1.A Correlational Study of Serum Magnesium Level with Microalbuminuria in Type 2 Diabetes Mellitus Patients
Jyoti Jha, Nishikant
Objectives: This study was to evaluate the correlation between serum magnesium level with microalbuminuria in type 2 diabetes mellitus patients. Methods: Under aseptic conditions, 5 mL blood was collected from ante-cubital vein for Serum Magnesium and random sample of urine was collected in sterile container for urine microalbumin. Magnesium was assayed by using photometric methods. Urine MA analysis was done by using Nephlometric method for the detection of albumin in urine. Results: when we compared the mean ± S.D. of U. microalbumin between cases and control, then p value was found to be less than 0.001. which is extremely statistically significant differences. But, when we performed correlation between mean ± S.D. of S. magnesium and urine microalbumin, r value was found to be -0.35 and p value was found to be greater than 0.05. which is not statistically significant. Conclusions: This study concluded that type 2 diabetes mellitus patients had significantly lowered serum magnesium levels. Serum magnesium and urine microalbumin was negatively correlated with each other in type 2 diabetes mellitus patients. And it was not statistically significant.

2.Consultation Liaison Psychiatry: Study from A Tertiary Care Hospital, Adilabad
Omprakash Lolam, N Kalyan Reddy
Introduction: The Proportion of mental health disorders is increasing globally. Psychiatric complaints are common especially in patients admitted in the hospital setting for various reasons. The present study has been done to determine the pattern of referrals to the Psychiatry department among patients admitted to the hospital. Methods: It was a hospital-based cross-sectional study done at a tertiary care hospital for a duration of six months. The total sample size was n=470 which were referrals for a consultation to the Psychiatry department from various clinical departments of the hospital. A pre-designed proforma was used to get the relevant information. Results: Demographic characteristics in the present study revealed that there was a male preponderance with the mean age being 42.6 years. The majority of them belonged to the Tribal area, were illiterate, and belonged to low socioeconomic status. The maximum number of Psychiatric referrals (77.4%) came from the General Medicine department; followed by Surgical branches such as General Surgery (7.4%), Obstetrics & Gynecology (5.9%), and Orthopedics (5.4%). Alcohol withdrawal syndrome and its related disorder was the most common psychiatric condition found among the referrals (80.8%). Conclusions: A detailed history and complete evaluation of the patients who had psychiatry referrals should be done. There is growing consensus that Consultation Liaison Psychiatry is extremely important and the need of the hour with a growing number of mental health disorders globally.

3.Anaemia in Pregnant Women: A Community Based Study in Rural area of Patna, Bihar, India
Shikha, Rashmi Singh
Objectives: This study was done to evaluate the sociodemographic profile and prevalence of anaemia in rural area, of Patna district, Bihar. Methods: Haemoglobin estimation was done by using Sahli’s method. Haemoglobin below 11 g/dL was labelled as anaemia during pregnancy. Results: Anaemia was seen in 125(83.33%) pregnant women. Most of the women 80(53.33%) were in age group of 25 to 29 years. Moderate anaemia was greatly seen in pregnant women 100(80%) in rural area, Patna, Bihar. Conclusions: Pregnant women who were associated with poor literacy, low socio-economy, multiparity had greater risk for developing anaemia in rural area of Bihar. So, the, health care system should organize medical camps time to time for awareness of maternal health during pregnancy and early detection and management of anaemia in pregnant women in rural area of Bihar.

4.Study to Ascertain the Profile of Refractive Error in Children Attending an Ophthalmology Outpatient Clinic at A Tertiary Care Hospital
Navin Chandra, Utkarsh Bhardwaj, Rajesh Tiwary
Aim: The aim of this study to determine the profile of refractive error among children attending ophthalmology OPD at a tertiary care Hospital in Bihar region. Methods: The Cross-sectional study was conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India from January 2017 to December 2017.  after taking the approval of the protocol review committee and institutional ethics committee. Children of age between 5-15 years, Signature of the informed consent by parents or legal guardians and no history of systemic diseases. Colour vision by Ishihara’s chart and squint evaluation was done wherever needed. Dry retinoscopy and automated refractometer examination were done in co-operative patients. Results: A total of 100 children between 5 to 15 years of age group were included, where majority (50%) were between 9-12 years with mean age as 9.5 years.  Astigmatism was the most common refractive error of about 56% followed by myopia 34% and hypermetropia 9%. Astigmatism was common in both males and females of about 22%and 34% followed by myopia which is 23% in females and 11% in males and hypermetropia which were almost 9% among both sexes. The common type of astigmatism was compound myopic astigmatism (46.43%) followed by simple myopic astigmatism (41.07%). Of the 100 children with refractive errors in the study 10 were non correctable. Of the 10 non correctable refractive error 5 belonged to age group 9-12 years. Out of 100 children examined, 14 were found to be amblyopes and the common refractive error among amblyopes was found to be compound myopic astigmatism followed by simple myopic astigmatism. Conclusion: The refractive errors with or without amblyopia is a common and significant cause of visual impairment in the children.

5.The Incidence, Clinical Profile and Outcome of Prenatal and Postpartum Women Admitted to the ICU: Retrospective Study
Prashant, B.K. Kashyap
Aim: The aim of the present study evaluates the incidence, clinical profile of antenatal and postpartum women requiring admission to the ICU the interventions required in these women and final outcome. Methods: This prospective observational study was done the Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India, from July 2018 to June 2019. Data were recorded and analyzed for each patient: age, parity, primary diagnosis (obstetric or non-obstetric e.g. community-acquired pneumonia, rheumatic heart  disease) responsible for the patient’s critical illness, indication of ICU admission, obstetric interventions performed, critical care interventions performed during ICU stay (mechanical ventilation, central venous catheterization, invasive arterial pressure monitoring, hemodialysis), duration of mechanical ventilation, length of ICU stay and outcome of patient. Results: During the study total 200 obstetric patients were admitted to the ICUs (4.76% of total ICU admissions). Out of 200, 70 women were admitted in Medical ICU and 130 women were admitted in surgical ICU. There were 10000 deliveries in this period, and the ICU admission rate was 20 per 1000 deliveries. The mean maternal age (in years) was 24.26±4.78 (mean±standard deviation). Primigravida (55%) were more as compared to multigravida (45%). Only 16% patients were in antepartum period while majority of patients (84%) were admitted during postpartum period. The main obstetric indications for ICU admission were pregnancy-induced hypertension (15%) followed by obstetric haemorrhage (9%) and community acquired pneumonia (7%), other indications were valvular heart disease (5%) and monitoring (6.5%). In the present study maternal mortality among the women admitted to ICU was 16%. The leading cause of maternal death was obstetric haemorrhage (28.13%) followed by pregnancy induced hypertension (21.87%). An ICU intervention during the stay of the patients in terms of mechanical ventilation was used in 135 (67.5%) cases. Conclusions: A high quality multidisciplinary care is required in complicated pregnancies for safe motherhood. So, there is a need for dedicated ICU for obstetric patients.

6.A Clinical Study to Evaluate the Functional Result of Distal Tibial Fractures Fixed with Distal Tibial Locking Plates
Ramashish Yadav, Ram Sagar Pandit, Nand Kumar
Aim: Evaluation of functional outcome of distal tibial fractures stabilized with distal tibial locking plate. Methods: A community based cross-sectional study was conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 1 year. We undertook a review of 30 patients treated by MIPO (Minimal Invasive Plate Osteosynthesis) for unstable fractures of the distal tibia our hospital. Adults (aged more than 18 years) males and females and Complex extra articular meta-diaphyseal fractures of the lower third of tibia were included in this study. Results: All the fractures united with an average of 16 weeks. Fractures of 12 (40%) patients united in 14 weeks, 8 (26.67%) patients united in 16 weeks, 8 (26.7%) patients united in 18 weeks and 2 (6.67%) patients united in 20 weeks. All cases fibula fracture healed without complications. At the end of our study of 30 patients treated 17(56.67%) patients had excellent outcome, 6(20%) had good results, 5(16.67%) had fair outcome and 2(6.67%) had a poor result based on subjective result and 19(63.33) patients had excellent, 5(16.67%), 3 had fair (10%) and 3(10%) had poor result based on objective result according to scoring system designed by Ovadia and Beals. Conclusion: It does provide excellent stability and allows early range of motion at ankle. The closed reduction not only helps in achieving reduction in difficult situations, but also in rapid union, because it facilitates preservation of the blood supply to the fragment and helps to achieve near normal anatomical reduction of the fracture.

