Relationship between ABO Blood Groups and Dengue Severity
Dipak Kumar, Ravindra Kumar
Abstract
Aim: To analyze the patterns and prevalence of different ABO blood groups in dengue and to find an association between ABO blood groups and severity of dengue. Methods: This prospective observational study was done the Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, from January 2020 to December 2020. Children between 0-12 years of age were included. All patients with serological confirmation of Dengue (NS1, IgM/IgG positivity) by Rapid Card Methods with hematology data were included. Blood groups (by Forward Blood grouping -Slide method with Anti-A, Anti-B sera from Tulip diagnostics) were also recorded. The severity of dengue was graded according to World Health Organization guidelines. Results: Of the 115 patients who presented with dengue fever without warning signs, 66(57.39 %), 19(16.52%), 27 (23.48%) and 3 (2.61%) had blood groups O, A, B, AB respectively. When compared with general population, this was statistically significant. Of the 31 patients with dengue fever with warning signs, 15 (48.39%), 5 (16.13%), 10 (32.26%) and 1 (3.22%) had blood groups O, A, B, AB respectively, which was statistically significant. Among the 14 patients with Severe dengue, 5 (35.71%), 2 (14.29%), 6(42.86%) and 1 (7.14%) had blood groups O, A, B and AB respectively. When compared with general population, this was statistically significant. 20% of this was blood group AB as compared with 7.14% of AB blood group in general population. This also indicated that AB blood group predisposes to severe dengue. Conclusion: The incidence of dengue fever is higher in children with blood group O, AB blood group is associated with severe forms of dengue, especially in secondary infections.

37. Assessment of the Coverage of the Measles-Rubella Immunization Campaign in the Bihar Region
Preeti Kumari
Abstract
Aim: To estimate the coverage of measles rubella vaccination campaign in urban field practice area in Bihar region. Methods: The present Prospective study was conducted in the Department of Community Medicine, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India from June 2020 to April 2021. 200 Children aged between 9 months and 15 completed years as on the day of study were included in this study. Results: Out of 200 children majority of the children (42%) were in the age group of 5 to 10 years followed by 35% in the age group of 1 to 5 years and 23% in the age group of 10 to 15 years. 90% of the children have been immunized with the MR vaccine and 10% of the children have not been immunized. Among males, 102 (56.67%) children were immunized and 8 (40%) were not immunized. Among females, 78 (43.33%) children were immunized and 12 (60%) were not immunized. When the immunization status was compared based on gender of the children, it was observed that the percentage of fully immunized children among male and female children was 56.67% and 43.33% respectively. There was a statistically significant difference of immunization status among male and female children (p< 0.05). The distribution of the children based on the presence of MR-Immunization card. 65% of the children had the card while 35% of them did not have the immunization card with them. 7 children (3.5%) had any adverse effects following vaccination while 193 children (96.5%) did not have any adverse effects. Conclusion: An emphasis should be placed on effectively disseminating campaign messages for implementation of the nationwide vaccination campaigns in the future for better utilization of the services. Enhancing population awareness about rubella disease and its prevention is an important mechanism for increasing understanding of the rationale of the MR vaccine over traditional measles vaccine.

38. A Study to Examine the Impact of BMI on Blood Pressure in Hypertensive Patients
Md. Shahzada, Nilofar Yasmin
Abstract
Aim:  To evaluate the effect of body mass index on blood pressure in adults with hypertension. Methods: A Cross-sectional survey was conducted in the Department of Pharmacology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, India. A total of 100 males and 100 females aged from 18 to 55 years were included in the present study. Anthropometric measurements including height, weight, circumferences (upper arm, calf), skinfold thicknesses (at triceps, biceps, subscapular, and suprailiac) and physiological dimensions like blood pressure were taken on each subject. Results: The basic measurements of males and females and the difference between the two genders for the same. Mean values of height, weight, upper arm circumference, calf circumference, pulse rate, SBP, and DBP were found to be significantly higher in males as compared with females. Similarly mean values of BMI and fat percentage were also higher among females. Age was found to have positive and statistically significant correlation with both SBP (r = 0.22, P < 0.01) and DBP (r = 0.19, P < 0.01) among males and for females the correlation between age and blood pressure (SBP and DBP) was r = 0.45, P < 0.01 and r = 0.28, P < 0.01, respectively. The prevalence of underweight was more in females as compared with males. As assessed by SBP and DBP, maximum percentage of overweight males had prehypertension; for SBP it was 50% and for DBP it was 40%. Among females also, prehypertension was maximum in overweight females when SBP (52%) as well as DBP (39%) were considered. The differences in the various categories were found to be statistically significant (chi-square P < 0.001). The prevalence of prehypertension and stage-I hypertension increased 2.85 and 2.69 times, respectively, in overweight/obese males as compared with their non obese counterparts. Almost 9.02 times higher rate of stage II hypertension was observed in overweight/obese males as compared with their non obese counterparts. Among females also, the prevalence of prehypertension and hypertension increased more than 2 and 3.80 times, respectively, in overweight/obese subjects as compared with the non-obese females. Conclusion: The present study concluded that the BMI being associated with prehypertension may suggest that such individuals are at increased risk of progressing to frank hypertension.

39. A Prospective Clinical Study to Evaluate Children with Acute Disseminated Encephalomyelitis
Shobha Kant Choudhary
Abstract
Aim: The aim of this study to study on acute disseminated encephalomyelitis in children. Methods: The present Prospective study was conducted in the Department of Paediatrics Vardhman Institute of Medical Science, Pawapuri Nalanda, Bihar, India for 1 year. Study group consisted of hospitalized children < 15 years of age admitted to our hospital with the diagnosis of ADEM were included in this study. Results: Maximum prevalence in 5- 9-year age group (58%) with 28% in 0-4 year& 14 % in 10-14years age group. Male predominates in the study 64% with female being 36%. Seizures were documented to occur in highest number of cases (66%). Next fever (60%) & altered sensorium (58%) followed. Encephalopathy was observed in 86%, followed by motor deficit in 68% & autonomic involvement in 40%. Out of 50 cases, MRI was done in 43cases, CT scan was done in 2 cases, 5 could not be done. T1 hypo intensity was observed in 52%, T2 hypo intensity in 76%, FLAIRS changes in 72% cases. Frontal lobe was involved in maximum number of cases (56%). CSF was done in 47 out of 50 cases, pleocytosis was observed in 42% cases, elevated protein in 70% cases & low sugar in 30% cases. Steroid were given in only 43 number of patients, steroid plus IVIG were given in 2 patient, only supportive treatment were given in 5 out of 50 patients. Out of 26 children with sequelae, epilepsy was predominantly seen 50% of cases. Motor deficit is seen in 50% of cases. Conclusion: ADEM most commonly present as a polysymptomatic encephalopathy and initially diagnosis may not be clear. Clinical evaluation, MRI & CSF studies are most useful to establish the diagnosis and rule out important differential diagnosis.

40. Treatment of Bell’s Palsy: Comparing the Administration of a Single Dose Intravenous Methyl Prednisolone vs Oral Prednisolone: An Open Labeled, Randomized Controlled Trial
Swetabh Verma, S. N. Sachit, Kumar Devashish, V. K. Mishra
Abstract
Aim: To compare the study of administration of single dose intravenous methyl prednisolone versus oral prednisolone in Bell’s palsy. Methods: The open labeled, randomized controlled trial was conducted in the Department of Pharmacology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India from July 2019 to May 2020. 100 patients were divided into two groups, according to a pre-generated computerized randomization table. Patients in group 1 received a single dose of 500 mg of IV infusion of methylprednisolone while those in group 2 received oral prednisolone in a tapering dosage schedule (60 mg daily for initial 5 days, tapered by 10 mg daily over next 5 days). All patients were followed for a minimum of 3 months after inclusion and the outcome analysis was done at 1-month and at 3 months.  Results: After 1-month of treatment, 25 (50%) patients from group 1 and 20 (40%) from group 2 recovered completely; a total of 45 (45%) patients thus recovered completely. The patients treated with IV methylprednisolone and oral prednisolone, both, showed improvement in the symptoms. The results were however statistically non-significant when compared between the two groups. After 3 months of treatment, 40 (80%) patients from group 1 and 40 (80%) from group 2 recovered completely; a total of 80 (80%) patients recovered completely. No statistically significant differences were observed between the two treatment groups. Conclusion: Single dose of 500 mg of IV methylprednisolone may be an equally efficacious alternative to a 10-day course of oral prednisolone. Early institution of treatment should be attempted for optimum results.

41. Pattern of Usage of Antibiotics in Rural Tertiary Care Education Institution for Surgical Prophylaxis: An Observational Research
S. N. Sachit, Swetabh Verma, Kumar Devashish, V. K. Mishra
Abstract
Aim: To study the pattern of antibiotics use for surgical prophylaxis in a rural tertiary care teaching institution. Methods: The cross sectional, observational study was conducted in the Department of Pharmacology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India from June 2019 to December 2020. After permission from the authorities, the record sheets were accessed from the record section of the institution and analysed regarding age, gender, demographic data, date of admission, date of discharge, chief complaint of the patient, diagnosis, surgical procedure, and the drugs administered. Results: Total 200 record sheets were included in the study. 102 (51%) patients were males and 98 (49%) were females. Maximum number of patients was from age group 35-45 years. The mean age +/- SD of patients was 39.97+/-15.87. 150 patients stayed in hospital from 1 to 10 days, 28 from 11 to 20 days, 10 from 21 to 30 days, 3 more than 30. No antibiotic was used in 10 cases; used for less than 24 hours in 10 cases and for more than 24 hours in 180 cases. 150 patients were given the same antibiotic pre- and post-operatively. In 50(25%) patients antibiotics were changed immediately after surgery. Cefuroxime in 42 patients (22.11%), Metronidazole in 35 (18.42%), amoxicillin + clavulanate in 30 (15.79%), ceftriaxone in 25 (13.16%), Ofloxacin + ornidazole in 15 (7.89%), Ceftriaxone + sulbactum in 10 (5.26%), piperacillin + tazobactum 6 (3.16%), ciprofloxacin 2 (1.05%), cefoperazone + sulbactum 3 (1.58%), amikacin   2 (1.05%), others 186 (12.28%) which included 39 different other antibiotics. A total of 49 choices of antibiotics/ FDCs were used. Conclusion: The prescribers should be educated about the national antibiotic policy and sensitised about the impending catastrophe of antibiotic resistant infections.