7.A Longitudinal Retrospective Research Looked at the Effectiveness of Caudal Epidural Steroid Treatments in the Management of Severe Lower Backache
Abhas Kumar, Kumar Gaurav, Manish Kumar, N.P. Sinha
Aim: To find Role of caudal epidural steroid injections in the management of chronic low backache. Materials and Methods: A prospective study was conducted in the Department of Orthopaedics, Department of Orthopedics Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. for 12 months. Total 80 Patients with chronic low back pain and sensory symptoms not responding to conservative management were include in this study. They were evaluated clinically before and after epidural steroid on the basis of pain, unrestricted activities of day-to-day life and work performance on the basis of visual analogue scale and oswestry disability index. Results: Total 165 ESI were given to 120 patients. 85 patients were given single injection, while 25 had two and 10 received three ESI doses. Out of 120, 50 were males and 70 females with chronic LBP. Out of 120 cases of LBP, Lumbar disc herniation was seen in 37, lumbar canal stenosis in 11 and degenerative disc disease in 22 cases while 50 cases had non-specific LBP. Follow up was done at one week, one month and then every three months up to twelve months of treatment (post third ESI 9 months). Mean pre ESI, VAS was 7.11while it was 4.82 at one year of treatment. Mean pre ESI, ODI score was 59.12 while after twelve months of treatment with ESI it was 44.64 at one year. We obtained excellent results in 27.5 percent, good in 38.33 percent, fair in 21.67 percent while poor in 12.5 percent patients. Conclusion ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.

8.Midshaft Clavicular Fractures: Intramedullary Nailing Versus Plate Fixation
Anshu Anand, Ajoy Kumar Manav
Aim: The aim of this study to determine the intramedullary Nailing Versus Plate Fixation for the Treatment Displaced Midshaft Clavicular Fractures. Methods: A prospective randomised trial was conducted in the Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India from December 2018 to December 2019. Those consenting to participation were randomised to open reduction and plate fixation with a 3.5 mm superior clavicular plate or a 2.0 mm to 3.5 mm titanium elastic nail in the second group. Patients with Age 18 to 58 yrs, Mid-shaft fracture, Displacement by one bone width, Tenting/compromised skin, Initial shortening of more than 15 mm, Angulation exceeding 30 were included in this study. Total of 100 fractures of the clavicle were included in this study and divided into 2 equal groups. Demographic data were recorded at presentation and patients completed a baseline Disabilities of the Arm, Shoulder and Hand (DASH) score to describe their shoulder function the week before injury. Standard standing radiographs with 15° caudal and 15° cephalad and a ‘panorama’ view of both clavicles were performed. Results: There were no demographic differences between the groups (Table 1) and they had the same baseline mean DASH score of 0.5 (0 to 6.7 for plate versus 0 to 15.8 for ESIN, p = 0.6). The duration of surgery was shorter for ESIN (mean 51.4 minutes, 20 to 118) than for plate fixation (mean 67.7 minutes, 34 to 104; p < 0.001, independent samples t-test).  After 12 months, there was no difference in DASH score between the plate fixation and ESIN, with both approaching their DASH   baseline   values   of   0.5.   Individual   differences between baseline data and the DASH score after one year showed no statistical difference (1.5, -4.3 to 12.2 for plate versus 2.1, -14.3 to 28.4 for ESIN; p = 0.5, independent samples t-test). Compared with baseline values, 1 patient (2%) with plate fixation had a DASH score which worsened by ten points compared with 4 patients (8%) in the ESIN group.  Both groups demonstrated similar satisfaction with their shoulder at 12 months as measured by VAS (9, 0 to 10 for plate fixation versus 9, 3 to 10 for ESIN; p = 0.87, independent samples t-test). Those in the ESIN group were, however, significantly more satisfied with their cosmetic results (mean 8.7, 3.6 to 10 versus mean 7.8, 0 to 10; p = 0.04, independent samples t-test). Conclusion: Fixation with plate or ESIN in completely displaced midshaft fractures of the clavicle produce equally excellent functional results at 12 months. In addition, nailing should not be undertaken with implants less than 2.5 mm in diameter. In the presence of comminution, plating may be the superior option.

9.Clinical and Functional Outcomes of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Grafts Fixed with Aperture Vs Suspensory Device
Bibek Kumar Rai, Ajoy Kumar Manav
Aim: A comparative study of clinical and functional outcome of arthroscopic anterior cruciate ligament reconstruction using hamstring graft with aperture fixation versus suspensory device fixation. Methods: This prospective study   was carried out in the Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India from January 2018 to Dec 2018. Two groups with 20 patients each, with at least 1 year follow up were included in the study. The aperture fixation group underwent interference screw fixation at both femoral and tibial tunnels. The suspensory fixation group underwent endobutton fixation on the femoral side and interference screw on tibial side. Results:   In the study population, 22 patients had isolated ACL injury and remaining 18 patients had ACL associated meniscal injuries. Associated meniscus tear was present in 8 (40%) and 10 (50%) patients of Group 1 and Group 2 respectively. Of the 8 patients in Group 1, 6 patients had medical meniscal tear and remaining 2 had lateral meniscal tear. And among 10 patients in Group 2, 4 patients had medical meniscal injury, 4 had both medial and lateral meniscal injury and remaining 2 had isolated lateral meniscal injury. But none required any intervention for meniscal injury. Lachman’s test was positive preoperatively in 85% in Group 1 (Interference screw) and 90% in Group 2 (Endobutton), with 100% negative at the end of 12 months in both groups. Anterior drawer test was positive in 85% in Group 1 and 75% in Group 2, with 100% negative at the end of 12months in both groups. Pivot shift test was positive in 100% in Group 1 and 100% in Group 2 when examined under anaesthesia preoperatively, with 100% negative at the end of 12 months in both groups. The pivot shift test was deferred till 6 months post operatively. The preoperative Tegner Lysholm knee score was poor in all the patients among both the groups (< 65). Post operatively in Group 1, 16 patients (80%) had excellent functional outcome while 4 patients (20%) had good outcome. In Group 2 (Endobutton), 15 patients (75%) had excellent functional outcome while 5 patients (25%) had good outcome. There was statistically significant improvement in Tegner Lysholm knee score from preoperative to postoperative with p value <0.001 in both groups, whereas there was not statistically significance difference in post-operative scores between the two groups. Conclusion: Arthroscopic anatomic single bundle anterior cruciate ligament reconstruction with quadrupled hamstring graft is an excellent treatment option for anterior cruciate ligament deficient knees.

10.To Evaluate the Prevalence of Vitamin D Deficiency in Children with Chronic Musculoskeletal Pain and its Comparison in Children with and without Joint Hypermobility
Ankur Priyadarshi
Aim: To compare vitamin D serum levels in Indian children with chronic musculoskeletal pain with and without hypermobility. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 1 year. Total 100 children were diagnosed with chronic musculoskeletal pain were included in this study. The subjects were divided into two groups, with or without hypermobility. Hypermobility was diagnosed using Modified Criteria of Carter and Wilkinson. Serum 25-hydroxy vitamin D (25-(OH)D) level and baseline characteristics were compared, and 25-(OH)D <30 ng/mL was considered deficiency. Results: A total of 100 children (61 girls (61 %), and 39 boys (39%)) with a mean age of 8.48 ± 2.39 years were included. Most participants (78%) were 5 to 10 years old.87 patients (87%) were diagnosed with vitamin D deficiency (25(OH)D <30 ng/mL). Children without joint hypermobility had a lower vitamin D level and a higher prevalence of vitamin D deficiency compared to those with hypermobility. However, the difference was not statistically significant. Conclusion: The high prevalence of vitamin D deficiency among children and adolescents with chronic musculoskeletal pain, but the difference in vitamin D deficiency between children with and without hypermobility was not statistically significant.

11.To Assessment of Neonatal Thrombocytopenia and Identification of Neonatal Thrombocytopenia Risk Factors and Clinical Study
Dinesh Kumar Rajak, Alka Singh
Aim: The aim of the study to evaluate the incidence of thrombocytopenia in neonates. To identify associated risk factors with the neonatal thrombocytopenia and clinical impact of thrombocytopenia. Material and methods: The Prospective study, which was carried in the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India, for the period of 1 year. Total 100 patients who had Platelet count of less than 1,50,000/cu mm was taken for determining thrombocytopenia and Babies having significant birth asphyxia were included in this study. Results: The incidence of neonatal thrombocytopenia in this study was 30.77%. Male preponderance was seen with 65% male babies admitted in NICU while female babies were about 35 %. About 45 cases (45%), showed Moderate Thrombocytopenia in neonates. 35 cases (35%) showed severe Thrombocytopenia in neonates. About 20 cases (20%) showed mild Thrombocytopenia in neonates. Early onset thrombocytopenia (<3days of age) was seen in 64% and late onset thrombocytopenia (3-28 days) in 36%. 69% of babies born during less than 36 weeks of gestation showed lower platelet count. Out of 69 cases born < 36 weeks, 18 cases with weight is < 1 kg and 51 cases with 1.5 -2.4 kg weight. Out of 31 cases born during gestational period 36- 38 weeks, 26 cases showed 2.5 kg and 5 cases 1.5 kg. 69% were preterm babies. Among 100 thrombocytopenic neonates, sepsis was observed in 64%. 32% of neonates had history of pregnancy induced hypertension in mothers. Conclusion: The neonatal thrombocytopenia incidence was 30.77%. There were more premature neonates of thrombocytopenia induced by sepsis.

12.A Study to Investigate the Effects of Different Topical Treatments on Chronic Plaque Type Psoriasis
Iftekhar Khan
Aim: To determine the effect of various topical agents in chronic plaque type psoriasis. Materials and methods: The study was carried out on patients having chronic plaque type psoriasis vulgaris came to Department of Skin and VD, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar for 1 year. Total 150 patients were enrolled and were divided into three groups comprising of 50 patients in each group. Group A patients were asked to apply ammonium lactate twice a day, Group B patients were asked to apply ammonium lactate in morning and clobetasol propionate in evening, Group C patients were asked to apply topical ammonium lactate in morning and calcipotriol in evening. Results: No significant difference was noted between study groups. Further on comparison of individual groups it was found that significant difference was present between PASI at 8 weeks between group A and group B, group A and group C but between group B and group C difference was not significant. Conclusion: Combination therapy is effective, well tolerated with minimal side effects and better compliance was seen with patients. Ammonium lactate 12% can also be considered as one of the topical options as a monotherapy and also as a maintenance therapy.

13.Effect of Aqueous Extract of Terminalia Bellirica Fruit Pulp on Alcohol Affected Learning in Swiss Albino Mice
Kapil Kumar Singh, Jeetendra Kumar, Khursheed Anwar
Aim: Effect of aqueous Extract of Terminalia bellirica fruit pulp on Alcohol affected learning in swiss albino mice. Methods: This study was conducted in the Department of Pharmacology, JLNMCH Bhagalpur, Bihar, India for 1 year. 56 Swiss albino mice of either sex weighing 20-30 grams bred and maintained under standard conditions in the central animal house in AJIMS and RC were used. The standard drug Piracetam was obtained from micro labs. The dried fruit of Terminalia bellirica was obtained by Ayurvedic Dispensary, BIHAR. Aqueous Extract of Terminalia bellirica fruit pulp [AETB] -Investigational product AETB (dose1) – 9mg/kg orally. AETB (dose2) – 18mg/kg orally. AETB (dose 3) – 36mg/kg orally. Results: In the present study, Piracetam (200mg/kg) and AETB (36mg/kg) significantly reduced the time taken to reach the reward chamber (p < 0.001), while Ethanol (1.5g/kg) significantly increased the latency when compared to vehicle treated groups (p< 0.001). Animals pre-treated with Piracetam (200mg/kg) and AETB (9mg/kg) significantly reduced the enhanced latency induced by Ethanol when compared to Ethanol alone treated group (p< 0.001). Conclusion: The test drug enhances the learning process and is comparable to the standard drug Piracetam at higher doses (36mg/kg). Also, it can oppose the alcohol induced learning impairment at lower doses (9mg/kg).

14.A Research to Determine Whether or Not Individuals with Hypertension are Adhering to their Drug Regimen
Khursheed Anwar, Kapil Kumar Singh, Jeetendra Kumar
Aim: Aim of the present study to assess the adherence to medication in patients suffering from hypertension. Materials and Method: This observational, cross-sectional study was conducted participants suffering from hypertension for the past 1 year and on treatment conducted in Department of Pharmacology, J.L.N.M.C.H, Bhagalpur. The study targeted outpatients aged ≥18 years who were diagnosed with hypertension. Participants were recruited using a systemic sampling technique. A detailed history, thorough medical examination, and counselling for lifestyle modifications was done on all participants enrolled. The patients were given questionnaire of Morisky Medication Adherence Scale-8 (MMAS- 8) and WHO-QOL Bref to be filled up the questionnaire in a separate room. Results: A total of 152 patients participated in the study with mean number of medication used being 1.68±0.79/person, 74% of patients were taking combination of drugs and mean MMAS-8 Score was 4.30±1.07. The participants were subdivided into two groups, Group 1 (on single medication) and Group 2 (on two or more medications). Group 1 had significantly higher MMAS-8 scores and better quality of life. Conclusion: Patient’s on single medication had significantly better adherence, slightly better quality of life and better adherence correlation as compared to patients on more than two medications.

15.To Investigate Unnatural Female Fatalities, Causes of Unnatural Deaths and the Role of Socioeconomic Circumstances and Violence Against Women
Manoj Kumar, Radha Raman Singh, Kumar Saurav
Aim: Unnatural Deaths Among Female Children and Adolescents in Bihar. Methods: A retrospective study was conducted in the Department of Forensic Medicine and toxicology, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. Total 50 cases of unnatural deaths referred for autopsy in the Nalanda Medical College and Hospital, Patna, Bihar, India was evaluated in the present study. Only female’s cases of children’s and adolescents with the age group of 5 to 20 years were enrolled in the present study. The approval of the institutional ethics committee was taken before starting the study. Results: This study describes the causes of injury related mortality among adolescents using post-mortem data from This study describes the causes of injury related mortality among adolescents using postmortem data from This study describes the causes of injury related mortality among adolescents using post-mortem data from. Conclusion: Majority of the victims of ‘unnatural deaths belonged to the lower socioeconomic category. Suggestions relating to road safety, decreasing the stress of the modern mechanical lifestyle, educating the public in general and regarding. The availability, use and storage of poisonous substances in particular have been put forward, while highlighting the social evil of dowry system prevailing in India.