42. Interleukin-6 and Ferritin Levels and their Clinical Correlation in COVID-19 Patients: A Quantitative Assessment
Ashish Kumar Jha, Hari Shankar Mishra, Chittaranjan Dutta
Abstract
Aim: Quantitative Assessment of Interleukin-6 and Ferritin Levels and its Clinical Correlation among COVID-19 Patients. Methods: The cross-sectional analytical study was conducted in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for 1 year after taking the approval of the protocol review committee and Institutional Ethics Committee. 120 COVID-19 positive patients, diagnosed upon admission by RT-PCR of oropharyngeal swabs with or without respiratory symptoms were included in the study group. Results: Group A had 55 patients among which 7 patients were asymptomatic and 48 had mild symptoms with RR <24/m and SpO2 >94% in room air, the number of patients with co-morbidities like type 2 diabetes mellitus were 15, with hypertension and cardiac disorders were 10 and with respiratory disorders were 5 in Group A, Group B there were 30 patients among which 9 had mild symptoms and 21 patients had moderate symptoms with RR: 24-30/m (or) SpO2: 90%-94% at room air. The mean levels with standard deviation of Serum IL-6 and serum ferritin in Group A, Group B and Group C patients, respectively has depicted in. table 2. On pairwise comparison by Mann-Whitney U test among the groups it shows that the mean IL-6 levels are significantly different in all the three groups. Kruskal Wallis pairwise comparison shows IL-6 levels to be significantly increased in Group C (35) patients with severe disease compared to Group A and Group B patients with mild and moderate disease respectively (p-value <0.001). Serum Ferritin levels did not show any statistically significant difference among Group A, Group B and Group C; however, ferritin levels were markedly increased in Group C patients with severe disease (p-value=0.44). Conclusion: Serum IL-6 levels independently showed a good correlation with disease severity among COVID-19 patients, and serum ferritin levels was elevated only in severely symptomatic individuals with COVID-19 infections. Hence, Serum IL-6 could have a significant role in assessment of disease severity and Prognosis among COVID-19 patients.

43. Prevalence of Liver Dysfunction in COVID-19 Infections and Its Correlation with Severity and Mortality
Rahul Kumar, V. M. Dayal, S. K. Jha, A. K. Jha, Ravikant Kumar, Manish Kumar Bhaskar, Sweety Kumari
Abstract
Aim: To evaluate the prevalence of liver dysfunction and its correlation with severity and mortality in patients with Covid-19 infection. Materials and methods: Total 120 patients fulfilled the inclusion criteria were enrolled for the study after giving informed consent and were divided into two groups (moderate and severe Covid-19 infection). Patients were treated as per national guideline for Covid-19 infection as mentioned in flow chart above. Hemogram and Liver function test and inflammatory markers (C-reactive protein, Lactate dehydrogenase, D-dimer and ferritin) were performed on every alternate day of hospitalization. Patients were followed during whole hospitalization course and weekly for 1 month after discharge with these tests. Approval for the study was sought from Institutional Ethical committee. Results: The median levels of ALT, AST, ALP, GGT, LDH, TBIL, DBIL, and albumin were 20 U/L (IQR, 14–31), 20 U/L (IQR, 17–26), 75 U/L (IQR, 55–193), 21 U/L (IQR, 14–36), 198 U/L (IQR, 172–232), 8.4 umol/L (IQR, 6.5–11.3), 3.4 umol/L (IQR, 2.3–4.6), and 45 g/L (IQR, 41–47), respectively. Severe patients had significantly higher levels of ALT (26 vs 20 U/L, p=0.017), AST (31 vs 20 U/L, p < 0.001), GGT (30 vs 21 U/L, p < 0.001), LDH (334 vs 197 U/L, p < 0.001), TBIL (10.2 vs 8.3 umol/L, p=0.029), DBIL (4.9 vs 3.3 umol/L, p < 0.001), but significantly lower albumin (37 vs 45 g/L, p < 0.001) than non-severe patients. Abnormal AST (40% vs 7%, p < 0.001), LDH (90% vs 35%, p < 0.001), DBIL (20% vs 7%, p < 0.001), and albumin (50% vs 8%, p < 0.001) were commonly observed in severe patients, compared with non-severe patients. On multivariate analysis, age >60 years, male gender, BMI > 30 kg/m2, comorbidity, abnormal LDH and albumin on hospital admission, and abnormal peak hospitalization LDH and albumin were associated with progression to severe COVID-19 (OR > 1; p < 0.05). Conclusion: This large sample retrospective cohort study, we described the longitudinal changes of liver function parameters in patients with COVID-19. In addition, we con- firmed patients with abnormal liver function parameters were at increased risk of severe COVID-19 and death.

44. A Study Comparing Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Isobaric Levobupivacaine for Lower Limb Orthopaedic Surgery: Double Blinded Clinical Trial
Shashi Bhushan Sinha
Abstract
Aim: The aim of the study to compare a combination of isobaric Levobupivacaine with fentanyl and dexmedetomidine for the characteristics of spinal blockade with respect to onset, duration and hemodynamic parameters and side effect. Methods: This was a prospective, randomized, and double blinded clinical comparative study conducted in the Department of Anaesthesia, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. The study population consisted of 300 adult patients who were classified as American Society of Anesthesiologists (ASA) physical status I or II, undergoing elective lower limb orthopaedic surgery under spinal anesthesia. The study participants were randomly divided into three groups. Group A: 0.5% Levobupivacaine Isobaric 2.5ml+ 0.5ml normal saline (total volume is up to 3.0 ml). Group F: 0.5% Levobupivacaine Isobaric 2.5ml + 25mug fentanyl (test solution will diluted with normal saline to total volume of 3.0ml). Group D: 0.5% Levobupivacaine isobaric 2.5ml +5 mcg dexmedetomidine (test solution will diluted with normal saline to total volume of 3.0 ml. Result: The mean time for onset of sensory block was 12.04 ±4.21 min in the saline group and 9.76±2.99 min in the dexmedetomidine group and 3.28±1.42 min in the fentanyl group. The mean time taken to achieve maximum sensory block in group A was 17.18±4.83 min, in group D was 15.16±3.42 min and in group F it was 6.52±1.67 min so maximum sensory block was achieved earlier in group. Peak level of sensory block attained in the fentanyl group was T4 and the peak level of sensory block in dexmedetomidine group was T6 and in the saline group peak level was T8. So, the highest sensory block was attained in the fentanyl group. The mean duration of sensory block in group A was 116.63±7.15min, and in group F was 164.32±12.74min., and in group D was 207.17±6.42 min. Prolong duration occur in the dexmedetomiine group. The prolongation of effect may result from synergism between local anaesthetic and alpha2 adrenoceptor agonist action. The mean onset time of motor block in group A was 12.04±4.21 min, in group D it was 9.76±2.99 min, in group F it was 3.28 ±1.42 min. Onset of motor block occured earlier in the fentanyl group. In the present study there was a significant difference in duration of motor block across the three groups with p value <0.001. In group A mean duration of motor block was 162.04±6.42 min, and in group D was 254.29±6.62 min and in group F it was 187.88±11.16 min. There was a significant difference in the pulse rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure from the 2 min to 20 min in the intraoperative period. In the postoperative time period the pulse rate, systolic blood pressure, diastolic blood pressure, mean blood pressure was not statistically significant with p value of >0.05. Conclusion: Dexmedetomidine group has longer onset of and duration of sensory block and effective postoperative analgesia and fewer side effects as compared to fentanyl group.

45. Comparison of Peak Expiratory Flow Rate Measurements Using A Flow Metre and Spirometer
Jai Ram Singh, Rajni Kant, Krishna Kant Prasad Singh
Abstract
Aim: Evaluate the Peak flow meter and digital spirometer. Methods: This cross-sectional comparative study conducted in the Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India, for 11 months. 180 healthy male students in the age group of 18-25 years were selected. After taking a detailed personal history, anthropometric parameters such as height and weight were measured using standard methods and from this, body mass index was calculated. Results: Our study comprised 180 healthy male students, aged between 18 and 25 years. The mean PEFR measured by peak flow meter and spirometer was 342.1 ± 121.98 L/Min and 297.88±119.12 L/Min, respectively, as shown in Table 2. PEFR value is significantly greater when measured by peak flow meter than by spirometer (P < 0.05). Conclusion: Even though the value measured by both instruments varies, still the peak flow meters as they are not expensive, easy to handle, and perform, as it also gives consistent readings, therefore, it can be recommended for measuring PEFR in healthy individual and daily monitoring of symptoms in asthma and COPD patients.

46. Prevalence of Impaired Glucose Tolerance and Diabetes Mellitus in Young Women with Polycystic Ovarian Syndrome
Garrepalli Saritha, Gara Bala Sreenivas
Abstract
Background: Polycystic ovarian syndrome (PCOS) is a common endocrinal disorder in females. Recent pieces of evidence have indicated the women with PCOS also suffer from metabolic derangements and diabetes mellitus more commonly as compared to normal women. We in the current study tried to evaluate impaired glucose tolerance and diabetes mellitus in young women with PCOS to facilitate the prevention of long-term consequences. Methods: This cross-sectional study was done in the Department of Obstetrics and Gynecology, Government Medical College Mahabubnagar, Telangana State, India.  Based on the inclusion and exclusion criteria n=100 cases aged between 15 to 25 years diagnosed to have polycystic ovarian syndrome were included. A detailed history along with measurement of BMI and OGTT was performed in all cases. Results: A positive history of PCOS in family members revealed n=14 cases had a positive history for PCOS and n=86 cases were with negative family history for PCOS. The OGTT test revealed out of n=100 cases n= 73 cases were with normal glucose tolerance. N=22 cases were with impaired glucose tolerance and n=5 cases were with Diabetes mellitus. Out of n=27 cases with WHpR of >0.85 abnormal glucose tolerance was revealed in n=11 cases and diabetes mellitus were found in n=3 cases. Conclusion: PCOS women have significantly increased prevalence rates of IGT and diabetes. The risk of glucose intolerance in PCOS patients seems to be 2-fold higher, increasing with the BMI, central obesity, and occurring at an earlier age than in the normal population.

47. A Comparative Assessment of Psoriasis Area Severity Index and Fasting Blood Glucose Levels in Psoriasis Patients with Diabetes Mellitus.
Sudhir Medhekar, Kruti Jai, Amani Joga, Simran Agrawal
Abstract
Purpose: The research was conducted in view of growing interest in association of psoriasis and diabetes mellitus and their potential for having an impact on each other, screening for diabetes mellitus as well as emerging new treatment options for patients welfare. Objective: To correlate Psoriasis Area and Severity Index (PASI) with Fasting Blood Sugar (FBS) in psoriatic patient with diabetes mellitus. Materials & Method: This was Cross sectional observation study conducted in the department of dermatology at the Government Medical College, Aurangabad from September 2020 to August 2021. All patients of psoriasis age more than 18 years and willing to be participate and to sign informed consent were included in this study. Exclusion criteria were those patients who were not willing to participate and those who had another systemic severe disease, pregnant females. Results: Total 54 psoriasis patients were examined. The male: female ratio was 1: 1. Mean (SD) age of the patients was 44.3 (16.4) years. Majority 50% of the patients were having palmoplantar psoriasis. Also 29.6% patients were joint involvement. The Pearson’s Correlation Coefficient between PASI with FBS was 0.60 & statistically significant. Conclusion: Psoriasis Area and Severity Index was positively correlated with fasting blood sugar in this study.