16.Assessment of Degree of Chronic Pelvic Pain and Adhesion: An Observational Study
Kumari Nutan, Rajendra Prasad
Aim: To evaluate degree of chronic pelvic pain and degree of adhesion. Materials and Methods: The present clinico-observational study was conducted in the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar among 40 women diagnosed with endometriosis. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously. Results: Mean age of study cohort was 30 ±5.75 years. As per VAS, majority felt moderate pain (47.5%) in present study. The presenting symptoms were dysmenorrhoea (45.0%), dyspareunia (17.5%) and chronic pelvic pain (35.5%). Conclusion: Degree of tubal involvement was more in all the women as compared to ovarian involvement. Post-operatively the intensity of the pain subsides.

17.The Prospective Clinical Study to Assess the Prevalence and Treatment of Fistulas in Patients with Chronic anal Fissure (CAF)
Pankaj Kumar, Kumar Ratnesh, Anamica Arya
Aim: To search for the prevalence and treatment of a fistula in patients with chronic anal fissure (CAF). Method: We started to look the presence or absence of any local sequels in 67 patients around the fissure in consecutive patients with CAF in the Department of General Surgery J.L.N.M.C.H. Bhagalpur, Bihar, India for 1 year. The duration of symptoms and a history of previous abscess formation and/or drainage were asked in detail. In patients with fissure-fistula, fistulotomy/ fistulectomy was first performed because this part of the operation necessitated division of some of the IAS in some cases. The patients were examined on the 8th postoperative day, 1 month & 6 months postoperatively. Results: Patients who underwent surgery for anal fistula were analyzed. Of the 67 patients (aged 18-60 years), 44 were males and 23 were females. 44 patients were treated with LIS only; 16 patients were treated with LIS + sentinel pile excision and 7 were treated with LIS + fistulotomy with/without abscess drainage. Conclusion: It is the factor that determines the effectiveness of CAF in the treatment of anal fistula that develops as a result of the presence of CAF. In the treatment of CAF and anal fistula forming on the fissure background, adequate sphincterotomy is effective.

18.Prospective Observational Assessment of the Prevalence of Infectious Skin Disorders Encountered in Children
Prem Prakash Pravakar
Background: Infectious skin disorders (ISDs) are commonly seen in pediatric emergency departments (PED), however the exact frequency is unknown. Skin infections in pediatric age group have a different clinical course and treatment as compared to adult, so it is studied separately as Pediatric dermatology. Aim: The present study aims to determine the prevalence and types of infectious skin disorders (ISDs) seen among children attending the Department of Skin and VD, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year. Methods: Prospectively, descriptive study of children evaluated in the PED with ISDs during 2020. ISDs were analyzed on the basis of their incidence, patient demographics, seasonal variations, and hospitalization rates. This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age over a period of 1 year. All patients were divided into four different study groups: <1 month (neonates), 1 month to 1 year, >1 to 6 years and 7 to 14 years. Results: Among the 600 pediatric skin infection patients, bacterial infections (210, 35%) were highest in number followed by fungal (198, 33%) and viral infections (54, 9%). Of the bacterial infections, impetigo was the predominant one contributing to 134(22.33%) cases. Other bacterial infections were furunculosis (64, 10.67%) and pyogenic abscess (12, 2%). Dermatophytosis (102, 17%) attributed the major bulk of cases of fungal infections. Pityriasis versicolor (20, 3.33%) and candidiasis (76, 12.67%) were the other superficial fungal infections recorded in the study. Most prevalent viral infection was Molluscum contagiosum (33, 5.5%) followed by wart (12, 2%) and pityriasis rosea (9, 1.5%). Scabies (96, 16%) and pediculosis (42, 7%) were the two entities in the infestation group. Conclusion: Our data reveal the extremely high frequency of ISDs seen at the PED, underlying the need for closer cooperation between dermatologists and pediatricians.

19.Studying the Relationship Between Serum C-Reactive Protein
and Disease Severity in COPD Patients

Ram Dayal Singh
Aim: Evaluating serum C-reactive protein level in patients with chronic obstructive pulmonary disease and its correlation with disease severity. Methods: A prospective study was conducted in the Department of General Medicine, Patna Medical College and Hospital, Patna, Bihar, India for 12 months. 50 COPD patients and 50 asymptomatic individuals were selected as the control group. COPD patients underwent spirometry tests, and the severity of disease was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The main inclusion criteria for COPD patients were having symptoms or history of COPD with FEV1/FVC below 70% after using a bronchodilator. Results: The mean hsCRP was 7539±437 ng/mL in the COPD group and 2894±493 ng/mL in the control group. In the comparative study of the two groups using t-test, a significant difference was observed (p<0.001). The COPD group underwent spirometry and blood gas measurements, and then FEV1, FEV1%, FVC, and FEV1/FVC parameters were measured. The severity of the disease was determined by the GOLD criteria, where 15 subjects (30%) were GOLD II, 25 subjects (50%) were GOLD III, and 10 subjects (20%) were GOLD IV. There was no case of GOLD I found among the subjects because patients were hospitalized. Mean FEV1 was 1.27 L/s, mean FVC was 2.226 l, and mean FEV1/FVC was 60%. The correlation between serum hsCRP and age, FEV1, PaO2, and FEV1/FVC was studied in patients with COPD, where the Pearson correlation coefficients between hsCRP and the above-mentioned variables equaled 0.171, 0.073, -0.329, and -0.045, respectively (P<0.05 in the correlation between hsCRP and FEV1, and P>0.2 in other cases). Conclusion: The findings of the present study demonstrated that plasma CRP is not only effective in the evaluation of inflammation in COPD, but also useful as a marker in monitoring inflammation during COPD treatment. CRP is decreased during treatment by inhaled corticosteroids.

20.An Outcome Assessment of Intertrochanteric Femur Fractures Treated with A Proximal Femoral Locking Compression Plate
Rajendra Prasad, Kumari Nutan
Aim: Evaluation of functional outcome of intertrochanteric femur fractures treated with proximal femoral locking compression plate. Methods: A prospective study was conducted in the Department of Orthopaedics, NMCH, Patna, Bihar, India for the period of 1 year. A total of 50 patients with intertrochanteric femur fractures were studied. All the patients who were brought to casualty and outpatient department with intertrochanteric fractures were selected for the study. Adults with intertrochanteric fractures, patients willing to give consent to participate in the study, patients with isolated intertrochanteric fractures confirmed on radiographs, patients with fractures less than two weeks old and patients who were medically fit for surgery were included in the study. Results: Mean age in years was 60.12±20.22 years. The fractures were classified according to AO-OTA classification and most of the cases in our study belonged to 31A2-2 (24%) followed by 31A2-1 (18%). The mean duration of surgery was found to be 88.36±20.39 minutes. The average blood loss was 212.5±21.51ml of blood. The average period of hospitalization was found to be 11.02±2.14 days in our study. Majority of the patients had no complications (82%). Complications seen were superficial infection (4%), varus collapse (6%), and screw cut-out (4%) and non- union (4%). The evaluation was done using the Harris hip score and 72% of patients had excellent outcomes, 16% patients had good outcome, 8% of patients had a fair outcome and only 4% of patients had a poor outcome. The mean Harris hip score at 1 month was 70.38±5.30, at 3 months was 78.69 ±6.55 and at 9 months was 88.6 ±6.96. The average time required for fracture union in our study was 15.76 weeks. Conclusion: Intertrochanteric femur fractures are one of the most common fractures seen by orthopaedic surgeons worldwide. Intertrochanteric femur fractures may be treated with DHS or intramedullary implants; however, they have several problems.

21.The Correlation of Platelet Count and Indices with Severity of Sepsis in Patients with Sepsis
Shachindra Kumar Astik, Bindu Arya
Aim: To study the correlation of platelet count and indices with severity of sepsis. Material and Methods: The present prospective clinical study was conducted in the Department of General Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India, from June 2019 to March 2020. A total of 100 patients diagnosed with sepsis were included in the study. All of them were thoroughly evaluated in terms of routine and specific biochemical investigations and complete blood count including platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT) and platelet large cell ratio (PLCR). To establish the diagnosis of Sepsis, SIRS (Systemic Inflammatory Response Syndrome) criteria were followed. The cases were divided into Survivors and Non survivors (who expired during the treatment process). Results: Mean platelet counts in the Survivors group and Non-survivors group were 203.305±39.84 x 109/L and 121.92±43.55 x 109/L respectively. The Mean platelet volume among the Survivors and Non-survivors group in the present study were 8.72±0.96 fL and 11.46±0.98 fL respectively. Mean Platelet distribution width value in Survivors group was 12.79±2.02 and in Non-survivors groups it was 15.67±0.85. The Mean plateletcrit values in Survivor and Non-survivor group were 0.23±0.05 % and 0.19±0.07 % respectively. The p value was found to be significant in case of Platelet counts, MPV and PDW among the Survivors and Non-survivors group. Conclusion: Platelet indices showed a statistically significant difference between survivors and non-survivors, indicating that platelet indices are readily accessible, inexpensive, and valuable prognostic indicators for patients in septic shock.

22.A Study to Determine the Prevalence of Anemia in Exclusively Breastfed Full Term Babies
Sanjeev Kumar, Vinay Kumar, Dhamm Jyoti Bala, B.P. Jaiswal
Aim: The aim of this study was conducted to estimate the prevalence of anemia in exclusively breastfed babies between 3-6 months of age so that we can identify, prevent and treat anemia and its consequences at an early age. Methods: This retrospective observational study was done the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India, for 13 months. Exclusive breastfed term infants aged between 3-6 months of age (90 days to 180 days) who undergone complete blood count (CBC) examination for some minor ailments was included in this study. All the infants were looked for anemia and its severity. Result: The prevalence of anemia was 83.20%. Among 125 infants, 75 were males and 50 were females. According to age 41, 53 and 31 babies were belonging to 3-4, 4-5 and 5-6 months respectively. Mean age was 4.4 month and Hb was 9.8 mg/dl. Median Hb was 9.5 mg/dl. A total of 104 children had anemia as per WHO criteria of <11 gm% of Hb, giving a prevalence of anemia of 83.20%. However, if we take 10.5 mg% as cut off value 93(74.40%) had anemia and for 10 mg %, 75 (60%) had anemia. Out of 104, 36 (87.80%) babies with age of 3-4 months, 45 (84.91%) aged 4-5 months and 23 (74.19%) aged 5-6 months had anemia. Segregating by gender, 70 males and 34 females were anemic. Conclusion: The exclusively breastfed infants between 3-6 months are at increased risk of anemia. Therefore, infants after 3 months, should be evaluated for anemia and iron deficiency which is the commonest cause of anemia.

23.To Determine the Clinical Profile and Prognosis of Children Admitted to the Paediatric Intensive Care Unit
Saroj Kumar, Sushil Kumar Pathak
Aim: The aim of the present study was to identify the clinical profile and outcome of children admitted in PICU. Materials and methods: A retrospective study were conducted in the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India, for the period of 1 year. 400 children less than 14 years admitted to PICU with complete patient information along with the investigation reports in the medical records were included in the study. Outcome was noted as discharge/against medical advice/referred. History, examination details, investigations done was noted. Results: Total of 400 patients was admitted in PICU. Out of these 400 patients, 300 (75%) were males and remaining 100 (25%) were females. Male to female ratio was 3:1. Maximum numbers of patients were in the age group of more than 28 days to 1 year which constituted 222 (55.5%) cases. This was followed by 1 year to less than 5 years age group which constituted 98. (i.e., 24.5%) cases. Under 5 years aged children constituted 320 (80%) cases. Next most common age group admitted was 5 years to 10 years with 58 (i.e., 14.5%) cases and 10 to 14 years age group constituted 22 (5.5%) cases. Central nervous system was the commonest system involved (n=134, 33.5%). Next system commonly involved was respiratory system (n=78, 19.5%). Other common causes were infections (n=64, 16%), cardiovascular (n= 44, 11%), gastrointestinal (n=18, 4.5%), haematological (n=22, 5.5%) and renal (n=8,4%) system causes. This was followed by metabolic causes (n=6, 3%), Down syndrome (n = 6, 1.5%) and poisoning in 6 (1.5%) cases. Conclusion: Children below 5 years constituted the major load of the patients in our PICU.

24.Comparative Study of Administration of Single Dose Intravenous Methyl Prednisolone Versus Oral Prednisolone in Bell’s Palsy: An Open Labeled, Randomized Controlled Trial
Saurabh Kumar, Khursheed Anwar, Jeetendra Kumar
Aim: Comparative study of administration of single dose intravenous methyl prednisolone versus oral prednisolone in Bell’s palsy. Methods: The study was an open labeled, randomized controlled trial conducted in the Department of Pharmacology, J.L.N.M.C.H. Bhagalpur, bihar, India for 1 year. 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, 26 (52%) patients from group 1 and 20 (40%) from group 2 recovered completely; a total of 46 (46%) 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, 41 (82%) patients from group 1 and 40 (80%) from group 2 recovered completely; a total of 81 (81%) patients recovered completely. No statistically Significant differences were observed between the two-treatment group. All patients of Grade 2 and 3 recovered completely while only 45.46% and 40% patients in Grade 4 and Grade 5, respectively, showed complete recovery. No meaningful recovery was observed in patients with Grade 6 Bell’s palsy. After 3 months, trends of recovery almost converged in terms of the difference in the two groups. In Grade 6, only 2 (33.33%) patients from group 1 showed complete recovery. In the methylprednisolone group, at 1-month, 62% patients (early group) and 48% patients (late group) had complete recovery. At 3 months, 86% and 76% patients in the two respective group had complete recovery. In oral prednisolone group, at 1-month, 42% patients (early group) and 32% patients (late group) had complete recovery, while at 3 months 84% and 72% patients, respectively, had complete recovery. None of the patients in either treatment groups reported any adverse event during the study period. Single dose of 500 mg of IV methylprednisolone may be an equally efficacious alternative to a 10-days course of oral prednisolone. Early institution of treatment should be attempted for optimum results.

25.The Study of Clinical and Epidemiological Factors of Ischemic Heart Disease in Patients Admitted at Tertiary Care Hospital of Bihar
Sunil Kumar
Aim: To study the epidemiological factors of ischemic heart disease in patients admitted in intensive care unit in the tertiary care hospital. Methods: Present study was carried out by the Department of Community Medicine, ANMCH, Gaya, Bihar, India, for the period of 1 year. History about epidemiological factors was obtained from patients or relatives by separate proformas. Results: Occurrence of disease had decreasing trend with the increase in literacy status of patients, which was statistically significant at p <0.0001. Maximum patients in the study were from socioeconomic class V i.e., 144 (36.64%). Study showed that household stress was more commonly associated with occurrence of disease which was significant statistically at p <0.001. Most common behavioral risk factor seen in patients was smokeless tobacco consumption. The occurrence of ischemic heart disease was seen more in the group of patients consuming mixed diet and consuming palm oil. Most common comorbidity in patients admitted for ischemic heart disease was hypertension, which was statistically significant at p <0.001. Conclusions: Age, literacy, socioeconomic status of the patient, history of behavioral risk factors in the patient, stress and comorbidities are related to the occurrence of ischemic heart disease.