48. Assessment of Arthroscopic Bankart Repair Among Patients of Recurrent Shoulder Dislocation.
Suryakant Purohit, Saurabh Agrawal
Abstract
Background: The shoulder is one of the foremost common and regularly dislocated joints within the body, accounting for quite 50% of all dislocations. the commonest complication of shoulder dislocation is recurrent instability. It accounts for a mean of 70-90% recurrence in patients between the age bracket of 20-40 years. The shoulder joint is liable for a wide selection of motion at various positions in three-dimensional space by utilizing the glenohumeral joint as a fulcrum. Material & Methods: 30 patients with recurrent dislocation of shoulder with Bankart lesion, treated with arthroscopic stabilization with suture anchors for surgical and functional outcome according to inclusion and exclusion criteria were enrolled in the present study. Study participants were enrolled by simple random sampling. Clearance from the hospital ethics committee was taken before the start of the study. Written informed consent was taken from each study participant. Results:  In the present study, out of total study participants, based on the number of suture anchors used, among the majority of patients 3 suture anchors were used (73.3%), and among 26.6% patients 2 suture anchors were used. In the present study, out of total study participants, based on the total ROWE score, the mean pre-operative score was 57, the mean total ROWE score at 3rd week was 69, the mean total ROWE score at 6th week was 71. the mean total ROWE score at 12th week was 82 and the mean total ROWE score at 1 year was 94. Postoperatively 90% of patients out of total attained a full range of external rotation in 90▫ abduction by the end of one year. Conclusion:  We concluded from the present study that patients with recurrent dislocation of shoulder with Bankart lesion, treated with arthroscopic stabilization with suture anchors had a good surgical and functional outcome. This operative method provides excellent postoperative shoulder motion and lesser recurrence rates.

49. Formulation of After Shave Lotion using Marigold floral waste.
Rajashree Y. Saoji, Amar Zalte, Vishal Guleccha
Abstract
In India, every year 8 tons of floral waste is disposed to rivers and water bodies, polluting them to huge amount. If this floral waste is used technically, the amount of waste can be reduced to a huge content. These flowers can be widely used in preparation of cosmetics products. This study identifies the use of marigold waste to prepare after shave lotion. In Nasik Maharashtra ample amount of marigold is available during festivals. In navratri marigold flowers are used to offer deities which is wasted afterwards and thrown in rivers. A small attempt is made here to reduce this waste and convert it into useful, aesthetic and leisure cosmetic product. The marigold extract was prepared and used in after shave lotion because of its useful properties and the product is tested on human volunteers and also according to Indian standards.

50. Clinical and Pathological Aspects of Gastric Cancer in Bihar Region, India: A Retrospective Study
Tulika Singh, Rashmi Rani Bharti, Bipin Kumar
Abstract
Aim: The aim of this study was to find correlation between clinical and pathological factors of gastric cancer in Bihar Region, India. Material and methods: This retrospective study was carried out in the department of pathology, Indira Gandhi Institute of Medical Sciences, Patna, India for 2 years. Total 50 patients were included in this study. Results: Of these 50 patients, 36 (72.0%) male and 14 (28.0%) female. 29 (58.0%) underwent distal gastrectomy, 2 (4.0%) proximal gastrectomy via abdomen and 14 (28.0%) via thorax, and 5 (10.0%) underwent total gastrectomy. Distal and total gastrectomy had more numbers of clearances of lymph nodes than the other operational approaches. The postoperative complications occurred in 4 patients 4/50, 8.0%. The complication was most common in proximal gastrectomy via abdomen. The diameter of the neoplasm was positively correlated with the depth of infiltration and lymphatic metastasis rate while hemoglobin was the opposite. 7 (14.0%) of 50 were early gastric carcinoma with metastasis of lymph nodes in 1 patient. The frequency of positive lymph nodes in these patients was 4%-5% less than in advanced gastric cancer. In linear regression analysis, age and diameter of the tumor were negatively correlated with the preoperative hemoglobin (P<0.001). The diameter of the tumor was positively correlated with age and the frequency of positive lymph nodes (P<0.01). The patients with tumor of bad differentiation were younger than the other groups, who had larger tumor diameter and higher frequency of positive lymph nodes. Conclusion: The clinic-pathological characters in gastric cancer varied with sex, location, and diameter of the tumor.

51. Assessing the Efficacy and Role of MRI as an Imaging Modality in non-pregnant Females with Abnormal Uterine Bleeding
Prakash Tayade, Neerja Jain Sudhakar, Pravina Deshmukh, Ranjana Becon
Abstract
Background: The differential diagnosis and etiology of abnormal uterine bleeding are complex and varied. Histopathologic examinations are considered controversial to TAV and TAS making a non-invasive and advanced technology, MRI, a reliable tool and imaging modality for accurate diagnosis of abnormal uterine bleeding. Objectives: The present study was conducted to assess the role and efficacy of MRI in abnormal uterine bleeding (AUB) patients. Methods: In the present prospective clinical study, 102 subjects within the age of 21-85 years with abnormal uterine bleeding and who had prior surgery were assessed after recording detailed history and systemic examination. Following this, all subjects underwent MRI. The treatment was planned based on MRI diagnosis, medical conditions, desire to have further pregnancy, parity, and age. Result: Majority of subjects were within the age range of 31-50 years, parity was 2. The duration complaint in study subjects were acute <6 months in 22.54% (n=23) subjects and was chronic >6 months in 77.45% (n=79) subjects. Bleeding pattern was PMB, IMB, HPMB, and HMB in 11.76% (n=12), 20.58% (n=21), 32.35% (n=33), and 35.29% (n=36) study subjects. Pressure symptoms, dysmenorrhea, dyspareunia, Discharge per Vaginum, Heaviness in lower Abdomen, and Pain in lower Abdomen in 9.80% (n=10), 15.68% (n=16), 10.78% (n=11), 14.70% (n=15), 12.74% (n=13), and 19.60% (n=20) study subjects respectively. No compliant was reported by 4.90% (n=5) study subjects. Conclusion: The present study concludes that in subjects where clinical diagnosis is not confirmatory, sonography is decisive, even in subjects with no symptoms and normal findings. MRI is an accurate and promising imaging modality.

52. Using Zinc Sulfate to Improve Pneumonia Symptoms in Children Under 5 Years Old
Dinesh Kumar Rajak, Alka Singh
Abstract
Background: Pneumonia is a form of acute respiratory infection that affects the lungs. Pneumonia is one of the most common implications of lower respiratory tract involvement. The World Health Organization estimates that of approximately 4 million annual deaths due to pneumonia, half of the cases occur in children less than 1 year of age. This study aimed to investigate the effect of prescribing zinc sulphate on improving the clinical symptoms of pneumonia in 2-59 months old children. Materials and Methods: This case control study was performed on 240 children with age of 2-59 months complaining of fever, coughs, and tachypnea in Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India. The patients were randomly assigned into control (n=120), and intervention (n=120) using double blinding method. In the control group placebo was prescribed, while the intervention group received oral zinc sulphate 10 mg (1 ml/ kg in children younger than 12 months, and 20 mg/kg every 12 hours for children of 13-59 months. During hospitalization, every 12 hours the clinical symptoms of both groups including tachypnea, duration of fever, coughs, intercostal retraction, hypoxia, crackles-wheezing, and duration of hospitalization were recorded. At the beginning and end of the treatment, two blood samples were taken for determining the serum level of zinc. Results: The normal range of serum zinc levels is in the range of 60-150 ug/dl. The mean value of serum zinc levels for the cases was 55.47 ug/dl compared to 57.94 ug/dl for the control group during admission. During discharge, mean value for the case group was raised upto 91.45 ug/dl while it was approximately same (60.37 ug/dl) for the control group. During admission, 85 (71.67%) and 88 (78.33%) patients from case and control groups respectively had complain of tachypnea but after 48 hours of admission, 15 (11.67%) and 23 (20.00%) patients had complained of tachypnea. Conclusion: Based on this study, it is suggested that prescription of oral zinc sulphate supplement be considered for pediatric patients to the standard and conventional pharmacotherapy of pneumonia. These effects can do major absolute reductions in childhood morbidity and mortality rates in the numbers of children who die from acute lower respiratory tract infections every year.

53. Prevalence of Oral Candidiasis in HIV positive patients: speciation by phenotypic methods and correlation with CD4+ count in Southern Rajasthan
Jay Sharma, Ankur, Anshu Sharma, Deepak Maheshwari
Abstract
Objective: Oral Candidiasis or Oral thrush is the most common mouth lesions occur in HIV positive patients caused by opportunistic yeast Candida which living as a commensal in healthy individuals. The clinical severity of candida infection prevalence may be a reflection of decreased CD4 count in HIV patient. The aim of the study to determine the prevalence of Oral Candidiasis in HIV seropositive patients, their correlation with CD4+ and speciation of Candida isolates using different phenotypic methods. Methods: A total of 100 oropharyngeal swabs were taken from HIV seropositive patients with or without clinical evidence of Oral candidiasis in this study at the ART centre of RNT Medical College. The speciation of isolated Candida was done using 4 phenotypic test – germ tube test, sugar fermentation test, inoculation on Hi Candida CHROM agar and morphology on starchy media such as corn meal agar. The correlation between Oral Candidiasis and CD4+ count was determined by Pearson’s Correlation test. Results: In our study 36 samples were found positive for oral candidiasis out of the 100 samples taken from HIV seropositive patients. 6 different species of Candida were found along with Candida albicans (61%) were the most common Candida species, followed by Candida dubliniensis (16%), Candida tropilasis (5%), Candida krusei (5%), Candida parapsilosis (5%), and Candida glabrata (5%). Oral Candidiasis was found to be significant correlated with decreased CD4+ counts (negative value of R). Conclusion: Human in immunocompromised states such as HIV AIDS are readily infected with opportunistic pathogen such yeast Candida. Speciation of Candida is necessary because the prevalence of NCA species increasing in last few decades and the prevalence of opportunistic Candida infection can be strongly correlate with decrease CD4 count.

54.Maternal and Perinatal Outcomes in Women with First Trimester Vaginal Bleeding
Ponnam Chandramathi, V Rama Devi, Ponnam Vaishnavi,Puppala Vinayaka Vishnu Vardhan
Abstract
Background: Out of 100 pregnancies, approximately 15 to 25 women have vaginal bleeding in first trimester. This vaginal bleeding usually occurs 1 to 2 weeks after fertilization during implantation of fertilized egg in uterus lining. Aim: The present study evaluated the maternal and perinatal outcomes in women with first trimester vaginal bleeding. Materials and Methods: The present study is a cross sectional study which was conducted between February 2017 to March 2019. 50 pregnant women with vaginal bleeding in the first trimester of pregnancy were admitted in Department of Gynecology and Obstetrics. Results: Premature labour was found to be highest complication during first trimester vaginal bleeding which was 28%, other complications were premature membrane rupture (8%), placental abruption (14%), intrauterine death (2%), Intrauterine growth retardation (4%) and there were no complication in 14%. Caesarean section (28%) was highest pregnancy outcome in women with first trimester vaginal bleeding. 7 women had abortion. Conclusion: The present study concluded that predicting factors of mother and infant consequences of pregnancy might be first trimester vaginal bleeding.