26.To Determine the Frequency of Primary and Secondary Meniscal Tears in Full Vs Partial ACL Injuries, as Well as the Location of Meniscal Tears in Complete Vs Partial ACL Injuries
Kanhaiya Lal Gupta
Aim: To study the meniscal tears associated with complete vs partial anterior cruciate ligament injury. Methods: A prospective study was conducted in the Department of Orthopedics, Jawaharlal Nehru Medical College, Hospital, Bhagalpur, Bihar, India from May 2020 to March 2021. 114 patients diagnosed with combined ACL and meniscal injury with a follow up 3months to 1 years of knee injury at our center. The patients were divided into two groups: Complete ACL injury group; 60 knees, mean age 28.2 years) and partial ACL injury group; 54knees, mean age 23.7 years). We compared the two groups with respect to the location of tear. Results: The incidence of complete ACL injury was diagnosed with MRI which was 52.63 % and partial ACL injury 47.36%. Regarding the locations of meniscal tears, in complete ACL injury (60 knees), medial meniscal tear was found in 60 %, lateral meniscal tear only in 31.66 %, and bilateral meniscal tears in 8.33 % (5 of 60 knees). In partial ACL injury (54 knees), medial meniscal tear was found in 46.29 % (25 of 54 knees), lateral meniscal tear in 42.59 % (23 of 54 knees), and bilateral meniscal tears in 11.11 % (6 of 54 knees). Medial meniscal tear was commonly associated with complete ACL injury and lateral meniscal tear was commonly associated with partial ACL injury. Conclusion: Incidence of medial meniscus tear was more than 50% in complete ACL tear. Lateral meniscus tear was more associated with partial ACL tear compared to complete ACL tear.

27.Fixation of Distal Tibial Fractures with Precontoured Medial Locking Compression Plate Through Lateral Approach A Prospective Study
Ajoy KumarManav, Abhinav, Sheetanshu Shekhar
Purpose: Tibia is the commonest long bone fractured in the body. Distal tibial fractures are still more challenging to manage surgically. This paper is aimed at using the precontured medial locking compression plate laterally through a lateral approach. Methods: This prospective study involved 56 cases with distal tibial fractures admitted in department of orthopedics PMCH and MOCMH Patna between July 2019 and August 2021. All were adults above 20 years of age with no compounding / vascular compromise or concomitent epsi lateral injuries. Results: 53 cases united well within 24weeks, 3 cases required bone grafting (un united at 24weeks) 2 cases had malunion, 4 superficial and 1 deep infection none of the patients had hardware complaints / demand for removal of implants. The mean dorsiflexion of the ankle was 18.50 and plantar flexion 35.30. The final outcome was graded as excellent 24 cases, good 20 cases and fair 12 cases. Conclusion: Lateral plating of distal tibial fractures with the precontrued medial locking compression plate is a safe and feasible procedure and provides good biological fixation with minimum soft tissue complications.

28.Role of Ginkgo Biloba Extract in Sensorineural Hearing Loss: A Randomised Prospective Clinical Study
Preeti Sharma, Ratnesh Kumar, Vineet Sinha
Background: Sensorineural hearing loss and tinnitus is one of the most frequently encountered problem in day-to-day practise. Despite best medical management, these patients often remain dissatisfied with improvement and search for more treatment strategies continues. Among the used medicinal plants, Ginkgo biloba (Folium Ginkgo) is frequently used in the treatment. Aims and objectives: To study the efficacy of Ginkgo biloba extract in cases of sensorineural hearing loss with regard to improvement in hearing and tinnitus. Material and Methods:60 patients with sensorineural hearing loss were included and randomly allocated into any of 2 groups being studied. Group- A received Ginkgo biloba extract along with conventional therapy and Group – B received conventional regimen (oral vitamin A and vitamin B complex). Results: There were subjective improvement in hearing in 23 patients in Group A compared to 18 in Group B. 20 patients in Group A compared to 15 patients in Group B showed subjective improvement in tinnitus. 7 patients in Group A showed greater than 10db improvement in hearing compared to only 4 patients in Group B. Conclusion: ginkgo biloba extracts together with conventional therapy helps in better patient management and improved symptomatology.

29.To Investigate the Relationship Between Common Bleeding Symptoms in Dengue and Platelet Levels
Anuradha Singh, Manoj Kumar Singh, Chandra Bhushan Kumar
Background: Dengue is an infectious disease caused by dengue virus (DENV). In general, dengue is a self-limiting acute febrile illness followed by a phase of critical defervescence, in which patients may improve or progress to a severe form. Severe illness is characterized by hemodynamic disturbances, increased vascular permeability, hypovolemia, hypotension, and shock. Thrombocytopenia and platelet dysfunction are common in both cases and are related to the clinical outcome. Objective: To study the common bleeding manifestations in dengue and see whether there is a correlation between them and platelet counts. Method: A prospective observational study was conducted in Upgraded Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar from Jan 2020 to January 2021. Children below the age of 14 years with dengue seropositivity were included in the study. Relevant blood investigations were done, and patients were managed according to World Health Organisation guidelines. Results: A total of 200 serologically positive dengue cases, with mean age of 8.5 ± 4.1 years, were included in the study. Males were 53% and females 47%. Other than fever, which was present in all cases, the most common presenting complaints were vomiting (26%), headache (10%), black coloured stool (6%) and bleeding (5%). During the course of the illness, bleeding occurred in 60% of the children. Whilst 26% had melaena, 20% had petechiae, 8% had hematemesis, 4% had epistaxis and 2% had gum bleeding. All (100%) the patients who had platelet counts between 50,001-100,000/cu.mm developed haemorrhage and 89.8% of patients with platelet range between 20,001-50,000/cu.mm of blood had developed haemorrhage. However, of patients who had platelet counts less than 20,000/cu.mm, 35.1% developed haemorrhage and 52.6% did not have haemorrhagic manifestations. Conclusions: No correlation was found between platelet counts <100,000/cu mm and increase in incidence of bleeding manifestations in DHF.

30.A Comparative Study to Evaluate the Risk Factors for Pediatric Patients Admitted with Community Acquired Pneumonia
Chandra Bhushan Kumar
Introduction: Community acquired pneumonia is defined as pneumonia that is acquired outside the hospital. The most commonly identified pathogens are Streptococcus pneumonia, Haemophilus influenza, atypical bacteria (i.e. Chlamydia pneumonia, Mycoplasma pneumonia, and Legionella species) and viruses. Community Acquired Pneumonia (CAP) is the leading cause of mortality in children younger than five years of age in developing countries, including India. Aim: To evaluate the risk factors associated with Community Acquired Pneumonia (CAP) in patients admitted to the Pediatric department at a tertiary care hospital in Bihar region. Methods: This was a case-control study which compared patients of CAP aged 2 months to 60 months, admitted in Pediatric Upgraded Department Patna Medical College and Hospital, Patna, Bihar, India. Risk factors that were evaluated included demographic, socioeconomic, housing, past and family history, birth variables, nutritional variables, immunization, delay in presentation and previous treatment. Results: In the present study, 68% of males were infected with CAP in contrast to 32% of females. The majority of the cases (63%) belonged to the urban locality. Lower socioeconomic status, lower maternal and paternal education, overcrowding and indoor air pollution were associated with CAP. Basic sanitation facilities were found to be better in control groups. Birth order of 3 or more, non-institutional, preterm deliveries, significant past and family history were significantly associated with CAP. According to WHO classification, in our study, 59 had severe pneumonia while 41 had pneumonia. Conclusion: Public awareness should also be increased to improve the better utilization of available resources. Improving the socio-economic status of people are welcome, this can take a long time to bear fruit.

31.To Investigate the Relationship Between Cord Blood Albumin and Serum Bilirubin Levels in Term Healthy Babies At 48 Hours
Shivani Nivedita, Kaushalendra Kumar Singh, Anil Kumar Tiwari, Anil Kumar Jaiswal
Aim: To study the correlation between various levels of cord blood albumin & serum bilirubin at 48 hrs of age in term healthy newborns. Methods: A prospective study was conducted in the Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar India for 1 year. 100 terms healthy newborns with birth weight ≥2.5 kg was included in this study. Newborns with a congenital anomaly, birth asphyxia, traumatic birth, respiratory distress, sepsis, metabolic diseases, pathological hyperbilirubinemia before 24 hrs, infant of a diabetic mother, and haemolytic diseases requiring admission in NICU were excluded from the study. Cord blood was collected at birth and analysed by auto analyser method for Cord Serum Albumin level. Newborns were dived into 3 groups for data analysis according to their cord albumin levels (<2.8, 2.8-3.4, and >3.4 g/dl), and were analysed to find out association with 3 risk zone according to Bhutani nomogram. Results: Out of the 100 infants enrolled in our study, 60(60%) were males and 40(40%). 20% newborn had cord albumin <2.8 g/dl, 50% recorded values between 2.8 to 3.4 g/dl and 30(30%) recorded cord albumin >3.4 g/dl. Newborns with higher birth weight had a significantly lesser incidence of low cord albumin (<2.8 g/dl). Out of 100 newborns, 20(20%) serum bilirubin levels were at the low-risk zone, 57(57%) at the low intermediate risk zone, while 23 (23%) were at the high intermediate risk zone at 48 hrs of age. 60% of newborns with cord albumin level <2.8 g/dl recorded serum bilirubin at or above high intermediate risk zone, while 7 were at low intermediate risk zone and 1 new-born was at low- risk zone at 48 hrs of age.  We found that a cut‐off level of cord blood albumin of 2.8g/dl had 84.9% sensitivity, 82.7% specificity, and PPV 85.1% for prediction of hyperbilirubinemia at high intermediate cut-off level with a p-value of <0.05 in term newborns, with NPV of 76% indicating its usefulness. Conclusion: Neonates with cord blood albumin <2.8 gm/dl had a significant association of the development of hyperbilirubinemia at or above intermediate high-risk zone according to Bhutani nomogram at 48 hrs of life.

32.To Investigate the Relationship Between Lipid Abnormalities and Blood Glucose Levels in Individuals with Type 2 Diabetes Mellitus
Pramod Kumar Sinha,  Md. Nasar Zubair
Aim: To research association between serum lipid profile and blood glucose, hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus. 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 Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. For the period of 1 year. A total of 200 newly diagnosed type 2 diabetics were enrolled in our study. Results: In our study, 96 (48.0%) participants had normal serum triglycerides levels which is <150 mg/dl whereas 104 (52.0%) participants had an abnormal level of serum triglycerides. Among the 104 (52.0%) 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.

33.Assess the Overall Incidence of Soft Tissue Tumours and to Investigate the Histomorphological Characteristics
Seema Kumari, Rajeev Ranjan Kumar, Asim Mishra
Aim: The main objectives of the present prospective study are to determine the overall incidence of soft tissue tumours and their frequency of distribution in relation to age, sex and various sites in the body, and to study the histomorphological features which would help in classification and sub classification of soft tissue tumours. Methods: This retrospective study was carried out in the Department of Pathology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 1 year. Total 100 patients of all the soft tissue tumors, both benign and malignant    were included in this study. Results: Total 100 cases of soft tissue tumours were included in this study. It’s slightly male preponderance with a male to female ratio was 1.5:1. Benign soft tissue tumours formed 85% of all soft tissue tumours while malignant soft tissue tumours constituted 15%. Malignant soft tissue tumours had a peak above 60 years age group .the male to female ratio among the benign soft tissue tumours was 1.57:1 and among the malignant soft tissue tumours was 1.14:1.On detailed histomorphological examination; the single most common histological group was the adipose tumours. The commonest benign tumour was Adipocytic (49%) of all benign tumours of soft tissue followed by vascular tumours (21%) peripheral nerve sheath tumours (19%), fibrous tumours (2%), fibro histiocytic tumours (3%) smooth muscle tumours (2%) and tumours of uncertain differentiation (1%) in the decreasing order to frequency. There is a highly significant association between the type of tumours and the category of tumours. The benign adipocytic tumours accounted for the majority of benign soft tissue tumours (47%) followed by vascular tumours (18%). Benign tumours of smooth muscle (1%) and tumours of uncertain differentiation are nil encountered. 37% benign soft tissue tumours were seen in extremities followed by head and neck 31% and for the malignant soft tissue tumours mainly lower extremities followed by trunk and abdomen. Conclusion: The diagnosis and management of soft tissue tumors require a team perspective. Even though soft tissue sarcomas are rare and usually present just as painless mass, the clinician must be able to diagnose it early for better management.

34.An Investigation to Determine the Prevalence of Dermatological Lesions in Individuals with Diabetic Retinopathy
Sudhir Kumar, Vineeta Laxmi, Ravi Ranjan
Aim: The purpose of this study to determine the prevalence of dermatological lesions in patients with diabetic retinopathy. Methods: This cross sectional study was done the Department of Ophthalmology,  Government Medical College and Hospital Bettiah, Bihar, India, for the period of 1 year. Total 90 patients with diabetic retinopathy having diabetes mellitus of at least 5 years duration, aged between 28-62 years, were included in this study. The dermatological examination was done by a dermatologist under proper day light and if needed, using hand held magnifying lens. Examination of the retina was done by an Ophthalmologist using indirect ophthalmoscopy of dilated fundus, fundus photo, fundus fluorescein angiography and optical coherence tomography of the macula. Results: Of the 90 diabetic patients included in this study, 8(8.89%) had Very Mild Non Proliferative Diabetic Retinopathy (NPDR), 29(32.22%) had Mild NPDR, 35(38.89%) had Moderate NPDR, 11(12.22%) had Severe NPDR, 7(7.78%) had Proliferative Diabetic Retinopathy (PDR) and 39(43.33%) had Clinically Significant Macular Edema (CSME). 71 among 90 DR patients had different types of dermatological lesions, the prevalence being 78.89%. Dermatological lesions among poor glycemic control DM patients had a prevalence of 56.67% which was higher as compared to 33.33% among good glycemic control DM patients. 39(43.33%) patients had diabetic dermopathy, 28(31.11%) had Xerosis, 24(26.67%) had IGH, 22(24.44%) patients had Icthyosis, 6(6.67%) patients had Intertrigo, 5(5.56%) patients had Tinea Versicolor, 4(4.44%) patients had Chronic Paronychia and 4(4.44%) patients had Tinea Unguium.4(4.44%) patients had Eczema, 3(3.33%) had Melasma, 3(3.33%) had Lichen Amyloidosis, 3(3.33%) had Varicose vein, 2(2.22%) had Fissure feet, 2(2.22%) had Pigmented Purpuric Dermatosis (PPD), 2(2.22%) had Dermatosis Papulosa Nigra (DPN), 2(2.22%) had Sclerodactyly, 1(1.11%) had Plain warts, 1(1.11%) had Macular Amyloidosis, 1(1.11%) had Cherry Aneurysm, 1(1.11%) had Xanthelasma Palpebrarum, 1(1.11%) had Photodermatitis, 1(1.11%) had Skin tags, 1(1.11%) had Onychomycosis, 1(1.11%) had Onychogryphosis and 1(1.11%) had Prurigo. Conclusion: Prevalence of Dermatological lesions in Diabetic Retinopathy patients was 78.89%, the most common being Diabetic Dermopathy (shin spots) which was 43.33%.