55.A Study Evaluate the Embryonic Fetal Heart Rate as Prognostic Factor of First Trimester Pregnancy Outcome: Prospective Observational Study
Priyanka Singh, Reena Yadav, Manisha Kumar, Abha Singh
Abstract
Aim: to evaluate the heart rate as prognostic factor of first trimester pregnancy outcome. Materials and Method: This prospective observational study was performed in the department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi. This study was conducted in 230 pregnant women who had satisfied inclusion and exclusion criteria. Detailed history like chief complaints, past history, present history, and family history was taken. After that detailed examination- general physical examination, systemic examination, per speculum, and per vaginal examination was done. Gestational age was calculated by last menstrual period. Each participant was subjected to transvaginal ultrasonography. Philips HD 11xE model ultrasound machine was used which had transvaginal probe of frequency 6-9MHz. All scans were performed by a single sonographer. All scans were performed by a single sonographer. On sonography embryonic fetal heart rate was estimated by M-mode. Results: Total subjects participated in the study were 230, minimum and maximum ages were 19 years and 38 years respectively. Mean age was 27.68+4.38-year, maximum number of woman 128/230 (55.7%) were in the age group of 23-30 year. Based on ROC analysis cut off value of Heart Rate that predict the abortion was <110b/m. Out of 230 women small yolk sac (<3.5mm) was observed in 17(7.39%) women. Out of 230 subjects 23 (10%) women were found to have decreased embryonic heart rate (<110) and out of these 23 women 14 (60.8%) women had abortion and remaining 9 (39.1%) women had continued the pregnancy. Conclusion:Suggested that abnormal embryonic heart rate is associated with poor outcomes.

56.Maternal and Perinatal Outcomes in Women with First Trimester Vaginal Bleeding
Anupam Kumar Chaurasia, Sushma Sinha, Lata Shukala Dwedi
Abstract
Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective  study was carried out in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 12 months. Total 120 cases were diagnosed with ectopic pregnancy. Results: The incidence of ectopic pregnancy (0.029%) or 2.9 per 1000 deliveries. The most common site of ectopic pregnancy was fallopian tube 102(89.17%). Ampulla was the commonest site 90(75%) for ectopic implantation in the fallopian tube. Heterotopic pregnancy is rare where pregnancy is seen in the uterus and tube at the same time. In our study, there were 3(2.5%)  cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 55(45.83%) followed by H/o previous abortion 25(20.83%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 32(26.67%). In our study, 17(14.17 %) patients were using copper IUCD. 67.5% of the patients had bleeding or spotting per vaginum. Urine pregnancy test was positive in 113(94.17%) of patients. Culdocentesis was positive in 53(44.17%) of patients. Ultrasound was able to diagnose 99(82.5 %) of cases. USG findings suggestive of ectopic pregnancy were extrauterine gestational sac 15(12.5%), haemoperitoneum 71(59.17%) and adnexal mass 91(75.83%). The incidence of ruptured ectopic pregnancy was 88%. 97.5% of the patients received one or more units of blood transfusion intra operatively and/or post operatively. All the patients with ectopic pregnancy were managed surgically. 95% patients underwent laparotomy and 5 % patients had laparoscopic treatment. 95% patients underwent unilateral or bilateral salpingectomy or salpingoophrectomy. Concurrent dilatation and curettage was performed in the patients who had heterotopic pregnancy 3 (2.5%). There was no maternal mortality in the present study. 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.

57.A Prospective Cross Sectional Examination of Anxiety in Individuals Receiving Complete Denture
Nikita Raman, Samir Jain
Abstract
Aim: To evaluate the anxiety in patients undergoing complete denture treatment. Methods: This prospective study conducted in the Department of Dentistry, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 24 months. A standardized, suitable, and reliable questionnaire was formulated and validated in a simple tick format consisting of ten questions. This questionnaire was then distributed among the patients who were undergoing complete denture treatment in the Department of Dentistry to determine the cause for their anxiety during and after treatment. Results: Out of the 500 edentulous patients surveyed, 273 (54.60%) patients were females and 227 (45.40%) were males. The data revealed that only 123 (24.6%) of the patients were comfortable with the idea of visiting the dentist, whereas 377 (75.4%) of the patients were not comfortable. Patients were asked to rate their anxiety level on the Visual Analog Scale–Anxiety (VAS–A) scale of 0–10, with 0 being not at all anxious to 10 being very anxious. Data showed distribution in various ranges predominantly between score 4 with 129 (25.8%) patients and score 8 with 112 (22.4%) patients, followed by score 3 at 84 (16.8%) patients. Out of the total 500 patients, 303 (60.6%) patients were previous denture users, and 197 (39.4%) patients were getting the dentures fabricated for the first time. While 222 (44.4%) patients showed readiness with the idea of using a complete denture, the remaining 278 (55.6%) patients disliked the idea of using a complete denture. Sense of vomiting while making the impression was the primary reason for anxiety in 298 (59.6%) patients. Fullness of the mouth comprised 122 (24.4%) patients. Fear of swallowing the impression material constituted 61 (12.2%) patients with breathlessness being considered by 20 (4%) patients. Although 71 (14.2%) patients were of the view that it was not substantial for them that the doctor should understand their language, 429 (85.8%) patients considered that the doctor understanding their language is important for them. Conclusion: There is a significant relation between denture satisfaction and anxiety. Proper recognition and diagnosis can significantly reduce many problems that may arise while treating a dentally anxious patient, thus preventing stress for both the dentist and the patient.

58.A Prospective Randomized Study Comparing Endoscopic Septoplasty with Conventional Septoplasty
Ratnesh Kumar, Preeti Sharma, Vineet Sinha
Abstract
Aim: The aim of the study was to study the advantages and disadvantages of endoscopic septoplasty and conventional septoplasty and to co-relate the two procedures in terms of intra-operative visualization, duration of surgery, procedural difficulties, hospital stay and complications. Methods: The present study was done to compare the conventional and endoscopic septoplasty was carried out in the Department of ENT, Patna Medical College & Hospital Patna, Bihar, India, for 12 months. Total 120 Patients with symptomatic DNS with no other comorbidities and willing for surgical treatment were included. Data was collected by selecting the patients with DNS willing for surgery. They were divided into two groups: one group undergoing conventional septoplasty and the other endoscopic septoplasty by random selection and following up the patients preoperatively and postoperatively. Results:  In the present study, major pre-operative symptom was found to be nasal obstruction 90%, followed by Headache 54.17%, postnasal drip 50%, Hyposmia 48.33% and epistaxis 33.33%. It was noticed that improvement of nasal obstruction was 92%, nasal headache (83.33%), Postnasal drip (77.78%) Hyposmia (87.10%) Epistaxis (80%) in endoscopic septoplasty (ES) group. On the other hand, in conventional septoplasty group improvement of nasal obstruction (60.34%), headache (54.43%), Postnasal drip (PND) (30.30%) Hyposmia (62.96%) Epistaxis (60%) was seen (Table 4). This difference in relief of symptom was found to be very significant. On 90th day of follow-up visit, residual deviation was found to be present in 20 (33.33%) of patient of conventional groups whereas it was present in 4 (6.67%) patients of endoscopic group (P=0.005). In conventional group, 19(31.67%) patients developed synechiae whereas in endoscopic group 7(11.67%) patients developed synechiae (P=0.021). Conclusions: For minimal and posterior deviations of the septum, endoscopic septoplasty is better, whereas for anterior deviations, conventional septoplasty could be better choice.

59.A Prospective Study to Determine the Thyroid Hormone Levels in Neonates Suffering from Sepsis and to Correlate These Levels with the Severity of the Disease
Tulika, Gopal Sharan
Abstract
Background: Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low and middle-income countries. Thyroid hormones levels tend to decrease in critical care patients who suffer from severe trauma or sepsis. Aim: to assess the thyroid hormone levels in neonates with sepsis and correlating these levels with disease severity. Materials and Methods: This is a type of prospective study which was done in a neonatal intensive care unit of Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India, for the duration of 1 year. A group of septic newborns and a control group of healthy noninfected newborns were evaluated. Blood samples were obtained at onset from septic and healthy newborns and at 10th day of the antibiotic therapy from only septic newborns, and thereafter serum total T3 (TT3), total T4 (TT4), and TSH levels were determined. 67 neonates were admitted in NICU during the duration of study and were identifies as the case group. Other 63 healthy full-term neonates were randomly selected as the control group. Comparison of mean levels of thyroid hormones between cases and controls was done. Results: At onset, serum TT3 and TT4 levels of all septic newborns were significantly lower with respect to those of healthy controls, while serum TSH levels were not significantly different between these groups. At the 10th day of the antibiotic therapy serum TT3, TT4, and TSH levels of septic newborns were markedly increased, but only the difference between TT4 levels was significant. Conclusion: levels of thyroid hormones like T3 and T4 are less in septic neonates as compared to healthy neonates before treatment, irrespective of gestational period and birth weight. So, the thyroid abnormalities at admission in septic neonates could be of prognostic value.

60.Prospective Analytical Study to Correlate Duration of Diabetes Mellitus, Microalbuminuria, Hyperlipidemia with Severity if Diabetic Retinopathy
Umesh Kumar, Nawin Kumar
Abstract
Aim: The aim of this study to evaluate the correlation of duration of diabetes mellitus, microalbuminuria, hyperlipidemia with severity if diabetic retinopathy. Methods: The prospective analytical study, which was carried in the Department of Ophthalmology, DMCH, Laheriasarai, Darbhanga, Bihar, India for 12 months. Total 220 patients were included in this study. For the study, type II DM is defined as a fasting plasma glucose of more than or equal to 126 mg/dl or 2-hour post glucose load plasma glucose of more than or equal to 200 mg/dl or a random plasma glucose of more than or equal to 200 mg/dl in the presence of symptoms of hyperglycemia. All the biochemical assessments were done using an Auto analyzer. Results: A total of 220 subjects of either gender were included in our study, out of which 120 (54.55%) were females and rest were males 100; 45.45%). The male to female ratio was 1.2:1. Majority of the patients lied in the age group of 40-60 years (54.55%) followed by 60-80 years (28.64%) and below 40 years (15.45%), while only 3(1.36%) patients were aged above 80 years. On ophthalmologic examination we found that only 112 out of 220 diabetics suffered from diabetic retinopathy and the rest 108(49.09%) did not show any signs of diabetic changes in the fundus. Out of 112 patients in the retinopathic group, 57 (25.91%) of them suffered from very mild to moderate NPDR, 32 (14.55%) patients showed signs of severe to very severe NPDR and only 23 (10.45%) had proliferative diabetic retinopathy. On doing a trivariate analysis between severity of retinopathy, microalbuminuria and serum cholesterol levels, it was observed that in microalbuminuria grade 0, difference in prevalence of retinopathy in patients with different serum cholesterol levels was not found to be statistically significant (p = 0.62). In microalbuminuria grade l, prevalence of retinopathy in patients having desirable cholesterol levels was lower as compared to those having borderline or high cholesterol levels and this difference was found to be statistically significant (p = 006). In microalbuminuria grade II, proportional differences in grades of retinopathy and serum cholesterol levels were observed and these differences were found to be statistically significant (p = 0.021). In microalbuminuria grade Ill. majority of patients were suffering from very mild-moderate retinopathy and no statistically significant association between retinopathy and serum cholesterol levels was found (p = 0.63). Multivariate analysis revealed a statistically significant association of Diabetic retinopathy with HbA1c values.High grade Microalbuminuria (Grade II and III Duration of diabetes >20 years). Association between retinopathy and high total cholesterol levels (Borderline high and high) was not found (p = 0.23). Conclusion: Duration of diabetes and microalbuminuria have been found to be the independent risk factors for diabetic retinopathy, but serum cholesterol levels did not show an independent role in our study. The findings in present study endorsed the view that microalbuminuria poses a risk for diabetic retinopathy which is affected by duration of diabetes, level of glycemic control and lipid levels.

61.Evaluation of metabolic urolithiasis and assessment of the prevalence of various abnormalities at a tertiary care facility
Vishrut Bharti, Manoj Kumar Singh, Sanjay Gupta, Ahsan Ahmad
Abstract
Aim: Study of the prevalence of metabolic abnormalities in a tertiary care centre in Bihar region. Methods: This was a prospective observational study conducted in the Department of Urology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India for 1 year. 50 patients over 18 years old admitted in the urolithiasis outpatient clinic of a tertiary centre were included in this study. Results: The majority of the population was women, making a female/male ratio of 1.5:1. 2% of patients were underweight, 38% presented normal BMI and 60% were overweight or obese. Taking other comorbidities into account, 24% had hypertension, 14% had diabetes mellitus and 28% presented with dyslipidaemia. Metabolic abnormalities (considering any of these hyperoxaluria, hypercalciuria, raised PTH, hypercalcemia, hyperuricosuria, hypomagnesuria or hyperphosphaturia) were found in 94% patients (Confidence Interval 95%: 87.2–99.8%). Almost a quarter (26% [CI95%: 16.0–36.8%]) only had one   metabolic   abnormality, and   68% patients CI95%: 56.9–79.4%) had multiple metabolic abnormalities. Hypercalciuria 54% (CI95%: 43.5–67.6%) and Hypocitrateuria 44% (CI95%: 34.1-52.91%) was the most commonly observed metabolic abnormality. Other significant metabolic abnormalities were hyperoxaluria (34% [CI95%: 22.4–49.8%]), hyperuricosuria (32% [CI95%: 21.9–44.7%]) and hypomagnesuria (30% [CI95%: 21.3–44.2%]). Several sociodemographic and clinical variables with the most frequent metabolic abnormalities found in our study (hypercalciuria, hyperoxaluria, hyperuricosuria and hypomagnesuria). Patients with hypercalciuria were older (55.8±12.9 years vs. 48.8±6.8 years, p = 0.022), family history of stone disease was significantly more frequent among patients with hyperoxaluria (70% vs. 30%, p = 0.011) and there was a higher prevalence of present and former smokers among patients with hyperoxaluria (p = 0.012). Conclusion: Immediate metabolic evaluation is the key for a better and individualized management, guiding the selection of proper pharmacological and dietary measures to prevent recurrent stone formation and to relieve all clinical and economic burdens behind this condition.

62.Evaluation of metabolic urolithiasis and assessment of the prevalence of various abnormalities at a tertiary care facility
Vishrut Bharti, Manoj Kumar Singh, Sanjay Gupta, Ahsan Ahmad
Abstract
Aim: Study of the prevalence of metabolic abnormalities in a tertiary care centre in Bihar region. Methods: This was a prospective observational study conducted in the Department of Urology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India for 1 year. 50 patients over 18 years old admitted in the urolithiasis outpatient clinic of a tertiary centre were included in this study. Results: The majority of the population was women, making a female/male ratio of 1.5:1. 2% of patients were underweight, 38% presented normal BMI and 60% were overweight or obese. Taking other comorbidities into account, 24% had hypertension, 14% had diabetes mellitus and 28% presented with dyslipidaemia. Metabolic abnormalities (considering any of these hyperoxaluria, hypercalciuria, raised PTH, hypercalcemia, hyperuricosuria, hypomagnesuria or hyperphosphaturia) were found in 94% patients (Confidence Interval 95%: 87.2–99.8%). Almost a quarter (26% [CI95%: 16.0–36.8%]) only had one   metabolic   abnormality, and   68% patients CI95%: 56.9–79.4%) had multiple metabolic abnormalities. Hypercalciuria 54% (CI95%: 43.5–67.6%) and Hypocitrateuria 44% (CI95%: 34.1-52.91%) was the most commonly observed metabolic abnormality. Other significant metabolic abnormalities were hyperoxaluria (34% [CI95%: 22.4–49.8%]), hyperuricosuria (32% [CI95%: 21.9–44.7%]) and hypomagnesuria (30% [CI95%: 21.3–44.2%]). Several sociodemographic and clinical variables with the most frequent metabolic abnormalities found in our study (hypercalciuria, hyperoxaluria, hyperuricosuria and hypomagnesuria). Patients with hypercalciuria were older (55.8±12.9 years vs. 48.8±6.8 years, p = 0.022), family history of stone disease was significantly more frequent among patients with hyperoxaluria (70% vs. 30%, p = 0.011) and there was a higher prevalence of present and former smokers among patients with hyperoxaluria (p = 0.012). Conclusion: Immediate metabolic evaluation is the key for a better and individualized management, guiding the selection of proper pharmacological and dietary measures to prevent recurrent stone formation and to relieve all clinical and economic burdens behind this condition.

63.A Cross-Sectional Investigation of Lipid Profiles in Newly Diagnosed Type 2 Diabetics
Navneet, Nistha Kishore
Abstract
Aim: The aim of this study was evaluate the lipid profile abnormalities in newly diagnosed type 2 diabetics. Material and methods: A cross-sectional study were carried out to determine the lipid profile levels in newly diagnosed type 2 diabetics in the Department of General Medicine, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for 15 months. A total of 200 newly diagnosed type 2 diabetics were enrolled in our study. Results: In our study, 96 (48%) participants had normal serum triglycerides levels which is <150 mg/dl whereas 104 (52%) participants had an abnormal level of serum triglycerides. Among the 104 (52 )participants with abnormal triglycerides, 30.5% had borderline high levels (150-199mg/dl), 19.5% had high levels (200-499 mg/dl) and 2% participants had very high triglycerides (≥500 mg/dl.In our study, among the 200 participants, 142 (71%) participants   had   desirable  total   Cholesterol  levels  of <200mg/dl, 51 (25.5%) had borderline high levels of 200- 239mg/dl and 7 (3.5%) had high total cholesterol levels of ≥240mg/dl and 31% of participants had near optimal levels of LDL, 35.5% had borderline high levels of LDL, 12% had high levels of LDL and 1% had very high levels of LDL. Conclusions: Deranged lipid profiles are quite prevalent in type 2 diabetics with females having higher triglyceride levels. Recognition of such elevated triglyceride levels in even newly diagnosed type 2 diabetics will help in better prevention of associated cardiovascular disease.

64.Clinical Characteristics of Individuals Receiving Intrathecal Bupivacaine with Clonidine or Bupivacaine with Fentanyl Spinal Anaesthesia
Deepak Kumar, Ram Nath Das, Pramod Kumar Sinha
Abstract
Aim: The aim of this study to assess the clinical characteristics of individuals receiving intrathecal bupivacaine with clonidine or bupivacaine with fentanyl spinal anaesthesia. Methods: A prospective double blind randomized controlled study was conducted in the Department of Anaesthesiology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 1 year. 100 adult patients were randomly divided on an alternative basis into two groups of 50 each. Group A-Bupivacaine plus clonidine group. Group B-Bupivacaine plus fentanyl group. Patients with ASA grade 1 and 2 patients and age group of 18 –70 yrs. Those patients scheduled to undergo elective lower abdominal, lower extremity, gynaecological or urological surgeries under subarachnoid block were included in this study. Patients belonging to group ‘A’ received 3 ml (15 mg) of hyperbaric bupivacaine 0.5% plus 1 µg.kg-1 of clonidine. Patients of group ‘B’ received 3 ml (15 mg) of hyperbaric bupivacaine 0.5% plus (25 µg) of fentanyl. After injection, patient was immediately turned to supine position. Results: Majority of patients in the both the groups belonged to the group 30 to 40 years.  The number of males 42% and females 58%. Majority of female patients in the both the groups belonged to the group 160 to 170 cms and males 171 to 175 cms, Samples were height matched. Most of the patient’s 40 percent from gynaecology surgery followed by lower limb surgery 35 percent and Lower Abdominal Surgery 25 percent. Conclusion:We concluded that the administration of local anaesthetics in combination with opioids intrathecally is an established technique for managing postoperative pain following abdominal, pelvic, thoracic or orthopaedic procedures on lower extremities. Local anaesthetics with opioids demonstrate significant synergy.

65.Using Zinc Sulphate to Improve Symptoms of Severe Pneumonia in Children Under 5 Years of Age: A Case Control Study
Tulika, Gopal Sharan
Abstract
Background: According to World Health Organization (WHO), Pneumonia is a form of acute respiratory infection that affects the lungs. Pneumonia is considered as the most important infection-induced cause of child mortality. Aim: To investigate the effect of prescribing zinc sulphate on improving the clinical symptoms of Severe pneumonia in 2-59 months old children. Materials and Methods: This case control study was performed on 120 children with age of 2-59 months and complaining of fever, coughs, and tachypnea. The patients were randomly assigned into control (n=60), and intervention (n=60) using double blinding method. In the control group placebo was prescribed, while the intervention group received oral zinc sulphate 20 mg on day of admission and then 10 mg BD for 7 days. During hospitalization, every 12 hours the clinical symptoms of both groups including tachypnea, duration of fever, coughs, intercostal retraction, hypoxia, crackles-wheezing, and duration of hospitalization were recorded. At the beginning and end of the treatment, two blood samples were taken for determining the serum level of zinc. Results: The findings indicated that the serum level of zinc sulphate after the intervention increased significantly in the intervention group. There was a significant difference in the duration of fever and tachypnea between the intervention and control groups 36 hours post-hospitalization. Conclusion: Supplemental administration of zinc can expedite the healing process and results in faster resolution of clinical symptoms in children with pneumonia.