35.To Investigate the Effects of Several Topical Treatments on Chronic Plaque Type Psoriasis
Rakesh Ranjan Kumar Rahul
Background: Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. A wide range of treatments are available for psoriasis, but identifying the most effective one can be difficult. Topical agents are also used as adjuvant for moderate-to-severe disease who are being concurrently treated with either ultraviolet light or systemic medications. Out of all topical treatment, ammonium lactate has been studied very little for its role in psoriasis vulgaris. Aim: To determine the effect of various topical agents in chronic plaque type psoriasis. Materials and Methods: The study was carried out on patients having chronic plaque type psoriasis vulgaris came to Department of Skin & VD, Shri Krishna Medical College, Muzaffarpur, Bihar, India for 1 year. Total 150 patients were enrolled and were divided into three groups comprising of 50 patients in each group. Group A patients were asked to apply ammonium lactate twice a day, Group B patients were asked to apply ammonium lactate in morning and clobetasol propionate in evening, Group C patients were asked to apply topical ammonium lactate in morning and calcipotriol in evening. Results: Physician global assessment scale shows that in Group A, 39% patients had excellent response, 15% patients had good response, and 21% patients had fair response whereas 25% patients had poor response. In group B, 35% patients had excellent response, 29% patients had good response, and 17% patients had fair response whereas 19% patients had poor response. In group C, 31% patients had excellent response, 28% patients had good response, and 22% patients had fair response whereas 19% patients had poor response. Conclusion: Combination therapy is effective, well tolerated with minimal side effects and better compliance was seen with patients. Ammonium lactate 12% can also be considered as one of the topical option as a monotherapy and also as a maintenance therapy.

36. Microbiota of Orofacial Cleft –A Comprehensive Review
T. Ashiq, S.R. Sri Ramkumar, S. Vinoth, N. Mugunthan, R. S. Uma, R. Ragunathan
Oral cavity microbiota act as an salient part of the human microbiota ,  which remains sterile throughout prenatal development,  first hours following delivery diverse ecosystem starts to colonize ,which includes several hundred  species  and has an important function to protect against colonization of extrinsic bacteria which could affect systemic health. On the other hand, the most common oral diseases like caries, gingivitis and periodontitis are based on these microorganisms, and organized as biofilms. In orofacial cleft cases several thousand diverse species  has been seen  because due to irregular dentition  and the oral cavity is always  opening outside through the cleft. Sequencing to characterize bacterial flora in cleft cases  samples collected at 3, 6, 12, 24 months and 7 years of age in 90 longitudinally followed children, 16S rRNA genes from sample DNA were amplified, cloned, and transformed into Escherichia coli. In 2,589 clones, 141 predominant species were detected, of which over 60% have not been cultivated. Thirteen new phylotypes were identified. Species common to all sites belonged to the genera  Gemella,     GranulicatellaStreptococcus, and Veillonella. in this review article literature discuss the role of microbial biofilms in orofacial cleft cases and the study  utilize culture-independent molecular techniques to explain the  bacterial diversity in the orofacial cleft  oral cavity,  and  to determine the site and subject specificity of bacterial colonization.

37. Maternal Near Miss Obstetrics Events and Maternal Death in a Tertiary Care Centre- a Retrospective Study
Sonal Agrawal, Rupal Malik, Garima Gupta, Vimal Agrawal
Objective: To determine the frequency and demographic characteristics of maternal near miss (MNM) patients. To analyse the causes of MNM events. To determine indicators of severe maternal morbidity and mortality in our hospital. Method: A retrospective study was conducted in the department of obstetrics and gynaecology in Jhalawar Medical College for a period of 12 months from March 2019 to February 2020. Data was collected retrospectively from the case records. Study Population: All antenatal patients and up to 42 days postpartum , who fulfill the WHO criteria, were included. Result: During the study period, there were total 12,288 deliveries and 12,158 live births.177 women with severe maternal outcome included with 131 MNM cases and 46 maternal deaths (MD).Severe maternal outcome ratio 14.56/1000 live births. MNM ratio is 10.77/1000 live births. MNM mortality ratio (MNM:MD) is 2.85. Mortality index of 0.259. Leading causes of MNM were hypertensive disease(48.1%) and hemorrhage(37.4%).

38. Management and Factors Predicting Outcome of Traumatic Epidural Hematoma in Pediatric Population in North East India
Asman Ali, Ankur Anand
Introduction: childhood morbidity and mortality is highly attributed by Traumatic Brain Injury (TBI). Near about 3% of all head trauma. Haemorrhage due to physical trauma commonly occurs in the epidural space which results from the active bleeding from the epidural venous plexus. The fracture of the temporal bone also damages the Middle Meningeal Artery (MMA) located just underneath the temporal bone. It has been shown that posterior fossa is less frequent as compared to supratentorial hematoma. Often the clinical symptoms are of slow onset and develop silently but they can become fatal if not treated in time. The prognosis of the patients of an epidural hematoma should be analyzed by considering the factors like age, sex, Glasglow Coma Scale (GCS) mainly. A CT scan results in an epidural hematoma is characterized by a uniform hyperdense lesion that is biconvex shaped. Materials and Methods: This is a retrospective study conducted in Gauhati Medical College and Hospital, Guwahati, India. The study sample is taken from the mentioned hospital and includes pediatric age groups ranging from 0-12 years old. The pediatric population from 0-12 years old between May 2017 and May 2021 is considered. The raw data is collected from the above-mentioned hospital and then each patient is systematically studied during the admission and outcome after management. The patient’s analysis is made by considering clinical characteristics, radiological evaluation, employing Glasglow Coma Scale (GCS), Glasgow Outcome Scale (GOS) and Modified Rankin Scale (mRS) which is determined at the time of discharge. The primary objective of the study was to analyse and compare the management of Epidural Hematoma and its respective outcome. The parameters that were considered in this study for comparison are Mechanism of Injury, the characteristics of the trauma for each patient, severity and the outcome of the management. Results: the study also considered the Glasglow Coma Scale (GCS) measured at the time of admission of these patients. The study found that 30 patients had GCS between 14 and 15, 11 patients were found to be between 9 and 13 and 4 patients were found to have GCS between 3 and 8. There was no seizure reported during the immediate or follow-up treatment period. Out of 22 patients who received Conservative treatment, 15 patients showed good recovery during the discharge from the hospital followed by 5 patients and 2 patients who showed moderate disability and severe disability respectively.  In total, 21 patients (46.6%) showed Good Recovery at the time of hospital discharge. During the follow-up, the number of patients who showed Good Recovery went up from 21 to 29 (46.6% to 64.44%) followed by moderate disability (12 patients; 26.66%) and severe disability (3 patients; 6.66%). The most common location of hematoma in this study was found to be in Parietal region (n = 12; 26.66%) and Frontal region (n = 12; 26.66%). The number of patients with mRS “0” increased from the time of discharge to the time of follow-up, increasing from 55.55% to 73.33%. The improvement is quite significantly observed among the patients who have undergone Conservative management as compared to Surgical Management. Conclusion: our findings has strongly concluded that the location of hematoma, volume of hematoma and GCS at the time of admission has significant influence on the prognosis of the Epidural Hematoma. This study has also concluded that only poor clinical statuses like lower GCS, higher Injury Severity should be managed in surgery. Otherwise, higher GCS and lower Injury Severity can be easily managed by Conservative treatment.

39. Study of Endothelial Cell Loss in Phacoemulsification Based on Different Grading of Nucleus
Mamta Meena, Reena Meena, Sameer Jagrwal, Mahendra Kumar Meena
Introduction: Phacoemulsification is now commonly used surgical procedure for cataract. The endothelial cell damage during phacoemulsification can be caused by factors such as irrigation flow, turbulence and movement of fluids, presence of air bubbles, direct trauma caused by the instruments or lens fragments, and the phacoemulsification time and power needed to achieve nuclear emulsification. Grade of nucleus sclerosis affect the corneal endothelial cell loss in phacoemulsification. Methods: We concluded the study in 500 cases of cataract and found that loss of corneal endothelial cells increases with increasing the grade of nucleus sclerosis. Many methods have evolved in recent years to enhance the efficacy of nuclear management during phacoemulsification. The main purpose of these techniques is to mechanically break the nucleus into smaller fragments with the help of a second instrument, which helps decrease the use of ultrasound power in nuclear emulsification and reduces surgical time and limiting endothelial damage. Results: The average percentage loss of cells during our study was 14.5% which was highly significant (0.981). Conclusion: In our study we concluded that the endothelial cell damage increases with increase in nucleus hardness.