66.Maternal and Perinatal Outcomes in Women with First Trimester Vaginal Bleeding
Anshupriya
Abstract
Background: Differential diagnosis of Parenchymal thyroid diseases by gray-scale ultrasound is quite difficult for a radiologist as the findings are very similar to each other. Aim: In this study we aimed to assess some quantitative spectral Doppler parameters, resistivity index (RI) and acceleration time (AT) together to show their reliability for differential diagnosis of parenchymal thyroid diseases. Methods: This study was conducted in the Department of Radiology, Patna Medical College and Hospital, Patna, Bihar, India for 18 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 Siemens ACUSON S2000 machine. Quantitative spectral doppler parameters such as resistivity index (RI) and acceleration time (AT) was recorded. Results: Out of 200, 62.5% were male and 37.5% female most of the patients between 30-40 years 42.5% and followed by 40-50 years was 30%. The Distribution of patients based on diseases and each group had 40 patients. The mean RI in group I was 0.57, in group II was 0.60, in group III was 0.45, in group IV was 0.51 and in group V was 0.53. Mean AT in group I was 25.9, in group II was 24.8, in group III was 69.5, in group IV was 45.8 and in group V was 44.5. The difference was significant (P< 0.05). Conclusion: The resistivity index and acceleration time together are reliable for differential diagnosis of parenchymal thyroid diseases.

67.A Prospective Observational Study to Evaluate the Prophylactic use of Antibiotic Coated Intramedullary Nail in Treatment of Open Tibia Fractures
Arun Kumar
Abstract
Aim: The purpose of this study was to evaluate the efficacy of antibiotic-coated intramedullary locking nail in the open tibia fractures. Methods: This prospective observational study was carried out in the Department of Orthopedics, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for 1 year. Total 100 patients were treated with gentamicin coated tibia interlocking nail. Patients with Open fractures gustillo type 1, 2, 3A fracture were included in this study. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Result: The mean age of such fractures to be 36.15 years in this study, there was predominance of male population. The most common cause of injury was found to be due to road traffic accident and accounted for 79 (79%) of cases. Fibula fracture was associated with 93(93%) of patients. Time taken in wound healing in majority of patients was less than 6 weeks 51 (51%), 6-8 weeks 32(32%) , 8-10 weeks 9(9%) and  those were not healed 9(9%). Majority of patents 57(57%) had RUST score 9 at six months of duration, 21(21%) of patients had RUSH score 11 and 9(9%) patients RUSH score was 6 at six months. 7 cases got infected in this study and in 5 case there was non-union. Average duration of hospital stay was 16.8 days. Out of 100 patients, 11(11%) patients had excellent outcome, 21(21%) had good and 59(59%) fair and only 9(9%) patients had poor outcome (Table.6). Average time of wound healing in our study was 4.29 weeks. Out of 100 patients, fracture union was achieved in 97 (97%) patients and two patient 3(3%) patient undergone non unions. This study comprised of 100 patients, out of them 59 patients (59%) had grade-I, 32 patients (32%) had grade-II and 9 patients (9%) had grade-III compounding. Conclusion: Implant related infection pose an important challenge in the surgical treatment of tibia shaft fracture. Local administration of antibiotics might minimize the risk of infection.

68.A Prospective Research to Analyse the Sight Restoration Rate (SRR): A Useful Metric for Determining the Effect of Cataract Surgery
Ganesh Kumar
Abstract
Aim: Study Sight restoration rate (SRR), Useful indicator to measure impact of cataract surgery. Methods: This prospective study was carried out in the Department of Ophthalmology, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar, India, for 1 year. Total 1200 patients were included in this study. Medical records of patients who did Cataract Surgery either SICS or Phacoemulsification, best corrected visual acuity (BCVA) was conducted using the Snellen chart and a pinhole. 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. Out of all data we excluded patient who did not follow up and all patients with comorbidities which may influence post-operative outcome remaining data considered for analyses. Results: we studied 1350 eyes, 150 had co morbidities in form of corneal opacities, optic nerve atrophy, retinal detachment, congenital anomalies were excluded. Total 1200 Eyes were studied. The SRR of the surgery in our study 49%. 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 15 eyes (1.25%). Conclusion: SRR of the surgery in this research is 49%, while our poor surgical outcome is 5.42%. High SRR means that alot of these patients can return to work, while poor surgical outcome means that the surgeries have very good standard. This will optimize “peoples right for sight” as was suggested with Vision 2020 motto.

69.An Observational Study to Examine Changes in Gross Morphology and Histological Architecture in Cadaveric Liver Specimens
Neelam Sinha, Sanjay Kumar Sharma, Rashmi Prasad
Abstract
Aim: An observational study to examine changes in gross morphology and histological architecture in cadaveric liver specimens. Methods: The cross-sectional descriptive study was done in the Department of Anatomy, Nalanda Medical College, Patna, Bihar, India, for 1 year. All embalmed cadavers and preserved livers were included with exclusion of livers that had destructed surface by using purposive sampling technique. Therefore, the total samples were 50 cadavers and preserved livers. Results: Among the total 50 studied livers, 23 (46%) were normal in their external appearance, number of lobes and fissures. However, 27 (54%) livers showed anomalies in lobes, fissures, and shape. Accessory sulcus or fissure (AS or AF) was found in 14 livers (28%) which includes unusually notched liver with diaphragmatic fissures that extended as prominent vertical grooves over the antero-superior surface. Accessory sulcus was present only on visceral surface of 8 livers, diaphragmatic surface only in 3 livers and on both surfaces, are 3 livers. In the current study 6 (12%) livers had no fissure for ligamentum teres however, in 2 cases (4%) it was found on the anterior surface. Pons hepatis (PoH) which bridge left lobe with quadrate lobe was seen in 5 (10%) specimens with different size and shape. Papillary process of the caudate lobe and complete transverse fissure dividing quadrate lobe into a superior and inferior lobe was seen in single specimen. There were additional lobes seen in 3 livers (6%) which were situated in lower lateral part of right lobe and around porta hepatis. The Absence of quadrate lobe and elongation of the left lobe were observed in 3 cases where the left lobe was seen to be extending into the left hypochondrium and reached up to the spleen. In 2 specimens (4%) liver was very flat and Quadrate lobe was ill-defined not reaching the inferior border. Conclusion: Morphological variations on the liver surface were accessory fissure, very small left lobe with deep costal impressions, pons hepatis, absence of quadrate lobe and mini accessory lobe, etc.

70.Outcome assessment of Tension band wiring of Mayo type IIA olecranon fractures in tertiary care facility in Bihar, India
Ram Sagar Pandit, Ramashish Yadav, Nand Kumar
Abstract
Aim: Clinico-radiological and functional outcome of Mayo type IIA olecranon fractures managed with tension band wiring in a tertiary care centre in Bihar, India. Methods: This observational prospective study conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 10 months. 20 Patients were included in the study after proper history, clinical examination, written informed consent for surgery and anaesthesia, and explaining the complications before the surgery. Functional outcome was assessed by Mayo Elbow Performance Score, at 6-month follow-up, consisting of four parameters: pain (maximum score = 45 points), range of motion (maximum score=20 points), stability (maximum score = 10 points), function (5 items, 5 points for each). Isolated olecranon fracture, Mayo type IIA fractures. Age, 18- 70 years. Closed fractures. Duration of trauma less than 2 weeks. Results: Out of 20 patients, 17 patients had clinical union at 8 weeks and 3 achieved clinical union at 9.5 weeks, with an average healing at 8.8 weeks. In 17 patients, radiological union was achieved at 11.9 weeks and in 3 patients the radiological union was achieved at 13.1 weeks, with an average radiological union at 12.5 weeks. Patients were functionally evaluated on the basis of MEPS at 6 months. The mean flexion was 132.6 degree, mean extension loss was 8.3 degrees, mean arc motion was 124.5 degree. The average MEPS was 91.5. In the present study, at 6 month follow up, 17 patients had no pain, 3 patients had pain at the extremes of motion. Out of 20 patients, (n=16, 80%) had excellent outcome, (n=2, 10%) had good outcome, (n=1, 5%) had fair outcome, (n=1, 5%) had poor outcome. Superficial wound infection was seen in n=1, 5% of patients which was managed by wound wash and antibiotics. Conclusion: Tension band wiring is an effective method for the treatment of transverse, non-comminuted and unstable fractures of the olecranon which provides stable fixation, early rehabilitation and gives excellent results when done in expert hands.

71.An Observational Research to Investigate the Spectrum of Co-Morbidities in Severe Acute Malnutrition Associated with Unexpected Dyselectrolytemia in Diarrhoea
Rizwan Haider, Subhrajyoti Tripathy, MD Rakif Raza
Abstract
Aim: The aim of the study to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Methods: The study was an observational study which was carried in the Department of Pediatrics, Darbhanga medical college and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 15 months. Total 50 Children upto 5 years of age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: out of 50, 94% were associated co-morbid conditions in SAM. Majority of children with SAM were having co-morbidity in the form of Anaemia (86%), Diarrhoea (64%) followed by pneumonia (30%), Rickets (28%), Tuberculosis (16%), Otitis media (14%), UTI (10%), Celiac (6%), Hypothyroidism (4%), & HIV (2%). Mean age (SD) of the diarrheal cases was 37(6) months (95% C.I. 23.7- 26.5) of which 29 were male (58.73%). Mean age (SD) of non-diarrheal cases was 28(6). (95% C.I. 16.6 – 19.4) of which 75.67% were male. Among 50, 32 (64%) SAM children presented with diarrhea of which 32 had dysnatremia in the form of Hyponatremia in 31 cases (62%) & Hypernatremia in 1 case (2%) No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.08). Serum Potassium levels of 50 SAM children were analysed. It was found that 22% SAM children were having hypokalemia. Hypokalemia was found in 13% of diarrheal cases & 9% in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.023) between Diarrheal & Non diarrheal cases. Conclusion: we conclude that dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions. Hence, we recommend that due care is to be given for management of dyselectrolytemia in complicated SAM children.

72.Short-term Intravenous Methylprednisolone Treatment of Abrupt Sensorineural Hearing Loss: an Observational Research
Chandan Kumar, Satyendra Sharma
Abstract
Aim: The aim of this study to evaluate the role of short course intravenous methylprednisolone in the management of sudden sensorineural hearing loss. Methods: This study encompassed the variables like pre-treatment hearing loss level, time of presentation since the onset of the symptoms, duration of therapy, post-treatment hearing level, and associated comorbid factors. We consider intravenous methylprednisolone in cases that present with SSNHL within seven days of its onset. Intravenous methylprednisolone is not considered in cases with uncontrolled DM, hypertension, and any other medical conditions where systemic steroids are contraindicated. These patients receive steroids via the intratympanic route. On admission, the patients receive injection methylprednisolone 1 gm IV stat followed by 500 mg IV once daily for two consecutive days. Results: At presentation, 6(12%) patients had mild hearing loss, 9(18%) had moderate, and 35 (70%) had severe hearing loss. Vertigo was present in 11(22%) patients and tinnitus in 42(84%) patients. Out of the 50 patients, 20(40%) patients had comorbidities, with 22% having hypertension, 12% having diabetes mellitus, and 6% having hypothyroidism. Collectively 10% of patients showed complete recovery, 52 % showed partial recovery, 38% of cases showed no recovery. Pre-steroid PTA and post-steroid PTA values were compared by using paired t-test, which showed a statistically significant difference when applied for the entire sample together (p value<0.05). But when we compared the pre-steroid PTA and post-steroid PTA values separately for each category using Wilcoxon sign rank test, only those with severe SSNHL showed statistically significant improvement following methylprednisolone injection (p value<0.05), whereas mild and moderate SSNHL, didn’t show statistically significant improvement (p>0.05). Conclusion: Comparing hearing loss, there was significant improvement after a short course of Methylprednisolone therapy. Short course Methylprednisolone can be an effective choice in a patient with SSNHL. Hearing outcomes are better in patients who do not have co- morbidities. Treatment must be of short duration to avoid complications although an adequate dose has to be provided.

73.Prospective Observational Study to Evaluate the Surgical Diseases and Surgical Outcomes in Geriatric Patients
Md. Hedayatullah, C.M. Narain
Abstract
Aim: The aim of this study to evaluate the surgical diseases and surgical outcomes in geriatric patients. Methods: 120 patients were included who fulfilled study obligations. Elderly patient’s ≥60 years of age admitted in General surgical wards for operative intervention were included in this study. Enrolled population is grouped into group I and II based on age. Population aged 60 years to 74 years grouped in group I and >74 years in group II. Detailed history, co morbidities and examination performed. Diagnosis made and divided into following systems; hepatobiliary, gastrointestinal, breast and endocrine, respiratory, vascular, hernias and others. Results: of 120 patients, 100 patients were under group I and 20 in group II. Out of 120 patients, 62.04% were men and 37.96% were women. Most common surgical diagnosis in our study population was gallstone disease (GSD/cholelithiasis) with 36% followed by Hernias with 31 cases (31%). About 23 cases were diagnosed with malignancy accounting to 23%. Diagnoses related to trauma were seen in 13 cases i.e. 13% of the population. The most common systems involved were hepatobiliary with 35 cases (35%) followed by Hernias 31cases (31%). Almost 100 cases (83.33%) of our study population were presented with benign conditions whereas 20 cases (16.67%) were malignant cases. About 69 cases (57.5%) of patients had medical co morbidities. 37.5 percent of the study population had hyper-tension and 12.5% had diabetes mellitus. Out of 120 cases, 105 cases had elective surgery and rest 15 had emergency surgery. About 50% of the study patients were ASA II and 12.5% where ASA V. Surgical complications were seen in 19.17% of study patients. Post-operative complications like seroma formation in 10 cases, surgical site infections in 6 cases of study patients were observed. These were managed conservatively. Nearly 5 cases were succumbed to death and mortality rate was 4.17% in our study. Mean Hospital stay in our study was 9.1±9.2 days. Conclusion: Most common indications for elective surgery in our study are hernias and gallstone disease. Early elective surgical intervention is preferred in elderly population when presented, as age, co morbidities and emergency settings increase risk of perioperative mortality.

74.Outcome Assessment of Cataract Surgery in Diabetic and Non-diabetic Patients: Prospective Analytical Study
MD. Jabir Hussain, Sheel Mani, Jagdish Choudhary, Uma Shankar Singh
Abstract
Aim: The aim of this study comparison of outcomes after cataract surgery in diabetic and non-diabetic patients. Methods: This prospective analytical study was carried out in the Department of ophthalmology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, for 14 months. Comparison outcome of cataract surgery in 100 diabetics as compared to 100 nondiabetics Within 15 days of Cataract surgery, all the patients underwent fasting blood glucose analysis. Recording of the complete intra-surgical and post- surgical complications along with visual acuity was done at 15 days, three  month and six months’ time in all the subjects. Results: In diabetic group 45(45%) were females and 55(55%) were males. Among the non-diabetics, 57 (57)%) were males & 43(43%) were females. At 15 days time, the occurrence of Post- surgical visual acuity in diabetic group and non-diabetic  group was found to be 0.24 and 0.33 respectively. At three month’s time, the occurrence of Post- surgical visual acuity in the diabetic group and the non-diabetic group was found to be 0.33and 0.44 respectively (table 2). Glycemic control was assessed using fasting blood sugar levels at the time of admission. Of the 100 patients in the diabetic group, 37(37%) had high blood glucose level (FBS: >100mg/dl). Their blood sugar was controlled and they were operated. 63(63%) patients had normal blood sugar levels at the time of examination (70-100mg/dl). Non- significant results were obtained while comparing the mean. Post- surgical visual acuity in between the two study groups at different time intervals (p value > 0.05). Striate keratopathy Was most commonly encountered post- surgical complication in the diabetic group 15 (15%) and the non-diabetic  group 10(10%) and followed by  Posterior capsular opacity 13(13%) and 9(9%) and Posterior capsular rent 12% and 6% in diabetic and non-diabetic, Pigment dispersion 12% and 9% per in diabetic and non-diabetic patatients respectively. Conclusion: we concluded that the small incision cataract surgery in diabetics without diabetic retinopathy yields similar visual outcomes as non-diabetics. There is a higher incidence of post-operative complications among diabetics, which can be managed conservatively.

75.Comparative Assessment of the Significance of Platelet Rich Plasma (PRP) and Corticosteroid Injection in Management of Adhesive Capsulitis of Shoulder
Ramashish Yadav,  Ram Sagar Pandit, Nand Kumar
Abstract
Aim: Significance of platelet rich plasma (PRP) and Corticosteroid injection in management of Adhesive capsulitis of shoulder. Methods: This prospective comparative study conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 1 year. 60 patients of frozen shoulder after proper clinical and radiological (X-ray, CT, MRI) assessment period of September 2020 to august 2021 in our institute and divided them randomly equally into two subgroups: subgroup A received PRP injection while subgroup B had received methylprednisolone injection. The inclusion criteria of this study was adult more than 18 year and stage 2 or more of periarthritis shoulder, shoulder range of motion decrease to 50% or more than opposite shoulder. All patients of our study advised neither to take any kind of analgesics i.e. NSAIDS nor any massage of shoulder, if patient had severe pain following injection opioids analgesic like the one tramadol can be given to patients. Patients were followed up at 1 week post injection, then after 1 month and then at 3 months. Results There is statistically significant reduction in VAS pain scores after getting either with PRP injection as well as with MPS injection over 3-6 month period. 23.33% patients with excellent, 43.33% with good and 33.33% with poor outcome with PRP injection. For subgroup B this was found as 20% excellent, 36.67% good and 43.33% poor outcome. Conclusion: we concluded that the PRP and MPS showed good efficacy on treating frozen shoulder.

76.Onlay and Sublay Mesh Repair in Incisional Hernias: Randomized Comparative Study
Sanjeev Kumar
Abstract
Aim: The study of Onlay and Sublay mesh repair in incisional hernias. Methods: This was a randomized comparative study conducted in the Department of Surgery, Madhubani Medical College and Hospital, Madhubani, Bihar, India, for 12 months. Clinically diagnosed as incisional hernia were included in this study. Total 100 cases were studied during the above said scheduled period. The patients were randomly divided into two groups. Group A (Onlay mesh) and Group B (sublay mesh) repair carried out. Results: Out of 100 subjects from onlay group, majority were from 31-40 years age group. i.e., 21 (42%) whereas in sublay group 27 i.e., 54% were from 31-40 years age group. In both group majority were from same age group. Proportion of males were 64% and 58% in onlay and sublay group respectively. Proportion of females were 36% and 42% in onlay and sublay group respectively. Postoperative complication like seroma was seen in 14% and 10% respectively from onlay and sublay group. This proportion of seroma was more in onlay group as compared to sublay group (<0.05). Postoperative complication like deep SSI was seen in 10% and 6% respectively from onlay and sublay group. This proportion of deep SSI was almost equal in both the groups (p>0.05). Postoperative recurrence of hernia was seen in both groups equally i.e., 3 case in each group (p>0.05). Mean days of hospitalization in onlay group was 8.52±1.8 days whereas in sublay group it was 0.071±1.35 days. Difference in mean days of hospitalization between both groups was found to be highly significant (p<0.001). It means number of days of hospitalization in sublay group was less as compared to onlay group. Conclusion: Sublay mesh repair has a lower rate of post-operative complications than onlay mesh repair, although larger studies are required to choose the better of the two procedures.

77.A Non-randomized Controlled Clinical Trial to Evaluate the Outcome of Surgery in Degenerative Spondylolisthesis
Samrendra Kumar Singh
Abstract
Aim: The aim of this study to evaluate the surgery in degenerative spondylolisthesis. Methods: This prospective non-randomized study conducted in the Department of Neurosurgery, IGIMS, Patna, Bihar, India, for 12 months. The patients were enrolled for surgery to be followed up postoperatively using self-administered questionnaire. Data from 50  patients were collected and analyzed over this period to compare the degree of pre- operative pain and functional disability with corresponding values at 6(six) months postoperatively. Results: Out of the 50 patients, three patients (6%) had pseudo arthrosis and the rest (94%) had bony fusion. Patients in the bony fusion group had complications like infection (2 patient), deep vein thrombosis (2 patient) and cauda equina syndrome in another patient. The degree of spondylolisthesis was reduced post operatively (24% vs 16%; p <0.001). Pain on visual analogue scale was also reduced post operatively (7.12 ±0.58 vs 0.37 ±0.64; p<0.001). Other disabilities including paresthesia (16% vs 2%), hypoesthesia (48% vs 32%), weakness (48% vs 28%), stiffness (6% vs 0), and urinary symptoms (12% vs 2%) were also significantly (p<0.05) reduced postoperatively. Conclusion: Decompressive laminectomy with posterolateral instrumentation (pedicle screws and rods) and inter-transverse process arthrodesis with autologous bone graft is the surgical procedure of choice as it facilitates good bony fusion and relieves symptoms of radicular pain and claudication.

78.Evaluation of Conventional Method and Endoscopy Assisted Nasal Septal Correction Surgery: A Comparative Assessment
Vikram Satyarthy, Manoj Kumar, Rana Pratap Thakur
Abstract
Aim: The aim of the study was to Comparative evaluation of conventional with endoscopy assisted nasal septal correction surgery in a tertiary care Hospital in Gaya. Methods: The present study was done to compare the conventional and endoscopic septoplasty was carried out in the Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 12 months. Total 100 Patients with symptomatic DNS with no other comorbidities and willing for surgical treatment were included. Data was collected by selecting the patients with DNS willing for surgery. They were divided into two groups; one group undergoing conventional septoplasty and the other endoscopic septoplasty by random selection and following up the patients preoperatively and postoperatively. Results:  Out of 100 patients, 40 were females (40%) and 60 were males (60%). Among 40 females, 20 patients underwent endoscopic and 20 patients underwent conventional septoplasty. Out of 60 males 30 patients underwent endoscopic and 30 patients underwent conventional. Mean age 40.13 years and std. deviation 11.67. In the present study, major pre-operative symptom was found to be nasal obstruction 88%, followed by Headache 54%, postnasal drip 49%, Hyposmia 48% and epistaxis 33%. It was observed that the mean time taken for conventional septoplasy was 33.11 minutes standard deviation 6.12 On the other hand endoscopic septoplasty required 25.41 minutes standard deviation 5.62. There was significant subjective improvement among patients of both groups. It was noticed that improvement of nasal obstruction was 92.86%, nasal headache (84.62%), Postnasal drip (75%) Hyposmia (88.46%) Epistaxis (78.57%) in endoscopic septoplasty (ES) group. On the other hand in conventional septoplasty group improvement of nasal obstruction (60.87%), headache (53.57%), Post nasal drip (PND) (32%) Hyposmia (63.64%) Epistaxis (63.16%) was seen. On 90th day of follow-up visit, residual deviation was found to be present in 19 (38%) of patient of conventional groups whereas it was present in 3 (6%) patient of endoscopic group (P=0.005).In conventional group, 18 (36%) patients developed synechiae whereas in endoscopic group 6(12%) patients developed synechiae (P=0.027). It was statistically significant. Conclusions: We concluded that endoscopic septoplasty is a better option for treating patients with posterior septal deviations as it provides good visualization of the surgical field. This procedure drastically reduces the operating time as compared to the conventional septoplasty.

79.Comparison of Efficacy and Safety of Gabapentin vs Nortryptiline in Menopausal Symptoms
Amit Kumar Ambasta, Shashi Prabha Sinha, Swetabh Verma, Asha Kumari, V K Mishra
Abstract
Aim: The aim of the present study was to compare the efficacy and safety of gabapentin vs nortryptiline in menopausal symptoms. Methods: A comparative study was conducted in Department of Pharmacology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India for 15 months (1 June 2020- 31 Aug 2021). 100 patients with menopause were included in the study and were randomized into two groups. One group was given Tab. Gabapentin 600mg once a day and the other group was given Tab. Nortryptiline 25mg once a day. Both the groups were followed up for 2 months and various parameters were seen and compared. Suitable statistics was applied after tabulating the data collected. The readings were taken at 0 week, 4 weeks and 8 weeks. Results: Mean years since menopause in gabapentin group was 48.32±3.06yrs and in nortryptiline group was 50.32±2.08yrs. mean age at menopause in gabapentin group was 2.28±3.59yrs and in nortryptiline group was 2.15±1.09 yrs. Mean menopausal symptom score was calculated in both the groups at baseline i.e. 0 weeks, 4 weeks and 8 weeks. Mean Menopausal symptom score at baseline in gabapentin group was 10.26± 3.84, at 4 weeks was 8.18± 2.09 and 8 weeks 7.92± 2.36. In nortryptine group baseline Mean Menopausal symptom score was 11± 2.51, at 4 weeks 9.34± 2.40 and at 8 weeks 6.66± 1.80. unpaired student t- test was applied in between both the groups and the p value at 0, 4 and 8 weeks came out to be 0.5025, 0.182, 0.130 respectively and all the values were statistically non-significant. Whereas on application of paired t test between 0,4 and 8 weeks in both the groups respectively, the values were statistically significant. Conclusion: Currently many treatment options are available for treatment of menopausal symptoms, gabapentin and nortryptiline has a potential to be used as new drugs in this field.

80.A Prospective Assessment of Clinic- Hematological Profile of the Patients Suffering from Dengue Fever
Nilashish Dey
Abstract
Aim: The aim of the study was to Assessment of clinical and hematological profile in dengue fever. Methods: A prospective study was conducted in the department of General medicine, Seikh Bhikhari Medical College, Hazaribagh Jharkhand, India for 1 year. Total 100 patients with complaints of fever and clinical features of dengue with positive NS1 antigen test or dengue antibody serology IgM or IgG or both were included in the study. Results: Most of the cases (44%) were seen in the 20-30 year age group  followed by 40-50 years 21%, 30-40 years 14%. Majority of the patients were males 64 (64%) compared to females, 36 (36%). Fever was the most common presentation and was seen in 50 cases (50%) cases and followed by Fever and  Myalgia 12%, Myalgia 10%, Petechiae 9%. Present study showed hemoglobin range of 6.5 gm% to 16.5 gm%. 46 (46%) cases showed Hb of 9-12 gm %, followed by 31(31%)   cases showed Hb of 12-15 gm %, 8(8%) had Hb of below 9 gm % and 15 (15 % ) had Hb of above 15 gm%. In the present study, 55(55 %) cases showed hematocrit of 25-35% and 27 (27 %) showed hematocrit of 35-45%. Raised hematocrit (>45%) was noted in 18(18%) of patients at presentation. The total leukocyte count ranged from 1500 cells/cumm to >11000 cells/cumm. Leucopenia with less than 4000 cells/cumm was present in 20 (20%) cases , count of  4000- 11000 cells/cu mm seen in  62(62%)  cases  and  >11000/  cumm was  seen   in 18 cases (18%). In the present study out of 100 cases of dengue fever, 87% cases had thrombocytopenia and 13% cases had severe thrombocytopenia (< 20,000/cumm) with bleeding manifestations. Conclusion: Hemoconcentration, leucopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that dengue cases can be diagnosed in their initial stages. This facilitates early treatment and aggressive fluid replacement therapy with good nursing care so that fatality rates can be reduced.

81.An Experiment in Healthy Volunteers Examined the Impact of Virtual Reality’s Optokinetic Stimulation on Weight-Bearing Shifts While Walking
Manoj Kumar Singh, A.K. Sinha, Vikas Kumar, Kumar Devashish
Abstract
Aim: Effect of Optokinetic Stimulation in The Virtual Reality Environment on Weight-Bearing Shift During Gait Movement in Healthy Subjects. Methods: This cross-sectional study was done the Department of PMR, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. after taking the approval of the protocol review committee and institutional ethics committee. 50 healthy subjects, 30 males and 20 females (22.1 ± 1.7 years), were included in this study. After applying the following exclusion criteria: impaired vision, visual field disturbances, and orthopedic disorders significantly affecting the gait of participants, 30 subjects participated in the static balance test, and 30 in the gait test; 10 subjects (7 males and 3 females) participated in both tests. Results: During HOKS and TOKS, CFPs on both sides (right, 0.67 ± 0.34 cm; left, -0.08 ± 0.38 cm for HOKS, and right, 0.73 ± 0.48 cm; left, -0.14 ± 0.48 cm for TOKS) significantly shifted to the right side compared to those during stationary conditions; consequently, the left CFP significantly shifted to the medial side, and the right CFP to the lateral side. These results demonstrated a rightward weight-bearing shift on the foot sole surface in both feet during TOKS and HOKS, which also shows that a rightward shift in weight bearing is associated with not only right-left foot balance but also the balance within each foot. Conclusion: OKS via HMD-VR could induce a significant weight-bearing shift, and significantly change the gait parameters. OKS via a VR environment can have potential implications for rehabilitation after stroke.

82.Association Between Blood Groups and Blood Hemoglobin Levels in Rural Population of Bihar Region
Rita Kumari
Abstract
Aim: Study of association between blood groups and blood hemoglobin levels in rural Population of Bihar region. Methods: The present Prospective study was conducted in the Department of Physiology, Nalanda Medical College, Patna, Bihar, India for 1 year, after taking the approval of the protocol review committee and institutional ethics committee. 100 adults (males and females) who are in the age group of 18-32 years were included in this study. Blood sample is taken using finger prick, under aseptic conditions and blood group is determined using glass slide method using antisera A, B and D. Hemoglobin concentration is estimated using Sahli’s method. Results: In our study, adults with hemoglobin concentration less than 10g/dl were taken as anemic. Total 29 adults are anemic, while remaining 71 adults are non anaemic. 40 adults are females out of which 60 are anemic whereas 60 adults are males where only 10 males were found to be anemic. 28 adults with Hb less than 10g/dl were Rh positive and 1 adults Rh negative. 66 adults and 3 adults were Rh positive and Rh negative respectively with Hb more than 10g/dl. Also 27 adults are blood group A, 5 with blood group AB, 35 with blood group B and O blood group adults are 33. Among the A blood group, 4 adults were anemic, among blood group B, 14 were anemic, among blood group AB, 2 were anemic and 9 adults with O blood group were anemic. In our study we found that adults with blood group B (14%) are more prone for anemia, followed by O (9%), AB (2%) and blood group A (4%). Blood group A almost resistant to anemia. Conclusion: Individuals with blood group B are more prone to anaemia followed by blood group O, AB and least is with blood group A.

83.An Observational Study to Determine the Correlation Between Cytological Findings and Histological Findings, as well as the Accuracy of FNAC in the Diagnosis of Breast Lesions
Prem Prakash, Sanjay Kumar Rao, Rajesh Narayan
Abstract
Aim: The aim of the present study was to correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. Methods: This was a retrospective and prospective study in which patterns of various breast lesions on FNAC were studied. This retrospective and prospective study was carried out in the Department of Surgery, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, for 24 months. Total 200 all cases of breast lump FNAC in which cytological impression could be given were included in the study. The patterns evaluated were biphasic, inflammatory, fluid rich, epithelial cell rich, spindle cell rich, small round cell rich and pleomorphic. Results: The accuracy of present study in diagnosing breast neoplasms is 97% .The specificity of 98% and the sensitivity of 95%. Conclusion: Systematic pattern analysis and systematic categorisation of the breast lesions as per patterns, assists the cytopathologists to reach the final impression. Each pattern has its own implications for management and has a variable risk of malignancy.

84.A Prospective Clinical Research on the Surgical Treatment and Perioperative Consequences of Peritonitis Related to Hollow Viscus Perforation
Rajesh Narayan, Prem Prakash
Abstract
Aim: Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre, Bihar, India. Methods: This prospective study conducted in the Department of Surgery, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, for 18 months, 100 patients with generalised peritonitis secondary to hollow viscus perforation were included in the study. Patients with primary bacterial peritonitis, peritonitis due to post-op leak and patients with immuno-deficiency were excluded from the study. Results:  Peptic ulcer disease was most common cause with 36% incidence, followed by idiopathic cause with 28% incidence, typhoid with 13% incidence, malignancy 12%, appendicular perforation 7%, followed by trauma 4%. Commonest site of perforation was found to be gastric 23%, followed by duodenal and ileal 15% each, large bowel 10%, appendicular 7%, jejunal 6%. After initial resuscitation, primary closure was done in 51 (51%) cases. Resection and anastamoses was done in 18 cases (18%). Resection and diversion in 24 (24%) cases Appendicectomy was done in 7 (7%) cases. Patients were followed up for 30 days and assessed with regular follow up. The mortality rate was 6 (6%), with complication rate of 72 (72%). 22 (22%) patients didn’t have any complications. Most common complication being wound infection in 41patients (41%), followed by abdominal dehiscence in 12 (12%), paralytic ileus in 12 (12%), bronchopneumonia in 19(19%), fecal fistula in 10(10%), abdominal abscess in 7 due to anastamotic leak (7%). Conclusion: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co- morbidities and aetiologies with difference in pathophysiology of tropical countries compared to western world.